Information System Modules In Dammam Hospital

Published Date: 02 Nov 2017

processes in an efficient and timely manner.

The current system in use is a paper based system which is not organised around the value of the patient, has no connectivity, has limited security and tracking of access, and has no ease of access for either its providers or patients. Thus it is currently acting as a barrier for the improvement of hospital services. In addition there is an independent module in each department; and therefore the employees rely on paper in order to exchange patient information, including orders for the radiology department, the laboratory and the endoscopy department etc., This has created a need for changes to be made to the current system in order for a more cohesive system. In all of the hospital units there is currently a CPOE system which is advantageous for the hospital and helps to facilitate the work of the Pharmacy (Bawardi, 2013).

This paper has aimed to formulate a future IS strategy proposal for Dammam Hospital in order to help change the way in which healthcare is delivered and to ensure the efficiency of the core clinical and non-clinical services. In developing this strategy, the environment where the hospital operates, the available sources and the driving forces which will help shape the future have been analysed. Therefore, PEST and SWOT analysis and others strategic techniques have been conducted.

The recommendations based on the findings are as follows: Interoperability of the existing technology (the ability to interact effectively to achieve shared goals) is needed. This is primarily related to uniting the hospital information system areas of patient management, operations management, and financial management through integration or interfaces in order to maximise the utility of the systems themselves and improved workflow. A paper based system is no longer considered to be suitable in terms of accessing and sharing patient data. Therefore a paperless environment, by digitizing the patient medical records has been recommended. In order to realise the full potential of this solution; electronic records will have to be integrated with the existing systems which will create the need for data standards such as HL7 (Patel, 2007).

Understanding the business situation is the building block of the information system. In order to formulate a perfect health informatics strategy, there is firstly a need to understand the business strategy, including the IT infrastructure, because this is the support/enabler of the information system (Ward and Peppard, 2002). With the help of an information system strategy, Dammam Hospital could transform its current business processes in a way which could help facilitate employees to accessibly and accurately communicate with their workforce and patients and help deliver efficient, joined up services.

Business drivers

Dammam hospital is regarded as being one of the most modern private hospitals in the Eastern Province of the KSA. It consists of 250 beds, 100 outpatient clinics, and eight specialised clinics with a modern radiology and laboratory medical department. It also provides a comprehensive and wide range of medical services to the customers. It currently employs more than 4000 employees from various nationalities and was recently accredited by the JCI for quality assurance (Dammam Hospital, 2012).

Over the past few years, the working environment for the Saudi private sector has changed significantly as a result of increased competition, technological change, and other factors (Ahmad, 2012). These changes have driven Dammam Hospital to think about optimising the way in which its care is delivered whilst simultaneously reducing its healthcare costs, capturing the market share and improving the quality of its healthcare (Dammam Hospital, 2012). As a consequence, the hospital would be able to cope with such changes as well as being able to achieve its mission related to the provision of high quality patient care through the continuous improvement of its medical services. This could be obtained through maximising the potential of the information system in use and/or adding new IS functionalities.

However the transformation of the business processes and information systems is unable to occur without certain challenges being encountered. The different parties involved within healthcare and the complexity of the healthcare process continues to be challenging. Interoperability of the existing modules through integration or interfaces could be a costly and lengthy process especially if two different venders are involved. Moreover, venders may resist building interfaces between their product and the products of other venders (Lockemann et al., n.d).

As for the digitizing of the patient records, challenges could vary with regards to resistance to change due to the multicultural work environment, the capability of the IT infrastructure, the capital and revenue costs, and fear of failure (Grant, 2013). Therefore Dammam Hospital should address all of these potential challenges to ensure the implementation of a successful IS/IT strategy.

Current information systems

The current information system (Bawardi, 2013) is a paper based system; whereby there are multiple paper patient records held in different locations. Although some patient care is supported with electronic data such as the laboratory results, radiology images and appointment scheduling, employees currently have to use paper to exchange patient information between the different departments.

