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Hospital Management Information System plays an important role in Information
processing in health care. It is the system used for the benefit of the hospital in which date are
coherently stored in a database, from where they are put at the disposal of authorized users at
the place and at the time the data are required, in a format adapted to the specific needs of the
users. It has many advantages such as faster access, storage and retrieval of data, cost effective,
user friendly, more secure and involve less manpower. Hospital Management information system
(HMIS) is indispensable for any hospital for strategic planning, programming, budgeting, financial
resource allocation, maintaining patients' record, personnel development, distribution and
management of equipment, supplies, drugs and supervision of the services. The present paper
reports Hospital Management Information System (HMIS) adopted in Sri Venkateswara Institute
of Medical Sciences (SVIMS), a tertiary care hospital, rendering medicare in Rayalaseema
region, backward region of Andhra Pradesh.


SVIMS is functioning since 1993. Its main aim is to provide Super Specialty facilities with
nominal cost to the poor. This institute by an Act of A.P. State Legislature became a University in
1995. SVIMS render patient care to people of Rayalaseema region in particular and neighboring
states in general. The major objectives of SVIMS include patient care and training in advanced
medical sciences and technology through various courses. Total computer automation of patient
care has been implemented in this institution for the first time in our Country. As per the UGC act
Section 12 (B) of 1956, SVIMS University is included in the list of Universities to get financial aid.
Free surgeries are being done under  !!
"#!$%. The following departments are rendering their services for the public :
Cardiology, Cardiothoracic Surgery, Neurology, Neurosurgery, Nephrology, Urology,
Endocrinology, Nuclear Medicine, Gastroenterology, General Medicine, Oncology,
Anesthesiology, Pathology, Biochemistry, Microbiology, Radiology, Transfusion Medicine,
Physiotherapy and Dietetics.

 


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The Information tools consists of Operating System, Networking(cat-3 cables) and
nodes(Hardware); Application software, Developing menus, server ( Pentium II 350 MHZ, 128 MB
RAM) Specialix Cards ,Line Drivers, Multi Language Terminals, Printers, Unix Network ,SCO
Open Server and Fox Base (Software).
The HMIS is used for Administration, Academic Activities and Patient Care. In
Administration and Academic activities, HMIS is utilized for correspondence, documentation,
maintaining payrolls & budgetary allocations etc.
In patient care, HMIS is utilized for registration, Billing, Diagnostic reports, Maintenance
of Stock and issue of indents, Patient status and discharge summary sheet. Out-Patient is
received in the OPD Block, registered and counseled to contact particular department depending
on their complaints. Consultant in particular OP attends the patients, advice and direct to
laboratories if further investigations are necessary. After reporting of results, the patient is asked
to re-consult the consultant. If further investigations are required he/she will be admitted in the
concerned departments. According to the clinical status of patient he/she may be transferred to
another department through transfer-in and transfer-out. Medicines, surgical and general items
whenever required in the ward are done through raising the Indent by In charge Nurse as indent
form. Based on the requirement of the particular department required items are delivered in the
Pharmacy after documentation. Results of Particular investigations will be sent by the particular
laboratory to the concerned department after entering into the terminal and the result can be
displayed in the department itself. At the time of discharge, the Patient will be provided discharge
summary sheet containing details of procedure s, mode of treatment, and list of medicines to be
administered. Services rendered for patient care is billed in the billing section. After treatment
Patients will be discharged and advised the mode of medication.
Adequate measures are taken to ensure security and confidentiality such as restricted
permission for documents to enable utilization by authorized users. Hospital information is stored
in tapes daily and weekly to avoid loss of data. Many of the problems surface due to mishandling
and lack of computer literacy among users.
The only disadvantage of this system is images cannot be transferred. The HMIS used in
SVIMS is cost effective, user friendly and suitable at tertiary care in developing countries like
INDIA.
Promotion of computer literacy among health care personal and updating with modern
infrastructure are essential for effective utilization of existing system in future applications, which
involves huge funding and patronage of Government.

