HospitalInformation System&Electronic MedicalRecord

ELSHOROUKHOSPITAL PreparedBy: MohamedEmadMostafa5567 NouranMohamedElSakka5584 YomnaHassanEissa5601 YomnaMohsenHussein5603 Underthesupervisionof: Dr.MohamedSobhy

 Index Abriefintroductionaboutthehospital TheoreticalbackgroundaboutElectronicMedical RecordandHospitalInformationSystem. InterviewGuide. Reportaboutinterviewandthesystems. Resistancetochangeandwaystoavoidit Howtomeasuretheperformanceofthesystem? ResultsandImplications Relationshipbetweenthehierarchyandthesystems Recommendations Reference

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IntroductionAboutthehospital:
AlShoroukisamultispecialtyhospitalfoundedin1996.ItislocatedinMohandessin, Giza.Theirvisionistohelppeoplelivealong,healthylifeandsupportthemwith thoughtful,dignifiedcaretotheend.Whiletheirmissionistoprovidegoodquality, affordableandhasslefreehealthcarewithscience,loveandwisdom. TheirvaluesasstatedbyDr.MohamedElSherbiny,thechairmanofthehospital was "Doforotherswhatyouwouldwantothersdoforyou".Throughintegrity, compassionandprofessionalismthevaluescanbeachievedsuccessfully. Itofferswiderangeofmedicalserviceslike;Lab,Dialysis,Physiotherapy,Clinical pharmacy,Radiology,Bloodbank&EmergencyRoom(ER). Theirstaffiscomposedofveryhighskilledprofessorswhoservemorethanone specialty;like: Anesthesiology Cardiothoracic ChestMedicine DentalMedicine. Ithas120bedsinadditionto13ICU,5dialysisbedsand8prematureincubators. AlShoroukhas 5 operating theatres in addition to a sixth in the Emergency Room.TheRadiologydepartmentisequippedwithaCTunit,conventionalradiology andthreeultrasoundunitsandawellequippedLaboratorywiththemostadvanced equipment. AlShoroukis a busy hospital, with average occupancy of 74% .An average 3500 operationsareperformedyearly,themajorityaremajoroperation. AlShoroukhasamoderninformationsystemthatcontrolsallitsdepartments.Andit wasknownasoneofthefirsthospitalsthatapplytechnologythroughitsoperations. Ithastwomodernizedsystemsthatmanagetheiroperationswhichare; HospitalInformationSystem(HIS) ElectronicMedicalRecord(EMR)

TheoreticalbackgroundaboutHospital InformationSystem(HIS)AndElectronicMedical Record(EMR):

Thehospitalfirstimplementedthehospitalinformationsystem(HIS)alloverthe hospitalfunctions.Asahospitalinformationsystem(HIS)isessentiallyacomputer systemthatcanmanagealltheinformationtoallowhealthcareproviderstodo theirjobseffectively.Thesesystemshavebeenaroundsincetheywerefirst introducedinthe1960sandhaveevolvedwithtimeandthemodernizationof healthcarefacilities.Thecomputerswerenotasfastinthosedaysandtheywere notabletoprovodeinformationinrealtimeastheydotoday.Thestaffusedthem primarilyformanagingbillingandhospitalinventory.Allthishaschangednow,and todayhospitalinformationsystemsincludeallclinical,financialandadministrative applications. ModernHISincludesmanyapplicationsaddressingtheneedsofvarious departmentsinahospital.Theymanagethedatarelatedtotheclinic,finance department,laboratory,nursing,pharmacyandalsotheradiologyandpathology departments.ThehospitalshaveswitchedtoHIShaveaccesstoquickandreliable informationincludingpatients'recordsillustratingdetailsabouttheirdemographics, gender,agteetc.Byasimpleclickofthemousetheyreceiveimportantdata pertainingto"hospitalfinancesystems",dietofpatients,andeventhedistribution ofmedications. Thesystemmustbeuserfriendlyandshouldincludetrainingbythevendors.Agood HISoffersnumerousbenefitstoahospitalincludingbutnotlimitedtothedelivery ofqualitypatientcareandbetterfinancialmanagement.TheHISshouldalsobe patientcentric,medicalstaffcentric,affordableandscalable.Thetechnology changesquicklyandifthesystemisnotflexibleitwillnotbeabletoaccommodate hospitalgrowth. AneffectiveHISalsodeliversbenefitssuchas: Enhancesinformationintegrity Reducestranscriptionerrors Reducesduplicationofinformationentries Optimizesreportturnaroundtimes

 Andthefigurebelowshowstheintegrationofthevarioushospitals'functions throughthehospitalinformationsystem(HIS).

