Hospital Health Information Management System

Open Source Software for Electronic Patient Records

User Handbook ersion !"! # !$%!!%&'!!

Hospital Health Information Management System Open Source Software for Electronic Patient Records

Table of Contents
(ew additions to the software in )ersion !"!""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""" & *eneral features""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""" + How to log on to the system"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""" , How to register a patient""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""" How to record a )isit medical record""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""" . Recording additional information on the )isit"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""" !' /arrying out )isit orders"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""" !& 0dmitting a patient""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""" !, (otification of infectious diseases""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""" !1 Managing the database tables"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""" !$ Using and creating 2uestionnaires"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""" &! Printing out information""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""" &+

New additions to the software in version 1.1

Performance (ew look3up method for database 2ueries # )ery much faster 0utomatic backup New f!nctionality More reports 4ar3codes included in some printouts It is possible to gi)e a )isit e)en if the patient discharge has not been registered 5rug prescription order%dispensing also for in3patients 6ab3test order%reporting for in3patients (ew help function 4ug % suggestion % ser)ice re2uest3sending modules 7red round button top right8 6ogs9 failed log: user log: system log and error log Midnight /ensus Improved f!nctionality Patient search screen changed to make it easier to find patients on each field 0ll tables can be filtered by fields: sorted and printed 7small button at the bottom of each screen8 System color theme changed to show the data in bright conditions ;ard patient listing impro)ed ;ait for !' sec if the user makes errors on login more than , times I/5 displayed on all S(OME5 look3ups I/5 displayed in admission diagnosis entering screen S(OME5 terms from four groups can be entered in patient history Repeat prescriptions with one click Ordering of lab tests in the future

HHIMS user handbook )!,

&

info<hhims"org

Hospital Health Information Management System Open Source Software for Electronic Patient Records

"eneral feat!res
The server
hhims is a free and open3source software system used to store and retrie)e a simple patient medical record" =he database was programmed by (et/om =echnologies for the I/=0 7Information and /omputing =echnology 0gency of the Sri 6ankan *o)ernment8 and the R5HS3>egalle 7Regional 5irector of Health Ser)ices8" 5esigned mainly for Sri 6anka go)ernment hospitals: it is currently installed in the out3patient and admission sections of o)er +' hospitals in Sri 6anka" ;hen installed on a computer ser)er in a hospital: it can be accessed )ia a local area network in the out3patient department: the clinics: the wards and other places such as operating theaters: laboratories and medical record departments" =he ser)er can be ?ust a large personal computer 7P/8 with a database that stores all the patient information" (o data is stored on the workstations around the hospital 3 e)erything is stored on the ser)er" 4ecause the data is centrally stored: it can be shared by all the computers connected to it" @or )ery large hospitals it may be necessary to run the system on a computer specially designed as a ser)er" ;orkstation computers allow staff throughout the hospital to see the pre)ious record on the screen when the patient comes again: to print )isit slips and discharge letters for patients to take home: and to prepare 2uarterly statistics and infectious disease notifications" =he initial systems were mainly used for recording in3patient records but many of the hospitals are now using the software for out3patients to impro)e documentation and to speed up the patient flow"

Your workstation
=he workstation is a normal P/ computer" Aou can use it for e)erything a P/ can do like writing letters or sending e3mails" @or these tasks it stores files on the hard disk inside the /PU 7/entral Processing Unit8" Some workstations ha)e a 5 5 writer for downloading data and for doing backups of your work on the P/" Aou are responsible for the data that you store on your workstation and should do your own backups" If you share the computer with other staff: arrange with them to store their files in different locations so that yours will not get deleted by accident" =he patient database is not stored on the workstation computers" Aou only use it to log on to the hospital ser)er which is connected by a network cable or a ;i@i" Aou donBt need to backup the patient database # this will be done by the network manager" Aou are strongly ad)ised not to use your workstation in the hospital for entertainment"

System-wide features
@rom any screen 06=C( goes to new patient screen" @rom any data entry form 06=CS will sa)e the data" @rom anywhere using 06=C@ you can open a patient record"

UPS (Uninterruptible Power Supply)

0 UPS is a battery which is charged from the mains current and supplies power when that fails" It is good practice to ha)e one to protect your workstation from short power failures" If the power fails: the battery in the UPS takes o)er and the UPS will start to beep" @inish what you are doing and wait for a few minutes" If the power doesnBt come back: shut down the computer" Small UPSs will only run for about D minutes" If this happens a lot: it is possible to install an In)erter with large batteries to supply mains )oltage for longer periods" @or eEample an in)erter or a large UPS with two large truck batteries each 1D >;H will keep a typical P/ running for about . hours" It can also supply current for a light" Note9 some UPSs ha)e an on%off switch at the back" Ensure that this is always switched to FOnG otherwise the battery will not kick in when the current fails"

Printers
0lthough the system makes paper patient records unnecessary: there are occasions when it is necessary to produce paper documents" Printers can be connected to the network or directly to indi)idual workstations" /onnection to the network is best as the printer is always a)ailable and can be shared with e)eryone on the net" 5irectly connected printers can also be shared but only when the workstation is switched on"

Getting a opy of hhims

0s hhims is open3source: you can obtain a copy to run on your own personal computer" *o to the Internet site hhims"org and register yourself" Aou can then order a copy of the software or simply use the demonstration )ersion at demo"hhims"org Aou can e3mail the de)eloper at info<hhims"org

HHIMS user handbook )!,

info<hhims"org

Hospital Health Information Management System Open Source Software for Electronic Patient Records

How to log on to the system

Start your computer and double click on the 6O*I( icon on the desktop" If you accidentally delete the icon: go to the browser and choose the link9 !$&"!-."!"& Aour system administrator will show you how to copy the icon from the browser on to the desktop" (ote9 in some hospitals another number has been selected for the ser)er" In order to use hhims you need to be registered as a system user" Aou will be pro)ided with a user3name and password by your system administrator" =his is like your signature as it pro)es to the computer that you are personally entering the data" @or this reason: always log on with your own user name and do not lea)e the computer without logging off" =his is standard computer practice" Enter these two items into the corresponding boEes on the 6ogin screen then click on the green Login button" Aou can go from one boE to the neEt by pressing the Tab key. Click Type password