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Healthcare problems have haunted human society since the time immemorial. Social and
economic gains of society have direct bearing on the status of the people. Cultural progress
depends upon the recognition and elimination of health problems. Health, therefore, is a major
ingredient of public welfare. Health is wealth: Good health in any community is possible only
when sufficient infrastructure, healthcare facilities and patient care services are ensured.
Despite the fact European and western countries transformed their manual health information
management systems including medical records into Information Technology, however, in third world,
the dependence on manual recording is still being continued and it is going to stay for some time. It is
an imperative to all the health care professionals to be fully acquainted with value and importance of
medical record maintenance and their utility in patient care, medical education, research, legal,
insurance and third party payments etc. In the process of computerization, the medical and nursing
staff have to be aware of the skills of entering information into the computer, brose for the reports and
act for the alert messages promptly. The physicians and nurses will play a very important role in
completing the information as required by the designed formats and also be able to identify the
lacunas, which inhibits to provide complete and appropriate information. The impact of the computers
had touched all the fields and unexceptionable to the field of Medicine. The CPR could emerge
because of advancement of the computers and communication. A computer-based patient record
(CPR) can be defined as an electronic medical record that includes all health information about an
individual throughout his or her lifetime, including all care provided at all sites of care in all media. A
CPR system includes the process and functionality to allow collection of this information and its
integration with knowledge base to create decision support mechanisms, alerts, reminders, and other
aids to clinical decision-making. The major value of a CPR is the availability of electronically stored
information online for access to the network users.

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Medical record is an orderly written document encompassing the patient's identification,
health history, physical examination findings, laboratory reports, treatment, surgical procedure
reports and hospital course. When complete, the record should contain the data to justify
investigations, diagnosis, treatment, and length of stay, results of care and future course of
action". Thus, it becomes a tool :

To provide a means of communication among physicians, nurses and other allied health
care professionals
To provide Continuity of patient care, help in medical education and research
To provide information for the quality review of patient care
To protect legally the physician, patient, hospital and helps in third party payment.
Failure to maintain an accurate, timely and complete medical records means the institution is
neglecting the responsibility to patients and the community as a whole. Medical Records are
valuable to patients, physicians, nurses, teachers, students, health care institutions, research
teams, national and international organizations. As a part of the hospital, Medical Records
Department is responsible for proper custody of medical records of patients, for making audits
and reports as may be necessary to demonstrate the quality and quantity of work done for
assisting in advancement of medical science through accurately recorded data.

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The CPR can also be defined as "electronically maintained repository about an
individual's lifetime health (from birth to death) information that includes status and treatment
received. The CPR replaces the paper medical record as the primary source of information for
healthcare delivery. It is seen as a virtual compilation of health data about a person across a
lifetime, including facts, observations, interpretations, plans, actions and outcomes. The CPR is
supported by a system that captures, stores, processes, communicates, secures and presents
information from multiple incongruent locations as required". Some of major advantages are:
convenient, facilitates remote access, health information is more organized and easier to read
compared to paper patient record, allows simultaneous access, improve the efficiency of
processes such as data collection, data management and data retrieval besides storing of
enormous data, analysis and production of outcome with a press of button.

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The process of implementing CPR is an art for which a master plan has to be drawn,
includes formation of committee, process of decision-making and implementation. The CPR
implementation committee has to be formed with the Director of Institution or selected personal
as the Chairman and Medical Record Administrator as the Project Coordinator with the following
members.

1. Physicians from Medicine, Surgical, Pediatrics Obstetrics and Gynecology.


2. Heads of Departments of Radiology, Laboratory, Nursing, and any other depending on
the institutions.
3. Hardware Engineers
4. System Analyst
5. System Programmers
A viable CPR to be developed that would meet the needs of health institutions, moreover,
it should secure information and protect confidentiality. In order to succeed in that direction the
following Systems Analysis and Design Processes have to be adopted which include the
following:

  


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System Analysis and Design is the process of examining the business situation with an
aim to improve it to better procedures and methods which includes the following: This is
particularly very much relevant in the healthcare field where the developed system is used for
patient care with life and death issues.

