Health Information System Solution

Published Date: 02 Nov 2017

EXECUTIVE SUMMARY

INTRODUCTION

This report is focused on introducing the E-health (electronic health) as a hospital information system, describing it as a work system, describing the work system components and creating a work system snaphopt to illustrate and review the major elements of the E-Business system. Furthermore, the principle based system approach will be used as a tool for appraising the work system and also creating value from the information. It will also be used to evaluate the work system, consider certain ethical issues within the E-Business system.

E-BUSINESS SYSTEM: TERMS OF REFERENCE

A business organization needs a working system to achieve its goals and objectives. What is a working system? According to Steven Alter in 2002, pg 92,

"A work system is a system in which human participants and/or machines perform

Business processes using information, technologies, and other resources to produce products and/or services for internal or external customers".

It is imperative for business organizations to implore a working system framework, to increase the efficiency of their business processes which may include recruitment of staffs, ordering and supplying of products from suppliers, creating financial reports and other functions(Alter, 2002).

A System: as a set of control is a system of interrelated components working together to achieve a collective goal(Bocij, 2003). The work system involves both static and dynamic view of the operations and changes in a system over a period. The static system focuses on the work system framework which shows the tools for understanding and evaluating a work system, identifying problems, opportunities and the impacts of those changes in the business organization(Atler, 2002,pg 90).

The E-Business framework: is a subsidiary of the working system which performs and coordinates business processes using computers,communication technologies and computerized data(Alter, 2002).

E-HEALTH: it is a health system relating to information systems, health care ad business, regarding the delivery of a health care service through the use of information and communication technologies (Rodrigues, 2010, page 8).

Agent Technologies: this is an area of research in software technology, which contributes to the development of value-added information system for healthcare organizations(Rodrigues, 2010, pg 8).

INFORMATION SYSTEMS: constitute a special case of work systems in which the business processes performed and products and services produced is devoted to information (Alter, 2002, page 95)

ELECTRONIC MEDICAL RECORD(EMR): Is the medical record of patients in digital format. ELECTORONIC PATIENT RECORD(EPR): this is a health application that stores, captures, retrieves, transmits and manipulates patient-specific health data.

E-PRESCRIBING is simply an electronic way to generate prescriptions through an automated data-entry process utilizing e-prescribing software and a transmission network which links to participating pharmacies(Pennell 2009).

THE WORK SYSTEM FRAMEWORK: is the basis for describing and analyzing an IT-dependent work system in an organization. It identifies problems and opportunities, describing possible changes ad tracing how those changes might affect other parts of the work system (Siau et al, 2011).

AIM: the aim of this study is to describe the Hospital information system, explaining its work system framework. Using the principle based system analysis(PBSA) to analyze and evaluate the work system, describing the key elements of the Hospital information system framework.

OBJECTIVES:

The objective is to introduce a Health information system as a work system, using Medservices STAT EMR and PM software.

To introduce the major elements used in principle base system analysis as a technique for analyzing the system.

Evaluating the system using tools like work system snapshot and SWOT analysis.

Discuss the ethical issues associated with implementing the work system.

METHODOLOGY: a secondary method of research will be used as a secondary source of information, using existing journals, articles, textbooks, lecture notes and the internet websites.

BACKGROUND ON ORGANIZATION AND SYSTEM

Background focus on the organization: The University of Port-Harcourt Teaching Hospital(UPTH) was established in 1985 and it’s a 3rd generation Teaching Hospital in Nigeria. It is one of the tertiary health institutions in the Niger Delta region in Nigeria, attending to the large cosmopolitan population indigenous and expatriate employees. Its network of operations has about 100 medical consultants, 300 resident doctors, 100 house officers, 300 experienced nurses, over 300 paramedical staff, 1000 administrative and support and logistics staff. It trains over 1500 medical students as doctors, over 1000 house officers and medical specialists(UPTH, 2011).

