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Journal of the Academy of Hospital Administration

A STUDY OF THE HOSPITAL INFORMATION SYSTEM (HIS) IN THE MEDICAL RECORDS DEPARTMENT OF A TERTIARY TEACHING HOSPITAL

Author(s): Praveen Kumar A, Gomes L.A.

Vol. 18, No. 1 (2006-01 - 2006-12)

Praveen Kumar A(1), Gomes L.A.(2)

Key Words: Hospital Information System, Medical Records Department, Computerization

ABSTRACT

Hospital Information System (HIS) is vital to decision making and plays a crucial role in the success of the organization. Computerization of the medical records and documentation has resulted in efficient data management and information dissemination for the users. Managers, Clinicians and other healthcare workers can now access the information without delay or errors. Present study reveals, the existing system requires up gradation to meet the requirements of the managers and the clinicians. Participants feel HIS assists in decision making, and medical audit. Participants felt that the existing HIS resulted in longer time for OPD consultation and delay in investigation results. Majority of the participants feel that HIS helps in education and research.

INTRODUCTION

Over the last few decades, medical sciences have made great strides leading to radical improvements in the modes of investigations, therapeutic activities and surgical procedures. This has enhanced the imperative need to have authentic and accurate medical records.

Every department and subsystems in an institution can be viewed basically as an information-processing agency. The Medical Records Department (MRD) is no exception. It is not a place where patient charts, complete or incomplete, are dumped and forgotten thereafter. The administration can actively use this department for monitoring and controlling the quality of patient care; in assessing of the performance of the medical staff; in keeping check on how some of the hospital’s resources are being put to use; and in gathering data for short term and long term decisions.

Most of the present Medical Records Departments have been changed into departments of hospital information management in order to take up responsibilities to function more effectively and efficiently in this regard. This new drift will support the need for an improved Hospital Information System making the Medical Records Department the main source of health information. It is no doubt that a carefully planned Hospital Information System and intelligently used information will be a great asset to any health care industry. The Hospital Information managers must have the necessary skills to facilitate and manage this transition and bridge the gap in the changing patterns switch over to 21st century.

Statement of the Problem:

A study of Medical Records Department of a tertiary care teaching hospital with special reference to the Hospital Information System.

Objectives:

  1. To study the existing Hospital Information System in the medical records department.
  2. To identify the shortcomings, if any, in the existing Hospital Information System in the Medical Records Department.
  3. To suggest the necessary steps to improve the existing Hospital Information System in the Medical Records Department.

Methodology:

The study was conducted in 1200 bedded tertiary care teaching hospital. The Medical Records Department of the hospital was studied for assessing the Hospital Information System. Descriptive research approach as adopted for this study. Descriptive statistics have been used to find out the deficiencies, if any, in the existing Hospital Information System. The target population consisted of managers, doctors and patients in the hospital. The data were collected from a sample of 60, consisting of 10 managerial heads, 20 doctors and 30 patients selected by the disproportionate stratified sampling technique. The inclusive criteria for selecting the sample, were the managers who involved in decision making process, doctors with experience of more than one year, and the computer literate patients, willing to participate in the study.

The tool used to collect the data was a structured, closed ended questionnaire. The questionnaire was constructed with emphasis on the content, clarity and simple language. The scoring for the managers and the doctors has been done on a four-point scale and the scoring for the patients is on a three-point scale. The scoring has been given according to the nature of the questions.

A pilot study was conducted for the patients, to check the validity and feasibility of the study. The tool was administered to subjects, for ascertaining the reliability. The reliability calculated by using split method r = 0.73, 0.86 and 0.76, for managers, doctors an the patients respectively, which was high and satisfactory.

Observation & Discussion:

It was observed that decentralizaed filing system is being followed in the Medical Records Department of the teritary care hospital i.e. the department is divided into two units – Out Patient (OP) and In-Patient (IP) MRD.

