System Implantation Plan In Nasser Institute Hospital

The American University in Cairo School of Business - Management Center

Postgraduate Healthcare and Hospital Management Diploma Gradation Project

System Implantation Plan

in Nasser Institute Hospital

Submitted to:

Prof. Mohsen El-Shammaa

Submitted by: Dr. Mohammed Fathy Sayed Mohammed Zaky

2013

بسم هللا الرحمن الرحيم

Contents Page

Introduction 1

Nasser Institute Hospital 4 Mission Vision Hospital divisions Organization chart

Hepatogastroenterology Department 7 Our mission and vision The services provided

Objectives 13

Current System 16 Characters of current system

Problems 17 Back draws of current system Main problems within system

Survey 19 The Survey Results Survey analysis & their impacts

Contents (cont.) Page

Recommended Solutions 37 Alternative Solutions Goals of proposed system

Implementation Plan 42 Stage I : Teamwork Stage II : Site preparation Stage III : Hardware Stage IV : New System Stage V : RFP creation Stage VI : Acceptance & Evaluation Stage VII : justification Stage VIII : Customization Stage IX : Testing Stage X : Training

Implementation in Department 74

Medical recording 82 Real-life case Workflow Reporting procedure

Conclusion 93

Introduction

INTRODUCTION

As we know the great development in the field of information technology and the boom that occurred in last years in this field especially in hospital management and using automation instead of traditional old methods.

Our project we will go through a brief review on the steps of implementation plan for a Hospital Information System (HIS) in Nasser Institute Hospital (NIH); the largest tertiary referral center for Ministry of Health (MOH).

We will put a pilot overview for implementation process steps at all hospital divisions while we choose the Hepato-gastro-enterology department to be an applied example for this project to discuss it in details.

At the beginning, we will take a look at the hospital composition, structure, divisions and organizational chart. Also we will make a spot on Hepato-gastro-enterology unit protocol, vision, mission and services provided.

Introduction

INTRODUCTION (CONT.)

Hospital goals and objectives are discussed thoroughly identifying its needs and requirements; also making a spot on the current system and its drawbacks and problems that make us look for alternative solutions and leads to our shift to the automated system.

We have done a simplified survey for the hospital staff to assess several factors include their ability to use the computer systems, evaluate their opinion for the current system, detect problems they face and how they see the way to solve it and their acceptance for our project idea of applying the hospital information technology system.

Introduction

INTRODUCTION (CONT.)

The implementation process will including the request for proposal, vendor`s proposals, and finally our project is justified to get the management agreement.

Afterwards we start implementation regarding tasks, responsibility, budget and time frame including site preparation.Then we start training and test the new system to evaluate all what we have done prior to go to real-life work.

Finally we will go through the hospital information technology system with a real-life case represent a case came to Nasser Institute Hospital admitted, diagnosed and managed with the new system. Also, we will see one of the computerized reports for that case.

Nasser Institute Hospital

NASSER INSTITUTE HOSPITAL

NIH was opened in July 1987. It is resides over on areas of about (130,000 m2). It has a main building and 3 associated buildings. The main building has 8 floors with 2 level basements. It is containing 885 beds. It has over about 40 medical specialties.

Mission

To provide advanced and unique health care for patients in Egypt and other countries with continuous improvement via education, training and research.

Vision

To be a center of excellence in providing health care services, training, and medical research.


Hospital divisions Surgical specialties: General surgery. GIT & liver surgery. Vascular surgery. Pediatric surgery. Obstetrics and gynecology. Endoscopic surgery. Plastic surgery. Orthopedic surgeries. Microscopic hand surgery. Arthropathy surgery. Oncology surgery. Ophthalmology surgery. Maxillofacial surgery. Dental surgery. ENT surgery. Neurosurgery. Urology surgery. Medical specialties: Chest medicine. Nephrology. Neurology. Cardiology. Gastroenterology. Pediatric medicine. Neonatology . Dermatology . Endocrinology. Checkup centers: Cardiac Checkup center Diabetes Checkup center General Checkup center Women Health center

Specialized ICU: Open Heart ICU. Cardiac care unit. Stroke care unit. Surgical ICU . General ICU. Nephrology ICU. Hepatology ICU . Pediatric ICU. Neonatal ICU. Unique specialties: Cardiothoracic Surgery center. BoneMarrow Transplant center. Maxillofacial Surgery center. Radiological Intervention units. Spine Surgery center. Hand & Upper Extremity unit. Oncology center. Kidney Transplantation center. Hyper baric Oxygen therapy. Gamma Knife center. Diagnostic Radiology unit: X-Ray – US – CT scan – MRI Laboratory: Classic and Advanced labs Training & medical research center

Tele-Medicine and Consultation.

Medical library


Organization chart In this is the real organization chart of Nasser

Institute Hospital. The chart shows accurate departmentalization, and work specialty, and shows good chain of command.

Hepatogastroenterology Department

HEPATOGASTROENTEROLOGY DEPARTMENT

Hepatogastroenterology department in Nasser institute hospital was opened in March 1999 and it is one of the outstanding units of the Ministry of Health as it is considered a reference unit for patients with gastroenterology and liver diseases from inside and outside the country.