The Federal Government has tried to modify the hospital to meet up with international standards but it still has some gaps mostly in its working system, like its prescription system and keeping medical records. It uses hand-written prescriptions which often generates errors due to handwriting illegibility, wrong dosing and drug-allergy reactions. Patient records are stored in files or folders which are often ruined and most time unaccessible. This lapse in its practices could result in the Hospital which has a record of 150,000 outpatients a year and about 10,000 inpatients per year, to lose out on these patients or clients, to a more sophisticated and high state medical functioning institution within the country or abroad, costing the government money and increased unemployment of the citizens in that region.

OBJECTIVES OF THE HOSPITAL:

ORGANIZATIONAL CULTURE: this is the shared understanding about relationships and work practice that determines how things are done in a workplace.(Alter,2002,p. 76). The culture involves the value, heroes, rites and rituals, culture network of the organization. The organizational culture of the Hospital has very strong beliefs of efficient health care service and high standards in its practice. These values are carried by the management board members or group executives and passed on to the individual staffs. Respect and self-discipline exist amongst staffs, however, this characteristic varies and it's based on motivational issues. The network of communication occurs in a vertical pattern, instructions coming from the board members who coordinate the various activities in the hospital. The consultants, nurses and any other medical staffs abide by the policies made by the board. However, due to the bureaucratic nature of the hospital, the organizational climate entails more of an autocratic nature than diplomatic management.

HEALTH INFORMATION SYSTEM SOLUTION

Health information systems have come a long way in implementing best practices and as a means of e-business in hospitals. This health system is made up of different applications that support the activities of the work system. The information gathered in this system uses the routine gathering process or the occasional gathering process (D’Altilia et al 2010).

Source: D’Altilia et al, 2010

Information gathered and recorded during the routine process are re-current events like consultation of patients to obtain their history, stock quantities of medical instruments and so on. On the other hand occasional gathering are information gathered and recorded during a time study. This information gathered is repeated periodically to achieve a trend in pattern(D’Altilia et al 2010).

The e-health system uses both the EMR/EPR application to support its operations.

The EMR/EPR using Medservices STAT EMR and PM software provided by Datanet solutions provide a lasting solution to the problems encountered by the present health system in the Institution. It has two types of systems:

e-prescribing and medication management systems, and

Imaging systems.

This software stores the patient information and their complete history, including x-ray files, lab test results, prescriptions, any known medical procedures and other important medical data (E-HEALTH NIGERIA, 2013.).

OBJECTIVES OF THIS SYSTEM:

Managing the huge amount of hospital data

Reducing medical errors through e-prescribing and medication management system

Improving diagnostics by providing an accurate visual and communication method through e-imaging system.

Improving the quality of care and reducing administrative cost.

The description of a work system can be measured by some tools like:

Data Flow Diagrams

Flow diagrams

Process maps

Entity Relationship Diagrams (for database systems)

Work Systems Snapshot (as first stage of PBSA).

A rich picture diagram

A rich picture of the business process in a hospital

WORK SYSTEM SNAP SHOT (FRAMEWORK)

The framework is made up of different elements that has significant importance in the working system.

Process and Activities ( Business Process): this is the various activities that take place within the work system, business process is one of the different perspectives for analyzing the events that occur within the work system. Other important perspectives used in work system include, decision making, communication, coordination, control and information processing (Siau et al, 2011, pg 96). This process involves :

Making changes from paper records to e-health system.

Information gathering to outline the planning process for the e-health implementation.

Options or alternatives in choosing the e-system based on available E-health technology that serves the purpose or objectives of the hospital.

Installation of the desired e-system, associated with training and pilot testing.

Application of the system in the final process, using it to demonstrate its capabilities and giving feedback from the users of the system.

Participants: these are people who actually perform the work by applying or the use of IT, computers or little or no technology. In this particular system, the participants are physicians, medical staffs, administrators and logisticians. These groups have the required skill and knowledge of the work system, capable of meeting the organization's goals. They are being motivated mostly by hygiene factors (incentives and higher pay). (Siau et al, 2011,page 96) Their activities are hindered by the inefficiency of the information system.