AstheHISsysteminvolvedthefinancialaspectaswellasthemedicalaspect,the hospitalstartedtouseElectronicMedicalRecordSystem(EMR)besidetheHIS system;Butwhy? Thereasonisthat,EMRreferstoapaperless,digitalandcomputerizedsystemof maintainingpatientdata,designedtoincreasetheefficiencyandreduce documentationerrorsbystreamliningtheprocess.Butitmainlyfocusonthe medicalaspectmorethanthefinancialaspectunlikethehospitalinformation system. BornofHealthInformationTechnology,EMRsystemsareintendedtokeeptrackof apatient'sentirehealthandmedicalhistoryinacomputerized,electronicformat. Bykeepingthesepotentiallyvastrecordsinthismanner,theyaremoreeasily retrievable,andcanmakeapatient'snavigationthroughthehealthcaresystems muchsaferandmoreefficient. EMRsarecomprisedoftwokindsofrecords.Olderrecords,areusuallyscannedand storedinagraphicformatofpdf.Further,becauseoftheprocessesusedtoshift frompapertodigitalrecords,orforrecordingnewdigitalrecords,manymistakes weresimplyreplicated,orevencreatedbythedigitalconversion.

 Morerecentrecordsmaybeelectronicallynative.Thatmeanstheywerenever storedinanyfashionexceptasadigitalrecord.Ifyourdoctorrecordsnotesasyou talk,orifyouareissuedaprescriptionfromacomputerprinter,thenyourcurrent recordsarebeingkeptnativelyindigitalform. TheElectronicMedicalRecordhasbeendefinedasacompletesystemasitcontains fourbasicfunctions.Whichare: Computerizedordersforprescriptions Computerizedordersfortests Reportingoftestresults Physiciannotes ThegoalsofElectronicMedicalRecords: Lowercostsinthelongterm Eliminaterepetitiveandunnecessarytesting Provideaccuratemedicalinformation Allowinformationtobeavailableanytimeandanywhere Allowforstreamlinedinformation

InterviewGuide:
1. WhatisHospitalInformationSystem?AndwhatisElectronic MedicalRecordssystem? 2. Whataretheinputsandoutputsofbothsystems? 3. WhydidthehospitalusedtheEMRsystemalthoughithadtheHIS systemappliedthroughoutthehospital? 4. Whatisthefrequencyofusageofbothsystems? 5. Howmuchdidtheperformancechangedaftertheapplicationof thesystems? 6. WhatarethedepartmentsthatstartedtouseHISandEMR systems? 7. Whatarethedrawbacksofusingthesystems? 8. Whobenefitsfromusingthesystems? 9. WhatisthestructureofbothHISandEMR?Andhowdothey work? 10.Arethesystemsuserfriendly? 11.Didthehospitalencouragethenursesanddoctorstostartuse theHISandEMRsystem?Andhow? 12.Whatistheimpactofapplyingthesystemsonthedoctors? Patients?Andthehospital'sperformance? 13.Whatdepartmentisinchargeofthedetailsofthesystems? 14.Howdoctorsgetbenefitfrombothsystems?

Reportabouttheinterview,HIS&EMRinAl ShoroukHospital:

o Theinterview:
Whenwevisitedthehospital,wefirstinterviewedDr.MohamedElSherbiny, thedirector(chairman)ofthehospital,aboutthetwosystems.Heensured thatthesystemsbytimebecamefromtheessentialsofthedaytoday operations.Noonecanperformhisworkinthehospitalnowwithout recordingthedatahereachedontothesystemandthathappenedthrough understandingthebenefitsandthevaluesofusingthesystems.Bytime,the nursesanddoctorsunderstoodhowit'simportanttousethesesystemsfor manykindofreasonsthatwillbeillustratedlaterinthereport. Healsoensuredthatitwasnevereasyorcheaptoimplementthesesystems inthehospitalandhowseverewastheresistance.But,heunderstoodform thebeginningthatiftheycouldntfollowthetechnologicaldevelopmentin themedicalfieldfromthebeginning,theywillalwaysbeleftbehindandit wouldbeimpossibletoachievetheirgoalsandmission. AndtheresultwasthatElShoroukhospitalhasnowoneofthemost advancedtheinformationsystemsthatareappliedhereinEgypt(EMR system)whichmakesthedoctorupdatedwiththepatient'srecordevenif he'stravellingabroadandhemayprescribeamedicationforthepatientjust bylookingattheiPad.ThismaynotbeappliedatanyotherhospitalinEgypt. "Ithelpedthehospitalinminimizingtheeffortandtime.Itmadetheprocess ofkeepingmedicalandfinancialrecordsofthepatientsmuchmoreeasier." Thissentencewassaidbymorethanonedoctorinthehospital commentingonhowmuchthesesystemsmaychangedthehospital's performance.Theyallagreedonthatapplyingthesesystemsandtheir developmentwasamust. Then,weinterviewedMr.AhmedRasmi,ITengineer,heillustratedthatthey hadapointofviewthatwitnessedahugeamountofresistancewhenthey wantedtoimplementtheHISsystemfirst,thentheEMRsystemrecently. "PeopleinEgyptneverknewhowtochangeinordertomakebetterresults; theyfollowtheusualstepsandwantbetterachievements.Thisisallwrong. Wefoundthatthesystemwillhelpusinfacilitatingmanystepsfacedbythe doctorshere.Sowhydon'twetaketheriskandtrytoimplementanew technologynomatterwastheresult?"saidMr.Ahmed. Mr.AhmedtoldushowtheHospitalInformationSystemwasfirst implemented.Andhowthesystemgathersbetweenthefinancialaspectand

themedicalaspect.Ittiesallthehospital'soperationsfromallthe departmentsalltogether. Asanareaofmedicalinformatics,theaimofanHISistoachievethebest possiblesupportofpatientcareandoutcomeandadministrationby presentingdatawhereneededandacquiringdatawhengenerated withnetworkedelectronicdataprocessing. Butheillustratedthattheusersofthesystemsweremainlythedoctorsand professorsinthehospitalratherthanthenurses.Onlyafewnurseswere taughttodealwiththesystem,asthedirectorexaminedthehighturnover rateforthenurses.Soit'snotreasonabletokeepteachingthemhowtouse thesystemwhichisanextracostonthehospitalthentheyjustquittheir jobs. Note:Nursesuseanotherapplicationwhichismuchmoreeasierandneeded intheirdaytodayjob,whichis"TheReservationSystem".

o OrganizationalStructure
TheheadoftheHISdepartmentisapersonwhoisqualifiedandexperienced incomputersystems.Graduateandpostgraduatecomputerdiploma/degree holdersareavailable.Dependingonthesetupandtheextentof computerizationanditssophistication,thedepartmentmayhavesomeorall ofthefollowingstaffinadditiontotheheadofthedepartment. SystemsAdministrator/DatabaseAdministrator Thesystemsadministrator/databaseadministratorisresponsiblefor systemsadministrationtoensurehighuptimeofthesystemandforhandling alldatabasebackupandrestorationactivities. ApplicationSpecialistandTrainer Thehospitalsapplicationspecialisttogetherwiththesoftwarevendoris involvedinalltheactivitiesrequiredforimplementingtheapplication software.Trainerstrainandretrainnewemployeesinthehospital. Hardware/networkEngineers Hardware/Networkengineersareresponsibleformaintainingthehardware andnetworksystemsinthehospital.Theyundertakealltroubleshooting activitiesthatmayberequiredto

o BenefitsofHIS:
EasyAccesstoPatientDatatogeneratevariedrecords,including classificationbasedondemographic,gender,age,andsoon.Itisespecially beneficialatambulatory(outpatient)point,henceenhancingcontinuityof care.Aswellas,Internetbasedaccessimprovestheabilitytoremotely accesssuchdata. Ithelpsasadecisionsupportsystemforthehospitalauthoritiesfor developingcomprehensivehealthcarepolicies.

