Information System Designing

General Hospital-Dompe

Hospital Information System

Content of Glance

(1)

General details about the organization

Dompe hospital is a district hospital that provides variety of medical services to its patients. It is
established in 1951 as small local hospital in the heart of Dompe town. In 1972 it was identified as
Main District Hospital in Sri Lanka. In 1941 it was started with only two doctors and three nurses.
Within the time the hospital has evolved to a modern hospital that provides various medical
services. Some of them are:

(2)

Accident Service(ETU)
Anesthesia and Intensive care
Deontology
General Medicine
Outdoor Patient Department (OPD)
Medical Clinic
Medical Lab
Medical Pharmacy

THE OLD SYSTEM

The procedure involved in the current system is that, when a patient visit the hospital for
medication, the patient will first of all get the receipt which contains name, and other relevant
information needed, and card identification number. The patient will then waits for the card to be
processed together with a file that holds the card that has column for diagnosis made by physician,
drugs prescribed, and date at the waiting room for the arrival of the card. When the file arrived, the
patient joints the queue to see a doctor. In that current system, the files are used for keeping
individual patient card enclosed in a file. This system is so unreliable to tracing a record files very
slow in processing of records, space occupied by the file time waiting while waiting for the patient
file to be retrieve by the receptionist. And also there are big problem for storing information with
hardcopy of health information data. the below picture is show to how the information is store in
the hospital.

Regardless the important function of medical records, it has come under hard threat that by the
manual system of medical record keeping. This system involves taking down patient data on pieces

of papers, which are then put in to the files and filed in cabinets. Another problem is sometimes
missing of information in the hospital. One standard hospital study reveals that on the average,
patient records visited, there are pieces of information the doctor could not find in the paper file.
Physicians and their office staffs have said that, they spent more time looking for patient
information, than the time they have for the patient, as issues related to risk
Management is security. The first consideration is the physical safety of the data being stored.
Threats exist externally in the form of natural disasters and the most important issue is the security
involved in patients privacy.

(3)

Problem with conventional system

1. Lack of immediate retrievals: - The information is very difficult to retrieve and to find
particular information like- E.G To find out about the patients history, the user has to go
through various registers. This result is inconvenience and wastage of time.
2. Lack of immediate information storage: - The information generated by various
transactions takes time and efforts to be stored at right place.
3. Lack of prompt updating: - Various changes to information like patient details or
immunization details of child are difficult to make as paper work is involved.
4. Error prone manual calculation: - Manual calculations are error prone and take a lot of
time this may result in incorrect information. For example calculation of patients bill based
on various treatments.
5. Preparation of accurate and prompt reports:- This becomes a difficult task as
information is difficult to collect from various registers.

(4)

The new Computer base System.

This new system is design for medical practitioner/physician to keep track of all patients
medical record/information such as diagnosis, drug prescribed, admission and discharged, etc
It is important to increase efficiency of whole work of the hospital and it conceders as a the
miracle of the information Technology, Because this system can control all the part of the
hospital.

Currently the hospital has a automated system running which is developed by ICTA. It is the
government organization which related to ministry of telecommunication service and information
technology and also with the help of World Health Organization which denote the found to
develop the project as a guide Hospital Health Information Management System (HHIMS) related
to the Ministry of Health. This is the first time which is introduced HMS in Sri Lankan
government hospital. It is commence at 27/12/2011 in Dompe district hospital. In this project is
used to iterative software development method to whole process of the project. At the beginning
the project is introduced the Patient Registration System and after that it introduce other part of the
software.

(5)

Goals of New system

1. Planned approach towards working: - The working in the organization will be well
planned and organized. The data will be stored properly in data stores, which will help in
retrieval of information as well as its storage.
2. Accuracy:- The level of accuracy in the proposed system will be higher. All operation
would be done correctly and it ensures that whatever information is coming from the center
is accurate.
3. Reliability: - The reliability of the proposed system will be high due to the above stated
reasons. The reason for the increased reliability of the system is that now there would be
proper storage of information.
4. No Redundancy: - In the proposed system utmost care would be that information is
repeated anywhere, in storage or otherwise. This would assure economic use of storage
space and consistency in the data stored.
5. Immediate retrieval of information: - The main objective of proposed system is to
provide for a quick and efficient retrieval of information. Any type of information would be
available whenever the user requires.
6. Immediate storage of information: - In manual system there are many problems to store
the largest amount of information.
7. Easy to Operate: - The system should be easy to operate and should be such that it can be
developed within a short period of time and fit in the limited budget of the user.