Type username. press tab If the details entered are correct the computer will take you to your Home page of the hhims database" If you do not use the computer for about ten minutes: you will be automatically logged off" Simply enter your name and password again to continue working with the system"

!ifferent home pages

0dmission staff 7(ew patient screen8

0dministrators 7User table8

HHIMS user handbook )!,

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Hospital Health Information Management System Open Source Software for Electronic Patient Records
5octors 7list of recent patients8

6aboratory staff 7Pending lab tests to be done8

(urses 7list of recent patients8

Programmers 7User table8

Pharmacy staff 7pending prescriptions to dispense8

Procedure room staff 7pending procedures to be carried out8

HHIMS user handbook )!,

info<hhims"org

Hospital Health Information Management System Open Source Software for Electronic Patient Records

How to register a patient

0 patient must first be registered before they can be admitted or gi)en an OP5 )isit" Each patient gets a number from the computer that they keep for e)er" =his number is shown on all the screens and the printed forms"

#$ N$T %&"IST&% TH& S'M& P'TI&NT ' S&C$N# TIM&

If the patient is already registered: they should not be entered a second time" =o help a)oid duplicate entries: when you sa)e the form a list of patients with similar details will be shown" /heck this list before making a new entry" If the patient thinks they ha)e been entered before: look for them in the search screen before registering them" If you find the pre)ious entry for this patient: you can stop registering the patient again and use their pre)ious entry" these arrows open a list the star is for obligatory fields this field uses capital letters only if you put in age you don't need birthdate village is a look-up field make remarks fields bigger by pulling on the corner

Title
=he form of address used on official forms or letters to the patient"

"ull #ame
=his is full name used by the patient on official forms 7I5 card: taEation form etc"8" Enter the name in capital and simple letters in the usual way for your hospital" If possible check the name on the (I/ card or some other official document in order to get it right"

$ther #ame
Other names or initials used by the patient such as HR"M"0"H" (ot normally used in official documents"

Gender
/hoose from the pop3up or put in a letter H@H or HMH"

%ivil status
/hoose from the pop3up or put in the first letter"

&ge
=his is an alternati)e to entering Date of Birth" Aears: months and days can be entered 7or all three8" @or an adult you can ?ust put in the number of years" @or a child you can ?ust put in the months or for a baby ?ust the days" =he approEimate date of birth will be calculated by the computer" #o not enter both &ge and !ate of 'irth.

!ate of birth
Enter the date as 55%MM%AAAA 7for eEample &&%'&%!$$&8" If the patient does not know the eEact date it is easier to enter the age" =he computer will con)ert one to the other" If you enter the Date of Birth: the computer automatically calculates the Age"

HHIMS user handbook )!,

info<hhims"org

Hospital Health Information Management System Open Source Software for Electronic Patient Records
#(%
Sri 6anka (ational Identity (umber 7(I/8" /urrently: each (I/ has a uni2ue !' character number: in the format (((((((((0 7where ( is a digit and 0 is a letter8" =he first two digits of the number are the year of birth 7e"g"9 ..(((((((0 for someone born in !$..8" =he final letter is generally a B B or BIB" =here are no spaces in the number" If the same NIC number is already in the database: this will produce an warning message" /heck that you are not trying to enter the same patient twice" #ote: currently this number is only provided to persons over ! years. It is planned to give everyone a number at birth and to change the format to NNNN"NNN"NNNN"N # $ digits for year% & digits for date ' gender% $ digits for a serial number and chec( digit e.g. )!*" $+"***)",

%onta t telephone
=he patientBs phone number # area code followed by the number 7spaces are allowed for eEample9 '-' &&& &&&&8"

&ddress ) and &ddress *

=he standard for addresses in Sri 6anka is two lines" =he first line is obligatory: the second line is optional" It is the postal address where the patient can be reached by letter or )isited by public health workers" Some ad)ice on finding the house can be put into the -emar(s field"

+illage
0ll the )illages of the country are stored in the computer and can be looked up by clicking on this field" In the pop3up window: )illages can be selected by 5istrict: 5i)ision and *( 5i)ision"

,emarks
=his is a free3teEt field 3 you can enter any information on the patient that you wish" @or eEample some helpful information to find their house will be useful for public health workers who may need to )isit them" 0bbre)iations are stored in the database # they start with a FJG" @or eEample FJnfaG eEpands to B(o fiEed addressG" 0 list of abbre)iations is a)ailable from the maintenance module" *o to the 5ata table Canned te.t" Aou can also add more abbre)iations to use on your system"

Save
Stores the new record you ha)e ?ust entered or the changes you ha)e made to an old record" 0ny errors detected by the computer in your input will be shown and ha)e to be corrected before the patient data can be stored in the computer" Aou can sa)e the record from anywhere in the screen by typing Alt#/ at the same time" Hold down the Alt (ey then press BsB" 0fter the data has been sa)ed: the computer will show the 0atient overvie1 screen" =here you can choose different printouts for this patient such as the 0atient slip or 0atient cards"

%an el
6ea)e the screen without changing the computer database"

Printing a ard for the patient

/ards like this can be printed from the Patient o)er)iew screen9 =here are $ letters included in the patient number standing for the district: the town and the type of institution" =his will be necessary when the system is used country3wide as patients might be registered in different places and it is necessary to identify the origin of the record" Howe)er to make the card more readable these letters are not shown"

HHIMS user handbook )!,

info<hhims"org

Hospital Health Information Management System Open Source Software for Electronic Patient Records

How to record a visit medical record

Patient sear h
4efore you can record a )isit: you must first choose a registered patient either by typing 0lt3( if you know the patientBs number or by searching for them on the search screen" click in this row to sort by a column type in these fields to limit the entries shown