The department is located in the third floor, partition (A), containing about 28 beds (10 double bed rooms and 8 single bed rooms). There is intermediate hepatic care unit containing 4 beds and also, well equipped single isolation rooms present to receive the cases that need isolation. All of the department rooms are overlooking the gardens of the hospital and the River Nile.

There is also an affiliated outpatient clinic and endoscopy unit located in the outpatient department of the hospital supervised by a group of specialized professors working 6 days per week.


OUR VISION AND MISSION

Our vision A highly qualified reference unit that capable of

providing the standard of care to patients and the best chance for scientific progress and practical training to young doctors in the field of Hepatogastroenterology.

Our mission

To offer evidence-based medical service for patients from Egypt and other countries, to establish the first specialized Hepatogastroenterology checkup unit, to raise multidisplinary team and improve facilities preparing for liver transplant program and to provide a complete training program for young physicians


THE SERVICES PROVIDED

The national (when available) and medical services provided by the department are planned according the international guidelines (reference guideline booklet is available in the department) taking into consideration the safety of the patient and the health care provider.

The outpatient clinic:

Assessment of the attending patients by residents,

specialists and consultants in a stepwise manner

according to the needs

Offering medical consultations to different specialties

Offering recommendations for medical tourism

patients before reaching Egypt after reviewing their

medical reports.

Providing multidisplinary team capable of evidenced

based decision making in some problematic cases

like hepatogastroentestinal tumors and liver surgery.


THE SERVICES PROVIDED (CONT.)

Inpatient section.

Intermediate care unit

Ordinary ward

Critical cases which are assessed in the outpatient

clinic or the emergency room will admitted to the

intermediate care unit

Non critical cases are admitted to the ordinary ward

Daily clinical and investigational follow up and

modification of the treatment plan are done aiming at

providing the highest level of medical care.

Continuous observation and follow up of the nursing

care and aiming at raising its level

Daily follow up of the patient file as it considered the

main source of patient's data.


THE SERVICES PROVIDED (CONT.)

Endoscopy unit.

The endoscopy unit was opened since 1999. It is

considered as a reference unit for patients inside

and outside the country. It is operated by a group of

professional professors.

The unit isolated in the ground floor of the hospital in

the outpatient department.

Emergency section.

Assessment and management of attending cases to

the emergency room such as:

o GIT bleeding

o Hepatic encephalopathy

o Hepato-renal syndrome

o Acute hepatitis

o Spontaneous bacterial peritonitis

o Non-surgical acute abdomen


Objectives

OBJECTIVES

Our aim is to make complete automation of Nasser

Institute Hospital through detailed Hospital Management

Information System (HMIS) implementation plan.

Goals should be SMART, specific, measurable,

attainable, relevant and time-based.

After the project management team discusses the

hospital goals; they reach the following major objectives:

Providing novel health-care services

Developing research skills

Effective organizing & control of the hospital

Objectives

OBJECTIVES (CONT.)

Providing novel health-care services:

The hospital plan to provide the best quality of

medical service in terms of the best medical outcome

and cover the Essential Public Health Services :

1. Monitor health status to identify & solve health problems.

2. Diagnose & investigate health problems and hazards.

3. Inform, educate, and empower people about health issues.

4. Mobilize community partnerships to identify & solve problems.

5. Develop policies & plans that support community health efforts.

6. Enforce laws & regulations that protect health & ensure safety.

7. Link people to needed personal health services.

8. Ensure a competent public health & personal health workforce.

9. Evaluate effectiveness, accessibility & quality of health services.

10. Research for new solutions to health problems.

Objectives

OBJECTIVES (CONT.)

Developing research skills:

By communicating with the international centers

and research units to share the most recent medical

knowledge.

Effective organizing & control of the hospital: The hospital aims at making all processes fast and

effective coping with the modern style of management

helping employees raise their skills and abilities and

minimize their work errors leading to efficient and

effective control of hospital resources and expenditure.

Current System

CURRENT SYSTEM

Characters of the current system

- A traditional manual system.

- Based on paper work methods.

- No sufficient types of reports.

- No effective IT department.

- No coordination between hospital units.

- No automatic warning system.

- No Patient IDs recordation.

- Ineffective archiving & storage of patient files.

- Insufficient communication lines with other hospitals.

Problems

PROBLEMS OF THE CURRENT SYSTEM

Back draws of the current system

- Late patients' administration.

- Overcrowds as no appointment schedule on follow up.

- Investigation reports are taking a long time

- Time wasting from request to get the results

- Requested drugs may not available.

- Deficient medical supplies and drugs.

- Staff doesn't know the pharmacy drugs.

- Slow ineffective data processing and collection .

- Many errors & time wasting.

- Inadequate referral system leads to conflicts.

- Poor connection among clinics or departments.

- High frequency in loss of reports & patient files.

- Insufficient financial records with errors & inaccuracy.

- Difficult evaluation & control of employees.

- Incorrect & delayed bells.

- Incomplete documentation of patient medical history.

- Poor data collection and statistical analysis.

