HOSPITAL AND HEALTHCARE INFORMATION

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Q.1. a. Differentiate between Quantitative and Qualitative audits.

Solution-

A litigation management audit can reveal several different categories of

information, depending upon the type of inquiry undertaken. The audit inquiry most
typically utilized by insurance carriers is the quantitative audit, which examines the
amount and breakdown of time that attorneys have invoiced. The goal of this type of
audit is to determine whether the law firm has substantially complied with the billing
guidelines imposed by the carrier. Such an approach identifies permissible payment
deductions for invoice entries that deviate from the carrier’s guidelines, or from
generally accepted billing practices. This approach can fairly be characterized as a
“procedural” review of the billings involved.

A different audit approach, one that perhaps is ultimately even more meaningful,
entails a qualitative assessment of the actual work reflected in the bills. This inquiry
seeks to determine whether the bills incurred in the litigation and submitted for payment
were in fact both reasonable and necessary, which is the dual standard required of legal
billings articulated by the U.S. Supreme Court. This audit approach can fairly be
characterized as a “substantive” review of the billings involved.

The ultimate goal of the qualitative litigation management audit is to ensure that
attorneys hired to conduct litigation and other legal activities do so in a goal-directed,
streamlined, and thus cost-effective manner. Through poor planning or neglect,
attorneys can inadvertently bill for activities which increase litigation costs while doing
little to resolve the litigation. A comprehensive qualitative audit is designed to analyze
the strategy, staffing and overall approach utilized in the case. When we conduct a
qualitative audit, we typically review the available work product, including the
pleadings, motions, discovery requests and correspondence to identify wasteful practices
and opportunities to increase efficiency.

The qualitative and quantitative audits are not mutually exclusive, but are
complementary to each other. While it makes sense to compare and contrast the two
approaches individually, a combined approach is perhaps the best way to achieve a fully
comprehensive audit. We often start with a quantitative examination of a law firm’s
invoices, while keeping an eye out for anomalies or troubling entries that raise more
qualitative concerns. Such a holistic process can result in significant cost savings to the
client, although it is more time intensive than relying on only a single approach. The
combined approach accordingly must be justified under the particular case
circumstances, both practically and economically.

b. Explain the evolution of the health system in India?

Solution-

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Healthcare in India is the responsibility of constituent states and territories of India.

The Constitution charges every state with "raising of the level of nutrition and the
standard of living of its people and the improvement of public health as among its
primary duties". The National Health Policy was endorsed by the Parliament of India in
1983 and updated in 2002.

The art of Health Care in India can be traced back nearly 3500 years. From the early
days of Indian history the Ayurvedic tradition of medicine has been practiced. During
the rule of Emperor Ashoka Maurya (third century B.C.E.), schools of learning in the
healing arts were created. Many valuable herbs and medicinal combinations were
created. Even today many of these continue to be used. During his rein there is evidence
that Emperor Ashoka was the first leader in world history to attempt to give health care
to all of his citizens, thus it was the India of antiquity which was the first state to give it's
citizens national health care.

In recent times India has eradicated mass famines however the country still suffers from
high levels of malnutrition and disease especially in rural areas. Water supply and
sanitation in India is also a major issue in the country and many Indians in rural areas
lack access to proper sanitation facilities and safe drinking water. However, at the same
time, India's health care system also includes entities that meet or exceed international
quality standards. The medical tourism business in India has been growing in recent
years and as such India is a popular destination for medical tourists who receive
effective medical treatment at lower costs than in developed countries.

Healthcare Infrastructure
The Indian healthcare industry is seen to be growing at a rapid pace and is expected to
become a US$280 billion industry by 2020. The Indian healthcare market was estimated
at US$35 billion in 2007 and is expected to reach over US$70 billion by 2012 and
US$145 billion by 2017. According to the Investment Commission of India the
healthcare sector has experienced phenomenal growth of 12 percent per annum in the
last 4 years. Rising income levels and a growing elderly population are all factors that
are driving this growth. In addition, changing demographics, disease profiles and the
shift from chronic to lifestyle diseases in the country has led to increased spending on
healthcare delivery.Even so, the vast majority of the country suffers from a poor
standard of healthcare infrastructure which has not kept up with the growing economy.
Despite having centers of excellence in healthcare delivery, these facilities are limited
and are inadequate in meeting the current healthcare demands. Nearly one million
Indians die every year due to inadequate healthcare facilities and 700 million people
have no access to specialist care and 80% of specialists live in urban areas.