Information: this includes coded and non-coded information used by participants in the work system. This information utilizes the use of a computer system or not(Siau et al, 2011,pg 96). The information used in the system are patient records (in-patient/outpatient records), staff duty schedule, lab reports, hospital policies, stock quantity of medical materials and equipments and so on. The credibility of the information gotten from the system is always questioned, and its access most times are difficult. The information may not be secured because of its management.

Technology: these are tools and techniques used by the participants in the work system to achieve a given task. Tools used include softwares, spreadsheet, business models and others to achieve management goals through objectives, optimization and remote tracking(Siau et al, 2011,pg 96). Technology in the health information system is the softwares used EMR/EPR application, computers, printers, telecommunication devices and intra/internet facilities.

Products and Services: this are products of the work system which includes a combination of physical things, information and services. These products are physical products, information products, services, intangibles such as enjoyment of peace of mind, and social products such as agreement, arrangement and organization(Siau et al, 2011,pg 97). The products/services are being used by the customer(external or internal). Prompt medical services from lab reports, x-ray films, medical reports, this information is being used by the external customers(patients) and by the internal customers(medical staffs).

Customers: these individuals benefit from the work system. The business process produces products and services which are utilized by the customers. Customers could be external or internal. External customers are patients,ministry of health, other health institutions, the internal customers work within the work system (Siau et al, 2011,page 98) and these groups are the staffs employed in the system. These individuals make use of the information system and give feedback on the information back to the work system.

Source: Steven Alter, 2002

Health Information System Anlysis:

Source: lucey, 2000.

INPUT

PROCESS

OUTPUT

Number of staff per category and per capita

Carries out the business goals at a specific timeline

The number of patients attended (immunization, diarrhea)

Basic equipment per activity rate

Executing the business plans of the organization

Number of new cases in the hospital

Expenses

Special cases and procedures done

Number and rate of patients in Hospital bed

Budgetary allocation per level

Average cost per hospital operation

Hospital bed occupation rate

Availability of drugs per care level

Number of drug shortages

Inputs: The system is user-friendly with graphic user interphases(GUIs) with easy to use programs,the information used in the system are patient history, drug prescription,lab reports, radiography reports, finance materials and so on such as storing appointment dates which is stored as a text format, operating at a lower costs and increases the Hospital without inhibiting medical practice. The participants of the business process like the medical consultants and every department staffs input information into the system.

The information or data are processed through selecting, sorting and are transformed into output. The process might involve immunizations, follow up of patients at home, family planning, child bearing and so on. The result of the process can be displayed on screen or printed out in the form of reports, prescription prints, hospital letter heads, which is then used by the participants or end-users to retrieve valuable information.

The data collected is connected to a data center and the master switch via the intranet, this stores and backup the gathered data. The information quality is highly secure, and the backups of the stored data are secured in their service provider database.

The Medservices STAT EMR and PM software have the following features:

Extremely user friendly and Customizable Super Bill

Privilege based access management to staff

Staff productivity tracking

Interoffice communication

Electronic Eligibility checks

Electronic claim submission

Electronic remittance posting

AR follow up for unpaid claims

Custom report management

Works for Solo Practitioner to Multi-Provider and Multi-Location Arena

Print Daily Reports with a Single Click(medservices, 2013)

http://www.medservicesstat.com/medical-practice-management.php

Through the patient portal, patients can securely access their medical records, view test results, pay bills, and schedule appointments from anywhere, at any time via the Internet.

EVALUATING THE WORK SYSTEM

BUSINESS PROCESSES

Within the work system, the business process involves one or more processes which may be structured or unstructured. The processes involved in this stage include; communication, information processing, sense making, decision making and physical actions(Alter, 2002,p. 92)

Defining the system; the system being analyzed is a working system that offers medical treatment and care to people who need it. The constraints limiting the changes in the working system is ignorance. People are not aware of this particular information system that can improve the business process, giving a higher degree of satisfaction to their customers or clients. The publicity or awareness of this particular information can lead to its implementation. To attain the level of excellent medical services, manpower training and research is a very important goal to the Hospital, this statement is of High-Priority. To get to that level of competition, they need the best medical practice and working system.