Problems

PROBLEMS OF THE CURRENT SYSTEM (CONT.)

Main problems with conventional system

Lack of immediate retrievals:

The information is very difficult to retrieve and to find

particular information like. For example to find out about

the patient’s history, the user has to go through various

registers. This results in inconvenience & time wastage.

Lack of immediate information storage:

The information generated by various transactions takes

time and efforts to be stored at right place.

Lack of prompt updating:

Various changes to information like patient details or

immunization details of child are difficult to make as

paper work is involved.

Error prone manual calculation:

Manual calculations are error prone and take a lot of time

this may result in incorrect information. For example is

calculation of patient’s bill based on various treatments.

Preparation of accurate and prompt reports:

This becomes a difficult task as information is difficult to

collect from various registers.

Survey

SURVEY

Simplified survey has been working on a random

sample of workers in the Nasser Institute Hospital where

this survey included two parts, the first is about ten

questions to be answered yes or no, while the second

part guarantees the five open ended questions.

Yes / No Questions:

1 - Do you have a personal computer? 2 - Do you know how to work on the computer? 3 - Have you attended any training IT courses? 4 - Are you satisfied with the current service level in NIH? 5 - Are you satisfied with the traditional work manner? 6 - Do you prefer to work in current system or new one? 7 - Do you think ITS will achieve better performance? 8 - Have you ever worked a hospital IT system? 9 - Are you ready to enroll in IT system qualifying courses? 10 - Are you with or against the application of ITS at NIH?

Open Questions:

1 - What is the nature of your work within the hospital? 2 - What are the biggest problems you faced in daily work? 3 - What are your suggestions to solve these problems? 4 - What are your experiences in the field of IT? 5 - What are the most important characteristics that requests be available in the new work system?

Survey

االسم :

الوظيفة :

: أجب األسئلة بنعم أو ال

؟ شخصيهل لديك جهاز حاسب آلي -1

هل تجيد العمل على الحاسب اآللي ؟ -2

هل سبق لك والتحقت بأي دورات تدريبة في الحاسب اآللي ؟ -3

هل أن راض عن مستوى الخدمة الحالي للمستشفى ؟ -4

بالطريقة الورقية التقليدية ؟ هل أنت راض عن العمل -5

تفضل العمل بالطريقة الحالية ام بنظام الحاسب اآللي ؟هل -6

تطبيق نظام تكنولوجيا المعلومات سيحقق أداء أفضل للمستشفى ؟ هل تعتقد أن -7

؟ نظام تكنولوجيا المعلوماتهل سبق ان عملت بمستشفى بها -8

؟ م تكنولوجيا المعلوماتنظاهل انت على استعداد لاللتحاق بدورات تأهيلية ل -9

هل أنت مع أو ضد تطبيق نظام تكنولوجيا المعلومات بالمستشفى ؟ -11

Survey

: أجب األسئلة باختصار

طبيعة عملك داخل المستشفى ؟ماهي -1

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ماهي أكبر المشاكل والعقبات التي تعاني منها في عملك اليومي ؟ -2

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ماهي اقتراحاتك لحل هذه المشكالت ؟ -3

...............................................................................................

...............................................................................................

...............................................................................................

؟ ماهي خبراتك في مجال تكنولوجيا المعلومات -4

...............................................................................................

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اهم الخصائص التي تطلب توافرها في نظام العمل الجديد ؟ماهي -5

…………………………………………………………………………………………

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Survey

Survey

Doctors 28%

Nurses 18%

Technichans 12%

Officers 38%

Others 4%

The Survey Results

50 hospital staff people underwent

this survey distributed as follows:

14 Doctors

9 Nurses

6 Technicians

19 Officers

2 Others

Survey

34

27

12

22

17 19

26

9

14

23

16

23

38

28

33 31

24

41

36

27

0

5

10

15

20

25

30

35

40

45

50

Q 1 Q 2 Q 3 Q 4 Q 5 Q 6 Q 7 Q 8 Q 9 Q 10

YES NO

The Survey Results

Q YES NO

1 68% 32%

2 54% 46%

3 24% 76%

4 44% 56%

5 34% 66%

6 38% 62%

7 52% 48%

8 18% 82%

9 28% 72%

10 46% 54%

Survey

0

5

10

15

YES NO0

2

4

6

8

10

12

14

YES NO

YES 68%

NO 32%

Q1 Q2

YES

NO

Survey

0

5

10

15

YES NO

YES 44% NO

56%

Q4

0

5

10

15

YES NO

Q3

YES

NO

Survey

0

2

4

6

8

10

12

YES NO

0

2

4

6

8

10

12

YES NO

YES 34%

NO 66%

Q5

YES 38%

NO 62%

Q6

Survey

0

2

4

6

8

10

12

YES NO

0

5

10

15

20

YES NO

YES 52%

NO 48%

Q7 YES 18%

NO 82%

Q8

Survey

0

5

10

15

20

YES NO

0

2

4

6

8

10

12

YES NO

YES 28%

NO 72%

Q9

YES 46%

NO 54%

Q10

Survey

0

5

10

15

20

25

30

35

40

45

50

YESNOYESNOYESNOYESNOYESNOYESNOYESNOYESNOYESNOYESNO

Q1Q2Q3Q4Q5Q6Q7Q8Q9Q10

Others

Officers

Technichans

Nurses

Doctors

Recommended Solutions

Survey analysis and their impacts

When we try to analyze the results of the survey

which we did in the hospital staff, we found that there are

positive and negative points. It is very important to

address and manage the negatives before and during

the implementation of our project to ensure that

implementation will be applicable and successful and

also to reduce the obstacles and difficulties that may be

face us during the process.