The other information available to the hospital management include

  1. OP and IP Statistics
  2. Death cases
  3. Left against Medical Advise (LAMA) cases
  4. Long standing cases
  5. Cash and Collection reporting

Structured questionnaires were used to find out the deficiencies in the existing system. The various studies conducted earlier, shows the importance of Management Information System (MIS) in an organization. It lays emphasis on the nature of the modern organization, the current legal and social environment; advancing technology and the expanding role of management that have created information needs which cannot be satisfied by traditional means. A closer examination of these four areas will reveal the demand for more sophisticated management information1.

Table – 1 Opinion about the existing Hospital Information System

Category
(n=60)
Response
Good Moderate Poor Total
Managers 7(70%) 3(30%) 10
Doctors 16(80%) 4(20%) 20
Patients 25(87%) 5(13%) 30
Totalresponse(%) 48(80%) 12(20%) 60

This hospital does not have a separate admission department and all the registration and admission procedures are through the Medical Records Department. The Medical Records Department is partially computerized. In addition, an in-hour Hospital Information System exists in this hospital.

The study reveals that the department is providing information to the health authorities regularly. The overall opinion of the managers, doctors and patients about the existing Hospital Information System in the hospital is satisfactory (80%) and 20% feel that the system is poor. (Table-1)

Table – 2 Opinion about the existing Hospital Information System

Role of HIS in Manager’s responses regarding the existing system
Strongly
Agree
Agree Disagree Strongly
disagree
Decision making 5 (50%) 4 (40%) 1 (10%)
Utilization of resources 4 (40%) 6 (60%)
Enhances communication 2 (20%) 4 (40%) 4 (40%)
Strategic planning 4 (40%) 3 (30%) 3 (30%)
Quality assurance 2 (20%) 8 (80%)
Reduces waiting time 4 (40%) 6 (60%)
Utilization process 1 (10%) 4 (40%) 3 (30%) 2 (20%)
Medical audit 2 (20%) 5 (50%) 3 (30%)
Role of HIS Doctor’s responses regarding the existing system
Strongly
Agree
Agree Disagree Strongly
disagree
Reduces the cost 2 (10%) 5 (25%) 13 (65%)
Shorten the stay 3 (15%) 13 (65%) 4 (20%)
Continuity of patient care 2 (10%) 3 (15%) 15 (75%)
Effective referral system 1 (5%) 6 (30%) 12 (69%) 1 (5%)

The purpose of the Hospital Information System is to raise “managing” from the level of piecemeal spotty information, intuitive guesswork and isolated problem solving to the level of systems insight, systems information and systems problem solving. It is, thus, a powerful method for aiding administrators in solving and making decisions2.

However, it was found that the majority of the managers (70%), disagree with the statement that the HIS of the hospital helps in discharging effectively their managerial responsibilities as well as in enhancing the inter and intra hospital communication (80%) Half of the managerial heads (50%) agree that the statistical information from the Medical Records Department helps in decisionmaking. With an increase in the number of third party payer’s utilization requirements, the admitting and utilization management are in frequent communication3.

The majority of the managers (80%) agree that the existing Hospital Information System does not help in the Quality Assurance Programme (QAP) as well as in enhancing the functions of the supportive services. Half of the managerial heads agree that the Hospital Information System does not help as a tool in the various utilization processes.

The various studies conducted earlier regarding information system reveals the benefits for doctors and nurses and includes, qualitatively better data, more available data on patients, direct consultations of colleagues and experts, use of decision based systems, reduced work load, the gain of time, and the availability of administrative support4.

Majority of the doctors do not believe that the existing Hospital Information System can help to reduce the cost of patient care (65%) or shorten the stay of the patient in the hospital (65%)5. (Table-2).

