THEORETICAL BASIS FOR

ADVACED NURSING PRACTICE

ASSIGNMENT FOR SELF DIRECTED

LEARNING

ON HOSPITAL

INFORMATION SYSTEM

SUBMITTED TO: SUBMITTED BY:

Dr. Jyoti Chaudhari Miss. Meera
ghane
Assistant professor 1st year NPCC
MGMNBCON ,KAMOTHE MGMNBCON,
KAMOTHE
 Introduction to Hospital Information Management:
Health information systems (HIS), defined by the World Health
Organization as integrated efforts to ‘collect, process, report and use health
information and knowledge to influence policy making, programme action
and research’, are essential to the effective functioning of health systems
worldwide.
1 Routine HIS, such as those operated through health information
departments or national statistics offices, provide information on risk
factors associated with disease, mortality and morbidity, health service
coverage, and health system resources.
2 Governments rely on the information provided to them from HIS for the
production of high-quality, user-friendly statistical information on the
health status of the community; the use and need of health services;
formulating, monitoring and evaluating health policies; and measuring
progress made in the provision of health services.

Contents-
o Introduction to Hospital Information Management: Concept of
information management, use of information in hospital administration;
application of information system in hospitals.
o Confidentiality, Security and privacy of hospital information system.
o Introduction to Hospital Software .
o Introduction to the Hospital patient care process analysis.
o Introduction to IT in medical equipments .
o Introduction to IT Projects

 Introduction to Hospital Software & Projects

Management of computerization project in the hospital: Areas of
computerization in the hospital: patient care, medical records, and business
administration.

1. Modular evaluation :
Conceptualise Components and standards of a Health Information System
 HIS resources
 Indicators
 Data sources
 Data management
 Information products
  Dissemination and use

An information system that facilitates the activities of a hospital takes into

consideration:
01. the functions of a health care facility
02. the capability of information technology

 The information management system complements the other components of

the very complex organizational structure and operations of a hospital. Its
scope, content and structure serve a myriad of functions. It contains a set of
sub-systems and applications that utilizes information technology and
computerization optimally to facilitate the delivery of services of the
hospital.
 In general, the various functions and services that can be facilitated by
information systems can be divided into two main group of activities:
 01. The core business of care of patients
 02. Managing the hospital as a business entity, a provider of hospitality
services and a physical facility

 The set of fully integrated hospital-wide information systems that support

the activities is called the Hospital Information System (HIS). It is focused
primarily on the Operations Management of the hospital. However, data
available from the system may be collated, analysed and used for strategic
or project management and research.

The HIS is envisaged as consisting of two broad systems i.e.

 01. Patient Care Information System
 02. Managerial Information System
The division into these two broad categories is conceptual. The information
system that supports
administrative, human resource, facility and hospitality management
activities are placed
arbitrarily under the Managerial Information System. Articles in this
website deals mainly with the Information Systems for Patient Care
Function, i.e. the core business activity of a hospital..

Hospital Information System (HIS)

Information System for Managerial Information

Patient Care Functions System
 Data obtain for Hospital Software & Projects -

 Medical Records
 Patient Registration:
 Investigation Cases:
 Interim Bill v/s Advance Report.
 Diagnostic centres
 Laboratory Systems- r Pathology, Radiology, Cardiology, Neurology, and Chest
Medicine
 Blood Bank
 PHARMACY-e.g Sale - Drug Sale - Receipt - Cash Refund o Rate list Return -Drug
Return Indent -Drug Indent

Components for to Hospital Software & Projects

According to software the components changes.
Ex .software regarding patient care –
A health record system must have provision to include patient identifiers of
following types:
1. UIDAI Aadhaar Number (preferred where available)
2. Both of the following in case Aadhaar is not available: 2.1 Local
Identifier (as per scheme used by HSP) 2.2 Any Central or State
Government issued Photo Identity Card Number
 ĂƚĂ͕ /ŶĨŽƌŵĂƚŝŽŶ͕ /ŶƚĞůůŝŐĞŶĐĞ

Today Tomorrow
Cure Patients Care for
Scope Citizens
Focus On the process and provider On the patient

Time Symptomatic, curative Preventive, lifetime

Location Hospita Decentralized, at home

l
Methods Invasiv Less invasive
e
 The Hospital

High Quality
Cost Effective

Activities Assessment

needs needs
Information

produces
 2. CONTRIBUTIONS TO OTHER HEALTH
INFORMATION SYSTEMS
The Hospital Information System should be capable of sharing patient
data with other health care institutions so as to enable continuity of care via
the Telemedicine approach or other means. It is expected to contribute to
the national health database (in Malaysia: the National Health- Management
Information System) by supplying information for health promotion,
disease prevention and early detection efforts as well as for planning,
resource allocation, epidemiology, case-mix calculations etc. at district,
state and national level. It should also provide information to systems
belonging to third party institutions e.g. external agencies like the Drug
Safety Council, Registration Department, Road Safety Council, the Police,
Insurance companies and many others.