Efficientandaccurateadministrationoffinance,dietofpatient, engineering,anddistributionofmedicalaid.Ithelpstoviewabroadpicture ofhospitalgrowth Improvedmonitoringofdrugusage,andstudyofeffectiveness.Thisleads tothereductionofadversedruginteractionswhilepromotingmore appropriatepharmaceuticalutilization. Enhancesinformationintegrity,reducestranscriptionerrors,andreduces duplicationofinformationentries.

Then,hetalkedabouthowthehospitalstartedtoexplorethefieldof
advancedtechnologythroughimplementingEMRsysteminonlytwo departments.WhichareUrology&Nephrology.ButTheITmanageristhe personwho'sresponsibleformanagingthesystems,notthedoctors. ThroughtheEMRsystem,onlydoctorsareallowedtouseit(Notevenold nurses,unliketheHISsystem).Becauseit'smorecomplicatedandmore advanced.

o TheeightcorecapabilitiesthatEMRsshouldpossessare:

Healthinformationanddata.Havingimmediateaccesstokeyinformation suchaspatients'diagnoses,allergies,labtestresults,andmedications wouldimprovecaregivers'abilitytomakesoundclinicaldecisionsinatimely manner. Resultmanagement.Theabilityforallprovidersparticipatinginthecareofa patientinmultiplesettingstoquicklyaccessnewandpasttestresultswould increasepatientsafetyandtheeffectivenessofcare. Ordermanagement.Theabilitytoenterandstoreordersforprescriptions, tests,andotherservicesinacomputerbasedsystemshouldenhance legibility,reduceduplication,andimprovethespeedwithwhichordersare executed. Decisionsupport.Usingreminders,prompts,andalerts,computerized decisionsupportsystemswouldhelpimprovecompliancewithbestclinical practices,ensureregularscreeningsandotherpreventivepractices,identify possibledruginteractions,andfacilitatediagnosesandtreatments. Electroniccommunicationandconnectivity.Efficient,secure,andreadily accessiblecommunicationamongprovidersandpatientswouldimprovethe continuityofcare,increasethetimelinessofdiagnosesandtreatments,and reducethefrequencyofadverseevents. Patientsupport.Toolsthatgivepatientsaccesstotheirhealthrecords, provideinteractivepatienteducation,andhelpthemcarryouthome monitoringandselftestingcanimprovecontrolofchronicconditions,such asdiabetes. Administrativeprocesses.Computerizedadministrativetools,suchas schedulingsystems,wouldgreatlyimprovehospitals'andclinics'efficiency andprovidemoretimelyservicetopatients.

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Reporting.Electronicdatastoragethatemploysuniformdatastandardswill enablehealthcareorganizationstorespondmorequicklytofederal,state, andprivatereportingrequirements,includingthosethatsupportpatient safetyanddiseasesurveillance." o

BenefitsofEMR:

Replacepaperbasedmedicalrecordswhichcanbeincomplete,fragmented (differentpartsindifferentlocations),hardtoreadand(sometimes)hardto find.Provideasingle,shareable,uptodate,accurate,rapidlyretrieveable sourceofinformation,potentiallyavailableanywhereatanytime.Require lessspaceandadministrativeresources. Potentialforautomating,structuringandstreamliningclinicalworkflow. Provideintegratedsupportforawiderangeofdiscretecareactivities includingdecisionsupport,monitoring,electronicprescribing,electronic referralsradiology,laboratoryorderingandresultsdisplay. Maintainadataandinformationtrailthatcanbereadilyanalysedfor medicalaudit,researchandqualityassurance,epidemiologicalmonitoring, diseasesurveillance.... Supportforcontinuingmedicaleducation. o

EssentialissuesrelatedtoEMR:

o o o o
o

Integratedsystemsrequireconsistentuseofstandardsine.g.medical terminologiesandhighqualitydatatosupportinformationsharingacross widenetworks Ethical,legalandtechnicalissueslinkedtoaccuracy,securityconfidentiality andaccessrightsaresettoincreaseasnationalEMRsystemscomeonline. Theseissuesbecomemorepressingwiththecurrentmovementto promotingconsumerempowermentandinformationownership, championedbytheEuropeanCommissionforexample,whichisleading towardspatientrecordsaccessiblebypatients(PersonalHealthRecords). Commonrecordarchitectures,structures Clinicalinformationstandardsandcommunicationsprotocols Securityandconfidentialityofinformation Patientdataquality;datasets,datadictionaries