Currently there are four information system modules in operation: patient modules, administrative and personal modules, financial modules and departmental modules. Each module has various functionalities. The CPOE system is linked to all of the hospital units and supports the Pharmacy department (Refer to Figure. 1). Patients are usually asked to provide information on several occasions when visiting the hospital.

The Dammam Hospital website is supported with a functionality which enables patients to book appointments online. However fragmentation in the system is clear and the hospital now requires an information system which is easily accessible, safe, patient centric, efficient, and can provide a holistic picture for a patient care pathway.

Information System Modules in Dammam Hospital

Administrative & personal module

System set up & security

Personal record

Payroll system

Staff scheduling

Patient module

Patient master index

Medical record

A & E

Clinics/outpatient scheduling

Inpatient managed & planned admission

Online appointment booking system

Financial module

Billing

Patient contract

Stores/inventory management

Purchasing

Patient account

Accounts payable

Cash book

General ledger

Budget & fixed assets

Departmental module

There is Independent, not integrated module for each department.

Radiology

Laboratory

Pharmacy, CPOE linked to all hospital units

Delivery room

Operating room

Endoscopy

Biomedical maintenance

Insurance companies

IT services

Figure 1: Current IS Application Architecture Diagram for Dammam Hospital.

STRATEGIC (Attack).

HIGH POTENTIAL (Beware).

Business opportunity-driven:

Competitive/Exploitation focus.

Complex.

Pharmacy module.

E prescribing system (CPOE).

IT opportunity driven:

Innovation/Experimentation focus.

Federation

Electronic medical records (EMRs).

Interoperability (systems which communicate with each other and are integrated with the EMRs).

Referral module.

Medical history and allergies module.

Outsource managing module.

Online refill prescription.

KEY OPERATIONAL (Explore).

SUPPORT (Safe).

Business issue-driven:

Backbone.

Patient modules.

Departmental modules.

Delivery room module.

Operating room module.

Endoscopy module.

Laboratory module.

Radiology module.

Biomedical module.

IT issue-driven:

Traditional.

Financial modules.

Administrative and personal modules.

IT Management.

Figure 2: IS Application Portfolio Matrix of the current systems within Dammam Hospital.

Dammam Hospital has an up to date technical infrastructure. This includes a highly skilled IT health care workforce with international standards experience who are responsible for the IT department; as well as an advanced procedure for data back up through the use of Recovery Manager (RMAN) as a primary back up system. The backup is a daily procedure whereby the data is stored in a disaster proof location where it can be used in the event of a disaster. Apart from this, the number of desktops has been increased after the installation of the CPOE system in all of the hospital units (Dammam Hospital, 2012).

As per the hospital report, adequate resources and funds are available. Dammam Hospital has a stable financial position as both Aramco and SABIC companies are its main sources of revenue. Maintaining a healthy relationship with these companies is crucial for ensuring the stability of the hospital’s funding. In addition the hospital management team has extensive experience in all areas of the hospital and is deemed to be competent for managing the change based on its previous projects. The employees welcome the introduction of the CPOE system and perceive it as a positive change (Dammam Hospital, 2012).

Strategic Analysis

The primary source of the information was gleaned from the Dammam Hospital profile and its 2012 annual report which was provided by an employee (K, Bawardi) from the medical affairs department within the same hospital. Certain information was also collected via an interview with the same employee through the process of social networking. The case was analysed using strategic tools which were applied in the health informatics strategy literature. A literature search was conducted to identify relevant articles using the key words: ‘strategic planning’, ‘information system’ and different synonyms in various combinations.

After defining the business objectives and in order to make a judgment about the necessary IS/IT strategy to pursue, it was vital to gain an understanding of where Dammam Hospital was in terms of its internal resources and competencies, and its competitive position (Ward and Peppard, 2002). Therefore, PEST analysis and SWOT approaches were used to explore the external and internal environmental influences associated with the hospital.