2.1 Requirement of a Hospital information system in a

hospital :
 Daily management of operations
 Competitive planning strategy
 Controlling dissemination of information
 Processing volumes of data
 Providing information for medical & financial auditing
 Inventory management
 Interaction between department heads for planning, coordination, &
control activities Provision of information for national level policy, decision
making.

3.BENEFITS OF HOSPITAL INFORMATION SYSTEM

The main goals of Information system are: Planned approach towards
working; Accuracy; Reliability; No Redundancy;
Immediate Retrieval of Information; Immediate Storage of Information; and
Easy to Operate. Furthermore, The benefits of using Hospital Information
are:

 Easy access to doctors data to generate varied records, including

classification based on demographic, gender, age, and so on. It is especially
beneficial at ambulatory (out-patient) point, hence enhancing continuity of
 care. As well as, Internet-based access improves the ability to remotely
access such data.
 Improved quality of patient care.
 It helps as a decision support system for the hospital authorities for
developing comprehensive health care policies.
 Efficient and accurate administration of finance, diet of patient,
engineering, and distribution of medical aid. It helps to view a broad picture
of hospital growth.
 Improved monitoring of drug usage, and study of effectiveness. This leads
to the reduction of adverse drug interactions while promoting more
appropriate pharmaceutical utilization.
 Improved quality of documentation.
 Enhances information integrity, reduces transcription errors, and reduces
duplication of information entries.
 Hospital software is easy to use and eliminates error caused by
handwriting. New technology computer systems give perfect performance
to pull up information from server or cloud servers.
 Development of a common clinical database.

WHO BENEFITS FROM HOSPITAL INFORMATION

SYSTEM

The information regarding hospital information system can gathered

from the staff members and patients, the computer user and the
administration staff. Hospital information systems can be characterized by
their benefits; their functions; their types of processed information and their
types of services offered. The following groups benefit from Hospital
Information System:

A) Physicians
 Introduces Computerized Provider Order Entry (CPOE)
 Improves accuracy & legibility of, and access to, the required patient
medications
 Improves clinicians’ efficiency & effectiveness through provision of key
patient information (e.g., allergies) at time of ordering, plus conflict
checking, order checking and online access to best practice information
 Improves care through the logging of all orders
 Reduces medication error rates

B) Nurses
 Will allow immediate access to orders and results
 Will provide immediate access to patient demographics, medication and test
results
 Will provide improved access to information on line (i.e.: suggested
medications or drug alerts)
 Will decrease the need for paper, decrease errors and increase patient safety

C) Allied Health Professionals

 Will allow immediate access to orders and results
 Will provide immediate access to patient demographics, medication and
test results
 Will provide improved access to information on line (i.e.: suggested
medications or drug alerts)
 Will decrease the need for paper, decrease errors and increase patient
safety

D) Ward and Registration Clerks

 Will provide a single point of contact for patient registration information
and reduce duplication of effort

E) Clinical Benefits
 Provide a common source of information about a person’s health history
 Enhance the ability of health care professionals to coordinate care by
providing a person’s health information and visit history at the place and
time that it is needed
 Link information from diagnostic information systems such as X-ray and
laboratory into the EPR
 Strengthen internal and external communication among health care
providers
 Eventually be accessible for use in all of Manitoba’s academic and
community hospitals, as well as long term care facilities
 Allow care providers access to the patient’s health history and results
between facilities
 Will provide improved access to information on line (ie: suggested
medications or drug alerts)
 Will decrease the need for paper, decrease errors and increase patient
safety

F) Administrative Benefits
 Will provide improved access to information on line (i.e. suggested
medications or drug alerts)
 Will decrease the need for paper, decrease errors and increase patient
safety
 Strengthen internal and external communication among health care
providers
 Will decrease the need for re-registrations of patients across multiple sites
 