(6)

Introduction to Hospital Information Systems (HIS)

Hospital Information systems are in high demand to handle increasing population needs and also
aids the practicing doctors and hospital service and support staff with timely service and precision.
There are varied metrics available to assess the performance of services like hospital industry, and
the successful implementation and usage of Hospital information system forms a crucial role.
Hospital information systems are available in the software market which in most cases needs to be
customized and in some cases HIS needs to be developed as a customized software based on
specific hospital requirements (user requirements).

Hospital information systems (HIS) are just one instance of health information systems, with a
hospital as health care environment. A HIS is a comprehensive and integrated information system
designed to store, manipulate, and retrieve information of the administrative and clinical aspects.
Resource requirements for a hospital health information system is require an information system
that serves primarily administrative and clinical functions and that can directly improve the quality
of services .Administrative functions include patient flow between registration and different
departments, accounting and billing, and inventory control for the pharmacy. Clinical functions

cover medical records, including results of diagnostic procedures, access to standard diagnostic
and procedure codes prompters for essential patient information (i.e. obstetric risk assessment), or
automated alerts in cases of drug incompatibility and contraindications. Most of the latter functions
require a computerized system. Hospital information systems Monitor indicators such as financial
status, quality of care, type and volume of services provided to referred and non-referred patients,
length of stay, case fatality rates, comorbidities, and severity of illness. How systems are
implemented in specific hospitals varies greatly among the type of facility, the economic status of

its client base, and the technology available to automate the system.

Basic Infrastructure of the Hospital Information System

(7)

Goals of Hospital information System

Goal of Hospital Information System (HIS) is supporting hospital activities in the levels of
practical, Tactical, and strategic .In other words, goal of hospital information system (HIS) is using
of computers and communications equipment for collecting, storing, processing, readout, and
communication between patients cares with administrative data on all hospital activities and
comply needs of all consumers system .In academic hospitals, also research and training support is
one of the hospital information system (HIS) goals. Generally the main goals hospital information
system (HIS) can be summarized in the following:
improving staff efficiency
To remove duplication and unnecessary procedures
Using computers as work tools
Statistics and data mining techniques faster and more accurate
Improving quality of health care status of
To create a modern working methods and systems and standardized hospital
Data communication systems, medical engineering
Data communication between hospitals and medical centers in
The country reaching a distributed database in the country and make its relationship with the
World Health Networks
Promote community health

(8)

Major Characters and Departments of the Hospital Information

System

(9)

The Importance and Necessity of Establishing Hospital Information System

Due to extensive changes in medical technology and increased expectations of patients, in the
twenty-first century hospitals that lacks hospital information system (HIS), they have nothing to
say and will not have the ability to compete with other hospitals. The most important necessity and
reasons for hospital information system automation are Inefficiency manual procedures, the growth
of medical research in the world, insurance industrial development and changing reimbursement
techniques to the centers of contracts, new methods of medical education, medical facilities great
achievement, and increasing professional in Employees and development how hospital catering
and management, growing health costs, increased patient expectations, the associated need for
medical centers and medical professionals together and etc.. Also a good management information
system is necessary to evaluate the quality of care for patients. So the reasons for using these
systems can be summarized as follows: Generation of alert and Reminds: HIS systems help with
the creation of Wake series warning messages to remind doctor in diagnosis. For example, patient
has an abdominal pain that is may be 45 diseases that have the same symptoms but doctor
remembers only 10 of them.
Critical Pathway of Decisions: HIS systems help a doctor in serious cases. In very serious
cases, that there isnt the opportunity for doctor to decide, these systems help the doctor and bring
his response quickly in emergency cases.
Automatic reporting: one of advantages and performances of HIS systems is that can be
provided report of patients diagnostic - care information automatically by them.
Reduce cost: HIS systems effect very significant in reducing the costs. So if you have detection
algorithms in the system, you wont need to review Problem Oriented of patient. In this case you
wont require performing additional tests and etc. Access to diagnostic information care of
patient with a PC: using of the appropriate Work station, physician can access patients and
hospitals easily from your location or where he/she is present.
Suitable Administration: One of the benefits of HIS systems is that allow the patient to call the
hospital network from home and reserve time to meet with the doctor. Thus make a Appointment is
much easier.
Reducing errors: because all data have been collected in one place, fewer mistakes occur.
Better Managing & Following: patient management and follow patient can be done better in
these systems .Therefore, accessing to previous information of patient will be better.

