HOSPITAL INFORMATION SYSTEM IN MEDICARE

- AN EXPERIENCE AT TATA MAIN HOSPITAL, JAMSHEDPUR

Mohanty Rajesh*, Rana Sarosh D**, Kolay Saroj K***

ABSTRACT

Hospitals are the key institutions in providing relief against sickness and disease. They have become an
integral part of the comprehensive health services in India, both curative and preventive. Significant
progress has been made in improving their efficiency and operations.

Effectiveness of a health institution - hospitals or nursing homes, depends on its goals and objectives, its
strategic location, soundness of its operations, and efficiency of its management systems. The
administrator's effectiveness depends upon the efficiency with which he is able to achieve the goals
and objectives. Some of the major factors determining the effectiveness of a health institution includes
patient care management and patient satisfaction.

Hospitals are very expensive to build and to operate. Administrators and professionals have to be
extremely cost conscious. Effective computerised systems and procedures need to be implemented to
ensure proper utilisation of limited resources toward quality health care. It becomes even more important
when an in-house medical facility is provided by an industry for it’s employees, as is the case for Tata
Steel.

Patient care management in Tata Steel has fully utilised the power of computers in Medicare, whereby
network of integrated systems maintaining patient database for the hospital services in the areas of
Pathology, Radiology, Medical Research, In-patient Admissions and Billing, Medical Stores & Pharmacy
are operational. The implementation of the above modules have evolved user-friendly computerised
systems which are loved and cared by all.

This paper tries to cover giving an insight to the Hospital Information system implemented at the Tata
Main Hospital, which is being fully utilised to provide quality service. The computerised system has
enabled the medics to serve their customers with a smile and to meet the corporate objective set by the
founder.

“We do not claim to be unselfish, more generous or more philanthropic than other people. But we think
we started on sound and straight forward business principles, considering the interests of the
shareholders our own, and the health and welfare of the employees the sure foundation o our prosperity”,
- JN Tata

I. INTRODUCTION local area needs the emphasis then was mainly

Tata Main Hospital (commonly known
as TMH) at Jamshedpur caters its services to
the employees (around 60,000) of Tata Steel,
their families, and dependent relations. It also
extends it’s facilities to patients coming from
in and around Jamshedpur and Associated &
Contractor company’s. TMH is a eight hundred
and thirty five bedded hospital equipped with
modern facilities and catering all specialities.
Computerisation at TMH has started in a
limited way since 1985 when standalone
systems were introduced to take care of routine
on book-keeping activities. Medicare areas
were not computerised. A need for an
integrated patient management system was felt
and a Information System Planning (ISP) study
was conducted. Since 1996 an integrated
information system have been implemented in
the areas of Pathology, Radiology, Medical
Research, Medical Stores & Pharmacy, In-
patient Admissions & Billing. On-line sharing of
information has made extension of the
existing system to ICU and wards possible,
whereby test results can be made available
on-line enabling prompt remedial action by
doctors.

