International Institute of Health Sciences

Assignment

Program and Batch: EMSc in Healthcare Administration 03 rd

Batch
Module: Health Information Systems: MGT 494
Title: Development of a proposal for an information system

for a Medical ward for SUWA SAVIYA; a 100 bed Hospital

Name: Dr. A.K.J.M. Wijayarathne
Registration Number: EMHA03/14/011

EMHA03/14/011
Systems

Hospital Information

Assignment HIS- EMSc HA Programme 2015- 03rd batch

Introduction - Hospital Information System (HIS)

Hospitals are information-rich organizations and pay an immense consideration on
information management and processing, which has to be done using appropriate
information systems. HIS is a computer-based system designed to assist the
management of the administrative and medical information within a hospital
(Trimmer et al. 2002). It helps to improve operational efficiency, quality of care and
helps decision making (Spathis and Ananiadis, 2005). HIS systems give comfortable
access to patient data (N.ghosh, 2010). Increasing customers expectations and
regulatory boundaries also necessitates the need for clinical information and
administrative tools that are immediately available. Furthermore, by increasing
operation efficiency, the adoption of the systems could also reduce the costs (Spathis
and Ananiadis, 2005). As stated by Hegji et al. (2007) serving patients with quality of
care would guide for better return in the future. Despite its extensively accepted
benefits, HIS adoption is still slow in certain countries due to lack of computer skills
and training (Meinert and Peterson, 2009). The inability of individual user to
strengthen their knowledge in the information systems application has caused
considerable barriers to wider adoption of HIS.
Healthcare is an essential part of day to day lives where most people nowadays prefer
to find a hospital that offers better healthcare services. Population demands for goodquality services force these organizations to improve their services by adopting
information systems (Burke, 2009). In hospital environment, the implementation of
hospital information systems is quite tremendous since many hospitals are able to
increase their service quality to compete with other healthcare entities (Puay and
Nelson, 2000). This is seen in many developed countries like United States of
America (Smith and Swinehart, 2001; Trimmer, Pumphrey and Wiggins, 2002;
Ovretveit et al. 2007; Meinert and Peterson, 2009; Caccia-Bava, Guimaraes and
Guimaraes, 2009; Lee and Meuter, 2010), United Kingdom (Procter and Brown,
1997), and some developing countries like in Malaysia. However; adoption of
information systems in hospitals in Sri Lanka is still at an early stage. Public sector
hospitals has introduced few initiatives like in Dompe Hospital but mostly they focus
on public health information systems which are mostly used in collecting, processing
and tracking public health data using open source software like DHIS2 (District
Health Information System). And the lack of funds and lack of motivation to initiate
such systems playing a big role to with hold the systems being put to action. But
private sector hospitals maintain a good trend by automating many of their processes.
Most of the private hospitals use information systems for billing, channeling, HR and
administrative purposes where as electronic health record systems are still not
positively adopted here in Sri Lanka.
2

EMHA03/14/011
Systems

Hospital Information

Hospital and Information Systems (IS)

Hospitals around the world have widely utilized IS for over many years. For example,
US government has made the adoption of the electronic medical records as mandatory
to all healthcare providers by 2014 (RAND Health, 2005). At the beginning of IS
implementation, it focused only on improving efficiencies in areas such as billing and
financial reporting (Trimmer et al. 2002). However, as the need to manage and
integrate clinical, financial and operational information grows and evolves, HIS gives
many benefits such as it could provide the best possible support of patient care and
administration by electronic data processing (Ammenwerth, Kaiser, Wilhelmy and
Hofer 2003). Realizing these benefits, most of the private sector hospitals adopt HIS
at a trending fashion. The adopted HIS is the systems that can help those hospitals to
become the benchmark of modern, automated hospitals and realize the goals of
becoming a model e-hospital in Sri Lanka in near future.

