Paper Less Hospital

8/3/2019 Paper Less Hospital

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The Workings of a Paperless Hospital

SELAYANG HOSPITALDR. ABDOLLAH SALLEH



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Paperless Hospital - Concept

Computerized hospital information system- paperless & filmless

Central ObjectivesProvide integrated care delivery system

Sharing of information

Automation of work processes

Greater efficiency

Storage and use of data



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THIS: Information System

Three Major System

Clinical: All clinical processes

Management information System

Administration

Finance

Office automation

Communications



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System versionsDuplicates of the integrated system made

available for various functions

Build and Test Version Production Version

Train Version (a duplicate of theproduction version with test patients

and scenarios) Parallel Paper records / transactions

for first three months.



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FunctionsComputerisation of various functions

Appointments and scheduling

Registration, admit / discharge / transfer

Documentation of clinical data

Clerking

Monitoring and charting Documenting diagnosis

Documenting outcome



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Functions (contd) Ordering tasks and tests

Ordering drugs and supplies

Entering results of procedures andtests

Viewing results

Referral and communications



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Benefits of a Computerised

Information System

Sharing of data and information

Automation of transactions or

work processes



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Appointments and schedulingUse of a common

scheduling book

Can be viewed by all

Ability for care

providers to schedule

appointments where

ever and whenever

Clients may call in or

present themselves



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Registration Each patient given a

unique identifier

Demographic andbilling data used for

all other functions

during same and

subsequent visit



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On-line admission / discharge / transfer

Inpatient admissions 150/day

Outpatient visits 1000/day



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Clinical documentation

Clinical data recorded using electronic

forms

Clinical problems / diagnosis entered

into a problem list

Allergies entered into allergy list



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Recording and Retrieving Information

Entering orders

Computerized PatientRecord

(5GB/month)

180,000 records:250Gigabytes

Concurrent Users9

00 to 1000 /hour



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Structured Data Entry



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The Electronic Medical Record

A record of all data generated during

care of patient Data captured or collected

Data generated on performing clinical

tasks



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On line transactions: Order

management(Provider order entry)

Order from a standard list

(tests, drugs, provisions)

Items has cost / charge

and other factors

attached

Allow additional

information to beattached

Decision support



The Ward Round ±Retrieving information via Wireless

Transmission

22 wireless notebook



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Completing orders and tasks



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Receiving specimens System integration

/ interface

Use of Bar Codetechnology for

recognition and

communications



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Communications by sharing of data:

Receiving orders in the lab

Automated charging based on tasks

150 barcode readers



Laboratory tests

Computer to

computer

communications

Machine-system

interface

Automated QualityControl



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Taking images



Capture of Digital Images

Cassettes



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Storage of Digital Images

Image Server

Juke-Boxes

X-ray Images - 3990 Gb



Viewing Images ± high definition

monitors



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Reviewing X-rays in Emergency

Department



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Dispensing drugs



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Dispensing drugs



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Dentist¶s procedure room



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On-line admission/ discharge and billing

Inpatient admissions 150/day

Outpatient visits 1000/day



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Data Analysis&

Interpretatio

n

Data Management

Data Storage

Data Retrieval

and Display

Data Entryor Capture

DataDistribution

DataTransfer

Data

Generation



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INFORMATION SYSTEMELEMENTS

Data Entry / CollectionFormat Data Display / View

Database Tables

SummaryReportsStatistical Analysis

Links to other systems

QUERY Archive

SQL



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Data Entry Hardware- using keyboard and mouse



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Ubiquitous PC Workstations

1200 PCs

1 PC / clinic room

5-6

PCs per ward

2 PCs per OR

I PC per lab desk

I PC per office worker



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Client

Application Server Database Server

Client Client

LAN

Client

3 TIER INFORMATION SYSTEM ARCHITECTURE

DATA



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Data Distribution: Servers

80 servers«(hardware / software)



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Business continuity

System availability

Help desk

Preventive strategies Alternative system

Redundancy

Back up Upkeep and prevention of data loss

Integrity of EMR



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THIS: Networking Security

Security

Access and authentication

Privileges

Culture re: confidentiality of information

Proxy server ± internet, Firewall with

Intrusion detection system No floppy/CD at workstation

Antivirus



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Support - 24 hour help desk



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Utilization



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Users Satisfaction

Survey on ER Doctors (December 2001)

90% prefer working with THIS

Satisfaction rate: 64% to 85%

70% found that EMR is excellent or very good in

terms of use

70% rated the process of ordering investigation

through THIS excellent or very good

60% rated the process of viewing results through

THIS excellent or very good



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User Satisfaction Survey 2003

1%

27%

53%

12%

7%

0%

10%

20%

30%

40%

50%

60%

Respondent

Unknown

Doctor

Nurse

Allied_staff

Clerk

Online Survey among staff (n=144)



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User Satisfaction

94% prefer working with THIS

94% experienced THIS improve workefficiency

80% satisfied with THIS



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User Satisfaction

60% rated viewing patient information

through THIS excellent or very good

80% rated system data integrity very

good or average.

80% rated system data security very

good or average



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Benefit Study

The business case of THIS in Selayang

Hospital was mainly to improve the quality of

healthcare services and the hospitalsystem«

A comparative study with typical

government hospital - to look for any

qualitative and quantitative benefits of THIS The study is still on-going



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Cost Benefit

Study still in progress - comparison with

Klang Hospital (documentation process/time

motion study) Some of the Early findings

40% time reduction for admitting patient

to the ward

10% time reduction during patient stay

70% time reduction for discharge process



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Cost Benefit

70% time reduction in time for viewing x-ray

following portable x-ray request

10% reduction in staffing for registration

processes

50% gain in efficiency in scheduling patient

80% reduction of time in viewing patientrecord



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Benefit Study

From the observation during the study,some qualitative benefits found wasthat Selayang has:

Easy availability of data and data sharingamong providers improves patient safetyin management of illness

Better patient record management and

security Improve workflow through reengineering

work processes



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What have been successful in

Selayang Hospital?

Prior process re-engineering minimizes hitches

Change Management Process Led toorganisation wide acceptance

Automation in Laboratory and Imaging ProcessesEliminate of redundancy & Improved accuracyand work efficiency

Filmless operation achieved - all internal images

are digitised Integration and interfacing of systems (a qualified

success)



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What were

less successful?

Achieved Paper-less but not paperless

Has to fulfil Regulation / medico legal paper

System performance - speed

Critical factor for acceptance

Underestimate the huge clinical data

Standardization - Need for a lean database

Views are queries of the database!

Training of personnel

Shortage of staff dedicated as trainers

Rely on on the job training



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Value

Knowledge transfer in medicalinformatics

Patient safety Vital information at point of care

A nursery bed for future IT

development Knowledge Management with

technology



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Critical Success Factors

Top management commitment

Commitment of + acceptance by Physician and

other users

Business process reengineering

Thorough System testing and simulation

Adequate number of Professional IT staff for

system administration ( System integrity andsecurity, business continuity) and

troubleshooting.



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Current Development

Fully automated Pharmacy Information

System with Decision Support System

Improve Reporting and Data analysis

Enhance the Clinical Documentation

Module (Decision support.)

Enhance mobile computing function



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The Future...

Selayang Hospital has a long way to go«

Previously : Concerned about the technology

and whether it can be done It is not the technology that matters«

It is how we use the technology to improve

decisions, behavior and effectiveness,

efficiency, outcomes and ultimately patientsatisfaction



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THANK YOU

[email protected]

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Paper Less Hospital