* MD, Registrar, Dept of Pathology, ** MSc (Computer) Dy Manager, Information Technology System,
*** BE, Senior Divisional Manager, Information Technology System
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 Effective systems and procedures have
helped TMH administration in achieving and
fulfilling their quality objectives -
“We shall constantly strive to provide
our employees, their families and dependent
relations prompt and expert comprehensive
health care services in a customer friendly
environment”.
II. OBJECTIVES OF THE SYSTEM
TMH is a large hospital which devotes
considerable emphasis on Patient Care. The
short term objectives of the on-line
computerised system in TMH are to reduce
costs and improve the accuracy and timeliness
of patient care, accounting and administration,
record keeping, and management reporting.
The long term goal are to build and maintain a
patient database for analysis of data to
facilitate decision making process.
III. SCOPE OF THE SYSTEM
As a prelude to computerisation a
comprehensive requirement analysis study was
conducted by a team of TMH staff and IT staff
to ascertain the various needs for
computerisation. Patient Care related areas
were given priority in order to achieve the
objectives.
TMH has computerised the following
functions:
- Admissions/Discharges/Transfers
- Pathology test result information
- Radiology test with appointment
scheduling
- Special test Information system at
Medical Research
- Inventory maintenance of medicines
& other appliances
- Issue of medicines of patient
- Communications with external world
using E-mail and web technology
- Patient billing
IV. METHODOLOGY ADOPTED
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As per the ISO 9000 standards a Project
team was formed for monitoring and managing
the computerisation project on schedule. The
team comprised of Head of Departments, Key
users consisting of doctors, Accountants etc,
each from various functional areas along with
IT personnel. General Manager (Medical
Services) called sponsor set directives and
reviewed project. Technical guidance was
provided by Senior IT personnel.
The project execution methodology was
carefully designed to incorporate almost all the
essentials of comprehensive methodology of
ITS, which is an ISO 9001 certified unit. Main
emphasis is given to Joint Application
Development (JAD) where approach was
participative, user driven, highly interactive,
stress on quality, use of productive tools, phase
approach etc. Each phase end was certified by
key users, Steering Committee members, and
finally by Central Quality Assurance (CQA)
group at ITS.
V. BUSINESS PROCESS
RE-ENGINEERING (BPR)
In order to achieve the objectives
through computerisation, each functional
business process was studied and then
questioned. Radical changes were brought
about by re-engineering the processes and
simplifying the existing business procedures to
meet the needs of computerisation.
A few example of re-engineered
processes are indicated in Table -1.
VI. FUNCTIONAL COVERAGE
A brief outline of the functions covered in
various modules is given below.
Admissions/Discharges/Transfers: This
module caters to the in-patient admissions and
discharges or transfers from various wards/
cabins/ICU. Registration of casualty/
observation patients. Birth and death records
maintenance. On-line and web based enquiry
facility. Daily bed availability and monthly
Management Information System (MIS)
statistical reports.
Accounts Billing: This module caters to money
receipt generation and instant bill calculation
for paying cases. Medicine, Pathology,
Radiology, MRC charges are available on-line
for billing. Monthly generation of reports for
recovery from Tata Steel employees/Associated
and Contractor companies/Govt. Employees.
Pathology: This module caters to pathological
test request handling and consolidated result
entry. Worksheets are printed by various
sections of path lab (i.e Bio-chemistry,
Histology, clinical, haematology etc) to perform
the respective tests. 911 blood autoanalyser
has been linked with RS 6000 for data transfer
eliminating data entry and increasing data
accuracy and timeliness.
Medical Stores: This module maintains
medicine and other appliances, close
monitoring of inventory with the help of online
stock enquiry. Issues of medicines driven by
expiry of medicines and maintenance of
batch details. Analysis of movement,
consumption and indent data available with
improved vendor control supported by VED/
ABC analysis and vendor rating facility.
Pharmacy: This module caters to accounting
of medicines dispensed to patients from
counters maintained by automatic indenting
from substore. Control of medicine over dosage
and drug to drug interactions are maintained.
Statistical analysis available on drugwise/
doctorwise.
Radiology: This module caters to accounting
of X-ray films, scheduling of appointments, and
reporting of X-ray requests and result entry.
Linked with Billing module. Statistical
analysis of graphical data doctorwise/unitwise/
type of X-ray film wise utilisation versus
wastage etc.
Medical Research: This module caters to
request and result entry for special tests
conducted such as T3, T4, TSH, HIV, Hepatitis,
FSH etc. Linked with Billing module.
Statistical analysis of data patientwise/testwise
etc.
Communications: In order to extend the reach
and range of the existing facilities to the outside
world, TMH has been linked with Internet,
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Intranet and E-mail facilities. The viewing and
printing facilities of test results are available
at remote locations such as Jamadoba and West
Bokaro, also daily admissions and discharges
are available on the Tata Steel web page using
intranet facility.
Future Plan: With the existing systems having
stabilised, OPD block computerisation is
planned for the future.
VII. PATIENT CARE FOCUS
Special attention was given to meet the
quality objectives of TMH.
“We shall constantly strive to provide
our employees, their families and dependent
relations prompt and expert comprehensive
health care services in a customer friendly
environment”
A few examples are illustrated below:
- Retrieval of reference data (i.e
name, age, sex, dept) for an employee to
facilitate online printing of case sheet at the
time of admission, reducing the patient admit
time.
- On-line enquiry as well as web
based new admissions information
availability, improved customer service.
- Computer printed stickers for
blood samples eliminated any chance of
sample mixup.
- Single requisition entry for all tests
has increased time for doctors at attend to
patients.
- On request test result print/reprint
facility eliminated the patient waiting time for
report collection.
- Retrieval of past results for statistical
analysis of data such as incidence rate of
occupational hazard like asbestosis Ca lung in
workers of Tata Steel and Incidence rate of
breast cancer below 40 years of age of No false
positive or negative cases in Fine Needle
Aspiration Cytology (FNAC)
- On-line scheduling for appointments by
doctors eliminated patient waiting time.
- Early alarm system for notification on
expiry of medicines.
- Automatic declaration of medicine as
obsolete after expiry date.
- Viewing/printing facility of test results
from wards/ICU/Remote locations to effect
prompt action by doctor
- Data bank of Medical Research cases
such as records of HIV positive cases and how
many turned down to be full bloom AIDS cases
and in industrial setup the usefulness of T3,
T4, TSH in patient for better followups.
- Instant billing facility improved
customer service and revenue savings to
hospital
- Warnings during issue of medicines on
Overdose of medicines eg. Chloramphenical,
Cotrimoxazole and drug to drug interactions
eg. Chloramphenical with Cotrimoxazole etc.
avoiding any chance of adverse reactions to
patients.
- Statistical Analysis of data for proper
utilisation of resources (MIS)
- doctorwise tests conducted
- Patientwise medicines
consumed
- Counterwise load distribution
- Demographic analysis of diseases
(eg. agewise, sexwise, disease
profile, test profile etc) eg. no. of
different malignancies with
agewise, sexwise distributions, No.
of malaria positive cases, No. of
Vibrio cholerae cases etc.
On account of the user friendliness the
computerised system thus evolved were not
still-born system (not used right from the
beginning) or an orphan system (not owned by
anybody) which has helped the hospital doctors
to provide quality service to patients.
VIII. KEY PERFORMANCE
INDICATORS (KPI)
The benefits of computerisation come
from better management through informed
decision making. The Key Performance
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Indicators (KPI’s) showed remarkable
improvements after computerisation.
A few of the salient one’s are listed in
Table 2.
IX. CONCLUSION
It can thus be seen that deploying IT can
help the medical profession in improving its
quality of service and thus automatically
increasing the preparedness and
defensiveness. Of course, it is of vital
importance that the software must have the
right type of modularity and openness so that it
is manageable, maintainable and upgradable.
The hardware should also be reliable, available
and have the necessary performance capacity.
Certainly, computers with their
intrinsic power can play a major role in a
hospital. Computers can act as a communication
link between departments and allows the
common database to be shared by them. They
can perform the complex task of matching,
tabulating, calculating, retrieving, printing and
securing the data as required.
Well designed, integrated computer
system can be a great tool in the hands of the
hospital management in improving services,
controlling cost, and ensuring optimal
utilisation of facilities.
REFERENCES
1. Prabhakar A & Visweswara GH:
Datanet Corp Ltd., Bangalore: IT -
Applications in Hospitals, Computer
Applications in Hospital (ISHA), chapter
13.
2. Jain Vipul: Director Kale Consultants
Pvt Ltd. Bombay: Computers in health
care, Computer Applications in hospital
(ISHA), chapter 15.
3. C 1979 Datapro Research
Corporation, Delarn, NJ 08075, USA:
Applications overview: Medical and
Healthcare, Computer Applications in
hospital (ISHA) chapter 12.
 Table 1
Process Benefits