In order to meet manpower shortages and reach world standards India would require
investments of up to $20 billion over the next 5 years. Forty percent of the primary
health centers in India are understaffed. According to WHO statistics there are over 250
medical colleges in the modern system of medicine and over 400 in the Indian system of
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medicine and homeopathy (ISM&H). India produces over 250,000 doctors annually in
the modern system of medicine and a similar number of ISM&H practitioners, nurses
and para professionals [8]. Better policy regulations and the establishment of public
private partnerships are possible solutions to the problem of manpower shortage.

India faces a huge need gap in terms of availability of number of hospital beds per 1000
population. With a world average of 3.96 hospital beds per 1000 population India stands
just a little over 0.7 hospital beds per 1000 population.[9]. Moreover, India faces a
shortage of doctors, nurses and paramedics that are needed to propel the growing
healthcare industry. India is now looking at establishing academic medical centers
(AMCs) for the delivery of higher quality care with leading examples of The Manipal
Group & All India Institute of Medical Sciences (AIIMS) already in place.

Q2a. What are the domains of the health management information

system?

Solution-
Health management information incorporates all the data needed by policy makers, clinicians
and health service users to improve and protect population health. Few countries in the world
today have effective and comprehensive systems in place to gather this data.

Yet there has never been a greater need for robust health information. As the world community
has turned its attention to meeting Millennium Development Goal targets, and ever increasing
resources are going towards preventing and treating high burden diseases such as HIV and
AIDS, tuberculosis and malaria, decision-makers need to be able to measure whether policies
and programmes are working, and whether progress is being made towards the goals that have
been set. Donors are also placing more emphasis on performance, linking the release of funds
to performance based measures.

See: Structuring information and incentives to improve health

The World Health Organization (WHO) argues that investment in health management
information systems (HMIS) now could reap multiple benefits, including:
• helping decision makers to detect and control emerging and endemic health problems,
monitor progress towards health goals, and promote equity;
• empowering individuals and communities with timely and understandable health-related
information, and drive improvements in quality of services;
• strengthening the evidence base for effective health policies, permitting evaluation of
scale-up efforts, and enabling innovation through research;
• improving governance, mobilising new resources, and ensuring accountability in the way
they are used.

This key issues guide examines some of the strategic and operational challenges involved in
implementing HMIS; considers the evidence from some case studies; and asks what lessons
have been learned to date.

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b. Write short notes on the Central Bureau of Health Intelligence.

Solution-

Introduction: The Central Bureau of Health Intelligence (CBHI) is the Health

Intelligence Wing of the Directorate General of Health Services. At national level, it is
the sole organisation which deals with the collection, compilation, analysis and
dissemination of the information on health conditions in the country covering various
aspects of health including health status, health resources, utilisation of the health
facilities etc. It also conducts the training programmes for various categories of
statistical personnel dealing with health and medical records and arranges training for
overseas fellows in the country on health statistics.

Monitoring and Evaluation of the strategy of Health for All: The Bureau is actively
engaged in the monitoring and evaluation of strategy for 'Health for all' by 2000 A.D. in
India. In compliance with the resolution of the World Health Assembly, the Ministry of
Health and Family Welfare (MOHFW) has been periodically conducting exercises for
monitoring and evaluating the national strategies adopted for achieving the goal of
'Health for All' (HFA). The earlier rounds of monitoring work were carried out in 1982,
1988 and 1994 while the evaluations were undertaken in 1985, 1991 and 1997.