=he search lists all the patients whose details ha)e been entered into the computer" Aou can mo)e around in this list using the na)igation buttons on the bottom Show more Choose a patient by row 7first: neEt: last8" entries clicking the line 0t the top there are details about the person logged in to this P/ followed by a language choice button" Each user can decide on a language in which to show prompts on the screens" 0t present these include Sinhala and =amil # more languages will be added in the future" =his button only changes the appearance of the screen promptsK all data is added using the Roman alphabet 70bcd"""8" Howe)er in -emar(s fields you can enter teEt using Sinhala or =amil characters by switching the keyboard" =his choice is remembered neEt time you log on" =he second row of the screen has a set of menu buttons that show the main modules of the database" /hoosing one of these menu items will take you to another module in the system" =he easiest way to find the correct patient is to type in their hospital number" If this is not known it is possible to search for the patient by name: date of birth: residence )illage etc" 0s you start to type letters or numbers: the screen will show a selection of patients that contain those characters no matter where they appear in the record"

Show *- entries
0s computer screens )ary in siLe: this button allows you to choose the number of rows that appear on the screen" If you choose fewer rows the system runs 2uicker" ;ith a fast connection: you can show more rows"

(d number
@ollowing international practice: the patients stored in the hospital database are gi)en a Patient Registration id number in the order in which they were entered" Each patient will keep this number on future )isits to the hospital" It ne)er changes" In order to identify the hospital where the patient was registered this number includes the hospital code in the database"

Patient personal information

=he fields selected for this list ha)e been chosen to pro)ide enough information to choose the correct patient" =he field name comes from the I/=0 Interoperability Standards for Sri 6anka" ;hen the screen first shows: the rows are sorted by Patient Registration number" =o sort by other columns: click on the field name"

#avigation around sear h s reens

0t the bottom of the screen below the patient rows is a na)igation button" @or any particular sort order: it is possible to browse through the search screens in se2uence" Aou can choose the number of the screen 7!:&:+"""8 or mo)e forward or back" =his function is especially useful if you ha)e shortened the list using a search"

%reating a visit
@irst choose a patient from the /earch screen or 1ith Alt#N" On the 0atient overvie1 screen that appears: create a new )isit from the menu or choose a pre)ious )isit to )iew" 0fter one day )isit data may not be changed" Create a visit - or /reate a )isit9 )iew a pre)ious )isit9

+iewing and entering visit data

0fter choosing to )iew a pre)ious )isit or to enter a new one: the screens that appear look the same" =he difference is that data for )isits on pre)ious days can only be )iewed but not changed apart from -emar(s" =he date of the )isit is recorded as well as the onset date for the complaint" Aou can choose clinical data from +

HHIMS user handbook )!,

info<hhims"org

Hospital Health Information Management System Open Source Software for Electronic Patient Records
lists # common complaints: I/53!' diagnoses or S(OME5 findings" If the complaint or I/5 term is one of the notifiable diseases: it shows in red and the patient can be notified to the patientBs Medical Officer of Health" =his linkage is pro)ided by the Epidemiology 5epartment of the Health Ministry" 0nother option on this screen is to enter free teEt remarks in English: Sinhala or =amil" 0bbre)iated teEt blocks may also be called 7new blocks of teEt can be stored in the database8"

type a few letters to show complaints choose more detailed findings from SNO !" or #C"-$%

edit the date using calendar

clean the field with this icon

after saving& you can add add drugs or lab-tests

!ate . time of visit

=his is the current time when the )isit is registered" Ensure that the time in your computer is correct"

$nset date
=he day the complaint first started" =his defaults to the current date when the )isit is registered but can be changed by clicking in this field then choosing a date from the pop3up calendar"

!o tor
=his is the name of the doctor responsible for the patient on this )isit" =he computer shows the person who is logged on but this can be changed" If a name is not in the list: it can be added in the 0reference module 2sers table"

+isit type
=he type of )isit or the clinic can be entered" 0dditional entries can be added in the system table"

%omplaints / (n0ury
=he reasons the patient gi)es for coming to the hospital can be chosen by typing in a few letters of the complaint" Aou can also open a pop3up list with the magnifier icon if you prefer" =his list can be changed in the 0reference module Complaints table" =he complaints can be chosen according to the type of term" 0s well as simple complaints: all the notifiable disease are included 3 they show in red in this pop3up window"

(%! / S#$12!
Optionally: diagnostic terms from the I/5 or findings from the S(OME5 terminology can be selected by clicking on the magnifier icon for the corresponding field"

,emarks
@ree teEt can be entered in this field" =here are no restrictions on the teEt that can be entered" /anned teEts can be used by entering a slash BJB followed by the abbre)iation" =o enter teEt in Sinhalese or =amil letters ask your System 0dministrator to install the appropriate keyboard" ;hen installed: press /trl3Space and the letters will change to the chosen language" @ields with a gray triangle in the bottom3right corner can be enlarged by dragging it with the mouse"

Save
Store the )isit you ha)e ?ust entered" 0ny errors in input will be shown and ha)e to be corrected before the )isit is stored" 0fter sa)ing the )isit the computer shows the 0atient 3isit Information screen where you can add more information or print out reports on the )isit"

%an el
6ea)e the screen without recording a new )isit"

HHIMS user handbook )!,

info<hhims"org

Hospital Health Information Management System Open Source Software for Electronic Patient Records

%ecording additional information on the visit

Patient overview s reen

This red arrow shows that the patient is admitted

Click to see more info on this visit

;hen you select a patient from the search screen or with the hot3key 0lt3@: the system shows the 0atient 4vervie1 screen" =his displays all the contacts between this patient and the hospital9 )isits and admissions together with past history and allergies" In the menu on the left of the screen there are Commands to record )arious acti)ities for this patient" =his is followed by 0rints which allows to print reports referring to this patient 7but not prints related to a specific )isit8" In this eEample the test patient with hospital registration number ! has ! )isit and & admissions" =here is one past history item and ! allergy recorded" =hese are shown in the four yellow windows under the blue patient information banner" In order to see more detail on one of the )isit: click on the row for this )isit in the top yellow window" =his opens up the 0atient 3isit Information screen"