(10) Monitoring & Controlling Hospital Information System

The HIS is improving day to day hospital operations. It has increased efficiency of doctors due to
easy access to electronic medical records, templates for treatment recording cycle codification
support. It has reduced time-to-serve patients and is enabling the provision of quality patient care.
At the same time it has streamlined the daily functions of various hospital staff, nurses,
pharmacists etc. and in resulting in their efficient performances. In this manner, it is saving daily
operational costs as well as unnecessary wastage of time and effort by putting in place
standardized and uniform processes.

(11)

The main Processes related to the HIS in Dompe Hospital

In Dompe District hospital there are four main processes that interact with this Hospital Health
Information Management System. They are
1.
2.
3.
4.

Registration Patients & Assigning Doctors

Provide Treatments for Patients
Create Reports
Inventory Handling(Pharmacy)

(12) Registering Patients & Assigning Doctors

In any Hospital recording Patients details is the most important part of the registering process.
Keeping information of patient helps to a well-organized treatment and identifies the patient from
other patients. Assigning Doctor to a patient is also carried out while registering the patient. It
makes them easy to identify the appointed Doctor to certain patient. And doctors also can manage
their work hours by simply checking assigned patient details. Also he can take a idea about the
patients that he is going to meet before they meet face to face.There are several steps that have to
be completed in order to fulfill the Registering Patients & Assigning Doctors Process.
First The Patient will be checked to know if he is a new patient or a existing patient.

If the patient is new he/she will have to go through a registration process

where a attendant will add patients details to the information system.

If the patient exists in the system a doctor will be assigned to him/her.

Assigning a Doctor to a Patient is common to both patient types also Patient registering and assign
doctor process is depending on a unique barcode and a number. This unique barcode and number is
used to identify a patient throughout the system. When a new patient comes to the hospital first the
patient will be checked to know whether he is a new patient or an existing patient. If the patient is
a new, he will be given a barcode and a number that is generated by the system.

Then the details of every patient will add to the system by a attendant. So the person needs to
register only once in his/her lifetime.

The process of assigning doctor will take place while the patient is registered. Soon as the doctor is
assigned the doctor will get a notification through the system.
After registering the patient, every patient will receive a Daily Appointment Number to ensure the
correct place in the clinic queue.

When the patient gets his turn, an attendant will call the patient through patient number screening
system so that the patient can go and see his/her assigned doctor. After the patient goes to the
doctors room he can see the patient details by simply swiping the barcode into barcode scanner.
The doctor can see all the relevant details of the patient within seconds.

Personnel details
Past medical history, Past surgical history
Examination findings, Treatment given, Allergic History, Familial Diseases,

Investigations etc.
And the exact date & time of each visit can be seen easily which is not remember by the patient
usually.

(13) Providing Treatments to Patients

Patients get the treatment they need by several ways. Treatment can be varying from patient to
patient depending on Doctors decision. Doctor will decide what type of treatment that a patient
receives. And this treatment process is combined with three places that interact with each other.
Treatment process is divided around three places to makes the process simple.

When providing treatment to a patient doctor records all the data that provided by the patient
including the complains and the diagnosis. Doctor can order lab test, procedure through the system
and default dosages, frequency, and duration can be arranged through the system. And the doctor
can see previous prescription and it can be continued if needed.