The survey analysis tells us that the poor general

economic situation has led to our underdevelopment

status with comparing to the world in the field of

information technology. Although that more than 68% of

the participants in the survey have personal computers,

only 54% of them are fluent users and less percentage

that have computer skills in the form of using software

applications such as office and network browsing.


Survey analysis and their impacts (cont.)

In fact negligence of this aspect in education and

employment is the main problem and this was evident in

the outcome of the third question where it was found that

less than a quarter of the survey participants have

enrolled in training courses in this field and the result is

our electronic illiteracy.

Also, the results of the survey show dissatisfaction

about half of the participants for the service provided at

the hospital and the reason for this result is the

traditional work methods which became now a path from

the past in the world. About 66% of the participants

answer negative when they were asked about their

satisfaction with the current traditional work method while

more than 60% of the participants prefer to use a new

technology in their work. Also, more than half of the

participants see that information technology will lead to

get a best performance in the hospital.



This may be a good indicator of general awareness

that there is a problem in the hospital current system and

realize that it needs to be solved through using of

information technology system.

Another aspect of the survey shows that the field of

information technology in the management of hospitals in

Egypt is very limited and that as we mentioned before is

because the limited funding and idea negligence. It was

appeared obviously in our survey in the results of

questions number (8) and (9) as only nine out of fifty

have previously worked in hospitals with information

system and only fourteen out of fifty have enrolled in

information technology training courses.



The question number ten in the survey explained

that the hospital staff had broken up into two teams, one

supporter of the idea of the project and the other is

against it. This will lead us to start the implementation of

the project by using and training the accepting team

hand by hand with trying to understand the reasons for

the objection of others and avoid it.

Open questions in an attempt to get closely

acquainted with the most important problems facing the

working groups and staff at the hospital and the ways to

solve them, also included questions asked about workers

knowledge about information technology and whether

they have any previous experience in use it. The was

Most important question was for properties that working

groups like to met in the new system that will be

implement in the hospital.



The participates whom answering the survey were

more than ten doctors, three pharmacists and a dentist.

Also it answered by three high Nurses, four nurses and

two assistant nurses. The participated group of

technicians was three radiological technicians and three

laboratory technicians. Also, a group of employees

participated from different hospital departments and

sections were reaches about nineteen officer.

Doctors' problems were summarized in the

difficulty of communication between hospital

departments, attendance system and data loss, while

nurses and technicians saw that's personal shortage,

excessive paperwork, and work overload were the main

problems. Officers said that their first problem is in

keeping and retrieval data.



The variety of proposals to resolve and are mostly

in the application of some successful methods of other

hospital systems, and the virtue of a number of doctors

and employees automated system to resolve the crisis.

The majority of the officer personnel in the hospital had a

good idea about the information technology system and

showed presence of some past experiences in it, while

experiences in such field for medical personnel and

technical were limited.

The main characteristics demanded by the

participants in the survey focused on ease of use,

adequate training and the quality of services.

Pharmacists focused on the importance of use of such

system especially in the field of drug store and medical

instruments. Also, doctors worried about patient

information security and privacy while officers stressed

on the importance of regular maintenance of the system.


RECOMMENDED SOLUTIONS

Alternative Solutions

1. Improved Manual System:- One of the alternative solutions is the improvement

of the manual system. Anything, which can be done by

using automated methods, can be done manually. But

the question arises how to perform thing manually in a

sound manner. Following are some suggestions, which

can be useful in the manual system. A more sophisticate

register maintenance for various Patient Information,

Doctor diary, Immunization Details and a good system

for writing bill amount employees and stock availed for

the customers can be maintained at central place.

Adequate staff may be maintained so that updating are

made at the very moment at the same time. Proper

person for proper work should be made responsible so

that a better efficiency could be achieved. This needs a

lot of work force.


RECOMMENDED SOLUTIONS (CONT.)

2. Online System:-

This system (HMS) provides online storage/

updating and retrieval facility. This system promises very

less or no paper work and also provides help to Doctor

and operational staff. In this system everything is stored

electronically so very less amount of paper work is

required and information can be retrieved very easily

without searching here and there into registers. This

system is been discussed here.



Goals of proposed system

1. Planned approach towards working : - The

working in the organization will be well planned

and organized. The data will be stored properly in

data stores, which will help in retrieval of

information as well as its storage.

2. Accuracy : -The level of accuracy in the proposed

system will be higher. All operation would be done

correctly and it ensures that whatever information

is coming from the center is accurate.

3. Reliability : - The reliability of the proposed

system will be high due to the above stated

reasons. The reason for the increased reliability of

the system is that now there would be proper

storage of information.