Epidemic Intelligence: The obligations under the International Health Regulations are
being observed. The morbidity and mortality figures in respect of internationally
quarantinable diseases (Cholera) are received by CBHI every week from all the

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states/union territories as well as from all major sea ports and airports. Based on the
figures, weekly Epidemiological reports are prepared and sent to WHO every week.
Surveillance on principal Communicable Diseases other than those covered under the
International Health Regulations is also being maintained on the basis of the monthly
reports received from States/Union territories in the prescribed proforma.

Training Programmes: To improve the health information system in the country, in

service training programmes for the personnel engaged in health statistics and medical
records are organised at the following training centres:

(i) Training programmes in medical record science: Training centres for medical records
at Safdarjung Hospital, New Delhi and Jawahar lal Institute of Post Graduate Medical
Education and Research (JIPMER), Pondicherry conduct training course for Medical
Record officers of one year duration i.e. July to June and Medical Record Technicians of
six months duration i.e. Jan. to June and July to December. During 1997-98, a total of 6
and 30 candidates were trained in the courses for Medical Record Officers and Medical
Record Technicians respectively at these centres.

(ii) Training programmes in vital and health statistics: The Model Vital and Health
Statistics Unit, Nagpur and Regional Health Statistics Training centre, Chandigarh
conduct 10 weeks course on General and Health Statistics (twice a year), 12 weeks
course on medical coding (twice a year) and 2 weeks demonstration course for Medical
Record officers. During 1997- 98, 11 candidates in General and Health Statistics and 11
candidates in Medical Coding were trained in these centres.

Field Survey Units: The CBHI conducts field research on priority health problems
through its field survey units located at Bangalore, Bhubaneshwar, Patna, Jaipur,
Lucknow and Bhopal which have been established in the office of the Regional
Directors, Health and Family Welfare. The first three units Bangalore, Bhubaneshwar
and Patna were established in 1981 (non-plan) where as the other three units at Bhopal,
Jaipur and Lucknow were established in 1986 (plan). These field Survey Units are
carrying out studies on the various areas of health problems especially where the
information is deficient. These Field Survey Units have carried out a total bumber of
160 studies by the end of March, 1997.

Health Management Information System: In pursuance of the National Health Policy for
establishment of an efficient and effective management information system in the
Health and Family Welfare sector in the country, a computer compatible health
management information system has been designed in collaboration with the
participating states, the National Informatics Centre and the World Health Organisation.
The CBHI acts as the nodal agency for the operation of Health Management Information
System. The system is being implemented in the States/U.Ts. of the country in phases.
Till now 13 States/U.Ts. are implementing the system and it has become operational in
the States of Haryana and Sikkim.

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(i) A review meeting was held during march, 1996 in which State/U.Ts. expressed
inadequacy of present HMIS (Version 2.0) to meet information needs of all concerned
and recommended in unequivocal terms the review of the formats. Accordingly a group
of officers of CBHI, NIC and the Ministry of Health and Family Welfare have been
examining the present HMIS formats in consultations with States to evolve a
comprehensive MIS to meet the requirement of all.

(ii) A workshop was held during 22-23 December, 1997 at Vigyan Bhavan, New Delhi
to discuss the problems faced in making the system operational in 11 State/U.Ts. in
which it is already implemented and the feasibility of computerisation of district medical
offices and connectivity through NICNET.

Publication: CBHI brings out the following publications : (i) Health Information of India
(annual); (ii) Directory of Hospitals in India (adhoc); (iii) Medical Education in India
(adhoc); (iv) Para-Medical Training in India (adhoc); (v) Health Graphics of India
(adhoc).

Q.3. Anupam Healthcare is a 50 bedded hospital located in a tier 2

city. It is considering going paperless, hence, it opts for a hospital
information system. Anupam Healthcare is a cardiac facility with an
in-house pharmacy and laboratory.

a. Why do you think Anupam Healthcare should consider a

hospital information system? Give 10 reasons.

Solution-
The importance of health informatics has long-reaching implications for a variety of
fields of medicine. The general principles associated with the concept include the use of
standardized informational science to provide better health care for patients. Health
informatics optimizes the medical industry's ability to acquire, store, retrieve and utilize
information about patients, diseases and treatment options. One of the key aspects, as
the technology becomes more prevalent within the industry, is the centralization of
databases and information. The overall goal of health informatics is to streamline
processes and provide more efficient and planned treatments for patients by biomedical
researchers, clinicians, dentists, doctors, nurses, pharmacists and public health officials.