4. HOSPITAL INFORMATION SYSTEM :
CHARACTERISTICS
A Hospital Information System can be designed and built in-house
from the outset or purchased. Either way, the suite of applications software
and databases need to be assessed or appraised to determine suitability for
use before being made available to intended users. Systems purchased off
the shelf, need to be customized to suit the hospital’s services, policies,
procedures and equipment. On the other hand, some compromises in the
existing processes may be required.
There will be definite changes in the way data is collected because
this needs to match with the data structure, collection and presentation used
by the system.
The data structure needs to be designed by defining entities,
relationships and naming of data elements and possible values attributed to
each data element. This is achieved through the activity of Business Process
Re-engineering, Customization and Database design.

SUBSYSTEMS OF HIS
As Lippeveld T. (2000) stated Hospital information systems contribute
to an "integrated effort to collect, process, report and use health information
and knowledge to influence policy-making, programme action and
research . There are different types of HISs including routine- and clinical
HISs. Components of a hospital information system consist of two or more
of the following:
1. Picture Archiving Communication System (PACS)
2. Radiology Information System (RIS)
3. Clinical Information System (CIS)
4. Physician Information Systems (PIS)
5. Financial Information System (FIS)
6. Laboratory Information System (LIS)
7. Nursing Information Systems (NIS)
8. Pharmacy Information System (PIS)
PHASES OF IMPLEMENTATION OF HOSPITAL INFORMATION
SYSTEM
Life Cycle Model is one of the methods for the development of
Information Systems. This method contains the following seven distinct
phases: the definition of the user needs, the analysis of the current system,
the design of the new system, the codification of the new system, the
acceptance and the evaluation, the implementation, and the maintenance of
the new system (Damigou et al., 2006).
Phases of implementing an HIS are (Allan and Englebright, 2000):
1.Planning phase
2.Analysis phase
3.Design phase
4.Development phase
5. Implementation phase
6.Evaluation phase
7.Upgrade phase

a. Planning Phase
The planning phase involves the following steps:
1. Define problem and /or stated goal
2. Conduct feasibility study
 State objectives
 Determine scope
 Determine information needs
 Decide whether to proceed
 Negotiate the project definition agreement
 Write the project definition document
3. Allocate resources
b. Analysis Phase
 In the Analysis Phase data must be collected in the form of written
documents, questionnaires, interviews, observations. After analysing data
with data flowcharts, grid chart, decision tables, organizational charts a
model can be made. Data must be reviewed before proceeding to the design
phase.
c. Design Phase
The design phase is divided into two parts:
I) Functional Design
1. Personnel
2. Time Frame
3.Cost and Budget
4.Facilities
5.Operational Considerations
6.Human-Computer Interactions
7. System Validation Plan
II) Implementation Design
1. Design Inputs
2. Design Outputs
3. Design Files and Databases, Design Controls
d. Development Phase
The Development phase includes the following:
1. Select Hardware
2. Develop software
3. Test System
4. Document system
 User’s manual  Operator’s manual  Maintenance manual
e. Implementation Phase
The implementation phase includes a detailed description of the
system that specifies not only all hardware and software components but
implementation, training, operation, and maintenance procedures as well.
Includes the following steps:
1. Train users
2. Install System
 3. Manage and Maintain System

f. Evaluation Phase (I)

The evaluation and test approach is to test each entity with
successively larger ones, up to system test level. Steps of project testing are:
Program testing; String testing; System testing; Project documentation;
User acceptance testing.
The following criteria are considered essential in selecting a Hospital
information system and can be used as a basis for evaluation:
1. Applications
2. Overall system performance
3. Evaluation features
4. .Ease of system use
5. Configuration or programming performance
6. Security
7. Simplification of reports
8. Database access
9. Hardware and software reliability
10. Connectivity
11. System cost
g. Evaluation Phase (II)
Methods and tools for evaluating a system s functional
performance include:
1. Record review
2. Time study
3. User satisfaction
4. Cost-benefit analysis

h. Upgrade Phase
Some of the important considerations in upgrading a system
include the following new technologies:
1. Bedside /point-of-care terminals
2. Workstations
3. Multimedia presentations
4. Decision support systems
5. Artificial intelligence
6. Neural networks
7. Integrated systems architecture
8. Interfaced networks
9. Open architecture

Usage of the system is a crucial factor for success for HIS, and the
users of the system use it on a voluntary basis. Barki and Huff proposed in
1985 that use is an appropriate measure of implementation success when
use is voluntary (Abreu and Conrath, 1993). And also, Kimaro and Titlestad
(2005) point out the problems if the communication between developers
and users is lacking: It will lead to insufficient capturing of design needs
and thus system failures. Intended users and developers need to agree on
what is being designed by sharing technological and contextual
understandings and available design options.

