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:
- To study the existing Hospital Information System
in the medical records department.
- To identify the shortcomings, if any, in the existing
Hospital Information System in the Medical Records
Department.
- 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
- OP and IP Statistics
- Death cases
- Left against Medical Advise (LAMA) cases
- Long standing cases
- 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
- Donald KW. Management of Information Systems –
A hand book for Modern managers, The Free Press,
Collier; Mac Millan Publishers, London: 1982; 266.
- Damen W, Kilsdonk A, Vander WA. Information
Networks, Hospital Management, Sterling
Publications Ltd., Netherlands, 1991; 568.
- Goel SL. Health Care Systems & Management,
Vol. III, Deep & Deep Publication Pvt. Ltd., New
Delhi. 2001; 223:232.
- Dutt S, Ghei P. Patient Information System in India.
Hospital Administration. 1986; XXIII (4):
- Banoub N, Gerlach W, Cost Control By tilisation,
International Hospital Federation London, 1990; 54-58.
- 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.
- 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.
- Agozzino F, Appropriateness of admission and
hospitalization days in a specialist Hospital PMID:
11414101 (Pub Med) March-April 2001; 121-127.
- American Hospital Association, The Hospital
Admitting Department, 2nd Edition, American
Hospital Publishing Inc. 1986; 102.
- Sahni A. Computer Applications in Hospitals,
Medical & Health Care; an update. Bangalore,
Karnataka. 162.
- 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
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:
- To study the existing Hospital Information System in the medical records department.
- To identify the shortcomings, if any, in the existing Hospital Information System in the Medical Records Department.
- 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
- OP and IP Statistics
- Death cases
- Left against Medical Advise (LAMA) cases
- Long standing cases
- 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
- Donald KW. Management of Information Systems – A hand book for Modern managers, The Free Press, Collier; Mac Millan Publishers, London: 1982; 266.
- Damen W, Kilsdonk A, Vander WA. Information Networks, Hospital Management, Sterling Publications Ltd., Netherlands, 1991; 568.
- Goel SL. Health Care Systems & Management, Vol. III, Deep & Deep Publication Pvt. Ltd., New Delhi. 2001; 223:232.
- Dutt S, Ghei P. Patient Information System in India. Hospital Administration. 1986; XXIII (4):
- Banoub N, Gerlach W, Cost Control By tilisation, International Hospital Federation London, 1990; 54-58.
- 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.
- 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.
- Agozzino F, Appropriateness of admission and hospitalization days in a specialist Hospital PMID: 11414101 (Pub Med) March-April 2001; 121-127.
- American Hospital Association, The Hospital Admitting Department, 2nd Edition, American Hospital Publishing Inc. 1986; 102.
- Sahni A. Computer Applications in Hospitals, Medical & Health Care; an update. Bangalore, Karnataka. 162.
- 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