Developing the Technology

Health informatics was first conceived of during the 1950s by the U.S. National Bureau
of Standards for use with dental patients to identify different statistics on routine and
advanced procedures. However, it wasn't until the 1970s and the creation of the MYCIN

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software system at Stanford University that the importance of health informatics became
prevalent. The MYCIN system used rudimentary algorithms and identification
techniques to analyze and diagnose blood clotting diseases as well as infections caused
by bacteria. Utilizing this system, doctors could easily find the correct antibiotics and
medicines to use on patients, standardizing treatment. Shortly thereafter, the
International Medical Informatics Association was established, regulating the field

Utilization of the Data

Beginning in 2004, the U.S. Department of Health and Human Services addressed the
importance of health informatics to the future of the health care industry by establishing
a program that would institute widespread use of computer systems to control
information on patients, procedures and insurance records. This plan, scheduled over the
course of 10 years, is headed by the Office of the National Coordinator for Health
Information Technology

Electronic health records became a prime focus of the initiative, prompting the
establishment of the Certification Commission for Healthcare Information Technology,
an organization that is tasked with ensuring the proper procedures and standards are
applied at all levels of the realignment. All vendors need to be certified by this agency.

Legal Aspects of Health Informatics

Information technology within the medical field can be a challenging legal subject. In
addition to the permanence of digital records, issues with privacy and ethics play into
concerns from both the public and industry alike. Dangers associated with central
databases, such as identity theft and file corruption, mean that the importance of health
informatics in the future can have large scale ramifications for society at large. Due to
the importance of these issues, a number of laws are presently being established to make
sure that operation issues are addressed and security is at the forefront of technological
advancements.

b. What are the factors Anupam Healthcare should consider while

purchasing a hospital information system.?

Solution-

Healthcare is a very important part of our society and it is imperative for healthcare
providers to do their jobs in an efficient and effective manner. Each day hundreds of
patients enter healthcare facilities challenging the administration to run the show
smoothly. The employees have to manage and integrate clinical, financial and
operational information that grows with the practice. Previously, this data was organized
manually, which was time consuming and failed to deliver the desired level of
efficiency. Most professionally run hospitals and clinics now rely on hospital
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information systems (HIS) that help them manage all their medical and administrative
information.

A hospital information system (HIS) is essentially a computer system that can manage
all the information to allow health care providers to do their jobs effectively. These
systems have been around since they were first introduced in the 1960s and have
evolved with time and the modernization of healthcare facilities. The computers were
not as fast in those days and they were not able to provide information in real time as
they do today. The staff used them primarily for managing billing and hospital
inventory. All this has changed now, and today hospital information systems include the
integration of all clinical, financial and administrative applications.

Modern HIS includes many applications addressing the needs of various departments in
a hospital. They manage the data related to the clinic, finance department, laboratory,
nursing, pharmacy and also the radiology department. The hospitals that have switched
to HIS have access to quick and reliable information including patients’ records
illustrating details about their demographic, gender, age etc. By a simple click of the
mouse they receive important data pertaining to hospital finance, diet of patients, and
even the distribution of medications. With this information they can monitor drug usage
in the facility and improve its effectiveness.

Hospital information systems have become very advanced and new innovations are
continuously being introduced. But a HIS is useless if it confuses the hospital
employees. The system must be user friendly and should include training by the
vendors. A good HIS offers numerous benefits to a hospital including but not limited to
the delivery of quality patient care and better financial management. The HIS should
also be patient centric, medical staff centric, affordable and scalable. The technology
changes quickly and if the system is not flexible it will not be able to accommodate
hospital growth. An effective HIS also delivers benefits such as:

• enhances information integrity

• reduces transcription errors
• reduces duplication of information entries
• optimizes report turnaround times

Modern hospital information systems typically use fast computers connected to one
another through an optimized network. These computers are programmed to collect,
process, and retrieve patient care and administrative information ensuring better ROI
and delivery of service. If the hospital authorities have more relevant information they
can make better decisions.