4. No Redundancy : - In the proposed system

utmost care would be that no information is

repeated anywhere, in storage or otherwise. This

would assure economic use of storage space and

consistency in the data stored.

5. Immediate retrieval of information : - The main

objective of system is to provide for a quick and

efficient retrieval of information. Any type of it

would be available whenever the user requires.

6. Immediate storage of information : - In manual

system there are many problems to store the

largest amount of information.

7. Easy to Operate : - The system should be easy to

operate and should be such that it can be

developed within short time & fit in the limited

budget of user.

Implementation Plan

IMPLEMENTATION PLAN

System implementation will be done in 10 stages :

Stage I : Teamwork

Stage II : Site preparation

Stage III : Hardware

Stage IV : New System

Stage V : RFP creation

Stage VI : Acceptance & Evaluation

Stage VII : justification

Stage VIII : Customization

Stage IX : Testing

Stage X : Training

Implementation Plan

Stage I : Teamwork

Our teamwork structure consists of :

General manager plays the role of the coach

TQM manager as the project manager

Financial manager is in charge of budget

HR manager is responsible for training

Medical manager is responsible for medical support

Implementation Plan


Data Center creation:

Preparation of the center in which the system

servers and network router will be located, as well

as any additional changes that might be introduced

to accommodate the automated system.

The data center site is selected to be in

isolated building. It will be divided to three sectors,

one for each stage. Each sector will be accomplish

within 4 months duration including testing the

additional changes done to insure that everything is

working properly and ready.

Implementation Plan

Specific considerations:

The floor and ceiling will be coated with

heat & sound proof walls.

Ventilation is modified to provide a high

cooling effect.

A heat detection point is placed to alarm

the management.

The servers are linked to the alternative

generators of the hospital.

Implementation Plan

Stage III : Purchase and Hardware

Fully integrated system.

3 servers.

1500 PCs.

150 scanners.

300 printers.

Communication lines.

Intranet.

Decision Support System (DSS).

Executive Information System (EIS).

Expert System.

Analytical System.

Virtual Private Network (VPN).

Implementation Plan

Functionality of required system :

High technical fully integrated system to support

electronic flow of information.

All modules have to exchange information

whenever needed & produce one single report.

All supplementary applications such as DSS, EIS

& ES should be a part of the proposed solution.

All medical healthcare equipment has to be

integrated with the new system.

The new system has to be fully integrated with

the old manual system available on site.

One single report should represent the entire

movement of the patient for the moment he is

admitted until discharged.

Implementation Plan

Stage IV : New system

General specifications :

- It should be workflow-based.

- It should be real time and on-line integrated MIS.

- It should be scalable, flexible, modular & fully integral.

- It should be designed full features ease of use.

- It should be have a multilingual capability.

- It should be able to chat messages between users.

- It should be allow implantation in a phased manner.

- It should be able to give formal reports.

- It should be able to store and print reports.

- It should be using uniform codes by all health units.

- It should be allowing pricing service.

- It should be a Medical Record oriented system.

- It should be compatible with internationally standards.

- It should be ensure data security and reliability.

- It should be have controls to minimize user errors

- It should be capable to concluding back up action.

- It should be conducting actions upon authorization level

Implementation Plan

The system modules :

1. Medical modules 2. Para-Medical modules 3. Non-Medical modules

Medical modules

- Master patient index system

- Electronic medical record system

- Inpatient management system

- Outpatient management system

- Intensive care management system

- Checkup information system

Implementation Plan

Para-medical modules

- Specialized centers management system

- Pharmaceutical services management system

- Medical supplies management system

- Nursing management system

- Laboratory information system

- Radiology information system

- Clinical research module

- Medical library module

Non-medical modules

- Biomedical engineering system

- Medical logistic system

- Management support system

- Administration module

- Cashiering module

- Accounting module

Implementation Plan

Types of reports:

Admission form

Referral letter

Discharge summary

Death declaration form

Vital signs report.

Blood transfusion form.

Fluid intake and output balance.

Patient medical data reports.

Out-patient clinic reports.

Lab. reports.

Radiology reports.

Inpatients follow up reports.

Emergency room statistical reports.

Referral reports.

Infection control reports.

Pharmacy contents reports.

Financial status reports.

Patient discharge reports.

Patient accounting reports.

Wages and salary analysis reports.

Employee leaves reports.

Purchase orders report.

Medical statistical reports.

Implementation Plan

Some reports forms used in hospital

Refeeral Sheet Treatment Request Form

Implementation Plan


Patient Admission Sheet

Implementation Plan


Nutrition Request Informed Consent

Implementation Plan


Medical Recommendation Report Blood Transfusion Form

Implementation Plan

Stage V : RFP creation

One single report should represent the entire

movement of the patient for the moment he is

admitted until discharged.

RFP is consists of :

1. Introduction 2. Objectives 3. Enterprise profile 4. Current operational system 5. Problems of the current system 6. Required new system 7. Functionality of required system 8. General terms and conditions

See

before

Implementation Plan

General terms and conditions:

Delivery:

Detailed delivery plan including

hardware units and software applications.