5. SYSTEM INTEGRATION
The information systems and applications are usually considered to consist
of modules for ease of description. Each module may have its own
subsystem or the various modules may be shared in a virtual server. It is
expected that the Hospital Information System is fully integrated so as to
function seamlessly across modules.
Integration refers to the interaction between applications software with
each other and with the hardware that supports it, enabling one to work with
another for a desired purpose. Poor integration often make it necessary for
the user to go through extra steps. Integration can be achieved at the stage
of:
A. HIS design
B. Implementation
It would be desirable to design or procure a HIS that have been
fully integrated from the start and where the modules and sub-systems are
proven to interact smoothly with acceptable response time and ease of use.
Trying to integrate disparate applications software with different data
structure and using different operation systems at the time of
implementation would be an unenviable task. Integration usually involves
two or more parties. Sharing out of responsibilities, agreeing on a schedule
and assigning costs are issues that can pose a stumbling block to speedy and
successful implementation.
6. INFORMATION SYSTEM FOR PATIENT CARE
The Hospital information System (HIS) can be broadly divided into
two halves:
01. The Systems for the Patient Care Function
02. The Managerial Information Systems

6.1 OBJECTIVES & FUNCTIONS OF PATIENT CARE

INFORMATION SYSTEM
Being a system for facilitating operations, these set of sub-
systems and applications are expected to utilize information technology and
computerization optimally to realize the following objectives:
a. Productivity
b. Effectiveness
c. Appropriateness
d. Efficiency
e. Quality
f. Safety

To achieve the above objectives, the computerized information

system provides the following functions:
01. Guide and enable the performance of Patient Care Processes
02. Facilitate communication between care providers through sharing of
information
03. Enable automation of work processes through links within it, integration
with other components of the hospital information system and interfacing
with other computers, machines, printers and scanners.
04. Provide clinical decision support at point of care
05. Gather, store and make available vital clinical information (individual
and aggregated) for primary and secondary use
 06. Maintain a permanent record of events and all activities of patient care
(as the Electronic Medical Record and other documents based on medico-
legal requirements) Any system being designed, proposed or implemented
must possess characteristics that would fulfil all the above objectives and
functions; both in its content and the methods used..

6.2 SCOPE, CONTENT & RELATIONSHIPS OF PATIENT CARE

INFORMATION SYSTEM
The Patient Care Information System consists of:
1. Patient/Client Management (Administration) Information System
2. Clinical Information System (CIS)
 CIS for various specialties
 Clinical Documentation
 Clinical Decision Support
 Centralized Continuous Monitoring System
 Electronic Medical Record
3. Clinical Support Systems
 Laboratory Information System
 Blood Banking Information System
 Radiology Information System
 Pharmacy Information System
 Food and Beverage Supply System
 Operation Theatre / Suite Information System
 Sterilization and Sterile Inventory & Supplies System
 Other support systems
4. Bridging or intermediary systems
 Order Entry - Result Reporting System (CPOE)
 Patient Information Database Management System
5. Clinical Governance System
6. Supply of Data for External Organizations
 The relationships of the systems are as depicted the chart
below:

Healthcare as a Process

 Isolated information
 Isolated information  Fragmented information
 Fragmented information  Not accessable information
 Not accessable information  Too much information
 Too much information  Bad information presentation
 Bad information presentation  Only clinical data is kept (no knowledge)
 Only clinical data is kept (no knowledge)  Some information is not computer usable
 Some information is not computer usable (free text, image features, (genome in the
(free text, image features, (genome in the future))
future))  No feed back to medical community and
 No feed back to medical community and society
society

Information Clinical Desicions

Medical operational Society objective subjective Assesment Planning

Community
 Adaptable Clinical Workflow Framework

Diagnostic Action

Assesment
Care Action

Planning
 Hospital consists of multiple variety of function performed by
different categories of people. With limited resources these personnel are
expected to produce an output with an acceptable quality. Strict regulatory
process and more documentation in the hospital process have hampered
these personnel performing assigned actual technical work, resulting
unproductive low quality service outputs. EX. Nursing process