Patient +isit (nformation s reen

Click to return to overview

Click to edit the information in this window

;hen you sa)e the information from the 3isit screen: the neEt screen shown is the 0atient 3isit Information" =his screen gi)es an o)er)iew of all the information stored for one )isit 7/omplaints: EEamination: 6ab3tests: Prescriptions and treatments8 as well as Past history and 0llergies" Each set of information relating to this )isit is shown in a separate small window" Each of these windows can be opened to edit the data by clicking on the icon on the right of each window" If the )isit was today: data can be changed: but after one day it is fiEed and cannot be changed" =he only eEception to this rule is that -emar(s can be added" =he menu on the left of the screen has Commands% 5uestionnaires and 0rints for entering or outputting the information for the single )isit chosen"

HHIMS user handbook )!,

!'

info<hhims"org

Hospital Health Information Management System Open Source Software for Electronic Patient Records

&dd past history

Once a )isit has been recorded it is possible to record an item of past history" =he S(OME5 database is used to select an e)ent or disease that occurred in the past" =he date can be gi)en approEimately # for )*ctive+ means the eEample ?ust the year or a time3period such as F0t computer record schoolG" not the condition "ates can be e(act or vague

&dd allergies
Once a )isit has been recorded it is possible to record an allergy" /urrently free teEt is entered" =he FStatusG of the allergy means whether it is currently )*ctive+ means the acti)e or ?ust a historical fact" =he term F0cti)eG is used in this system to show whether an item should be ignored" (o computer record not the allergy data is actually deleted from the database but is ?ust shown as inacti)e 7scored out on the patient o)er)iew screen8"

Choose the type of term to enter

Status of the allergy

23amination
If the patient is eEamined during the )isit: the findings can be recorded on this structured screen" (ormal )alues for the numerical fields can be entered by clicking on the hand icon" =hey can also be nudged up or down using the arrows at the end of the boEes"

Nudge values up or down Click to enter normal values

$rder lab-tests
On this screen: the doctor can order lab tests for the patient who had this OP5 )isit" =he tests are sorted by department 7e"g" Hematology: 4iochemistry"""8 and within each department tests are grouped so that they can be ordered together 7e"g" Urine screen: 6ipid profile"""8" =ests in the group not re2uired for this patient can be remo)ed from the list"

Pres ribe drugs

'emove unwanted tests by clicking on these bo(es

On this screen: the doctor can prescribe drugs for the patient" =he first pop3up window on the left shows the list of drugs a)ailable in the dispensary and for each "rugs in short supply preparation: the number of doses remaining in stock" shown in red =he other pop3up windows allow you to record the amount of each dose: the fre2uency and the duration of each drug prescribed" =his helps the dispensary to choose the appropriate number of doses to be dispensed" 5efault )alues show in these + windows but can be changed by the doctor" =he defaults are stored in the Drugs table" =hey can be changed in 0references"

$rder treatments
On this screen: the doctor can order treatments for the patient who had this OP5 )isit" =reatments not in the list can be added here or by using the Treatments table in 0references"

Treatments carried out can be recorded in Remarks

HHIMS user handbook )!,

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Hospital Health Information Management System Open Source Software for Electronic Patient Records

Carrying o!t visit orders

0fter the doctor enters the orders for a )isit: the staff can record the action taken for each type of order such as drugs to be dispensed: lab3tests to be carried out and treatments to be gi)en" 0dditional types of orders will be added in the future if there is demand" Each of the different types of order is processed by staff attached to different out3patient departments" @or each department there is a separate module which allows the staff to record the orders carried out but does not re)eal the clinical information" Missing drugs: lab3tests or treatments can be added in the data tables of the 0references"

Pharma y dispensing module

=his module is chosen from the menu bar at the top of the screens" It allows the pharmacy staff in the out3 patient dispensary to dispense the drugs prescribed by the doctors" =he first screen shows the prescriptions made today" Other days can be chosen using the calendar on this screen" Aou can also show all the prescriptions for this day or only the ones that ha)e not been dispensed" =he pharmacist can search for the prescription from the patient name or registration number"

,hich types of order to show Click on the row to open a prescription Search for name or number 0fter clicking on the row for one prescription: a screen opens showing details of each drug prescribed" 4y )iewing the prescription on the screen: it is not necessary to use paper so the dispensary can run paperless" =he computer calculates the approEimate number of tablets from the doctorBs prescription" =his figure can be changed by the pharmacist if necessary" 0t the end of each day 7or in the morning before starting work8: )arious reports on the drugs prescribed and dispensed for an indi)idual day can be listed"

,e ording of lab test results

=his module is chosen by laboratory staff from the menu bar at the top of the screen" It allows the laboratory staff to see tests ordered by the doctors and to record the results" ;hen the screen first opens: it shows the tests ordered today" Other days can be chosen using the calendar at the top of the window and confirming the choice with the BMMB button" Aou can show all orders for that day or only the ones that are pending"

Click on the row to open a test order

HHIMS user handbook )!,

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Hospital Health Information Management System Open Source Software for Electronic Patient Records

;hen you click on one of the lab3test orders in the o)er)iew list: a screen opens showing the details of that lab3test" On this screen it is possible to enter the results manually" 0fter the results are entered: the entered )alues must be confirmed to a)oid errors"

Confirm the results

,e ording treatments
=his module is chosen from the menu bar at the top of the screen" It allows the nurses in the treatment room to see what treatments are ordered and to record the fact that they ha)e been carried out" =he first screen shows the treatments ordered today" Other days can be chosen using the calendar on this screen" Aou can also show all treatment orders for this day or only the pending ones" One of these treatments can be selected by clicking on the line" Click on the row to open a treatment

