Hospital Management System

Theory

Hospital - A service industry - covered under industrial dispute act 1947.
Service industry - Produced and Consumed at the same time. - Very little scope for the errors - Human life at stake.

Problems of Hospital Management
Discharge takes long
Doctors unhappy with their payments
Non availability of medicines on time
Piled - up inventory
Corporate overdue
Supplier payments
Overworked staff
Customer satisfaction - patient & relatives - doctors and suppliers - employees

There are basically two areas in hospital
Patient Management : those department which interact face to face with the patients and relatives
Back office : the departments units which do not interact face to face with the patients and relatives

Back office functions
Financial accounting Payroll
Billing Materials management
Personnel management diet/kitchen
Linen and laundry Maintenance
Internet library Operation theatre
Labs Pharmacy
Blood bank Investigation analysis and report
Refer Chart (Hospital Management system Overview)

Departments
OPD (Out Patient ) IPD (In Patient )
Laboratories Surgical Department (Rooms)
Pharmacy Medical Section
Accounts / Billing Services
Patient Monitoring Administration / Management

Flow
Flow can be discussed with following points
Patient registration
Patient admission
Patient discharge
Patient transfer
Ward management
Medical records

Person enquries at the reception counter - Submits or presents the available documents i.e. initial case file, prescriptions, surgical reports, note by any other doctor etc. - Registration as IPD patient and send it for preliminary tests - keep record of all those test - All these tests are conducted at the various labs in the hospital and normally by resident doctors. - Provide medicines if required - Prepare IPD report for the patient. - Give suggestions as per the diagnosis - If everything is perfect prepare bill. - Maintaining IPD History

Otherwise treat the patient as OPD patient and get registration details (in detail initial information of patient - Conversion of IPD data to OPD - Ask for patient details (personal details, physical details (height - weight), about illness, habits, allergies, previous treatment) - Ask information about doctors - Prepare case file based on these details and details from IPD report. - Get admitted the patient by allotting room / ward / bed. - Accordingly update occupancy charts - Inform registration details to various sections - Allotting the doctor (Resident doctor - Consulting doctor)

Utilization of various services (Food, Room Tariff, services to relatives, telephone etc.)
Various other activities such as Room/Ward/Bed Transfer, Complaints & suggestions, Different tests at various Labs (Inhouse Labs or external Labs - CT Scan), Operations, Consumption of medicines (Inhouse or external), Use of various equipments or instruments (Oxygen Cylinder).

Patient Stay Details (Maintenance of Clinical Notes) : Maintenance of case file details, Doctor's remarks, suggestions, treatment details, various readings, reports for various tests, employee attendance / observation details.

Monetary transactions : Record of each and individual transaction i.e. Service transactions, room charges considering room types and timings, consultation charges (resident and consulting doctor/s), medicine cost, operations, use of supporting instruments & equipments, charges for various tests (blood, urine, X-Ray etc.), Documentation cost, service charges, transportation (if any), general overheads etc. - Billing

Observations & suggestions, "Pathya Pani", Discharge card preparation, Preparation of Master and copy files with all clinical details and handing over to patient, Transferring data to History & maintenance of History.

Preparation of death certificate and completion of other formalities (if any death)

Maintenance of Master Data
Employee : Personal details, Qualification, Education, Duties, Experience
Doctors : Resident or Visiting, Personal details, Qualification, Education, Duties - days and timings, Experience, Availability.
Rate list or charge list for various tests, services, rooms.
Medicine price list - catalogs.

Important factors to be considered
Reservations for pre planned admissions (Motibindu - cataract)
Emergency admissions
Billing instructions
Capture birth and death details

Refer Context level diagram

First level Processes
Master maintenance
Admit patient (Registration, Initial investigation, Allotting bed, ward, and room)
Prepare case file (Recording diagnosis details, allotting doctors, keeping details)
Record transactions (Services, tests, labs, operations, Medicine etc)
Prepare Bill
Discharge / Death / Birth & Maintenance of history.
Reports

Refer ERD

List of files
Patient
Bill
Receipt
Discharge card
Service - case file Doctor
Bed
Room
Case file (H)
Case file - Doctor Service
Test
Lab
Case file (D)
Test - Case file

Important Files
Patient Master
Patient Code
Name
Address Birthdate
Sex
Blood Group Contact details
allergies
illness

Doctor
Doctor Code
Name
Address Birthdate
Sex
Blood Group Contact details
Specialization
Qualification

Test Transaction
Date / Time
Test code Case file no (FK)
Test details Charges
Emp code (FK)

Case file
Case file no
Case file from date
Patient code
Bed No (new) Registration no
To date
company letter no
History reference Bill No
Doctor code
Discharge card no.
death/birth certificate no.

Reports ( Management is interested in MIS reports related with)
M = Men
M = Money
M = Materials
P = Patients
Average length of stay Intensive care Index
Free patient ratio Revenue statement
In and out patient mix seasonal statement
Occupancy
General Topics

Validations

1. Day / Date / Time
2. Opening / Closing balances ( + ve OR - ve)
3. Maturity date - Final date - Exit date ( FD or Checkout date )
4. No duplication of transaction ( not only PKs but other unique fields also )
5. Missing document number (Check Serial Number )
6. Validation of master data ( Referential integrity, Cascade effect )
7. Empty field not allowed and calculated field not updated ( it is display only )
8. Cross reference - referential integrity

Need of Computerization OR Objectives

1. Up to date information of master data ( as 80% systems are online )
2. To handle voluminous data
3. Time bound system ( Payroll )
4. Speed and Accuracy
5. Sequential output
6. Manpower / Humanware Planning
7. Input / Output document control ( Accept only valid data )
8. Printing history, reports, accounts etc. in standardize format.
9. GUI, Security, Backup

Guidelines of Good MIS

Be management dirven / justified
Be integrated
Have common data flows
Have a heavy planning element
Have a sub system concept
Have flexibility and be easy to use
Have a database
Be a distributed system
Use information as a resource.