In the process of evaluating the work system, the seven work system principles of Steven Alter are applied:

Principle

Related Work System Element

#1: Please the customers.

Customers, Products & Services

#2: Perform the work efficiently

Processes and activities

#3: Serve the participants.

participants

#4: Create value from information.

Information

#5: Minimize effort consumed by technology.

Technologies

#6: Take full advantage of infrastructure.

Infrastructure

#7: Minimize unintended conflicts and risks

Environment

#8: Support the firm’s strategy.

Strategies

#9 Maintain balance between work system elements

All elements in combination

Original set of work system principles (Alter 2010)

For the purpose of this course work, only performing the work efficiently will be evaluated.

In order to perform the work efficiently, the business process- a set of work steps or activities that are performed within the work system, in which people use information and other resources to create value for internal or external customers, this could be structured or unstructured- will have to broken down, discussing its activity rate, output rate, consistency, productivity, cycle time, downtime and security. According to Steven Alter, 2002,p. 64,

"Efficiency is an internal view focusing on how well resources are used within a work system to produce a particular output".

The internal performances include business process involving consistency, productivity and cycle time. Also, Steven Alter, 2002,p. 6, defines

"Effectiveness is an external view related to whether the products and services produced are what the customer really wants, with regards to cost, quality and responsiveness".(Alter, 2002, p.64).

Effectivity relies on the efficiency of the working system to produce good results of performance.

Using Principle Based System Analysis(PBSA) to evaluate the working system against the information system being implemented.

PROCESS PERFORMANCE VARIABLES

PROBLEMS ENCOUNTERED

INFORMATION SYSTEM CAPABILITIES

ACTIVITY RATE

Inefficiency in the usage of resources and un-progressive work-in-process during registration of patients.

The IS can monitor, schedule and keep track of work steps

OUTPUT RATE

A high increase in the rates of errors and rework during prescribing and drug administration, decreasing productivity rate.

It can decrease the rate of errors by doing the task automatically, hence increasing output

CONSISTENCY

The errors encountered in the output rate reduce the quality of service perceived by the patients

It can provide immediate feedback information to detect errors and analyze the cause of the defect.

PRODUCTIVITY

Productivity is at the low end due to the poor quality of medical service given.

Work input can be systemized to reduce waste. An Increased output rate can be achieved in a shorter time

CYCLE TIME

This is increased due to delays in attending to patients increases costs and waste.

Data processing can be performed faster in a process to reduce cost and waste

DOWNTIME

A six day downtime period, leading to lower productivity and longer cycle times.

It can perform backups and recovery, to reduce the downtime period.

SECURITY

Security is stable, due to the very few computer systems

Performing the work efficiently in the Hospital has to do with providing customer satisfaction and effective internal activities of the work system. The business process here is structured, consultation, laboratory, pharmacy and radiology fees are fixed. The quality of service is often poor, due to the response and the delay of the hospital staffs due to the inefficiency of the information system. The cost of treatment is moderately fair, but the system of payment is quite tedious owing to the crowd of people making payments at the same time.

Customer satisfaction for an efficient performance depends on the process characteristics of the structure, the range of involvement, the level of integration, rhythm and complexity of the information system. The structure of the proposed Health information system has the potentials of handling enormous volumes of data, improve detailed communication amongst medical staffs thereby sharing useful information in a process of delivering efficient service. Security policies and training will be put in place to protect patients data or information. This application of the information system can be integrated in the working system of the Hospital involving several departments- laboratory, pharmacy, physiology, surgical and logistics departments. The information gotten from the patient diagnosis during a consult session goes to medical departments, creating records or stored data for future references or as information for an urgent alternative opinion for another medical facility.

In evaluating the working Systems in an organization, several other techniques could be used :

SWOT analysis: it’s a structured technique used to evaluate the strengths, weakness, opportunities and threats in a business organization.