=he screen that opens when you choose one of the treatments: shows the details of the doctorBs order including the remarks for each treatment entered by them" Aou can add further remarks if necessary" 0fter the treatment has been carried out: the status can be changed to from FPendingG to F5oneG"

Cannot be changed

'ecord if done

*dd remarks if necessary

HHIMS user handbook )!,

!+

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Hospital Health Information Management System Open Source Software for Electronic Patient Records

'dmitting a patient
Click to admit 4efore a patient can be admitted: they must first be a patient registered" Selecting a patient on the /earch screen or using 0lt3@ will show the 0atient 4vervie1 screen" @rom this screen: create a new admission from the menu or choose a pre)ious admission to )iew" 0dmission data may only be changed before the patient is discharged" 0fter choosing to )iew a pre)ious admission or to enter a new one: the screens that appear look the same" =he difference is that data for discharged patients can be )iewed but not changed" Aou can only add -emar(s"

2ntering admission information

=he information to be entered is the same as that entered using the current manual documentation"

!ate . time of admission

=his defaults to the current time and date when the admission was registered" If wished this can be changed"

$nset date
=his is chosen from a calendar 3 for this month ?ust choose the number of the day" If earlier than that: the month must be chosen also"

-ields marked . are obligatory

'ed 4ead #o5

=his is the number of the Bed 6ead Tic(et 7B6T8" It will be calculated by the computer if possible: but you should check the result" 6ater you can search the list of patients using the 4H= number"

!o tor
=his is the name of the doctor who will look after the patient during this admission"

%omplaint / in0ury
=he reason the patient gi)es for coming to the hospital can be chosen by typing in a few letters or from a pop3 up list using the magnifier icon" Aou can add more complaints to this list in the 5ata =ables section of the Preferences" 0ll the notifiable disease are included 3 they show in red"

6ard
=he ward in which the patient is currently placed" Aou can transfer the patient to another ward later if wished" =he list of wards can be updated in the 5ata =ables section of the database"

,emarks
@ree teEt can be entered in this field" =here are no restrictions on the data that can be entered"

!ead on admission
If the patient was dead on arri)al at the hospital or died before being admitted to a ward: they still need to be registered as an H0dmissionH as they ha)e actually entered the hospital" It is important to store the information relating to the death for statistical purposes" In order to facilitate the management of data on deaths: it is recommended to create a ward entry called HDead on admissionH and to store the patient there until they are FdischargedH" In this way the data will be easily integrated with the rest of the database"

Save
/licking on this button confirms the entry and checks the input for )alidity" If there were errors on the screen or missing information: these must be corrected before the computer can store the corrections in the database"

%an el
6ea)e the screen without changing any information in the database"

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Patient &dmission (nformation s reen

In order to keep the system as easy to use as possible by hospital staff: all the admission information is summariLed on one screen: the 0atient Admission Information screen" 0ll additional information will be entered during an admission from this screen" 0s additional information is stored in the different modules: a window will open up on this screen showing a summary of the data" =his gi)es the clinical staff a logical o)er)iew of the clinical data as it accumulates during an admission" Each window can be minimiLed by clicking on its green title and enlarged by clicking on the pencil3icon on the right"

last / e(aminations are shown reports on this admission the main diagnosis must be indicated for the statistics click here

Past history( 'llergies( &)aminations

=hese items can also be added in the OP5 section" =hey are described in detail there"

#iagnoses
Shortly after admission: it should be possible to enter a pro)isional 7working8 diagnosis to guide the clinical staff on the initial treatment and diagnostic in)estigations that are necessary" If there is more than one diagnosis: the main one should be indicated by choosing the star" =he I/53!' 7International /lassification of 5iseases: )ersion !'8 is the database used by the Health Ministry to code hospital diagnoses" ;ith the help of the teEt look3up in hhims: it can be used directly by clinical staff to select a diagnosis" =he FIMMRG term that appears on this screen is a summary term used by the Epidemiological 5epartment for statistical purposes" Howe)er: the I/5 classification is not easy to use" In order to facilitate diagnostic lookups therefore: Sri 6anka has recei)ed a free license to use the S(OME5 database" =his contains o)er a million terms from e)ery aspect of clinical terminology including disorders used for diagnoses" It contains most of the e)eryday terms used by clinical staff in the hospital" =he S(OME5 database has a link to the I/53!' so that I/5 terms are selected automatically" =his selection is only a suggestion # the decision whether to accept the corresponding I/5 code suggested is up to the user" =he main diagnosis 7used for the statistical summary8 should be indicated by clicking on the star neEt to it"

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Hospital Health Information Management System Open Source Software for Electronic Patient Records #iagnostic tests
=his module is similar to the one de)eloped for OP5 )isits" ;hen eEperience has been gained by the use of the system in the hospitals it will be eEtended further as appropriate"

Medications
=his module is similar to the one de)eloped for OP5 )isits" ;hen eEperience has been gained by the use of the system in the hospitals it will be eEtended further as appropriate"

Proced!res
S(OME5 also has a listing of surgical and non3surgical procedures" It can therefore be used to select the surgical operations carried out on the patient or the medical procedures" =hese procedures will show on the discharge summary 7including any remarks entered8"

Notes
5uring the admission: doctors and nurses can enter remarks to indicate the progress of the patient or other useful clinical information" 0s many notes as necessary may be entered" 0bbre)iations used in -emar(s fields can also be used"

*ard transfers
It is necessary for administrati)e and statistical purposes to keep a track of the ward where the patient is treated" =his can also be used help to locate a patientBs record in the computer" ;hen a patient is transferred from ward to another: the ward recorded in the computer should be corrected immediately with this module" 0ut in the new ward here

#ischarge
On discharge: the main pro)isional diagnoses will be shown again 7this is the one shown by the star entered when the diagnoses are recorded8" =he -ields marked . outcome and the referred3to hospital: if any: are obligatory are recorded in the usual way" #C" code taken from diagnosis