Table 3 – Disadvantages of the existing Hospital Information System – HIS

Disadvantages of existing
Hospital Information System
Doctor’s responses regarding the existing system
Strongly
Agree
Agree Disagree Strongly
disagree
Non-Existence of ward
Computers is affecting
patient care
17 (85%) 3 (15%)
OPD consultations take
longer time
16 (80%) 1 (5%) 3 (15%)
Delay in getting
longer time
1 (5%) 14 (70%) 5 (25%)

The majority of the doctors (85%) feel that the nonexistence of ward computers is a hinderance in providing the expected patient care. They also feel that the existing Hospital Information System does not help either in making the OPD consultations quicker or in generating quick laboratory reports6. (Table-3)

Table – 4. Opinion about current HIS with respect to Internal and Personnel Performance

Internal Performance of the Hospital Doctor’s responses regarding the existing system
Strongly
Agree
Agree Disagree Strongly
disagree
Infection Control 7 (35%) 12 (60%) 1 (5%)
Defining Community needs 2 (10%) 14 (70%) 4 (20%)

Majority of the doctors disagree that the Hospital Information System helps in infection control (65%) and in defining the community needs (90%). Majority of them agree that the Hospital Information System helps in education and research (60%)7.

The different benefits of information system to the community are, to prepare a programme of health education for the area (with priorities for the health activities), information on the indicators of health which can help to focus attention on target group for specific health services, and, help to prevent epidemics8,9.

CONCLUSION

The present scenario in India is that most of the Medical Records Department are partially computerized10. This system exists in some Health Care facilities, where entries are made by different Health care providers, such as Physicians, Nurses and therapists, into the computer in different nodes in a local area network. The survey conducted in the hospital reveals the importance of information networking between the departments. Majority of the beneficiaries of Hospital Information System, are aware about the advantages of computerisation in the HIS in providing better health care. All of them agree that only in an efficient system the information can be readily available. The exciting possibility of a modern and computerised information system is not too far. In the coming years we can visualize the patient record existing in electronic medium, where a patient can have a single record from birth to death that can be assessed from any where in the world11.

REFERENCES

  1. Donald KW. Management of Information Systems – A hand book for Modern managers, The Free Press, Collier; Mac Millan Publishers, London: 1982; 266.
  2. Damen W, Kilsdonk A, Vander WA. Information Networks, Hospital Management, Sterling Publications Ltd., Netherlands, 1991; 568.
  3. Goel SL. Health Care Systems & Management, Vol. III, Deep & Deep Publication Pvt. Ltd., New Delhi. 2001; 223:232.
  4. Dutt S, Ghei P. Patient Information System in India. Hospital Administration. 1986; XXIII (4):
  5. Banoub N, Gerlach W, Cost Control By tilisation, International Hospital Federation London, 1990; 54-58.
  6. Kipatrick ES, Holding S, Use of computer terminals on wards to access emergency test results: a retrospective audit. Br Med J 2001; 322: 1101-3.
  7. Mogli GD. Methods of Patient care Evaluation, MEDREC-2002, National Workshop on Challenges of Medical Record Professional in Effective Hospital Management, May 2002, Madras Medical Mission, Chennai.
  8. Agozzino F, Appropriateness of admission and hospitalization days in a specialist Hospital PMID: 11414101 (Pub Med) March-April 2001; 121-127.
  9. American Hospital Association, The Hospital Admitting Department, 2nd Edition, American Hospital Publishing Inc. 1986; 102.
  10. Sahni A. Computer Applications in Hospitals, Medical & Health Care; an update. Bangalore, Karnataka. 162.
  11. Huffman KE. Medical Record Managem ent. 9th Edition, Physician Record Company, Illinois, 1990.

(1) Praveen Kumar A is Hospital Administrator, Lakeshore Hospital & Research Centre Ltd., Maradu, Nettoor P.O. -Kochi-682 304
(2) Gomes L.A. is Assistant Professor & Deputy M.S., Lakeshore Hospital & Research Centre Ltd., Maradu, Nettoor P.O. – Kochi - 682 304
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