PEST analysis: This is considered to be a useful tool. Overall its use helped to gain an understanding of the business environment in which Dammam Hospital was currently operating. This was achieved by assessing the hospital’s external business influences which included the political, economic, social and technological factors (Ward and Peppard, 2002).

As a consequence the results of this analysis could be used as a guide for future business decisions. Politically there are many factors associated with the Saudi government which could influence the hospital service strategy such as government objectives, legal restrictions, policies and other factors (Ahmad, 2012). For instance, the high unemployment rate amongst the Saudi population, particularly in the private sector, ranges between 10 to 30% and has driven the Saudi government to launch the policy of Saudization (localised jobs for Saudi nationals; and making the Saudization ratio mandatory for the private health sector to be no less than 15% (Alanezi, 2012). This ratio may increase because people may start to ask for additional rights through protestation and social networking. It is hard to predict the future for local regulation as the regulatory environment in which the hospital operates is subject to change.

From an economic perspective, the oil price fluctuations could have a direct impact on the economy of the KSA and subsequently would be felt at all micro levels including those of Dammam Hospital and its market value. As for the taxation on services or products, although this is not applied to the population of those in the KSA; this could mean that people could consume more services but a higher unemployment rate could result in a lower demand for non-basic health services, for example regular check-ups or cosmetic surgery (Ahmad, 2012).

Socially, the population growth rate is continuing to grow which drives demand for healthcare services in the KSA in terms of product and service requirements. The KSA is also considered to be a multicultural country with people from a number of different social backgrounds. Therefore the private hospitals in the KSA need to promote their products in order to appeal to the different social backgrounds as this will increase their hospitals sales and will enable their services to fulfil their potential market share (Ahmad, 2012).

From a technological perspective, the delivery of healthcare is changing due to the continuous advancement of technology (Felecia et al., n.d.). As the new technologies create new markets and opportunities, the hospital mangers should study these updating technologies and adopt them within their own hospitals in order to maintain a competitive position.

Another strategic tool is SWOT analysis. This is used to assess the internal strengths and weaknesses of an organisation, as well as its external opportunities and threats (Ward and Peppard, 2002). The need to understand the current hospital situation was deemed essential for determining its strategic direction (Refer to Figure. 3).

Strengths:

Focused business strategy.

Good profitability level and stable financial position.

Strong reputation, which is JCI accredited.

Wide client base.

IT systems supported by qualified technical and management staff.

Joint cooperation agreements.

Extensively experienced management team.

External contracts network.

Weaknesses:

Fragmented hospital information system.

Paper based patient medical records.

Opportunities:

Ensure a stable financial position by maintaining the contract with Aramco and SABIC through continuous efforts for service improvement.

Threats:

Dammam hospital could be placed in a vulnerable situation if:

There was any kind of violation of Saudi government laws, rules and regulations.

The hospital failed to maintain its contracts with Aramco and SABIC.

The hospital failed to maintain the subcontract with the Al Maghrabi hospital which currently operated the ENT health services.

The hospital failed to compete effectively against current and future competitors. Thus competitors would constantly attempt to attract more business from Aramco and SABIC and other healthcare insurance companies.

Figure 3: SWOT analysis.

According to Ward and Peppard (2002), in order for a company (e.g. Dammam Hospital) to survive and thrive in the competitive environment, there is a need to understand the interaction between the competitive forces (competitors, buyers, suppliers, new entrants and substitute products/services), and the implications in terms of how Dammam Hospital could avoid being disadvantaged; as well as understanding the opportunities for adding competitive advantage. Therefore, the author used Porter’s five forces model to show the current competitive position of Dammam Hospital and to investigate whether information system technology could play a role in its competitive strategy, for example by changing the basis of its competition, building in switching costs, generating new services, or changing the balance of the power in the suppliers’ relationships (Refer to Figure. 4).