# ' code produced automatically

Prints
=he reports that can be produced on this patient and this admission are shown in the second section of the left menu" 0nother chapter in the help file describes how to produce these reports"

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Notification of infectio!s diseases

=he Epidemiological 5epartment of the Health Ministry prescribes a list of disease whose notification 7e)en for suspected cases8 is mandatory" =hese diseases are currently9 0cute @laccid Paralysis /hickenpoE 7 aricella8 /holera 5engue @e)er 5engue Shock Syndrome 5iphtheria 5ysentery Encephalitis Enteric @e)er 7=yphoid @e)er8 @ood Poisoning Human Rabies 6eptospirosis Malaria Measles Meningitis Mumps 7Infectious Parotitis8 Plague Rubella /ongenital Rubella Syndrome 7/RS8 Se)ere 0cute Respiratory Syndrome 7S0RS8 Simple /ontinued @e)er of 1 days or more =etanus =etanus 3 (eonatal =uberculosis 7Pulmonary8 =yphus @e)er iral Hepatitis Pertussis % ;hooping /ough Aellow @e)er

=here are two phases in the notification of an infectious disease" =he first is for the doctor who sees the patient to indicate that this case should be notified and to place it in a list for deli)ery" =his can be done from the 3isit module 7OP5 or /linics8 or from an Admission" =he second step is for the person responsible for notifications to choose them from this list and to send them out either on paper or by e3mail"

#otifi ation for ambulant patients

;hen doctors choose a complaint for a patient )isit: the notifiable diseases are listed in the pop3up window" In order to remind hospital staff: they are shown in red in this list and also in the I/53!' listing"

;hen such a diagnosis is entered: the computer reminds you that this is a notifiable disease and re2uests permission to notify it to a corresponding Medical Officer of Health based on the residence of the patient9

If you answer BAesB you are then asked to confirm the notification on a further screen9 Creation #ate defaults to todayBs date and time Type of visit copied from the )isit data #iagnosis the condition chosen as the complaint +ab confirmed answer yes or no depending on whether the disease has been confirmed by labtests Notification re,!ested answer yes or know depending on whether you want to notify this case #octor the doctor making the notification %emar-s these will appear on the notification form 'ctive is this re2uest currently acti)eN Send &.mail to put in the e3mail address of the MOH where the notification should be sent

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#otifi ation for admissions

@or admissions: the notification process is triggered by the pro)isional%working diagnosis" In this case the notifiable disease markers are stored in the I/53 !' file pro)ided with the system" /urrently the S(OME5 file does not ha)e these markers" =he notifiable diseases are shown in red in the I/5 list and in the diagnosis window" Of the right of the diagnosis window is a small icon for re2uesting a notification" /licking on that icon opens a confirmation window similar to the one used for )isits" Notifiable #C" codes shown in red

Sending notifi ations

/hoosing the menu3bar module (otifications opens a screen with a list of all the outstanding notifications" =his list may be enlarged to show all notifications: including those already sent out" =o send a notification click on that line9

Click on this icon to re1uest a notification Click on a line to show this notification

0 screen opens showing the notification form as it will be sent by e3mail" =his can be further edited by choosing the BEditB button at the bottom of the screen" 0 screen similar to the pre)ious confirmation re2uest screen opens"

-inal edit of the form before sending out

/licking on BprintB produces a P5@ file with a copy of the Epidemiology 5epartmentBs printed notification form filled in9 =his can be printed and posted to the appropriate MOH" (ote9 the printing of the data in red in this picture is for clarity # on the actual form they are printed in black"

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Managing the database tables

0s well as storing the patient record: the hhims software has a number of tables that contain background data for running the system" In order to see the menu of tables: the userBs 9enu Bar must include 0references" =he /ystem tables are uni2ue to your institution and will need to be set up when a new system is installed" =he Clinical tables can be used immediately but some of them will probably need to be edited to include specific data used in your hospital" =he Application tables re2uire specialiLed knowledge and updates will be pro)ided by the software distributor" If you wish to be ad)ised when updates are a)ailable please contact info< hhims"org"

System tables
/sers
Each user of the system needs to be registered in the database" In order to use the system: they must ha)e their own user3name and password which they use at login" =his ensures that the person is authoriLed to use the system and identifies them to the computer" Each user belongs to a group where the permissions and the )isible menu bars are recorded" =his controls access to the software functions which are a)ailable for them: and determines what screens they will be able to access"

"ro!ps
=hese are sets of users that share the same permissions and menus bars" =he home page shown on login is also set in this table" =he initial groups in the system are9 'dmin # system administrators who look after the system 'dmission # staff registering and admitting patients #octor # staff doctors and consultants +ab Tech # laboratory staff N!rse # hospital nurses Pharm # pharmacists and dispensary staff Proced!re0room0staff # staff carrying out treatments%procedures%in?ections /ser # persons who can only see the patient list 7e"g" telephonist%front desk staff8 0dditional groups can be added if necessary" 0fter creating a group you must gi)e it Permissions 7see below8"

Permissions
Each *roup is associated with a list of hhims functions that this group of users is allowed to access" =his access can be applied separately for printing: )iewing: editing and creating the item"

Click to give permission

1isit types
=he standard out3patient module can be used for a )ariety of purposes" =his includes the normal OP5 department and clinic )isits: but it is possible to add other types of )isit" Aou can add these from the menu" In the original distribution se)eral eEamples are included9 OP5 )isit O paediatric clinic medical clinic certificate surgical clinic blood donation antenatal clinic O psychiatric clinic O O certain types of )isit ha)e associated 2uestionnaires 2ni1ue code for each hospital

Hospital settings
=his describes your institution" It should be gi)en when the system is installed to a)oid faulty patient records" =he code consists of + letters each for the district: town and type of institution" =he eEample shown refers to 2egalle 5istrict: Mawanella: Pro)incial 3ase Hospital" It is part of the patient registration number"

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Other hospitals: Medical Officers of Health etc"

