The main objective of this study is to evaluate hospital information systems (HIS) acceptance and satisfaction, through exploring the influential factors that might increase or decrease acceptance and satisfaction levels among different healthcare professionals, in order to provide solutions for successful HIS implementation. METHODS: The study used objective quantitative survey methods to collect data directly from different types of HIS users. The questionnaire included five sections; a demographic user information section, a general HIS assessment section, a section about accessibility and availability of computers, a section about HIS and patient care and a section about satisfaction with HIS. RESULTS: The availability of computers in the hospital was one of the most influential factors, with a special emphasis on the availability of laptop computers and computers on wheels to facilitate direct and immediate data entry and information retrieval processes when healthcare professionals are at the point of care. Users believed that HIS might frequently slow down the process of care delivery and increase the time spent by patients inside the hospital especially during slow performance and responsiveness phases. RECOMMENDATIONS: Three main areasshowed improvement potential; system performance, organizational support and users’feedback. Improving the performance of the HIS is very crucial for its success, in addition to increasing the availability of computersat the point of care. User friendliness and new innovative methods for data entry, such as automated voice recognition,can improve the workload and enhance information quality. Organizational support is very crucial, through providing training, dedicated and protected time during working hours for users to learn and practice on HIS. Better and more reliable channels of communication and feedback are needed to consider users’ complaints, suggestions and contribution.
The Client: a 350 - beds multispecialty hospital in Cochin, serving more than 800 out patients per day.
The Need: The client hospital has always had a commitment to quality with a strong infrastructure in place to support improvement efforts. However, it did not have a systemic way to make sense of all the information that can contribute to improved quality and reduced waiting times. The hospital management recognized that the information it needed for improvements was buried in a pile of paperwork, which it couldn’t possibly keep up with. Their existing MRD area, where they kept their medical records exceeded the space limit and they couldn’t afford to find an additional space for keeping new records. Keeping this in mind, the client has approached us to identify a solution that would help them.
Facts Found in the Initial Study:
- The client's existing MRD area, exceeded the space limit and they couldn’t afford to find an additional space for keeping new records
- 2000 square feet area was allotted for MRD in the ground floor
- 200000 medical records were required to be scanned prior to EMR implementation
- Management wasn’t receiving any information on the percentage of prescriptions realized in Pharmacy.
- Hospital Pharmacy stores witnessed hectic patient traffic. Long queues and endless waiting led to frustrated people going out to local pharmacy shops to purchase their medicines
- Patient records never reached Doctor’s consultation rooms on time. Sometimes it took almost one hour or more to get these files from MRD. Most of the times doctors moved on to the next patient after wasting considerable time waiting for a record. This has created issues in patient token sequences leading to patient disputes and dissatisfaction.
- Lab results, though ready on time, would not reach the doctors’ room before the morning consultation ends. This has caused delayed diagnosis and treatment decisions, leading to patients waiting till the evening session to get their prescriptions.
- No control or tracking system for reagents used in the Laboratory
- No stock record or control over the consumables used in nursing stations and operating theatres
- Expired medicines in nursing stations caused financial loss to the hospital. In the previous year, INR 6 million worth medicines were written off because there was no system to trace the list of medicines that were reaching the expiry.
The client wanted to find a way to decrease the delay that occurred between an event and the actions taken to prevent future events. After careful consideration of all the above said facts and gap analysis made by our team, we’ve implemented MEDIWARE Hospital Management System in the hospital during the year 2004.
Reduced costs, higher revenue!
MEDIWARE AT WORK: Profits from Pharmacy
The conversion to e-Prescribing has been smooth and pain- less for the hospital. Users came up to speed quickly, and the practice began to immediately benefit from the efficiencies, mobility and deep feature set by the new system. Patients are better served at pharmacies. The impact on bottom line productivity has been impressive, quickly ramping up to significantly higher levels of general productivity and profitability.
- New online prescriptions and token management system in Pharmacy department itself generated 0.7 million additional revenue per month. Additional revenue per year is 8.4 millions!
- Loss due to expired medicines reduced to Rs.22000 as against INR 6 millions in previous year. Revenue increased by 20%
- Pharmacy inventory reduced by 20% by monitoring prescription realization of each specialty and each doctor.
- Through online prescriptions, Pharmacy staff are able to see prescriptions online and get the medicines ready before the patient reaches the counter. This has tremendously reduced the patient waiting in Pharmacy department.
MEDIWARE AT WORK: Profit from the laboratory
- Implementation of Mediware Lab Equipment Interface has enabled the systems to have better control and monitoring over lab reagents’ usage. With the new control mechanism, all re-tests and unbilled tests are traceable while capturing the direct output from the equipment. Reagent purchase reduced by 10%
- By going digital, the hospital has saved INR 1.25 million worth stationary consumed for lab result printings (1000 sheets a day i.e. Rs 4000 per day Rs 24000 per week Rs.1.25 million a year). Stationary purchases reduced by 10%
MEDIWARE AT MRD: Profits & Benefits
The security and redundancy in storing those electronic records to MEDIWARE eliminated the need for filing and storing paper records. Reports and other documents related to a particular patient or encounter are now scanned and attached to the record.
- As the hospital has turned paperless, the 1000 square feet space that was consumed by the MRD department is now renovated as Orthopedic and IT departments. The 1000 square feet space saved in terms of real estate cost in a metro city like Cochin is a pretty awesome amount and this stands out as an example to anyone worrying about a costly expansion to their hospital.
- As there is no question of delay in lab and radiology results reaching OP consultation rooms, patients are able to finish the consultation at once and leave home early.
- With Mediware’s Doctor’s desk module in place, discharge summary preparation is just a compilation of data that has already been entered into the system. Doctors are able to provide summary faster and this saves everyone’s time.
ULTIMATELY MEDIWARE HELPED THEM ACHIEVE:
- CONSISTENCY AND IMPROVED QUALITY IN PATIENT CARE
- REMARKABLE COST REDUCTION IN MULTIPLE AREAS
- TREMENDOUS INCREASE IN PROFIT LEVELS IN MULTIPLE AREAS
- ELIMINATION OF PHARMACY PILFERAGES & WASTAGE
- REDUCED STORAGE SPACE CONSUMPTION
- INCREASED COMMUNICATION BETWEEN DEPARTMENTS AND EMPLOYEES
- REDUCED POSSIBILITY OF HUMAN ERRORS
- AVOIDANCE OF COSTLY MEDICAL MISTAKES
- FASTER SERVICES AND IMPROVED PATIENT SATISFACTION
- EFFICIENT SYSTEMS AND INCREASED CAPABILITY TO HANDLE MORE PATIENTS
With the same human resources, facilities, space and time the hospital is now proudly handling 1500 outpatients per day. The revenue growth from this alone is 100% as compared to pre- HIS implementation period.
ROI (RETURN ON INVESTMENT)
Over a period of 16 months, the hospital has recovered the investment of INR 12 million towards the hardware and software purchase. After the full ROI (return on investment), they enjoy INR 6 millions as profit gained every year from Mediware’s efficient systems in place. As the infrastructure grows, the cascading effect of the software implementation will reap them more profits.