TheobjectivesofimplementingHISandEMRsystems:

Theobjectiveistomakethehealthsystemmoreefficient,saferforpatients,and, ultimately,toreducecostsandimprovequality.
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Theprocess:

InHIS,Theprocessstartswiththedoctororthenursethatentersthedataofthe patientonthewebinterfacethenthepatient'smedicaldataandfinancialdataare

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transferredtothecomputer,tobeavailabletotheuserofthesystemwhenever he/shewantedtouse. Throughthesystem,everypatienthashisownfilewithallthedatarelatedtohim. Likeshowninthepicturebelow.

ElectronicMedicalRecordsissimilartotheHospitalinformationsystem,exceptfor thattheEMRneedshighskilleduserstoentertheinformationandtheinformation willbeavailabletodoctorsonlyandtheymayuseitontheiriPadseveiftheyare notavailableinEgypt.Withthesymptomsofthepatiententeredonthesystemand thepatient'shistory,Thedoctorcanprescribeaspecificmedicationforthepatient withoutevenexamininghim.Thisisconsideredtobetimeandeffortsavingfactor. TheonlydifferencebetweentheEMRandHISisthatEMRfocusesonlyonthe medicalside,ignoringthefinancialside.Itonlycaresaboutthepatient'smedical history.

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 Asshownabove,Theinterfacejuststatesthepersonalinformationofthe patient,thesymptomsandthemedicationswiththedosages,ignoringthe financialside,neitherwhatthepatientpaidnortheinsurancecompanyhe dealswith.

o Thecomponentsofthesystems:
First,HISsystemconsistsof: o ClinicalInformationSystem(CIS): AClinicalInformationSystem(CIS)isacomputerbasedsystemthatis designedforcollecting,storing,manipulatingandmakingavailableclinical informationimportanttothehealthcaredeliveryprocess. ClinicalInformationSystemsprovideaclinicaldatarepositorythatstores clinicaldatasuchasthepatientshistoryofillnessandtheinteractionswith careproviders.Therepositoryencodesinformationcapableofhelping physiciansdecideaboutthepatientscondition,treatmentoptions,and wellnessactivitiesaswellasthestatusofdecisions,actionsundertakenand otherrelevantinformationthatcouldhelpinperformingthoseactions. o FinancialInformationSystem(FIS): FinancialInformationSystems(FIS)arecomputersystemsthatmanagethe businessaspectofahospital.Whilethehospital'sprimarypriorityistosave

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livesandnotmakingprofits,theydoacquirerunningcostsfromdaytoday operations;includingpurchasesandstaffpayroll. FeaturesofFinancialinformationsystem: 1. Payroll 2. PatientAccounting 3. AccountsReceivable 4. GeneralLedger 5. FixedAssetManagement 6. ClaimsManagement 7. ContractManagement. o LaboratoryInformationSystem(LIS): Alaboratoryinformationsystem(LIS)isacomputerinformationsystemthat manageslaboratoryinformationforallthelaboratorydisciplinessuchas clinicalchemistry,hematologyandmicrobiology. LaboratoryInformationSystemsprovidemodulesforsendinglaboratory testsordertothecomputersthroughitsmultipleinstrumentinterfaces, someareknownastohaveasmanyasfivehundred,trackthoseordersand thencapturingtheresultsassoonastheybecomeavailable.Theresultcan thenbeanalyzedandareportthegeneratedfromit. Thisreportcanbesentoffforprintingataspecificpoint,sentofftoother systemseithertobeaddedtopatientselectronicmedicalrecordorfor billing. o NursingInformationSystem(NIS): Nursinginformationsystems(NIS)arecomputersystemsthatmanage clinicaldatafromavarietyofhealthcareenvironments,andmadeavailable inatimelyandorderlyfashiontoaidnursesinimprovingpatientcare. Otherfeaturesprovided: 1. PatientCharting 2. StaffSchedules 3. ClinicalDataIntegration 4. DecisionSupport o PharmacyInformationSystem(PIS): Pharmacyinformationsystems(PIS)arecomplexcomputersystemsthat havebeendesignedtomeettheneedsofapharmacydepartment.Through theuseofsuchsystems,pharmacistscansuperviseandhaveinputsonhow medicationisusedinahospital. Someoftheactivitiesofthesystem: 1. ClinicalScreening 2. PrescriptionManagement 3. InventoryManagement 4. PatientDrugProfiles 5. ReportGeneration 6. Interactivitywithothersystems