Men! bar
=he bar at the top of each screen shows the modules that users in each group can access" =his is independent of the permissions # if a module appears for which there is no permission: an error message will appear when it is chosen" =he current list of modules is9 Home 7the module to show when users first log in8 Pharmacy 7)iew%dispense prescribed drugs8 +aboratory 7)iew%record lab tests ordered8 Preferences 7menu of tables8 +og o!t 7return to login screen and cancel the session8 Proced!re room 7)iew % record procedures ordered8 New patient 7register a patient for the first time8 Search 7find a registered patient8 # leads to patient )isits and admission modules Notifications 7)iew notifiable cases % prepare forms8 *ards 7see the patients in each ward8 %eports 7printouts not related to a specific patient8

%lini al tables
0lthough the system is distributed with a set of clinical tables that can be used immediately: they can be updated by the users in order to tailor them more eEactly to the information used in each hospital"

Complaints
=he list of complaints%in?uries showing in the )isit and the admission screen"

Treatments
=he list of treatments%procedures ordered by a doctor during a )isit to be carried out by procedure room staff"

#r!gs 4 dosages 4 fre,!encies 56 tables7

=he drug list can be edited and the amount of stock recorded and the prescription default )alues are stored in this table" =here are separate tables for the dosages and fre2uencies that pop3up in the prescription module"

Canned te)ts
-emar(s fields ha)e a set of abbre)iations that can be chosen by preceding the code with a back3slash" @or eEample typing FJchfG followed by a space will produce the teEt Fcongesti)e heart failureG" (ew teEts may be added: up to a maEimum of D'' characters 7approEimately !' lines8"

+ab tests 4 test gro!ps 4 test departments 56 tables7

6aboratory tests are listed by department 7initially 4acteriology: 4iochemistry and Haematology8 and within department by group" *roups P departments can be seen by choosing the indi)idual table" (ew tests are added to 6ab=est table and can be allotted to a *roup and a 5epartment" (ormal reference )alues may also be added"

*ards
=he wards in the hospital can be added or re3named" Aou cannot delete wards as this might affect old records" Howe)er it is possible to de3acti)ate an entry so that it will not show in the screens or listings" Make sure all the patients are discharged from that ward before doing this"

8!estionnaires
=he neEt chapter in this handbook describes how to create and use 2uestionnaires"

&ppli ation tables

=hese large tables are copied from public or licensed databases and will be updated by the software distributor" =he IMMR list was pro)ided by the Medical Statistics 5epartment of the Health Ministry" =he list of )illages was prepared by the U( agency IOM as part of the tsunami program of the U(5P" It has not been updated for se)eral years: certain )illages may therefore be missing" =hey can be added )ia the system table module 7in preparation8"

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/sing and creating ,!estionnaires

=he first release of hhims includes a simple patient )isit screen that is suitable for documenting most types of medical )isits either to a general OP5 clinic or to specialist clinics" Howe)er: in order to enter specialiLed patient information into the database: it is possible to create different 2uestionnaires tailored to the re2uirements of consultants in different specialties" =hese can be called during a )isit to record specialiLed information in addition to the basic information collected in the standard )isit screens 7complaints: S(OME5 findings and I/5 diagnoses: past history: allergies P eEamination findings8" =hey can also be used for data entry by the patients themsel)es" =heir use is optional" hhims comes with se)eral of these 2uestionnaires already designed" =hese can be edited if necessary and additional ones can be created by the users using a simple screen editing module" /urrently 2uestionnaires are only implemented for )isit records" If there is a demand: 2uestionnaires will later be eEtended to admission records" /urrently: each 2uestionnaire is related to a specific type of )isit" If there is demand: later releases will allow 2uestionnaires to be related to an admission 7e"g" detailed deli)ery information8 or to a patient 7e"g" personal life3style and habits8"

Choosing a ,!estionnaire to !se

Questionnaires are chosen from the menu list to the left of the screen when )isit data is being entered and the ones 3uestionnaires are that show are those related to the type of )isit in 2uestion" specific to a visit type @or eEample: the -outine Antenatal 2uestionnaire is related to the Antenatal )isit" It therefore appears in the left menu of Choose a 1uestthe 3isit Information screen when an Antenatal )isit has ionnaire to fill in been chosen" @or other types of )isit: this particular 2uestionnaire will not show" 0 2uestionnaire can only be related to one type of )isit at present" If the same 2uestionnaire is re2uired for different types of )isits: a copy must be made" Howe)er: one type of )isit may ha)e many different 2uestionnaires attached" 0n eEample in the original database is the Antenatal )isit: which has two 2uestionnaires # Initial and -outine antenatal visit 2uestionnaires"

/sing a ,!estionnaire
0n eEample of a 2uestionnaire is shown on the right" =his is a routine antenatal )isit: which can be called up for patients attending the 0ntenatal clinic" =he different types of field and the default )alues can be defined and edited by the user with programmer pri)ileges" Howe)er: it is not recommended to change 2uestionnaires that are in use as the data in pre)iously filled in ones may become una)ailable" =he fields show in the order in which they were defined" =he information recorded by the user is stored in the database as part of the )isit information" Questionnaires can be printed or used to produce listings or aggregate statistics"

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%reating a new 7uestionnaire

Questionnaires defined by the users or included in the hhims distribution: are stored in the database" =hey can be created or edited from the 0reference screen by choosing the Clinical Tables section of the menus on the left and then selecting 5uestionnaires" @rom the list of 2uestionnaires that show you can choose one for editing or add a new one by clicking the button at the top of the screen" =o make a new 2uestionnaire9 !" @rom the list of 2uestionnaires that show: choose one for editing or add a new one &" Relate the table to a specific type of )isit +" Open the new 2uestionnaire and add fields ," =est it 7ask a few colleagues also8 =he 2uestionnaires are numbered se2uentially by the computer" Name 5of the ,!estionnaire7 . this is the same as the teEt that appears in the menu of 2uestionnaires that users can choose for a particular )isit" %elated to . each 2uestionnaire will only show for one type of )isit" =his )isit is selected here" @or each 2uestionnaire: only one type of )isit may be linked to it" Howe)er se)eral 2uestionnaires may be linked to one type of )isit" Type 9 reser)ed for future de)elopmentK the only currently a)ailable )alue is BopdR)isitB 7also applies to clinic )isits8 %emar-s . these may be added to clarify the reason for the 2uestionnaire and how it can be used" 'ctive . it is not ad)isable to delete a table once it has been used: as patient data may get lost" =ables no longer re2uired can be simply deacti)ated in this field" =hey can be reacti)ated for future reuse" Save4$2 . sa)e any changes made or return without making any changes to the database