Installation:

Complete installation plan for all

required components whether internal or

external.

Warranty:

Present the standard warranty period

with the annual cost of every extra

warranty period.

Maintenance:

Submit a draft of comprehensive

maintenance contact which should

include : full guaranty – renewal contract

– periodic inspection – annual follow up –

training for hospital medical engineers.

Training:

Specify training programs that will be

offered covering theoretical overview

sessions and practical hands-on courses.

Implementation Plan

Terms of payment:

- 20% down payment upon the signature of contract.

- 30% 2nd payment after the delivery composition & testing the system.

- 30% 3rd payment upon sign off the system.

- 20% last payment will postponed one year after complete the operation.

Implementation Plan

Stage VI : Acceptance and Evaluation

Acceptance Criteria Wt. 100%

Easiness It can be used easily by all medical teams

13 %

Training Full training course for all medical teams including cross-training methods

12%

Flexibility Can communicate with other hospitals systems wither local or abroad

11%

Cost Minimal cost can met our needs accepted.

10%

Modularity Must be able for farther improvement with other modules later on.

10%

Compatibility It can used with the present medical unit & equipment, PCs, printers & scanners.

9%

Speed Should be have very high speed to help getting reports within minute

8%

Maintenance Comprehensive maintenance by renewal contract, periodic inspection & follow up.

7%

Features Important to be a high technical fully automated one.

6%

Customization Each department have to get has all required items to get full report data

5%

Integration It is mandatory to be integrated with old hospital isolated systems

5%

Documentation Briefly detailed booklets should be provided with software

4%

Results d if get score You will be accepte

more that 70% in evaluation criteria

Implementation Plan

At this stage vendors offer their proposals and

the project management team evaluate these

proposals according to the acceptance criteria

mentioned in the request for proposal.

Evaluation Criteria

Wt. %

A B C Rate Score Rate Score Rate Score

Easiness 13 % 2 5.2 3 7.8 5 13

Training 12% 5 12 3 7.2 1 2.4

Flexibility 11% 5 11 2 4.4 2 4.4

Cost 10% 2 4 4 8 5 10

Modularity 10% 1 2 4 8 2 4

Compatibility 9% 1 1.8 3 5.4 2 3.6

Speed 8% 2 3.2 3 4.8 5 8

Maintenance 7% 4 5.6 3 4.2 4 5.6

Features 6% 3 3.6 2 2.4 5 6

Customization 5% 2 2 4 4 5 5

Integration 5% 1 1 2 2 4 4

Documentation 4% 4 3.2 4 3.2 4 4

Results 100% 54.6% 61.4% 70.0%

As we see, three vendors offered their proposals

and are evaluated and the project management

team choose vendor C as he has the best offer.

Vendor C values his proposal by 3,000,000 US$

including site preparation, complete installation and

implementation of the new system.

Implementation Plan

Stage VII : Justification

Management agreement:

A management agreement must be obtained by

top management and project team to be committed to

the new system and must take full responsibility for the

success of the implementation, also must share the

responsibility for failure.

It is obtained through formal meetings to discuss

the project from different aspects and take in to

consideration top management ideas and opinions. Also

a report is written clarifying and justifying the project.

A survey was done at the hospital to know to what

extent they are satisfied with the current hospital

situation and according to the previous results we

suggest that we have to shift our hospital to become fully

automated with a budget of 3,000,000 $ to start our

project. The system is likely to be installed & signed off

by the end of 2015.

Implementation Plan

Justification elements:

The project has to be justified regarding time scale, costs & benefits.

Time scale:

The project will last for 3 years as follows:

The project will start on 1st Jan 2013.

The project will end on 31th December 2015.

This period divided into for 3 stages as follows:

The 1st stage will include medical modules.

The 2nd stage will include para-medical modules.

The 3rd stage will include non-medical modules.

Each stage consists of 3 steps as follows:

The 1st step will last 4 months for site preparation.

The 2nd step will last 4 months for implementation.

The 3rd step will last 4 months for training & testing.

Implementation Plan

System costs:

Hardware Equipment 200000 $

Supplies 150000 $

Software Operating system 200000 $

Application software 300000 $

Installation Stationary 50000 $

Training 25000 $

Maintenance 75000 $

Total cost per stage 1000000 $

System benefits:

Quantifiable Unquantifiable

The predicted direct increase in

hospital profits approximately

20% by the end of coming 3 yrs.

The predicted decrease in waste

is approximately by 5% annually

Better hospital performance

Better hospital reputation.

Better hospital services.

Better working conditions

Implementation Plan

Stage VIII : Customization

The implementation process in each stage will

be divided into 4 levels, everyone will lasts only one

month, to be all ended within the determined period

for implantation step (4 months).

Implementation Plan

The Medical modules stage : Starts at May 2013 and ends in Aug 2013

level 1:

Master patient index system

Responsible team: TQM and Medical managers.

level 2:

Electronic medical record system

Responsible team: TQM and Medical managers.

level 3:

Outpatient management system

Checkup information system

Responsible team: Checkup center & Outpatient managers

level 4:

Inpatient management system

Intensive care management system

Responsible team: ICU and In-patient managers.