After Doctor has decided what type of treatment to be given to a patient he will direct the patient to
the Pharmacy or Collection Room depends on the treatment type. There are several types of
treatments such as a drug (pill, syrup) and injection.
If the patient needs a drug doctor will direct the patient to the Pharmacy. Or the patient needs to
confront a test (urine, blood etc) doctor will direct him/her to the collection room.
In the medical lab all the tests are done and the reports are sent to responsible parties.

(14) Pharmacy
This is the please which is use to supply medicine for patient. Also Pharmacy is very busy and
complicated please in the hospital previously but the manual system is introduced a long queue, so
new system reduce the long queue and get more effective and efficiency for the patient as well as
other staff of the hospital. Finally the patient comes and meets the doctor and the doctor prepares
the prescription for relevant patient and send to the Pharmacy. Then the pharmacist sees the
relevant prescription with the relevant patient Id card with the patient. Then pharmacist gives the
medicine to the patient with help of their ID.

Pharmacy plays a major role in supply treatment process. It is the place where drugs are issued to
the patients for a prescription. When a prescription is issued by the doctor a attendant in the
pharmacy can see that prescription and issue drugs as it is in the prescription.

At the Pharmacy: Issuing drugs to patients is based on a barcode where no. of tabs/caps to be dispensed is
calculated automatically.
Report of daily consumption of drugs is generated and kept for references.
Drugs that reaches the reorder level is shown in red color and Chief Pharmacist, Doctor and
DMO (District Medical Officer) can see it anytime.
And the DMO can see how many patients are there in the queue from his office and he can
view the dispenser of any patients prescription.

(15) Collection Room

This is the please which is used to treat the patient in the hospital. Finally the patient comes and
meets the doctor then the doctor prepares the Medical report for relevant patient and sends to the
collection room, then the patient can get treatment directly in the collection room.
At the Collection Room:A sample slip is generated with a barcode for each sample of bottle and this sample slip put in to
the bottle for send the medical lab.

The sample slip is attached in each bottle.

Medical Lab is fully functional with a barcode and the operation done in the medical lab can be
done by priority base. And all the reports regarding a particular sample can be seen by the Doctor
through the system. Daily summary details of the pharmacy can be obtained for reports

(16) Medical Lab

This is the please which is used to check and produce all the lab report in the hospital. Finally the
patient comes and meets the doctor then the doctor prepares the Lab report for relevant patient and
sends to the Medical Lab, then the Medical Lab Technician produced the lab report for the relevant
patient and it send back to the doctor.

Different types lab reports are there to check by the Doctor.

(17) Creating Reports

Dompe District Hospital is a main hospital that provides variety of healthcare services to its
patients. And it is managed by Health Ministry. To provide information for Doctors and other
responsible personals they create various types of reports.

There are several information files that is used to create these reports.
Patient Detail File
Prescription File
Patient History File
Schedule File
Attendant File
Appointment File
By using these file sources the system can generate Reports that can be help to utilize the man
power of the hospital. And these reports can be help to evaluate the efficiency of the current
operation of the hospital.

Notification Report
System prompts the doctor to notify the disease. Notification Form ( H-544 ) filled
automatically and Sending done via e-mail or Hard copy can also be obtained & send by post.
(if needed)

(18) Inventory Handling

Dompe District Hospital uses a simple inventory management system that is connected to the fully
automated system. The pharmacy has a large inventory that has to be manage accurately and
efficiently in order to provide drugs to patients. After issuing drugs for prescriptions the inventory
level of the relevant drug is updated through the system. Two attendants are in the pharmacy to
issue drugs and update the inventory level of each drug.
Whenever the stock level reaches the re-order level the system will notify it by
showing the relevant drug name in red color. And then the chief pharmacist can take necessary
actions to order new stock. He can take a report about all the drugs that are in the re-order level.
Then he will place the order that includes these drugs.
After receiving the ordered amount of the drugs, attendants will update the stock levels of each
drug. When adding a new drug to the inventory system, attendants should add details about the
drug manually.