Introduction SUWA PIYASA Hospital, Kottawa

SUWA PIYASA is a 100 bed hospital located in the heart of the city of Kottawa,
which is a highly urbanized area at the suburbs of Colombo City. It is a multi
disciplinary hospital with wards (Medicine, Surgery, Paediatrics, Gynaecology and
Obstetrics), 24 hour Out Patient Department, ETU, PCU and Day Care, ICU,
Operation Theatre, blood bank and physiotherapy facilities. It also provides
channeling facilities, Ambulance services and 24 hour pharmacy and Laboratory
facilities.
Its Mission is to prevent diseases and cure patients through health promotion, patient
education, professional training and proper treatment.
And its vision is to be the leader in providing high quality care and enhancing the
lives of individuals nationally and regionally and also to take part in contribution to
research, technology development, and novel programs in education and training.
The organization is basically categorized in to two sections according to the
services which are needed.

Medical Services
Non Medical Services

Under medical services; the basic departments are;

Wards (Surgical, Medical, Paediatric, Gynaecology and Obstetrics)

ICU
PCU & OPD
Operating Theatre

EMHA03/14/011
Systems

Hospital Information

Labour room
Channeling
Ambulance
Clinics
Laboratory
Pharmacy
Radiology
Physiotherapy
Blood Bank
CSSD

Non-Medical

HR
PR
Marketing
Finance
Plant and House Keeping
IT
Kitchen
Janitorial
Administration

Under each category, the bed capacity is as follows;

Category
Wards

Bed Number
75

ICU
PCU & Day care
ETU
OPD
Labour room

Sur-20,Med-22, G/O-15, Pd-18

5
5
5
5
5

Medical ward- Description

EMHA03/14/011
Systems

Hospital Information

Our aim is to grant a high standard of medical and nursing care in a relaxed and
friendly environment, in which patients and their family members are considered as
the centre of attention and the main priority.
The patient should retain his or her individuality and should be cared for physically,
psychologically, and socially while maintaining privacy and confidentiality and
dignity.
Care will be planned and carried out jointly by doctors, nurses, the multidisciplinary
team, and family where appropriate.
Our staff, through their expertise, professional development and clinical supervision,
is bound to provide a high standard of care, acting as one of the family at all times.
Environment
Medical Ward is a 20 bed General Medical ward. Within the ward there are 4 low
acuity Cardiac beds which are attached to monitors.
The patient population includes patients with wide range of medical conditions,
including Cardiac, Respiratory, Endocrine, Gastroenterology and infectious
conditions. Most of the patients are older adults.
Care is provided by a multidisciplinary team. We have an experienced Nursing staff,
with Registered nurses providing routine care, assisted by other junior attending staff.
Medical care is provided by specialist Physicians and Medical officers, who work in
conjunction with the ward staff. The patient's stay in the ward is monitored closely
which ensures that their investigations occur in a timely manner, and management is
done according to latest treatment methods and finally aiming for a safe and timely
discharge.
A full range of health services are provided as needs are identified by medical and
nursing staff. Physiotherapy, Speech therapy, Dietetic advice and clinic follow ups are
provided in collaboration with the other units of the hospital. Referral to other
services also arranged on a needs basis. All staff involved in patient care meet
regularly to review patient care goals and identify particular needs post discharge.
The floor area is organized as follows:

EMHA03/14/011
Systems

Hospital Information

D
o
ct
or
s
a
n
d
N
ur
s
R
e
c
e

PLANNING
Identifying the Needs (Justification):
Basic inefficiencies of the existing system at the medical ward:

Current ward registration is paper based and there are lots of errors and
duplications occur in entering patients data. It is also time consuming.
An admission through OPD, ETU and channeling is not integrated, so the
duplication of patient registration work.
Relevant consultant physicians can be informed by an automated SMS/email
system if the registration process is automated.
Junior medical officers and consultants have to physically come to the ward
and manually go through the patient details and relevant investigation reports
each and every time which is a time consuming and a waste of resources and
irrelevant at times.
Emergencies in the ward are not informed to every person who is responsible
at the time of emergency which may result in a fatal outcome. With an
automated alarm system/ pager system it will be much easier to alert the care
team at once.
Coordinating and getting the reports on time from the laboratory is manually
done in the current setting, its a time consuming and tedious job.

