Thakral IIHMR New Delhi A Review of HIS TrakCare at Sir Ganga Ram Hospital Its Workflow and success at userend Introduction Comprehensive information system dealing with all aspects of information processing in a hospital ID: 542939
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Slide1
Yogita ThakralIIHMR New Delhi
A Review of HIS (TrakCare )atSir Ganga Ram Hospital:Its Workflow and success at user-endSlide2
IntroductionComprehensive information system dealing with all aspects of information processing in a hospital.
Integrated, computer-assisted system designed to store, manipulate and retrieve information concerned with the administrative and clinical aspects.So far, any studies focusing on reviewing the TrakCare (the HIS at SGRH) from the user’s perspective have not been carried out. Slide3
SGRH - Profile675-bedded multi-specialty state-of-the-art hospital [1]
Initially founded in 1921 at Lahore by Sir Ganga RamNABH accreditedSGRH’s expectations :Better inventory controlRapid access to lab resultsReduced allergy and drug interactionsEfficiencies Through Automated Billing
Savings Through Better Inventory and Medical Package Control
Substantial Cost Savings Through Pharmaceutical SubstitutionSlide4
Intersystems’ TrakCareUnified healthcare information system that lets authorized healthcare professionals access and work with complete patient records.
[2]Leading Web-based HISProvides a full range of clinical, administrative, lab capabilitiesEnables timely and more informed decisions about patient care, based on up-to-date information.Slide5
Rationale of study
Having a good HIS is crucial for the success of hospitals.enhances information integrity
reduces transcription errors
reduces duplication of information entries
optimizes report turnaround
times
The HIS should also be patient centric, medical staff centric, affordable and scalable.Slide6
This study aims at reviewing TrakCare
insofar as it’s success from the user-end is concerned, explaining how the various modules are interconnected and mapping the workflow involving patient care, as seen on TrakCare.Slide7
Review of literatureThe International Perspective :Methods for evaluating hospital information systems: a literature review [6]
Assessing User Satisfaction of using Hospital Information System (HIS) in Malaysia [7]Hospital Information Systems In Nigeria: A Review Of Literature [8]Slide8
The Indian Perspective:Hospital Information System in Medicare – An Experience at Tata Main Hospital,Jamshedpur [9]A study of the Hospital Information System (HIS) in the Medical Records Department of a Tertiary Teaching Hospital
[10]Evaluation of computerized health management information system for primary health care in rural India. [11]Slide9
ObjectiveGeneral objectiveTo review the existing HIS (TrakCare) at Sir Gangaram Hospital from the end-user’s perspective.
Specific objectives1. To map the workflow of the hospital as seen on TrakCare in various departments, by creating a fictitious patient.2. To determine whether CPOE is being used judiciously at SGRH by clinicians.3. To assess the knowledge and behavior of employees towards TrakCare.Slide10
MethodologyStudy design: Cross sectional , Descriptive
Study area: Sir Gangaram hospitalStudy population: Doctors / consultants , Nurses / Paramedics, Front office executives, Billing executives and pharmacistsSampling and sampling design : Sample size 51 ,Convenience.Data collection tool : Questionnaire (close ended, Likert scale)
Duration of study
: 2 months (2
nd
Apr – 31
st
May)
Information thus obtained from the above questionnaire
entered
in SPSS software and
analyzed.
Slide11
Advantages & Disadvantages
Adv. OPD :An episode number created for each visit.Easy and convenient identification of patientAll the categories have been segregated very meticulously.
Disadv
. OPD
Appointments are not be maintained.
During downtime, the whole process has to be maintained manually.Slide12
Adv. ADMISSIONSSystem can recalculate the charges if a patient downgrades or upgrades his plan.Unique identification numberProcess of room allocation has become easy.
Disadv.The waiting list for the patients is not being maintained in the HIS.Often the system takes a lot of time to update new information.Slide13Slide14
Adv. WARDS“Abnormal results” removed.A ward list showing all the current patients and their details can be seen by any nurse
Nurse has now full control of the final discharge.The nurses can order medicines, medical consumables and tests for patients from a single menu.Disadv.Patient’s details are not entered at each patient visit. Clinician’s notes and nurse’s notes menu is not being utilized. System capable of showing an alert if wrong dosage of a drug is entered into the system. Slide15
Adv. of LabTrak in Laboratories andCICA
ll the previous and present test reports of a patient on a graph available.No sample mixing now because of separate barcodes for different labs, patients and tests.One lab can not see and scan the sample of other. Report distribution is decentralized.Slide16
Adv. PHARMACYHandwriting errors have reduced to a great extent. The system doesn’t allow packing of expired medicines.