HIS leverages a highly optimized core library that ensures the delivery of operational
and administrative information required by users. A centralized information system can
be customized according to the specific requirements of a hospital. A hospital can tell
the solution provider its needs and the applications can then be molded to deliver exactly

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what was demanded. For instance, you can demand a solution that is based on RDBMS
for easy retrieval of information. You can also ask the vendor for a HIS that has user
friendly features and a multilingual interface that can be used by a diverse workforce.

HIS for Different Departments

Nursing Information Systems (NIS) – These computer based information systems are
designed to help nurses provide better patient care. A good NIS can perform a number
of functions and deliver benefits such as improving staff schedules, accurate patient
charting and improve clinical data integration.
The nursing department can have a better managed work force through schedule
applications enabling managers to handle absences and overtime. The solution can also
be used to monitor staffing levels and achieve more cost-effective staffing. Patient
charting application allows users to enter details regarding patients’ vital signs. Nurses
also use it for admission information, care plan and all relevant nursing notes. All
important data is securely stored and can be retrieved when required. Clinical data
integration is also very useful, allowing nurses to collect, retrieve and analyze the
clinical information and then integrate it to design a patients' care plan.
All these features in NIS ultimately lead to a reduction in planning time and better
assessments and evaluations. The chance of prescribing the wrong medication also
decreases since there is always a reference for electronically prescribed drugs.

Physician Information Systems (PIS) - As the name suggests, PIS systems aim to
improve the practice of physicians and are also recommended by the government for
deployment. Physicians can avail the Federal Government stimulus package aimed to
provide better medical care. Various packages are available to suit different budgets and
can be implemented to increase efficiency, cut costs and deliver high quality patient
care.

Physician information systems are delivered through computers, servers, networks, and
use widely deployed and popular applications such as, electronic medical records
(EMRs), electronic health records ( EHRs), and more. Mose of these services have 24/7
remote support that allows hospital staff to troubleshoot problems occurring during
system usage.

Radiology Information System (RIS) - These systems are also popular for their ability
to provide radiology billing services, appointment scheduling as well as reporting and
patient database storage. The radiology practice has become more complex with
advances in technology and more hospitals now turn to RIS to manage the business side
of their practices.

Pharmacy Information Systems- Designed to address the demands of a pharmacy

department, PIS helps pharmacists monitor how medication is used in hospitals. PIS
helps users supervise drug allergies and other medication-related complications. The

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system allows users to detect drug interactions and also helps administer the proper
drugs based on the patient’s physiologic factors.

Selecting a Hospital Information System

Total cost of package- Generally, HIS providers are happy to visit and discuss the
requirements of your hospital with you. Solutions are available for hospitals of all sizes
and budgets. It is important to have a hospital information system that has a low cost of
ownership. Some vendors reduce costs by having a design that requires less hardware
and fewer servers. This type of design is known to cut upfront acquisition costs and also
reduces maintenance in the long run.

Web based system- In addition to the user friendly features, a good HIS system must be
available on the web. Availability on the web means authorized personnel can access the
information whenever they want from anywhere. This does not bind all caregivers to
their office desks and also provides them with information when they need it most. A
web based system becomes even more important if it used to share information between
two or more hospitals. Healthcare facilities in different geographic locations can share
relevant data quickly if they use an internet based HIS.

For instance, a hospital may decide to shift a patient to another facility for better care or
specialty treatment. If the present hospital has updated all the patient information in their
HIS, the second hospital can instantly access the information needed for treatment. The
medical history of the patient will always be stored within these facilities and can be
readily retrieved if the patient is not able to provide it himself.

Implementation and support- Change is always resisted by humans and deploying or

upgrading a hospital information system may also invite employee criticism. It is always
better to ask the vendor for support in an implementation and request for staff training.
Choose a vendor that offers 24x7 support via the telephone or web, so your hospital staff
can immediately access support. Some hospitals also consult their staff while making a
purchasing decision, as the staff may be able to tell you something new or inform you
about things others may have overlooked.

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