EMHA03/14/011
Systems

Hospital Information

Coordinating and getting the reports on time from the radiology department is
manually done in the current setting, its a time consuming and tedious job.
Coordinating and issuing of drugs from the indoor pharmacy, alerting of out of
stock drugs, inventory management of the pharmacy will be more efficient
with a integrated system
Referrals and transfers to other wards or consultants has to be arranged
manually which is time consuming and tedious. With an integrated system itll
be easier to find an available consultant and refer the patient where necessary.
Ambulance service has to be arranged manually which can be cumbersome for
the person who is coordinating.
Follow ups are not arranged in a proper manner and the follow up of the
patient from medical clinic is not properly tracked from the ward and the
doctors cannot get an idea about whether the patient is properly followed up or
not.
It is a cumbersome effort to get the reports done manually; which are
necessary for day to day administration processes of the ward.
Difficulty in handling the discharges from the ward as there are number of
places to be searched and inquired before making the final bill at the discharge
such as laboratory, radiology department, pharmacy etc.
Inability to efficiently reach data for research and audit processes with the help
of the current paper based system.
Record keeping of the discharged patients is a tiresome process with the paperbased system
Patient satisfaction is high if they can access and arrange their medical profile,
their consultancy appointments, next clinic appointments from their home, and
also health insurance and other payments can be done at the ease of their
home.
Even if a patient has misplaced his previous records, it will be easier to access
their old health records at ease with an automated system.

Broad objectives of having a HIS is to make a cost effective processes at medical

ward of SUWA SAVIYA hospital; which boosts hospital professionals commitment to
provide quality services to the patients and to support decision making of
professionals.
Specific objectives of the system:
The project will be carried out in basically two phases.
Phase I
The project is aimed to develop to maintain the day to - day state of
admission/discharge of patients to each unit, reports generation, laboratory, radiology
and pharmacy integration, accounting and audit, list the staff and payrolls and general
7

EMHA03/14/011
Systems

Hospital Information

information (HR), channeling services, ambulance services and to maintain

inventories of each unit of the hospital etc. It is designed to achieve the following
objectives:
1. To computerize all details regarding patient details & hospital details.
2. Scheduling the services of specialized doctors properly so that facilities
provided by hospital are fully utilized in effective and efficient manner.
3. Scheduling channeling appointment of patient with doctors to make it
convenient for both.
4. If the pharmacy issues medicines to patients, it should reduce the stock status
5.

of the medical store and vice-versa.

It should be able to handle the test reports of patients conducted in the

laboratory of the hospital.

6. It should be able to handle the test reports of patients conducted in the
radiology department of the hospital.
7. The inventory of each unit should be updated automatically whenever a
transaction or addition is made.
8. It should generate reports which are used in administrative purposes.
9. It should maintain accounting data pertaining to the all areas of the hospital
and its staff and patients.
10. It should maintain the HR database and the payroll status of each staff
member.
11. It should co-ordinate the ambulance service offered to patients and outside
12. The information of the patients should be kept up to date and there record
should be kept in the system for historical purposes.
Phase II
Development of a complete Electronic Medical Record (EMR) system integrating all
the above features along with a fully automated clinical care (Paper-less Hospital
concept).
Benefits:
The benefits will be directed mainly towards the health administration; patient
information administrative work and making the administrator more competitive in
the area of responsibility, prepared for auditing & legal demands. It will immensely
improve the quality & efficiency in patient management. Integration of units will
contribute to better process co-ordination and smooth running of processes as well as
8

EMHA03/14/011
Systems

Hospital Information

efficiency in HR management. It will also help to identify the areas of inefficiency in

the areas of service delivery and cost effectiveness. It will be a great benefit for data
readiness; especially in the areas of research and audit.