The system shows alert for allergies and drug interaction at the pharmacy as well. Disadv. PHARMACYA pharmacist cannot challenge the doctor’s prescription. Slide17Slide18
Adv. BILLINGBilling errors have been reduced greatly.Control on pricing.
Option of reverse financial discharge is available. An order can be cancelled from the billing department only, once it has been executed. Slide19
Study Findings
6 7 8 15 9 6
6
7
8
15
9
6Slide20
Can
HMIS increase work efficiency?
Frequency
Percent
Valid Percent
Cumulative Percent
Valid
Strongly Agree
9
17.6
17.6
17.6
Agree
30
58.8
58.8
76.5
Neutral
9
17.6
17.6
94.1
Disagree
3
5.9
5.9
100.0
Total
51
100.0
100.0
Agree
58.8%
Strongly Agree
17.6%
Neutral
17.6%
Disagree
5.9%Slide21
How frequently do you experience problems while using
TrakCare?
Frequency
Percent
Valid Percent
Cumulative Percent
Valid
very frequently
6
11.8
11.8
11.8
frequently
19
37.3
37.3
49.0
sometimes
24
47.1
47.1
96.1
rarely
2
3.9
3.9
100.0
Total
51
100.0
100.0
Sometimes
47.1%
Frequently
37.3%
VF
11.8%
Rarely
3.9%Slide22
Can you differentiate between HIS and EMR?
Frequency
Percent
Valid Percent
Cumulative Percent
Valid
yes
16
31.4
31.4
31.4
no
35
68.6
68.6
100.0
Total
51
100.0
100.0
NO
68.6%
YES
31.4%Slide23
What are the limitations of
TrakCare?
Frequency
Percent
Valid Percent
Cumulative Percent
Valid
NA
22
43.1
43.1
43.1
not user friendly
1
2.0
2.0
45.1
slow processing
16
31.4
31.4
76.5
long downtime
3
5.9
5.9
82.4
can not calculate complex mathematical equations
9
17.6
17.6
100.0
Total
51
100.0
100.0Slide24
How
much downtime does the system experience usually ?
Frequency
Percent
Valid Percent
Cumulative Percent
Valid
Few minutes
25
49.0
49.0
49.0
Few hours
21
41.2
41.2
90.2
A day
5
9.8
9.8
100.0
Total
51
100.0
100.0
49.0%
41.2%
9.8%Slide25
Do you enter the patient details yourself? (Doctors & nurses only)
Frequency
Percent
Valid Percent
Cumulative Percent
Valid
NA
36
70.6
70.6
70.6
Yes
11
21.6
21.6
92.2
No
4
7.8
7.8
100.0
Total
51
100.0
100.0Slide26
DiscussionUnique registration
number and episode creation. The EPR is at the centre of patient management.System well-equipped to show various important alerts. No sample mixing is ensured by Labtrak and barcoding. Certain features of TrakCare are not being capitalised upon fully.No record
in
case a doctor acts upon an allergy alert shown by the
system.Slide27
Recommendations
It is the doctor who needs to enter all the patient details and at each patient visit.Brief training on TrakCare for every new employee.There has to be a feature that can calculate mathematical equations in the system , this would be of great help in laboratories.Since slow processing seems to be one of the major grouses that employees have with TrakCare, steps should be taken to speed up the system.Slide28
PACS (Picture Archiving and Communication System) implementation at SGRH
: Process of vendor selectionSlide29
Agree
58.8%Strongly agree17.6%Disagree 5.9%
Neutral
17.6%Slide30
IntroductionSound HIS system; but the hospital did not have a Medical Image and archiving solution.PACS has the ability to deliver timely and efficient access to images, interpretations, and related data.Breaks down the physical and time barrier associated with traditional image retrieval, distribution, and display.Slide31
PACSA Picture archiving and communication system is a medical imaging technology which provides economical storage of, and convenient access to, images from multiple modalities such as X-ray, CT, MRI, etc. on computers, within the hospital as well as in doctors clinics and homes.Slide32
ObjectiveTo study the process of vendor selection for PACS at SGRH.To determine the advantages of PACS for clinicians and the imaging departments.Slide33
MethodologyInterviewsObservation
People interviewed were- Head IT, Head medical informatics, FUJIFILM’s representatives, Head of radiology department. The workflow of the radiology departments was observed.Slide34
Process of vendor selectionPreliminary demonstrations and discussions with various vendors