1. System Analysis
2. System Designing
3. System Programming
4. System Testing
5. System Implementation
6. System Evaluation
V. System Training

%
% is the process of collecting organizing and evaluating facts about information
system requirements and the environment in which the system will operate.

%&,, is the creative, technical process of converting information system


requirements into a detailed set of specifications for the new systems. System Designing
includes; Forms, Data, and Data flow designing. Hipo Charts are hierarchical Input Process,
Output chart. HIPO charts are also graphic diagrams, which are very effective for documenting of
system. System security designing is one of the important elements to avoid unauthorized user
access as the patient records and information is confidential.

%,, is to select appropriate software and hardware in the first step. The
software dictate the requirement of the hardware.

% ,is the critical process for the program development. The objective of the
system testing is to prove that there are no errors in the program. The following are to be included
as part of System Testing such as System Objectives, Input forms and procedures, Output
Reports

%! There are three types of implementation such as: Phase by phase
implementation, total implementation and parallel implementation.

%$ is one of the important tasks to be performed after the implementation


phase. There are three types of evaluation, they are: Top-down begins with high level, Middle-out
- begins somewhere in the middle of the system and Bottom-up evaluation begins with the
detailed modules of the system an proceeds to look at higher level modules of greater
aggregation.

% , Success of any system is on hands of the end users. As part of CPR
implementation, the training to the end users should be given.

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Conventionally, the role of the health care professionals have been mainly to provide
patient care services perform research studies and to administer the organization. Hence one has
to spend two-third of his time in collecting the manual patient care information to perform the
above said functions effectively. The new role, will be quite different in terms of management of
patient care. The availability of online health care information and the flexibility of sharing the
patient care data can, and to cross-referencing the patient CPR information available globally
would strengthen the health care professionals in rendering swift safe and accurate patient care
at moderate health care cost. However, the health care professionals have to acquaint
themselves with the Information Technology through continuing education on IT to exploit the
amenities of the CPR to utilize the health information maximum to provide best possible health
care and to control the health care cost that would benefit the nation and achieve the WHO goal
of "HEALTH CARE FOR ALL".

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Although we meticulously approach to develop the CPR, in a very systematic way taking
into every possible constraints and consideration to evolve, a friendly user system that would
facilitate end users with ease. Despite all efforts, certain issues required to be evaluated and
addressed to avoid: later problems such as :

Many senior staff are accustomed with the written data, would hesitate to deal with the mouse
cursor facing the screen and they may fee uncomfortable to document as most of the patient
information are to selected from the available list instead of writing as free text.
The software consultant should not depend on one particular physician exclusively for
developing the software.
There is a need to for concurrent checking as it forbids retrospective evaluation.
Sound to be incorporated in MPI to offset various spelling mistakes.
Training to all the staff to be proficient with the operational system.
Besides one-computer maintenance person, one MRD staff with computer programming
background required to work as standby.
Hand held computers have to be properly planned, convenient to the users such as physician,
surgeons, nurses, paramedics, so that is strain free and end users able to work properly.
It is advisable to have forms content, data-exchange, and vocabulary standards, that are
necessary for transmitting complete or partial patient records, and that they are essential to
the aggregation of information from many sources, either for longitudinal records for individual
patients or for databases of secondary records to be used for research purposes.

Training, educating and validating are on ongoing process. Computer literacy varies in
most departments, so plan to train and retrain. Attitude is a major factor in this process. If your
staff is excited about the conversion, their attitude will spread to other users, thus enhancing the
acceptance of the system. Implementing an information system is a challenge, however, the
benefits far outweigh the difficulty of installing it and the great benefactor is the patient.

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1. Role of Health Information for Care for Cost, Quality Assurance - published as poster in
13th International Health Record Congress, October -2000, Australia.
2. Implementing Paperless Medical Record System- by Dr. G.D. Mogli, IHRIM Journal,
March, 03, UK.
3. Chapter - 9 of Medical Record Organization & Management - Computerization of Medical
Record Systems by Dr. G.D. Mogli, Jaypee Medical Publishers, India.
4. Role of Medical Records in Quality Nursing Services - By Dr G.D. Mogli, Oman Nursing
Journal, July 2004.