Feasibility study:
Four primary areas of interest in feasibility study are:
Economic Feasibility: An evaluation of development cost compared against the final
income of benefit derived from the development of product. cost benefit analysis is
done to evaluate the expected cost and benefits.
Cost and Benefit Analysis:
Developing a hospital Information system is an investment. After implementation, it
provides the organization with profits. Profits can be financial or in the form of an
improved working environment.
In performing cost and benefit analysis it is important to identify cost and benefits
factors. Cost and benefits can be categorized into the following categories:

Development Costs Development costs is the costs that are incurred during the
development of the system. It is one time investment.

Operating Costs Operating Costs are the expenses required for the day to day
running of the system. Examples of Operating Costs are Wages, Supplies and
Overheads.

Hardware/Software Costs It includes the cost of purchasing or leasing of

computers and its peripherals and software.

Personnel Costs It is the money spent on the people involved in the

development of the system.

Facility Costs Expenses that are incurred during the preparation of the physical
site where the system will be operational. These can be wiring, flooring, acoustics,
lightning, and air-conditioning.

Supply Costs These are variable costs that are very proportionately with the
amount of use of paper, ribbons, disks, and the like.
9

EMHA03/14/011
Systems

Hospital Information

 Benefits
We can define benefits as Profit or Benefit = Income Costs
Benefits can be acquired by:
Increasing income, or
Decreasing costs, or
Both
When considering the time factor, human resources and increased patient satisfaction
and good turnover rates of patients, it will be beneficial to adopt a HIS in this
scenario.
Technical feasibility:
Technical Feasibility includes ability to acquire and audit of existing and new H/W
and S/W requirements that are required to operate the project.
Operational feasibility:
Operational feasibility is mainly concerned with issues like whether the system will
be used if it is developed and implemented.
Legal Feasibility:
A determination of any infringement, violation, or liability that could result from
development of the system. Legal feasibility tells that the software used in the project
should be original purchased from the legal authorities and they have the license to
use it.
The process flow and key result areas of the medical ward (from patient
reception to follow up at clinic after discharge)

Reception

Registration and admission

Consultation

Investigation

Treatment (Drugs/ procedures)

Transfer

10

EMHA03/14/011
Systems

Hospital Information

Ambulance

Discharge

Follow up

Payments

Other services not related to medical process but essential in - HR/

Housekeeping/ Accounts and Finance/ Administrative/ kitchen etc.

As per the diagram we can see the collaborative work to be done by several
departments to keep the work flow alive and consistent and hassle-free.

Scope of the proposed system for whole hospital and Medical ward:
Considering the needs and the details distributed from the IT department regarding the
project scope and resources for the whole hospital; following is a brief description of
the scope, resources and planning of the floor area of the proposed system for the
medical ward.
The hospital information system will consist of the following modules as informed by
the IT department.

11

EMHA03/14/011
Systems

Hospital Information

CLINICS

TRANSFER

HR

The modules are described in brief; with reference to the key result areas in the
medical ward.
Patient Registration (OPD & Ward): Every patient who visits the hospital has to get
registered prior to getting any consultation, treatment or investigations done.
Registration of patients involves accepting certain general and demographic
information about the patient. The patient is allocated a unique Registration number
and a Patient Identification number. The Patient ID will remain same for his all
subsequent visits to the hospital whereas he will be allocated a new registration
number on every visit.
The following information is required for the registration of OPD Patient

ii.
iii.

i. Patient Demographic Details like Name, Age, Sex, Address, Contact

number, Nationality, etc.
Referring Source
Department & Consultant to be visited.
For Inward patients the additional information requirements are:

iv.
v.
vi.

Room / bed requirement.

Consultant In-charge
Treatment required (optional)
After registration a BHT (bed head ticket) is printed for the inward patients,
which list all his registration information. This is used to record the
information in the ward till discharge.
12

