Professional Documents
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INTRODUCTION
Enterprise profile; background:
AL AGOUZA MEDICAL CENTER is a newly constructed governmental primary care center, situated in the heart of Al Agouza district in Giza governorate. It's only constructed 3 years ago to meet the needs for health care services at this region at affordable costs, with the kind of improved modern and advanced services the Ministry of Health is striving to achieve. The center presents only outpatient clinics services from 9 am to 2 pm daily, except for Fridays, and emergency services everyday from 8 am to 5 pm. The specialties that are found in the center are pediatrics, internal medicine, gynecology and dentistry. There is no inpatient department and no operating rooms as this center is a primary care center only.
The center has its own pharmacy that gives medications that were prescribed to the patients by the center's physicians and dentists for free. There is also a laboratory in the center. This laboratory presents a group of advanced hematology and parasitology investigations for the people at affordable costs. An ultra-sonic unit is present too in the center, serves mainly the pregnant women during their pregnancy months. The center is composed of two floors only. The ground floor is made up primarily of the reception area, the administrative affairs department, the laboratory, the pharmacy and the emergency department, the second floor is made up of the outpatient clinics, the dentistry department, the sonar room, and in between there is a waiting area for the patients. The manager room is found at the second floor too.
The administrative affairs department and all HR operations are done in paperwork, and that, for sure, will cost a lot of time for writing, organizing, arranging, preparing and filing. Filing in special, takes not only time, but also space and costs. For example, a piece of instruction should be written in paper, signed by the director of the department, then copied and distributed to all employees by hand. The reservations of outpatient clinics appointments are done by hand at the reception. The laboratory investigations bookings are done too by hand. The employees of the finance department, which constitutes a part of the administrative affairs department, do all their transactions in paperwork, and as expected, these transactions are submitted to the human faults. In the medical affairs department, the physicians, themselves, examine the patients; complete their files in paper with the aid of the nurses, the physicians fill in the medical missing information of the files, and the nurses fill in the personal aspects. The physicians order for the investigations they want in paper too. The laboratory investigations results are written in paper and are given to the patient by hand; these results together with the patient data are registered in files at the laboratory by hand too. All the pharmacy work is done too by hand and in paper work, medications in and out, and the inventories are all registered in paper files.
Incomplete automation, or better say the NO automation, which is found in the center itself is a big problem that faces the strategic management of the center, and constitutes a huge obstacle in front of any improvement and development hoped. The deficiencies of the current system are as follows: A very slow and cumbersome system that takes a lot of time and effort to complete the operation, any operation with no time saving at all. A very costly system that spends a lot of money on paperwork. Time of the physicians and the employees are spent totally and misused while using the current system; this will make them lose the opportunity of good use of that time in ongoing improvement and research. Time of patients too is precious for them; they will prefer to go a fast-moving hospital rather than this center. This system is impractical among the nowadays highly technological communities, giving the chance for competitors to exceed and prevail.
Objective
"A patient is a person and not a statistic. It is our job to satisfy him" Dr. William E. Lowers Credo Founder, Cleveland Clinic, USA, 1921
Al-Agouza Medical Center is a promising center which devotes considerable emphasis on patient Care. It plans to implement complete automation of all its departments. The short term objectives of the on-line computerized system in the center are to reduce costs and improve the accuracy and timeliness of patient care, accounting and administration, record keeping, and management reporting. The long term goal is to build and maintain a patient database for analysis of data to facilitate decision making process.
SWOT analysis
Strength: It will help the medical professional in making quick and effective decision by analyzing patient history particularly when the patient is in critical condition.
It will minimize the paper work for administrative department. It will help to collaborate and share knowledge between health professionals. It will also improve the standard of inter department function. Errors in treatment and medication will be reduced to a large extent. Weakness: Complex structure of developing the IS. Huge database to be developed and maintained. Training the different users of IS. Cost and time involved in developing the IS. Opportunity: Unwanted occupancy rate is reduced. Effective Patient relationship management will increase the occupancy. Threats: Ethical and legal implications involved, if the security of the data fails.
IMPLEMENTATION APPROACH
Formulating justification to convince the top management with reference to
general benefits of IT, present situation, problems and requirements of the hospital, expected benefits, costs and time line of costs and benefits. Preparing the center first by implementing the ten steps of infrastructure; 1We make and take decisions. 2We manage information. 3We need IT tools; (Hardware, Software, Communication lines and Networks). The first 3 steps constitute Phase I (orientation). It will start by convincing every employee that he could make and take decision in general, about everyday work and about future plans and taking the responsibility of this decision and clarifying the difference between making and taking decisions, and the steps of making decisions (Identifying a problem, decision criteria etc.) and everyone in an organization makes decisions, and that not always decisions are time consuming. This step can be enhanced
by revising the center mission and vision. Orientation, too, is about ''change'', putting in mind that nearly all mankind has constraints about change. 4Flat organization. 5Automation. 6Flow of Information. The second 3 steps constitute Phase II. It starts by flattening the organization, that's decreasing leveling stages of managerial system, to work as a flat organization. The manager will serve as a coach for all departments, supporting them, aiding them finishing their work and removing any obstacle. Each department works as one unit, with its own coach, members putting their heart in completing work, and the department goals are by their eyes. 7Empowerment. This is Phase III. 8Defining Objective. This is Phase IV. 9Results. This is phase V.
10- Personnel and this is phase VI, and the last phase.
Identifying the general requirements of the center; The need to automate the administrative department (ADMINISTRATIVE INFORMATION SYSTEM) The need to automate the medical department (CLINICAL INFORMATION SYSTEM) The need to automate the pharmacy (PHARMACY INFORMATION SYSTEM) The need to automate the laboratory (LABORATORY INFORMATION SYSTEMS)
Write and deploy a request for proposal (RFP) to the IT vendors. The RFP addresses the centers profile, objectives, problems and requirements, current, required system and functionality, delivery lead time, installation place, warranty, maintenance, training and acceptance criteria.