Implementation Plan

The Para-medical modules stage: Starts at May 2014 and ends in Aug 2014

level 1:

Specialized centers management system

Nursing management system

Responsible team: Specialized centers & Nursing managers

level 2:

Pharmaceutical services management system

Medical supplies management system

Responsible team: Pharmacy & Medical supplies managers

level 3:

Laboratory information system

Radiology information system

Responsible team: Lab and Radio managers.

level 4:

Clinical research module

Medical library module

Responsible team: Medical manager.

Implementation Plan

The Non-medical modules stage: Starts at May 2015 and ends in Aug 2015

level 1:

Management support system

Responsible team: General manager.

level 2:

Administration module

Responsible team: Administration managers.

level 3:

Cashiering module Accounting module

Responsible team: Finance managers.

level 4:

Biomedical engineering system

Medical logistic system

Responsible team: Engineers & Public relation managers.

Implementation Plan

Stage IX : Testing

The system testing is an endless process

starting before the system software installation &

extends after the go-live date. It is involved in each

stage within the determined period for training &

testing step (4 months).

System testing stages:

Testing the system on development. Testing the system upon installation. Testing the functionality within each module. Testing the integration between modules. Testing the system interaction with external systems. Testing and follow-up after going-live.

Implementation Plan

Testing the system on development:

o Performed at the vending company by the

system developers

o To confirm that orders and requirements

of the hospital

o Are all uploaded on the system with the

desired specifications.

Testing the system upon installation:

o Performed at the hospital by the IT

specialists

o To confirm that tests conducted and

documented by the system

o Developers give the same results when IT

specialists perform them.

Testing functionality within each module:

o Performed by the department managers.

o To ensure that everyone's module is up to

par & meet standards.

Implementation Plan

Testing the integration between modules:

o This stage represents a demo version of

the real system.

o It tests the integration between all

modules as if you work in real life.

Testing interaction with external systems:

o The new system is tested regarding

interaction with external systems

o Hospital suppliers systems like

pharmaceutical companies ,

o Insurance providers, banks, catering

agents and other hospitals.

Testing & follow-up after going-live:

o This is an important ongoing process after

launching new system.

o To ensure that new system is working

effectively & meet standards.

Implementation Plan

Stage X : Training

The training process in each stage will be

divided into 3 levels, everyone will lasts only one

month, to be all ended within the determined period

for training and testing step (4 months).

level 1: “ one month ”

Aimed group: IT specialists

Trainers : system developers. During implementation process to ensure that it meet the standards.

level 2: “ one month ”

Aimed group: tactical managers.

Trainers : IT specialists. Involved in testing process to provide ideas and support.

level 3: “ two months ”

Aimed group: Every staff member.

Trainers : IT specialists. How to use their module which relevant to his function.

Implementation Plan

Training go through 3 phases:

Phase 1: general overview of the new system.

Phase 2: specific procedures & activities of each module

Phase 3: controls, errors and recovery procedures.

By the end of the training process:

Each user receives his copy of the user manual

specific for his module.

It is a continuous process doesn’t stop but checked

periodically.

Members' performance is evaluated and corrected

continuously.

Implementation in Department

IMPLEMENTATION IN DEPARTMENT

The Hepatogastroenterology department

implementation will be done as a part of the major

implementation process. We will explain the specific

consecrations that are belonging to it.

Stage I : Teamwork

General project teamwork:

Plays the major roles that mentioned above including

coaching, budget, training, supporting and controlling

Hepatogastroenterology department teamwork:

Leader is for coordination.

By: Head of Hepatogastroenterology department.

Training supervisor is for training.

By: A Specialist with IT previous experience.

Medical supervisor is for medical support.

By: A Specialist with best medical experience.



The system servers and network router will be

located in an isolated building as mentioned. We

choose three rooms to be the location of the IT

equipment and tools in the Hepatogastroenterology

department as shown in the figure.


Stage III : Purchase and Hardware

In addition to the basic general requirements we need

to have the following in in the Hepatogastroenterology department:

Eight Personal Computers:

Four for the Hepatic ICU

One for the endoscopy room

One for the officer of outpatient clinic

One for the officer of inpatient department

One for the officer of endoscopy unit

Three scanners:




Three printers:





Stage IV : New system

In addition to the previous modules we need a specific software and reports as:

The system modules :

Hepatic ICU software.

Endoscopy unit software.

Hepatogastroenterology clinic software.

Types of reports:

Upper GI endoscopy report.

Colonoscopy report.

ERCP report.

Stages from V to VIII are same as major process.

Stage V : RFP creation Stage VI : Acceptance and Evaluation

Stage VII : Justification Stage VIII : Customization Stage IX : Testing


Stage X : Training

As we explain before the training process in will

be divided into three levels, level (3) will aim to train

every staff member. Our department is consisting of:

Doctors:

- 5 consultants

- 10 specialists

- 20 residents

Nurses:

- 10 high nurses

- 10 nurses

- 5 assistant nurses

Officers:

- 5 secretaries

Training two main phases:

Phase 1:

General overview of the new system.