- Laboratory test requisition forms were reduced Improvement in doctor's

to a single format instead of three productivity

- Laboratory test results were consolidated and Reduced patient waiting time
printed on a single sheet

- Laboratory test results were printed only on Eliminating wastage of stationary

request

- On-line system extended to ICU/hospital wards Prompt medical attention

for test result viewing

- Linking 911 Blood autoanalyser with RS 6000 Accuracy and timeliness of data
where by data entry was eliminated

- Sticker printing was introduced at the time of Eliminating any possibility of mix-
registration and blood sample collection up of blood samples

- Linking RS 6000 with 1MB mainframe for Authorisation check & accurate
transfer of employee data billing

- Linking RS 6000 on-line with the Tata Steel Extending viewing & printing of
network test results at remote locations
Table - 2

Key Performance Indicator Before After Benefits

Computer Computer

- Average patient waiting 10 mins 5 mins. Reduction in patient

time at Admission waiting time

- Avg. no. of pathlab requisitions 3 nos. 1 nos. Saving of Stations

- Avg. retrieval time of pathlab test 5 mins 0.5 mins Reduction in patient
result reports waiting time
- Back log of bills 5 months nil Revenue losses
eliminated
- Medical Stores inventory 2.46 mon 1.7months Better system
availability
- Monthly closing cycle time of 3 days same day Better system
- Medical Stores Inventory availability
- Avg. monthly consumption of 14.731akhs 13.471akhs Revenue savings
Revenue

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