Evaluate the proposals of the selected IT vendors; evaluate their previous
Modularity, Flexibility , Documentation, Training , Language, Platform, Customization, Speed, Maintenance, Compatibility & Cost ) Select the optimum vendor.
Formulate standards and procedures for monitoring. Standard Operating
Procedures (SOPs) within the context of HIS, is a written description of steps for all significant activities relating to the practice of management of HIS that has been approved by a program/ persons in charge of an HIS. SOPs should accurately reflect good information management practices, be sufficiently practical and be usable in the HIS. The good HIS management practices relate to general aspects of HIS management functions including data collection, compilation, analysis, storage, data processing, record storage, handling of urgent data requests/ needs, management of the devices/ tools/ appliances used to manage the data .
involved. The manager must also be involved in motivating the timely progress of the project since motivation declines as we go forth. Construction involves several phases, each of which must be evaluated at its conclusion and approved with signatures before proceeding to the next. A flowchart was developed highlighting the various departments and their modules, revolving around the patient information database (PID), and communicating with each other. Operations and specifications of the system are documented.
vendor as a turnkey solution. Check that it meets the agreed upon specifications, warranty, and manuals are provided. This involves the server, client PCs, network, accessories, printers, bar code readers etc.
c. Installation of a local area network in the Centers building. The LAN will
connect all departments and divisions to the health information portal. The WAN will connect the center with the national authorities.
d. Software Acquisition (check you have all modules and third party software,
check speed, integration, communication, generated output reports, periodic upgrades/ manuals) e. Training:
Training is an ongoing process whether for new applications or for new employees. Conduct training needs assessment of HMIS and program staff at all levels.
Specific training: for operational management, to be the first line, on site troubleshooters. Check that the vendor has trained on-site trainers from among selected centers staff.
f. System testing: # Interoperability: The hardware, software, LAN, and telecommunication system used by HMIS and sourcespecific databases will be userfriendly. Impediments to interoperability, involving language, interface, or data structure, will be taken into account at the outset. HMIS users will be able to access required information in the predefined required format through simple menudriven procedures. # Check that the system objectives are met. Output reports are the only measureable criterion for the objectives. It should be exactly as requested, and the information displayed should be as entered in the input forms. # Input forms procedures: Check that the center staff is aware of the proper methods for data entry. Check that data input is not compounded by crashes, errors or changes in the information fed. # Error and correction procedures: Check that your staff (especially front line managers) is aware of the measures to be taken upon encountering regular system errors. I.e. restart if system hangs. # Check that the systems running cost is within the expected.
# Check that user and troubleshooting guides are available; complete system documentation (procedures manual, computer programs, and machine operation manuals). # Check that you have a working backup copy from which to restore the software in case of system collapse. # Check that the number of users and the capacity of the system are as agreed upon. # Check that the system speed in generating reports is as agreed upon. # periodically check for possibly required or available upgrades and discuss those with the vendor. Upgrades include modules, new versions of the software, more clients, more program record capacity, etc. Upgrades should be tackled in advance to the time they are required at to anticipate for delivery delays. Implementation set off: the system is handed over to the hospital staff, yet monitored by the IT vendor for a while.
g. h.
Data conversion; converting manual files to electronic files. It should be limited to the bare minimum data required for efficient operation of the system.
i.
System maintenance: System maintenance can be: Scheduled: contract based maintenance service, whether on site or remote, that is provided for a known period of time that is extendable as per the centers requirements. Unanticipated: The vendor should be able to provide immediate support upon unexpected events.
Backups are an important aspect of system maintenance. They should be performed on daily basis and the backups stored in a remote area. This can be media based or internet based, the latter however is more costly.
System Evaluation (by user teams, the internal IT department or even an external auditor)
j.
Objectives achievement: evaluated by the output report. Evaluates speed, integration, communication etc grades (fully achieved, mainly achieved, partly Achieved etc)
System Cost.
Benefits evaluation; check that you are getting the due benefits which you should start harvesting by the third year from implementation and should be rising so forth, including quantifiable benefits such as higher financial gain, and non-quantifiable benefits such as better work flow and patient satisfaction. Benefits should exceed cost. Security and control; check that the system complies with the level of security you originally desired and preset with the vendor including the per person authentication, firewalls, antivirus and anti hacking protection. Future needs. We should define the anticipated future needs and expansion possibilities and make sure the system will be able to cope with them before they are due.
Meeting the pre-designed key success criteria put by the designer and manager.
Evaluating the design techniques (A system may meet the key success criteria and yet not be technically a good system): i. Design efficiency: check the relationship of various modules, data Flow and output reports
ii. Operating efficiency: check simplicity, user friendliness, accuracy,
speed, report design, down times, fast recovery from crashes etc.
iii. Maintenance efficiency: logs, backups, remote repair etc.
System Efficiency Audit: a third party external auditor can check the efficiency and evaluate the system. Efficiency audit will seek to answer the following questions on annual or semi-annual basis: -Is the system being used in the right way? -For the right reasons? -Is it cost effective? -Is the system secure? -Is the system in concert with the organizations strategy? -Does the organization have the computer knowledge and skills it requires to run the system?
Results
In ten years time, after implication of the HIS in the center, proper usage, periodic evaluation and updating, this center will be one of the brilliant centers allover Egypt. It will gain patients confidence and satisfaction and its profits will be increasing obviously.
Special Thanks
I would also like to thank all my colleagues for the time I spent with them.
T hank You