'dding a ,!estion
:ield Name 9 this is free teEtK it is recommended to make the field names as meaningful as possible in order to make it ob)ious for different staff 7or e)en patients8 how to fill in the answers" Type of field 9 select from9 teEt: number: select: remarks: date: yes%no" @or BselectB type of fields: the possible )alues can be be defined in the neEt boE" Possible val!es 9 this applies to BselectB fieldsK the )alues that appear in the pop3up window a listed here separated by two )ertical bars 7BSSB8" spaces are allowed within each )alue but not at the beginning or end" #efa!lt val!e 9 this is the )alue that appears when the user first opens the 2uestionnaire # they can still change or remo)e this )alue 'ctive 9 it is not recommended to delete a field as pre)iously entered data may become una)ailable" If the field is no longer re2uire it can be de3acti)ated here and is not shown to the user" Entered )alues remain howe)er and the field can be re3acti)ated later" Save4$2 . sa)e any changes made or return without making any changes to the database

Preview
EEisting 2uestions can be edited or new 2uestions added" /hoose a 2uestion to edit with the link at the end of the line"

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Printing o!t information

It is possible to print the information in the database" =he prints refer either to an indi)idual patient 7e"g" personal information: )isit information: notification form8: to groups of patients 7e"g" all patients seen today: IMMR 2uarterly statistics8 or to the database 7e"g" drug stock: staff list: complaints8" =he reports related to the screen being )iewed are shown in the -eports menu on the left" =his list of reports will differ depending on where it appears # the patient o)er)iew screen has different reports from the )isit information screen" 0s time goes on: the number of reports will increase depending on re2uests from users" If you need a report which is not shown: contact info:hhims.org"

%hoosing a printout
/lick on -eports on the left of the screen to first open the window showing a)ailable reports: then click on one of these reports" @or reports re2uiring selection information such as date range: an intermediate window will open to enter this information before the report can be printed"

+isuali8ing a printout on the s reen

=he reports are produced in what are called BP5@B files 7Portable 5ocument @ormat8" Originally de)eloped by the 0dobe /orporation: this format is now in the public domain and can be used free of charge" Most browsers can read P5@ files without any additional software: but unfortunately they handle these files in slightly different ways" @or this reason we recommend the /hrome browser from *oogle: also a)ailable free of charge" =his browser shows the files in a window or allows you to print them or to store them on your workstation" It is also possible to change the shape and siLe of the printed report" 0n eEample of a P5@3file displayed by the /hrome browser is shown on the right" 0t the top of the window is some technical information describing the file that /hrome has retrie)ed" =he blue boEes at the bottom right allow the window to be re3siLed: to be stored on to the hard disk of your workstation or to be printed on paper" /trl3S sa)es the fileK /trl3P prints itK /trl3@ searches it -ile information -rom the browser

Si4ing the window& Storing the file& printing

Storing reports on your omputer

If you want to keep a copy of the report: it is possible to store it on the hard3disk of your workstation computer" =he files are gi)en meaningful names so that they can be browsed and found easily" (ormally reports will be stored in the sub3directory Do1nloads in your home3folder but this can be changed with browser settings" Aour system3administrator can help you to do this"

Printing on paper
Printers can be attached to your workstation or to the network" If you attach a printer to one computer you can limit the access that other users ha)e to this printer or you can make it generally a)ailable" If the printer is attached directly to the network: this re2uires an additional network plug" Usually network printers are made a)ailable to all users on the system: but it is possible to restrict them to certain specific users" In a small hospital or clinic we recommend attaching the printers directly to the ser)er and permitting other users to access them )ia the local network" In both cases: configuring a printer for )arious paper siLes: orientation etc": is done using a system program on your computer" Aou can make this configuration specific to yourself or allow other users to use the same configuration" Aour network administrator can help you to configure a printer according to your specific needs"

Sending reports by e-mail

@irst sa)e the file on to the disk then log on to your e3mail pro)ider" /ompose a new e3mail 7or a reply to another one8 and attach this file" It will be )isible to the person at the other end 3 most computers can read the P5@ format" If you re2uire a different format: contact info:hhims.org"

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1odule where report available 0references /ystem tables

-eports

0atient overvie1

3isit information

0harmacy

,eport Users User groups *roup permissions isit types Hospital settings Institutions *roup menu bars Clinical tables /omplaints =reatments 5rugs: dosages P fre2uencies /anned teEts 6ab tests: groups P departments ;ards Questionnaires Application tables S(OME5 findings: disorders: e)ents and procedures I/53!' codes IMMR illages Patient listings 7)isits: clinics: admissions: discharges: dispensed drugs8 Encounter statistics 7admissions P )isits8 isit complaints treated 5aily drugs dispensed /urrent dispensary stock /reate drug order IMMR 72uarterly listing of admissions%diagnoses8 Patient slip Patient cards Patient summary of encounters Questionnaires appropriate to that type of )isit Prescription 6ab test results Patient slip Patient cards isit summary 5aily drugs dispensed /urrent stock balance 5rug order form isit prescriptions Prescriptions by drug

Laboratory 0rocedure room Admission

4ed3head ticket =ransfer letter 5ischarge ticket Patient history 0dmission summary Patient slip Patient cards (otification form

;ards Notifications

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