EMHA03/14/011
Systems

Hospital Information

Note: After implementing EMR module at phase II; all the information will be
recorded in the computers on wheels (COW) in wheel and at discharge the
summary and diagnosis card will only be printed to be handed over to the
patient.
Ward/room Management
This will help in ward clerk/ nurse in-charge to manage the rooms and ward and bed
allocation
Emergency/ ETU module
Records ETU data and integrates the ETU with the other units with reference to
patient s details, bed allocation, vitals recording of in house patients, doctor alert
system etc.
Doctors work bench Module
Provides the private and restrictive logging for doctors who are in- charge of
wards/patients to visualize data and order investigations as well as view investigation
reports.
Laboratory and Radiology information systems allow authorized users to view and
order investigations form lab and the radiology department.
Pharmacy- The Pharmacy Module deals with the Retail Sale of medicines to OPD
patients and Issue of medicines to the Inward patients in the hospital. Its function
includes, online drug prescription, inventory management and billing of drugs,
consumables and sutures. This module is closely linked to the Billing Module and
ward Modules.
Certificate module is responsible for issuing medical certificates according to
requests made by patients
Roster module allows editing and integrating all the rosters of the staff working in
the hospital by relevant heads and administrative staff. Rosters can be viewed by
every staff member.
Communication module is used for circular issuing, policy circulating, message
forwarding, making announcements, alert systems and all the relevant communication
processes of the staff.
Inventory and fixed asset module is there to manage the ward assets by the relevant
authority.
Diet and kitchen module collects all the data regarding inward patients and staff diet
plans and manages them.

13

EMHA03/14/011
Systems

Hospital Information

Blood bank, ambulance, CSSD, dental and physiotherapy modules will handle the
relevant departments and collaborate with other relevant departments.
Clinic module will arrange appointments in hospital clinics which are held in a
monthly basis.
HR module will keep track of all the employee details and collaborate with the
relevant modules like payroll and financial/accounting modules.
Billing - For billing of any service like Pathology Tests, or any imaging investigation,
the patient moves to billing counter. Here the services are charged as per the rates
already defined for various categories to the patient with his Patient ID. The Payment
is collected for the service provided and a receipt is generated.
For inward patients; the entries for billing are automatically transferred to the patient
bill by the respective departments, which provide the service.
Financial and accounting module integrates all the expenditures of the hospital and
income with reference to department and time frames.
Payroll module can calculate, edit and organize the pay rolls of each individual and
secure and timely payments can be arranged.
User Management module provides the essential option of managing users and
providing users with user names and passwords as well as editing and deleting them
per the requirement. It is critical to keep the privacy of the patient and hospital data.
**EMR Module will be functional at the end of the successful implementation of the
first phase of the project.

And the basic networking architecture for the HIS system can be illustrated as
follows;

14

EMHA03/14/011
Systems

Hospital Information

Database/ email/ web/back up servers are connected to internet through a firewall and
the other computers of the network are connected to the servers via switches, and
there will be wireless access points separately for the use of wireless computers and
laptops and tablets.
For the medical ward; the planned networking architecture and placement of
computers is illustrated below;

The medical ward will connect to the hospital network via a switch which is situated
in the ward floor and there will be an integrated wireless access point as well.

Placement of computers:
15

EMHA03/14/011
Systems

Hospital Information

Computers on Wheels

Equipment and resources needed for the Proposed System (As discussed with IT
department)
Software Perspective:
The application will be web-based software product. Front end- HTML/ Java Script
Back end- Java SE, database server- MySQL
This will be out-sourced to an IT company to be developed and maintained. Source
code will be available to the company.
Software System Attributes will be Reliability, Availability, Security, Maintainability
and Portability.

Java SE
MySQL

Hardware perspective (minimum requirement)/equipment needed

Processor: Pentium IV or above
16

EMHA03/14/011
Systems

Hospital Information

RAM: 512MB or above

Hard Disk: 40GB or above
Input Devices: Keyboard, Mouse
Output Devices: Monitors
Tablet devices/ laptops
Printers/ Scanners/UPS
Acquiring servers/firewall
Rent an leased line from a service provider
Networking- wiring/routers/switches/hubs

Human resources:
As we have a trained IT staff already; the training aspect of the other staff is the main
worry. This can be acquired via scheduled workshops/ training sessions.
Responsibilities should be allocated to each staff member. Maintenance can be done
in collaboration with the IT Company and our IT department.