Objectives:

 To make a cost effective hospital

 To provide quality services to their patients
 To enhance the decision making process
 To support user confidence
 To boost hospital professionals commitment

9.current gaps in Hospital information system

• Management & medical systems: Underutilization of available data in day-

to-day management, unavailability of soft ware & hard ware.
• Hospital & clinical systems: Incomplete data sheets, low man power
• Hospital staff & data base developers: little or no knowledge in respective
personnel regarding IT & hospital activities. Poor communication & lack of
interest of the mentioned categories
• Development of long-term plan for five-year period with short tem, annual
plans.
• Identification of current operational problems & need for soft ware
solutions, making phase wise deployment of those solutions.
• Site visit & determining estimating how the soft & hard wear enhance
work process.
• Cost effective Method of the development of the soft ware; Purchase, in-
house development or customization of developed soft ware.

.
9.1 KEY BRIDGING APPLICATIONS
Integration within the Patient Care Information System is essential.
The main patient care applications software i.e. the Clinical Information
System and the various Clinical Support Systems are built around key
bridging (intermediary) applications i.e.

1. Patient Administration/Management System (Registration, Scheduling,

Resource allocation)
2. Order-Entry Result Reporting Application (CPOE)
3. Database Management System (DBMS)
4. Electronic Medical Record

These applications are thought of and designed first and then

amended as each clinical and clinical-support application is designed. Any
additional applications software is designed to be
compatible with these key bridging (intermediary) applications.

Chart Showing Bridging Role of Four Key Applications of the Patient Care
Information System
 .

10 .MANAGERIAL INFORMATION SYSTEM

10.1 FUNCTIONS OF MANAGERIAL INFORMATION SYSTEM

The Managerial Information System refer to the set of sub-systems and

applications that assist managers in running the hospital as a:

 business entity
 provider of hospitality services
 physical facility

10.2 .COMPONENTS OF MANAGERIAL INFORMATION

SYSTEM

Systems that support the business operations include:

1. General Administration Information System & Office Automation
2. Charging, Billing and Receipt of Payment (Accounting) System
3. Human Resources Management System
4. Finance and Budgetary Systems
5. Consumables Purchasing and Inventory System
Systems for facilitating the hospitality services of a hospital include:
 Bed management
 Food-Beverage Order-Supply System
Systems for management of the hospital as a physical facility include:
 Facility Engineering Systems
 Equipment and Machinery Maintenance and Inventory System
 Environmental Safety, Housekeeping, Cleansing and Waste Management
Managerial Decision Support Systems can be very helpful and include:
 Business Intelligence Systems
 Enterprise Resource Planning System
The components making up the Managerial Information
System is wide-ranging and complex. They are not within the scope of this
discussion (at this point) but mentioned here for completion. However
certain components that integrate or interface with the Information System
for Patient Care Function will be discussed.

Chart Showing Components of Managerial Information System

11. New Technologies:

• Telemedicine
• Medical records
• Smart Card
• Digital library
• Multimedia

12. Resources for installing HIS

• Operating system
• Data Base management
• Antivirus soft ware
• Server
• Data base backup drive
• Ups
• Terminals
• Hub
• Manpower
 Conclusion
HIS are integrated efforts to collect data and transform it into useful
information for use in policy, program action and research. Accurate,
relevant and timely information on the health status of communities is
essential to public health as it assists in identifying risk factors and the
characteristics of people who use and need health services. HIS play a key
role in health system stewardship, priority setting, clinical management,
monitoring global epidemics, and resource planning.
Better data can provide insight into public health problems and
guide the development of policies: both resulting in improved health.
However many HIS remain complex and fragmented due to years of
chronic under-investment, with little awareness on the true value of
information in health care. Many countries still do not have reliable
information regarding trends in mortality and morbidity, and while many
countries are collecting increasing amounts of data, there is a lack of
appreciation that data alone have no value, as data must be transformed into
information for use. Despite these issues and challenges, there is growing
international demand and attention on improving HIS. This is a positive
step forward in the wider recognition of HIS as an essential component of
health system development, and continued work is required to strengthen
HIS to support evidence-based decision making.
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