For: all stuff members

Phase 2:

Specific procedures & activities of each module

For: certain chosen stuff members

Medical Recording

MEDICAL RECORDING

Real-life case came to Nasser Institute Hospital and managed with the new system

Medical record information

Inpatient encounter Responsible party

Sch

edu

lin

g

Reason for admission: active GI bleeding Number of available hepatic ICU beds: 2

Office staff. Scheduling staff.

Medical Recording

Ide

nti

fica

tio

n s

he

et

Pre

adm

issi

on

Demographic data: Patient’s name: Nour ahmed Age: 55 ID Number: xxxxxxx Address: Naser city. Insurance eligibility: eligible. Predicted length of stay: physician's decision. Authorizations: Egyptian MOH

Admin staff.

Au

tho

riza

tio

n

Reg

istr

atio

n

Verify information: by ID Bed assignment: ICU, bed no. 4. Identification bracelet: issued.

Medical Recording

Pro

ble

m l

ist

(dia

gn

osi

s) G

ener

al d

ata History

Chronic Back pain on large doses of aspirin Heavy smoker for 15 years Diabetic for 10 years

Medical staff.

Ass

essm

ent Examination

Severe GI bleeding = hematemesis and melena Patient vitally stable No chronic liver diseases.

Co

nsu

lt

Provisional diagnosis bleeding peptic ulcer

Medical Recording

Pro

ble

m l

ist

(ma

na

ge

me

nt)

Inv

esti

gati

on

Laboratory CBC, Blood group. PT,PTT & INR LFTs & KFTs Glucose level.

Radiology Plain X-ray. Pelvi-abdominal ultrasound

Medical staff. T

reat

men

t Management Egret upper endoscopy Antibleeding measures Stop aspirin and NSAIDs

Fo

llo

w u

p

Care Vital signs / 2 hours. Regular investigations. Insure drugs intake.

Dis

char

ge

3 days after controlling of the bleeding.

Medical Recording

Me

dic

al

reco

din

g a

nd

re

sult

s

D.

Chronic drug induced peptic ulcer Consultant

Lab

CBC = Anemia Blood group = O+ PT,PTT & INR = 1.7

LFTs = normal KFTs = normal GL level = elevated

Lab. Technician

Rad

Plain X-ray. = free Pelvi-abdominal ultrasound = fatty liver

Radiologist

Pro

ced

ure

s

Diagnostic & therapeutic Endoscopy = Chronic active bleeding prepyloric peptic ulcer injected by ethanolamine

Endoscopist M

edic

atio

ns Controloc 40 mg vial every 8 h

Sandostatine amp sc every 8 h Rocephine 2 gm vial for 10 days 2 units of packed RBCS & FFP daily

Physicians

Fo

llo

w u

p

Vital signs / 2 hours. Enema / 12 h. Regular investigations.

Nurses

Medical Recording

Dis

cha

rge

in

stru

ctio

ns

a

nd

su

mm

ary

Dis

char

ge

Stop aspirin & NSAIDs intake Re endoscopy after one month Strict follow of medications.

Nour Ahmed, 55 years old, presented with a GI bleeding due to PU. He was admitted to hepatic ICU & was subjected to full medical assessment & subjected to complete management & had endoscopic intervention & a follow up schedule.

Medical records

Medical Recording

Workflow of real-life case in Nasser Institute Hospital

1- Emergency workflow :

2- Blood transfusion workflow :

3- Lab investigations workflow :

Medical Recording

4- Imaging workflow :

5- GI endoscopy workflow :

6- Medications workflow :

7- Discharge workflow :

Medical Recording

The workflow represents system integration:

Administration where the data of the patient is recorded.

Out-patient clinics for patient case assessment and examination.

In-patient departments to make any interventions or admission.

Lab. & Radio. if it requested according to patient needs.

Pharmacy as patient will get his medications.

Finance where patient will pay and get report.

This process done automatically through the new system using data to make the patient`s electronic file which is sent electronically to the different parts in second

Medical Recording

Reporting procedure at Endoscopy unit in Nasser Institute Hospital

Procedure : Shape a single final endoscopic report

contains the all patient required medical information.

Work flow

Secretary

Assessment

Nurse

Consultant

doctor

Resident

doctor

urseN

Medical Recording

Secretary by writing patient basic data and Registration

medical report data and print it.

Assessment nurse by video recording & taking Documentation

he endoscopic procedure.pictures of t

Consultant doctor by operating the endoscopic procedure Diagnosis

and select medical report data.

Resident doctor by observing procedure steps, report Supervision

writing & choose report pictures.

Nurse eport data and by reviews r Conformation

delivers it to the patient.

Medical Recording

Conclusion

CONCLUSION

Automation of Nasser Institute Hospital is a multi-stage

process requiring accurate planning and on-time performance.

The hospital automation will add much to the effectiveness and

efficiency of the hospital management.

Information Technology is of great importance in modern

management of hospitals and is totally advisable to any hospital to

be fully automated. It is important to remember that complete

automation of the hospital is not the end of the road, as the future

carries more advances and promises for the science of Health-

care Management Information System (HMIS).

Thank You