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o PictureArchivingCommunicationsystem(PACS): PictureArchivingCommunicationSystem(PACS)isaloosetermtodescribea setofsystemsthatfacilitatethearchiving,processingandviewingofdigital radiologicalimagesandtheirrelatedinformation. Theimagesareacquired,archivedandretrievedoveranetworkfordiagnosis andreviewbyphysicians.Theseimagescanbeinterpretedandviewedat workstations,whichcanalsodoubleasarchivestationsforimagestorage. o RadiologyInformationSystem(RIS) Aradiologyinformationsystem(RIS)isacomputersystemthatassists radiologyservicesinthestoring,manipulationandretrievingofinformation. Someoftheareasthatcanbeaddressedbyradiologyinformationsystems are: 1. PatientManagement 2. Scheduling 3. PatientTracking 4. ResultsReporting 5. FilmTracking Thesesystemsareallintegratedtoformthehospitalinformation systeminElShoroukhospitalasinputsforthesystemandtheyprocess alltogethertogeneratethebestachievedresultsintheformofallthe timeavailabledatawhichareaccurateandcomplete.

CIS RIS FIS

PACS PIS

HIS
NIS

LIS

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TheEMRsystemconsistsof: Itismainlybasedonthewebinterfacemodel,wheretheclienttheweb browsertodealwiththesystem.(platformindependence) MostcommercialEMRsaredesignedtocombinedatafromthe pharmacy,laboratory,andlargeancillaryservices,suchas radiology,withvariousclinicalcarecomponents(suchasnursing plans,medicationadministrationrecords[MAR],andphysician orders) ThecomponentsofEMRarelistedas: o AdministrativeSystemComponents o LaboratorySystemComponents o RadiologySystemComponents o PharmacysystemComponents o ComputerizedPhysicianOrderEntry o ClinicalDocumentation

Asshownabovewecanillustratethatthehospital'sfunctionswereallintegrated throughtheEMRsystemasinputsandendedupasoneprocesswhichdoesn'tneed morethanonecoordinator.Throughthisweobtainedthedesiredoutputandwe savedtimeandeffortthroughapplyingthesystem.

Privacyofthesystems:
Privacyandconfidentialityarethemostimportantaspectsinbuildingpatienttrust. Consequently,oneoftheguidingprinciplesofanyEMRsystemiselectronicsecurity

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andsurveillancetechnologythatmaintainstheintegrityofthesystemandthe recordsitcontains.Regularsecurityreviewsandupdatesarenecessarytoensure thesafetyofapatient'sprivacy.Atthesametime,thesystemshouldbecapableof providingelectronicsyndromicsurveillancedatainformationonemerginghealth risksandoutbreakssuchasthefluorotherillnessesidentifiedbytheorganization's physicians.Thisshouldbeavailabletopublichealthagencieswithoutviolating patientconfidentiality.

Usagerateofthesystems:
ElShoroukhospital'soperationsmainlydependontheHISandEMRsystems.The doctorsandnursesusethesystemsondailybasistorecordthepatient'sdata.That's whatishappeningnow.Butfewyearsago,theusageratewasn'tasmuchasnow. 90%oftheoperationsnowareoperatedviaHISandEMRsystems.Thereisnoother choiceratherthanusingthesystemsnow.Lackofstandardization,andissuesof securityandprivacyhavestoodinthewayoftheirimplementationfirst,butnow theseproblemsarealmostsolvedandtheusersofthesystemslearnedhowto adaptwithit.