The pharmacy has a large inventory that has to be managed efficiently to provide medicines for
patients. It has to be updated consistently in order to operate with their government supply
warehouse. Attendants working in pharmacy have to keep records end of every day. They have to
record about

Amount of drugs that were given to patients.

Number of patients that came to receive drugs.
Inventory level of each drug at the end of the day.

Usually when the reorder level reaches for a particular drug, an attendant will notify the chief
pharmacist. Then he will place a order through the telephone.

(19) Challenges in Implementation this system

High cost of software development
While HIS holds vast potential in improving healthcare delivery and management, a major road
block in its way is that the cost of developing the software is on the higher end. Given this, the
deployment and improvement of the software over time has been highly challenging. This factor is
also limiting the up-scaling of the system to the entire public healthcare system till the village
level. While policy makers are convinced of the need to build a health IT infrastructure, the high
costs involved often delay and limit their acting power.
Difficult to migrate from manual processes
The manual processes at work in government hospitals were installed decades ago, hence the staff
as well as patients are used to these processes and are being unable to speedily cope up with the
new system. The transition from manual processes to this IT based system is a long drawn and
gradual process, which presents numerous challenges in adequately deploying and using the new
system. Perhaps a way out would be to roll out the new system in phases and prepare both service
providers and beneficiaries for the bigger changes to come.
Lack of tech-enabled medical personnel
The lack of IT friendly medical personnel is presenting several challenges in the successful
running of the HIS. Though data entry operators have been provided at select hospitals, they do not
present a permanent solution as it involves incurring greater costs. Efforts have to be made to
adequately and frequently train medical personnel and convince them about the need to use the IT
based system and aware them about the advantages it can accrue.
Huge influx of patients
The large volume of patients coming to government hospitals makes the process of migrating to
automated processes highly difficult. They do not have the patience to wait for registration and
data entry and often fail to understand the functioning of automated processes; hence they adopt an
uncooperative stance often resulting in disillusioning the hospital staff about the overall usage of
the HIS.
All the above challenges can be addressed through proper awareness generation efforts and gradual
roll-out of the software instead of a complete roll-out at a go.
Sustainability

Overcoming the above challenges can make the HIS sustainable in the long run. While the
initiative enjoys the support of service providers, a vast scope for improvement remains in terms of
patient awareness generation. At the same time, the initiative needs to display its.

(20) System drawbacks and our recommendation

There are some drawbacks in this system, and we can identify it to system analysis process of the
Information System Design project. Some of the important arias we discuss this paragraph. In this
hospital information system is more complicated and more reliable to the system users, but there is
a good training condition, no harmful thing happen to the HIS .Also there are some service can be
introduced to the main HIS system

1. Country Electronic Network System.

2. Patient Transfer System.
3. Emergency Ambulance Service.
4. Patient Guiding System.
5. Health Emergency Alert System.
6. Hospital information Security System.

(21) Country Electronic Network

We require planning based on opportunities and threats of the way and self-strengths and
weaknesses to develop this industry within the country. A group of major and noticeable
obstacles are considered in the way of development, have the effect of possible factors that are
related to space management outside the country and their management is not In addition to the
above, Informatics Technology has features generally that encourages the countries in the world
to investment in this sector. Medical informatics industry includes three areas: software, hardware
and medical services. The areas of medical informatics as artificial intelligence applications in
medicine, remote medical services, will be a good background for planning and investment in its
product offering in the sector due to the research stage.