Analysis of Critical Success Factors (CSFs): this a term for a variable or element that is very significant for a business firm to achieve its objectives. Porter’s Value Chain analysis

Porter and Millar’s Five Forces Model

Ends/Means analysis

Scenario Analysis

Principle Based Systems Analysis

Using SWOT Analysis to evaluate the working system of the organization

USING SWOT ANALYSIS: it’s a structured technique used to evaluate the strengths, weakness, opportunities and threats in a business organization.

STRENGTHS:

Every department has a PC and a standard telephone.

An existing intranet cable network in the hospital.

Almost all staffs in the Hospital have the basic skills on how to use a computer.

Weakness:

The present method used in backing up information and the security of information across the company is not efficient. Fire outbreak in the company could result in loss of data.

Departments do not have documentation system driven by Information technology. Administrative documents are managed manually and kept as personal documents.

No standardized method of Information flow across the Hospital, as information can be delivered over the phone, talked over breaks, hand written or posted.

All staffs need to be trained according to their departmental functions since they have no previous experience in health information system.

Opportunities

Documentation and accessing of information will be more efficient.

Time and speed of which information will be processed including the size and volume of information processed, stored and accessed within the Hospital will improve. This will completely eliminate time wasting due to information lapses.

Paper system used in documenting will be eliminated

Patients can register on the hospital network and make an appointment, saving the time of driving over and waiting.

Faster update of information needed by Laboratory, pharmacy and radiology department from medical consultants will be achieved.

Threats:

No policy on how to select or implement new software or purchase new systems.

The financial budget for the implementation of the Health information system may be delayed.

No installation of fire safety devices in some parts of the building, to protect the systems in the cause of a fire outbreak.

Training of staffs on the use of the information system software might be difficult:it's time consuming and some staffs may resist the change in technology.

INTRODUCING MANAGING INFORMATION SYSTEM

Ethical issues

According to Steven Alter in 2002, p. 286,

"Ethics is a branch of philosophy dealing with principles of right and wrong behavior related to other people".

Ethical issues that arise in Health information systems are usually as a result of the leaking or sharing of patient health data without the patient’s knowledge. This issue usually occurs as administrative errors or theft. This security breach in patient confidentiality leads to patients concealing sensitive information in their history charts, compromising their chances for effective treatment(Layman 2008).

ETHICAL THEORIES

This theory proposed by philosophers provide the basis of managing ethical dilemmas.

Maximize the overall good: this theory suggests people should act in ways to capitalize on the beneficence of the society.

Maximize personal best: this theory suggests that people should make choices that could benefit their own personal goals. This theory has some basics of employer rights.

Treat others well: this theory suggests one should acknowledge and teat other in the same manner they would be treated. .(Alter, 2002, pg 291)

Health policy makers should discuss the ethical issues of health information system before the episodes of conflicts among the ethical principles. Some other major ethical issues that occur in information systems are as follows:

Ethical issues: Privacy and security

Privacy is an act of keeping or withholding personal data or information about themselves private. This ethic of privacy is categorized into physical and information privacy. (Alter, 2002, p. 291) and (Boyce, 2002). Data security and confidentiality of health information are very major concerns in e-health system. The e-health system faces challenges regarding delivering effective health service and facing threats of misuse of patient information in the database of past treatment data, medical records, diagnostics of digital image(x-ray films, scans) and lab test reports(Tan 2005, p.459).

Roles of the health information staffs

An extensive and specific training should be practiced to understand the complexities of the morals and ethics in the work system. These staffs should be legitimately registered to give good service to the public with regards to the information stewardship, access oversight and maintenance of confidentiality of the information. They should have a sense of autonomy in making decisions and judgements(Harman 2006,p.9).

Challenges in the e-health system

The acquisition, storage and processing of patients and hospital data.

Getting consent from the patient for processing and disclosure of their medical information.

Who has the right to access and rectify the health data set of the patient.(Tan 2005, 452)

ACCURACY: This involves the quality and accuracy of information on which firms assume to be correct based on bias or misrepresentation of information (Boyce, 2002). There are three types of accuracy; Suppression of information, misrepresentation of information and acceptance of misleading information because it fits the rules.(Alter, 2002, page 291)

CONCLUSION