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 Resistancetochangeandhowtoavoidit:
Naturally,whenapplyinganewsystem,thehospitalfacedaresistancefromthe existingformulaoftheprevioussystem,mainlystaffandnursescouldntcopewith thenewtechnologyappliedinsidethehospital,theyfacedproblemswithusageof computers,howtoinputdata,theyreceivedatrainingindeed,butdealingwithnew systemdependingonthemselvestookawhiletogetbetterandmoreeffective,the hospitalfacedmanydifficulties,andhadtodealwithlateresponsesometimesfrom doctorsandstaffwhocouldntusethesystemeffectively,inordertoeasethe processandtrymotivatingusersofthesystemthehospitalhasdonetwothings: 1.Thehospitalshowedthevaluesandbenefitstotheusers. 2.TheylaunchedaTrainingprogram"technoacceptancemodel. Thehospitalwassocarefultoteachwhatisgoingtobetheoutcomeofeffective applicationofthesystemtothestaffinordertoshowthemhowthebenefitswould gointhebestwayforallfactorsofthemedicalprocess,fromincreasingthenumber ofpatientsthatwouldcheckin,tohoweveryprocessinsidethesystemwouldget easieronthestaff,howtheywontlosehourssearchingfordifferentdatainold, storedpaperfiles,wastingtimeinschedulingoperations,timesforclinicand patients,andhowbyasimpleclickofthemousetheywillreceiveimportantdata pertainingtohospitalfinancesystems,dietofpatients,andeventhedistributionof medications,withthisinformationtheycanmonitordrugusageinthefacilityand improveitseffectiveness,besidemanyotherbenefitslike:enhancinginformation integrity,reductionoftranscriptionerrors,reductionofduplicationofinformation entries,optimizesreportturnaroundtimes. Thetechnoacceptancemodelisawayoftrainingthestaffonhowtogetoverthe obstaclesanderrorstheyfacebythesystem,howtheycaneffectivelyandeasilyuse thesystem,wewerenotprovidedbymuchinformationofthestepsoftheprogram astheITmanagermentionedtheydesignedittoservethestaffofthehospitaland itwasverycustomized.

Howtomeasuretheperformanceofthesystem:

Therearetwowaysofmeasuringtheperformanceofthetwosystemsinsidethe hospitalaccordingtotheITmanager,theyare: The feedback that is submitted by doctors and other users of the systems, whichhappensofaperiodicalbasis The surveys that are conducted for the purpose of maintenance and updatingthesystemsaccordingtowhatfitstheneedsoftheusers. Comparisonthatisconductedperiodicallyaswellonthefinancialpositionof thehospitalinaccordancewithitsdependenceonthesystems. Inthiscase,thereisnocertainadoptedmeasurementofthesystem,theyuse mostlycommonsense,feedbacks,theITmanagerexplainedthatthesystemis alwaysuptodateaccordingtowhatissubmittedbydoctorsandusers,complains

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arealsotakenintoconsiderationandaccordingtoanyeditinthetechnical formulationofthesystem.

ResultsandImpactsofapplyingHIS,EMRsystems insidetheHospital:
Applyingthetwosystemscertainlyandaccordingtomainfigureshascertainly increasedthehospitalperformanceonmanylevels,financialperformance,surgical andmedicalperformanceandtheoverallperformanceofthehospitalstaff,stated asfollows:

Financialperformance:
Forsecurityreasonswewerenotprovidedbyanysourceinsidethehospitalbyany financialfiguresorfinancialstatements,wecouldn'tobtainthedataexternallyas well,butfromtheresultsfoundedbythemanagerstheycouldonlyprovideuswith infothatnumberofpatientshasincreased,theeaseofinformationinsidethe hospitalhassignificantlyimprovetheperformancewhichledtosavingincosts,what onceusedtobedoneinweeksisdonenowinminutesandwithminimalerrors, whichsavealotofmoneywiseinsidethehospitalthatisdirectedtobetter investmentandexpansionstoservethemedicalpurpose,alsoitisdirectedin updatingthesystemsandmakeitmoreuptotheincreasingneedsofusers.

Surgicalandmedicalperformance:
Thatisthemainimportantfactorinthehospitalactivitythatthesystemsare focusedon,andthemainareawhichtheresultshasshownpositivelymorethanany otherarea,forseveralreasonstheusageofthetwosystemshasincreasedthe medicalperformance,doctorswereabletoreviewtheirpatientshistorymore quicklyandwithaccuratedata,theywereabletodocumentofanysymptomsor postsurgicalupdateofthecaseanditcanbereviewedbyanyotherdoctor,they wereabletoschedulethemedicationsandrescheduleitwhennecessary,record theirobservations,recommendationsandnotestonurses,nursescouldusethe systemsaswellformanypurposes,organizingtheirshifts,reorganizethem, scheduletheirduties,scheduletheirmedicalresponsibilitytowardspatientsand theirmedications,theirnightshiftsandsoon.