(22) Patient Transfer System

In order to add this feature to the current system we assume that at least all the main government
hospitals have this Automated System running and all the government hospitals are connected with
each other using WAN technology. Patent Transfer system is transfer a patient to another hospital
because Specialist treatment not available at the hospital and the required facilities at the hospital
are fully occupied.
Problems Associated with the Manuel Patient Transfer
Lack of understanding in the regional main hospitals about the
Limited resources and support in rural areas and smaller regional hospitals
Lack of defined processes for access to clinical advice , coordination of transport and
finding a appropriate facility
Low standard of hospital documentation provided during the transfer process.
The severity of the patients illness is often underestimated and the level of escort not
appropriate.
Lack of clear accountability for transfers
As these problems occur during a Patient Transfer, most of the Sri Lankan government hospitals
failed to provide the service to higher standards. Every ward and ICU will maintain a one
computer each at their premises. And each computer will have a dedicated operator for its tasks.
This computer can be connected to main network in the hospital by using LAN technology.
Internet facility also provided for each computer.
When a new patient comes to the hospital he will be given a computer generated Barcode
and a number. This barcode and the number can be used in this proposing system also. In every
ward patient details can be seen through the automated system just like a doctor can see the patient
details. If a patient needs a transfer to a another hospital a transfer slip will be generated including
patients

Patient Number and the barcode.

Patient Name, Address and Telephone Number.
Transferring Hospital and Address.
Reason for Transferring.
Responsible Doctor Name etc.

This transfer slip and the barcode will send with the patient to the transferring hospital.

And the hospital can view the availability of the facilities and the medical personals of the
transferring hospital through the automated system. So that they can pre determine the situation
going on the transferring hospital. If the transferring hospital is a government hospital they can use
the barcode to add patient details to their system or they can add patient details to their manual or
automated system by simply using the generated transfer slip that is send with patient. Same
transfer slip will be sent as an email to the transferring hospital through internet. One of the major
problems in Patient transfer is lack of properly organized documents. This proposed system can
prevent any errors that occur during the Patient transfer and deliver the service up to higher
standards.

(23)

Emergency Ambulance Service

Hospitals in Sri Lanka can be divided into two categories.

Private Hospitals
Government Hospitals
Both private and government hospitals have brand new Toyota and Nissan Ambulance vehicles
that can be used to implement this proposed Emergency Ambulance Service.
Every Ambulance vehicle should be equipped with Global Position System, Radio Transmitting
Unit and Inbuilt Computer with a internet connection for emergency patient care. Global Position
System can be used to identify the quickest and less traffic roads to the transferring hospital. The
primary hospital and the transferring hospital can be able to track down the current location of the
ambulance vehicle.
The Radio Transmitting Unit can be used to continuous communication between
hospital and the ambulance vehicle. And it can be used to inform the response time and the
treatment given while the patient is travelling in the ambulance vehicle Patients condition will be
checked in every minute and information will immediately send back to the primary hospital and
the transferring hospital. From onboard computer the medical personals inside the ambulance can
access the information about availability of the hospital facility (ward beds, ICU availability).And
if required medical personals can retrieve information about the patient by swiping the barcode or
entering the patient number.They can access the information that helps to treat the patient onboard
the ambulance. Such as

Treatments given
Past Diseases
Past Operations

All the above processes are automated under the Hospital Management System. And these
processes interact each other to provide the best results to the administration of the automated
system. This automated system can be improvised by adding it some more useful features to
deliver several extra services.

(24) Final Objectives of the Study

Examine the process of existing system and procedures.
Identification of the weaknesses of the existing system and minimize the
manual work and operations.
Maximize the data processing work load and satisfy the managements needs.
Provide the benefits to the Hospital using the system by providing information
rapidly
Minimize manual paperwork and operations.
Providing good,valuable service to the patient.
Satisfaction of workers
Help to protect the environment
To maximize the profit.

(25) Conclusion
This study embarked on the patient medical information which substitutes the current (manual
system) of sorting, handling, searching, amending and keeping of patient medical records. This
portrays the importance and indispensable nature of the computer and its application in the
hospital. The database aimed at reducing paper work in the reception area to reduce the time
wasted by patients in the course of waiting for their files to be retrieved. This also reduced the

spaced occupied by the files and provide adequate security for patient s medical record. Based on
the finding of this study, the design of hospital patient database record will be a solution to the
problem being experienced by the current manual method of keeping patient medical records. The
study has critically identified the importance associate with using electronic in keeping patient
medical record to eliminate missing files and enhance speedy retrieval of patients record.

(Information System Design UCD MIS Batch 17 Group B-11Group Assignment)