IMPLEMENTATION
Introduction:
In accordance with Ovretveit, et al. (2007) early system implementation phase is very
vital. During this phase, there are many changes occurring to the existing system.
According to Stefanou and Revanaglou (2006) when a new system is introduced such
as HIS, there will be changes in the manner of the medical staff approaching their
tasks. So, bad management during the implementation phase can cause users
resistance towards the new system. Also, these researchers also found that the level of
resistance towards new system implementation was quite high as they were familiar
with manual practices. Trimmer, Pumphrey and Wiggins (2002) stated that the
medical staffs tend to resist and look at the new system as a threat that could affect
their work and potential. Therefore users should be educated regarding the importance
of fully utilizing the system and its good effects towards a better working
environment.
Implementation strategy of HIS
It includes developing a Policy schedule & responsibilities for programme
implementation, Establishment of task force & assigning responsibilities, Identify &
train user group and encouragement by the top management level.
This is planned to be carried out in a unit by unit basis and finally integrating each
unit with each other.
17

EMHA03/14/011
Systems

Hospital Information

Key activities of implementation

HIS testing by user groups and proper evaluation of the modules has to be
done in the initial phase. So the needed changes can be carried out before final
steps f implementation.

Determination of priorities should be done because of the tight schedule in

implementing the HIS

Architecture of the system should be defined and

Acquiring of the software/ hardware/ human resources should be planned

beforehand.

Also the site visit and building the floor area as per the requirements should be
done at the initial phase.

After that; the integration and installing of the hard ware and installing of
software can be done at the site.

Outsourcing of needed activities could be done according to the demands and

time schedule. The IT company which is providing the solution can manage
this aspect

Create a task force to carry out the implementation activities and training
activities.

Empower uses using motivation techniques and rewarding and celebrating

successes is essential.

Change management planning is also critical because it directly affects the

successful implementation of HIS and acceptance of HIS by staff.

18

EMHA03/14/011
Systems

Hospital Information

Implementation timeline
Task
Implementation
planning study
Key process mapping
and redesign
Policy development

Timeline (weeks)
1 2 3 4 5

10

11

12

13

Implementation
sequence planning
Change
management
planning
Benefits
management
planning
Development of training
materials/training
Assigning
Responsibilities
Education and training plans should include:

development, sign-off and production of the education and training

materials

the availability and support of any online learning management system used
to support training

the approach to training; for example, vendor training or in house training

the types of training, including informal and formal, pre-implementation,

HIS system and refresher training

the number of trainers required, the length of time they will be required and
their skill sets, including clinical experience

identification and booking of training facilities, including dedicated training

areas

development, availability and support of the sandpit for consolidated

learning

the timing of training in relation to HIS go-live

detailed costs, including expectations from the business regarding crosscharging for clinical time.

Proposed Policy outline

1

Introduction
19

EMHA03/14/011
Systems

Hospital Information

14

The HIS used by the SUWA PIYASA Hospital represent a considerable

investment and are valuable assets to the Hospital. The assets comprise
equipment, software and data, essential to the effective and continuing
operation of the Hospital.
Much of the data used in HIS is of a confidential nature, and it is necessary for
it to be protected against any events, accidental or malicious, which may put at
risk the activities of the Trust or the investment in information.
All staff are required to adhere to this policy.
2

Policy Statement
The purpose of this policy is:
To bring to the attention of all staff the need to improve and maintain
security of information systems, and to advise managers of the
approach being adopted to achieve the appropriate level of security.
To bring to the attention of all managers and staff, their responsibilities
under the requirements of relevant legislation, including Data
Protection and Human Rights legislation and guidance, and the
importance of ensuring the confidentiality of personal and sensitive
data.
To ensure that the hospital complies with current legislation
To minimize the risk of security breach and prosecution.

Policy

3.1

Overall
Our hospital is committed to maintaining and developing an information
systems infrastructure, which has an appropriate level of security and data
protection.
HIS is mainly managed by IT department of the hospital. In the case of
departmental or stand alone systems it is the responsibility of the relevant
Manager to ensure compliance with this policy.