Thehospitaloverallperformance:
Onseveralbasisthehospitalperformancehasincreasedandshownpositiveresults insideandoutsidethehospital,thestaffhasshownmoreproductivityrates,the numberofthepatientsgotincreased,thehealthstandardsandmedicalstandards insidethehospital,thatmadeagoodpublicityforthehospitalstartingfrom checkinginveryeasilyandtillthetreatmentiscompleted.

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Therelationshipbetweenthehospital'shierarchy andtheapplicationofHISandEMR:
CEO

CEO
Departments heads

Department heads Operational doctors

Operationaldoctors

Nurses

Clerks

Nurses

BEFOREAFTER
Theorganizationalchartofthehospitalcouldhavebeendescribedbeforeapplying HISandEMRbybeingatallchart,withmanystaffingmembersandpositionsto ensurethatthedaybydayactivitiesarebeingheld,andtomaintainacertain productivityrates,yettherehasbeenalotofdelaysandmissperceivingofthe tasks,alotofunnecessaryextralabor,thatwerehiredforjobswhocouldbeen donebyusingthelaterappliedsystems.AfterapplyingHISandEMRhospitalchart hasincreasinglyshiftedmanytimestillitsettledonaflatchart,thathasfewerstaff andmanagerialposts,butinthesametimetheywereeffectivelymakinganimpact, thehospitalfinallywasabletominimizetheextraworkcapacitybyreplacingthe daytodayoperationstaffwithcomputerizedsystems,theycoulduseoneperson insteadof10byjusthandinghimacomputerandanaccesstothetwosystems.The positionofCIO(ChiefInformationOfficer)wasfoundedinthechartinorderto maintaintheperformanceofthetwosystemsandtheirrequirements,wecansay thattheapplicationofHISandEMRhasputthehospitalonabetterorganizational trackandsavedtimeandcosttobetterusages.

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 ConclusionandRecommendation:
Throughoutthereport,wefoundouthowmuchtheimplementationoftechnology throughthesystemswasessentialforimprovingtheefficiencyofoperationsinEl Shoroukhospital.But,maybesomemodificationsinthestrategyofimplementation shouldbeusedtogetbetterresults Thesemodificationsfromourpointofvieware: 1. Nursesshouldgetmoreinvolvedintheprocesseveniftheireducationlevel wasn'tthathigh.Thenurseswouldfacilitatetheprocessesmoreandmore onthedoctors.Wecandothisthroughapplyingspecialtrainingprograms otherthanthe"technoacceptancemodel". 2. Therearesomeothersystemsinthehospitalthatshouldbeintegratedto theHISandEMRsystems;likethereservationsystem;whichisusedbythe nursesinthehospital. 3. Increasingtheawarenesstothehugeimportanceofapplyingthesystemsin thehospital,sothatallthedoctorsandusersuseitwithouteventhinkingof anothersolution. 4. ApplyingtheEMRsystemonotherdepartmentsotherthantheUrologyand Nephrology.Thissystemshouldgetimplementedthroughoutthewhole hospital

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References:

Book,"Hospitalinformationsystems:designanddevelopment" HansUlrichProkosch,JoachimDudeck. Book,E.Coiera.TheGuidetoHealthInformatics(2ndEdition). Arnold,London,October2003 Article,C.PeterWaegemann.StatusReport2002:Electronic HealthRecords.MedicalRecordInstitute Article,SujanskyWV.Thebenefitsandchallengesofanelectronic medicalrecord:muchmorethana"wordprocessed"patient chart.WestJMed.1998 Article,ElectronicHealthRecordsOverviewApril2006,National InstitutesofHealth,NationalCenterforResearchResources. Somewebsiteslike: www.alshoroukhospital.com http://www.emrconsultant.com/education/hospital informationsystems www.patients.about.com http://www.biohealthmatics.com/technologies/intsys.aspx

Thank You

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