3.2

The purpose of information systems security is to ensure an appropriate level

of Confidentiality, Integrity and Availability

3.3

Passwords and Access Control

Each individual is responsible for keeping their own password secure, and
must ensure it is neither disclosed to nor used by anyone else, under any
circumstances. Staff must only access systems using their own login and
password. All staff are accountable for any activity carried out under their
login and password, and this is audited.
20

EMHA03/14/011
Systems

Hospital Information

Access is controlled on the basis of service requirements. Procedures are in

place for allocating and controlling access, and passwords.
3.4

Management and Staffing Arrangements

Information security should be addressed at recruitment stage for all staff, and
a confidentiality clause included in contracts of employment.
There is a formal procedure for reporting, investigating and recording
Information security incidents. Any incidents should be reported to the IT
department immediately.
Delegation of responsibilities is outlined in detail in the Information Security
and Data Protection Procedures.

3.5

Network Connection
Network Management is the responsibility of the IT department. All devices
connected to the hospitals network must meet the required standards. Failure
to do so will result in immediate disconnection.

3.6

Security of Assets
All major IT assets should have a nominated owner who is responsible for
security measures.
Availability of data should be maintained by taking back ups.
Departmental based systems are the responsibility of departmental managers.
The IT department will provide guidance and advice to departmental managers
to ensure that information security is sufficient.

3.7

Computer Operations
Responsibilities and procedures for the management and operation of all
computers and networks should be established, documented and supported by
appropriate operating instructions. This refers to both hospital-wide systems
and Department based systems.
Procedures should include: Back-up, media control, event logging,
monitoring, protection from theft and damage, unauthorized access and
capacity planning.

3.8

Systems Development, Planning and Procurement.

Security issues must be considered and documented during the requirements
phase and the procurement phase of all system procurements and
21

EMHA03/14/011
Systems

Hospital Information

developments. All changes to the system should be passed through a formal

change control procedure.
3.9

Legal Requirements and Regulations

The hospital and the HIS is governed by government laws & regulations
including:

3.10

Data Protection act

Computer crime act

Process Continuity Planning

There is a process to develop and maintain appropriate plans for the speedy
restoration of all critical IT systems. All systems will have threats and
vulnerabilities assessed to determine how critical they are to the Trust.
Individual departments should have procedures in place to maintain essential
services in the event of IT system failure.

3.11 Data entry Computers

They shall be specified and purchased via IT Services, in accordance with
current recommendations on software and hardware.
Precautions must be taken to prevent and detect computer viruses. ICT
Technical Services will provide advice and support on virus control.
3.12

Personal Use
Personal use of IT equipment is strictly prohibited.

3.13

Awareness
Managers are responsible for ensuring that all staff are aware of, and adhere to
this policy.

Implementation and Monitoring Plans

Delegation of responsibilities is the responsibility of the managers of each
department. Managers may seek help from the IT department where necessary.

Assigning responsibilities
The HIS system will be used by nursing staff, junior medical officers, consultants, and
other staff.

22

EMHA03/14/011
Systems

Hospital Information

The responsibilities of should be assigned with respect to the key roles of key result
processes in the ward.
The existing responsibilities can be similarly assigned in accordance to the modules of
the HIS.

MONITORING AND EVALUATION

Monitoring should be done by relevant leaders and managers where necessary in
order to get an idea about the motivation among the staff to utilize the system and
adhering to policies and maximum usage of assets.
It involves establishing indicators of efficiency, effectiveness and impact; Setting up
systems to collect information relating to these indicators; Collecting and recording
the information; Analyzing the information; Using the information to inform day-today management.
Evaluation components should include:

an evaluation framework

This is done as a combined effort from the IT staff and the relevant ward staff.
IT department should come out with a proper framework for evalution.

expected outcomes following implementation of the HI system

It should reflect the basic requirements of the staff regarding key processes of
the ward and whether they are met or not met with using the HIS

baseline indicators
Example of baseline indicators for paper-based medication charts and
expected changes when using an HIS

23

EMHA03/14/011
Systems

Hospital Information

Paper-based chart indicator

Whether error-prone abbreviations
present in the medication order

were

Whether the medication order was clearly

legible
Which nurse had done the administration of
the medicine
Whether allergies were recorded

Whether the patient medicines information in

the discharge summary reflected medicines
on admission, medicines prescribed during
the admission and medicines on discharge,
and listed reasons for any changes between
admission and discharge

Expected changes in a HIS

Error-prone abbreviations will not be
configured in the HIS. so this indicator will
be 100%
Legibility will not be an issue in the HIS, so
this indicator will be 100%
The signature of nurses and midwives
administering medications will be defaulted
within the HIS with the logging in
The HIS can make recording allergy and
adverse drug reaction information mandatory
at the time of prescribing, so this indicator
would be 100%
Alignment of patient medicines information
according to time intervals and the discharge
summary is generated, by the HIS

evaluation activities

Should be guided by the IT department in collaboration with the medical ward

staff

Post-implementation review planning

This is essential in getting a feedback from the real life users (ward staff) to
get an idea about the functional and non-functional requirements of the
system which basically results in smooth run of the HIS.

References
Trimmer, KJ., Pumphrey, LD., & Wiggins, C. (2002), ERP implementation in
rural health care, Journal of Management in Medicine, 16 (2/3), 113-132.
Spathis, C., & Ananiadis, J. (2005), Assessing the benefits of using an
enterprise system in accounting information and management, The journal
of enterprise Information Management, 18 (2), 195-210.
N.ghosh (2010), Benefits of Hospital Information System, Retrieved
September
12,
2011,
from
http://www.healthcaredigital.com/categories/benefits
Hegji, C., E. et al. (2007), The link between hospital quality and services
profitability, International Journal of Pharmaceutical and Healthcare
Marketing, 1 (4), 290-303.
24

EMHA03/14/011
Systems

Hospital Information

Meinert, DB. & Peterson, D. (2009), Peceived importance of EMR functions

and physician characteristics, Journal of System and Information
Technology, 11 (1), 57-70.
Burke, R. J., Eddy, N. S. W., Fiksenbaum, L. (2009), Virtues, work
satisfactions and psychological wellbeing among nurses, International
Journal of Workplace Health Management, 2 (3), 203-219.
Puay, C., L. & Nelson, K. H. T., (2000), A study of patients expectations and
satisfaction in Singapore hospitals, International Journal of Healthcare
Quality Assurance, 13 (7), 290-299.
Smith, ES. & Swinehart, KD. (2001), Integrated systems design for customer
focused health care performance measurement: a strategic service unit
approach, International Journal of of Health Care Quality Assurance, 14
(1), 21-28.
Ovretveit, J., Scott, T., Rundall, TG., Shortell, SM. & Brommels, M. (2007),
Improving quality through effective implementation of information
technology in healthcare, International Journal for Quality in Health Care,
1-8.
Caccia-Bava, MDC., Guimaraes, VCK, & Guimaraes, T. (2009), Testing some
major determinants for hospital innovation success, International Journal
of Health Care Quality Assurance, 22 (5), 454-470.
Lee, OF., & Meuter, ML. (2010), The adoption of technology orientation in
healthcare delivery: Case study of a large-scale hospital and healthcare
systems electronic health record, International Journal of Pharmaceutical
and Healthcare Marketing, 4 (4), 355-374.
Procter, S. & Brown, AD. (1997), Computer-integrated operations: the
introduction of a hospital information support system, International
Journal of Operations & Production Management, 17 (8), 746-756.
Ammenwerth, E., Kaiser, F., Wilhelmy, I, & Hofer, S. (2003), Evaluation of
user acceptance of information systems in health care: the value of
questionnaires, Studies in Health Technology and Informatics Europe, 95,
643-648.
Stefanou, CJ. & Revanoglou, A. (2006), ERP integration in a healthcare
environment: a case study, Journal of Enterprise Information Management,
19 (1), 115-130

25

EMHA03/14/011
Systems

Hospital Information