RFP prepared , had all technical and functional specificationsRFP was sent to 9 vendors.Proposals received were compared, second RFP was then floatedAn initial evaluation was done based on functionality provided and number of installations and support base in India4 vendors were excluded after the initial evaluationA team of 4 experts went for site visits.Slide35
Each hospital was visited for about 4 hours. The hospital team was accompanied by a member of the PACS provider company. A four page questionnaire was used to gather relevant informationSlide36
Advantages
For Imaging DepartmentBetter radiologist reporting accuracyImaging data can be stored for lifetime at the hospital.In MLC case, hospital will be able to print out fresh copies of the previous image as and when requiredSlide37
For cliniciansClinicians themselves can alter image contrasts, brightness, window levels, magnification, etc. on the viewing computer, allowing tm to detect finer detailsDifferent images of the patient to be viewed side-by-sidePatient’s images can be seen/accessed by the clinician from wherever he is, at whatever time
The orthopedic department can use its inbuilt computerisation (Trauma CAD) for advanced planning of hip replacements, deformity corrections etcNeurosurgeons can use the inbuilt computerised measurement facilities to guide their stereotactic and robotic systems to that brain lesions can be operated upon with greater accuracy.Slide38
Cost savingsPatients can be issued with a whole series of x-rays, CT scans, MRIs, etc. on a single CD without having to print themIn the ICU ,images can be viewed via the IU doctors on their monitors without the need to print films daily.Manpower requirement to carry films from one location to another will be reduced Slide39
ConclusionFuji ranked second place in RIS and third place in PACS, which is very rare. Fujifilm has been selling PACS in Indian market for 3years now (10+ years globally)
Other hospitals who also have Fujifilm PACS say that it has good functionality, professional approach , commendable support and services and seamless and quick integration with HIS.Slide40
Case Study:TYPES OF STICKERS AND BARCODING USED AT SGRH AND THEIR BENEFITSSlide41
IntroductionWhenever any new patient comes to SGRH : Unique registration number, episode creation.Information is printed on to stickers , pasted on to the patient’s forms at various points in time.
Unique barcodes for each patient, visit and departments.Slide42
MethodologyStudy design : Cross sectional, DescriptiveStudy area : Sir Ganga Ram Hospital
Study population : SGRH employees at OPD Reg.,Front Office, Biochem and Microbiology labs, Nursing stationsSampling design : Convenience. 25 people were interviewedData Collection tools and techniques : Interview Slide43
REGISTRATION STICKERSlide44
EPISODE STICKERSlide45
LABORATORY STICKERSlide46Slide47
Advantages of
Barcoding and StickersEfficient bar-coding and sticker generation system reduces the chances of sample mixing.Reduced time consumption at each step.Important patient information is available in condensed form at all times.Reduction in medication errors, increased accuracy.Slide48
DiscussionProved to be a milestone in improving quality at SGRH
Reduces sample mixing, makes patient identification easy and saves time at each step.Slide49
References1.http://www.lexic.us/definition-of/hospital_information_systems
2.http://www.sgrh.com/3.http://www.intersystems.com/trakcare/index.html4.http://www.jbtdrc.org/Symposium/Topics/Role_hospital.htm5.http://www.emrconsultant.com/education/hospital-information-systems6.http://www.emeraldinsight.com/journals.htm?articleid=1728173 Vassilios
P.
Aggelidis
,
Prodromos
D.
Chatzoglou
7. http://www.ipedr.com/vol5/no2/45-H10139.pdf
Indah
Mohd
Amin
et al
8.http://www.j.kdnc.org/index.php/j/article/view/73
Ayodele
Cole Benson
9. http://medind.nic.in/haa/t01/i1/haat01i1p70.pdf
Mohanty
Rajesh,
Rana
Sarosh
D,
Kolay
Saroj
K
10.http://fkilp.iimb.ernet.in/pdf/Healthcare_Quality/Assessment_of_Quality_of_Health_Facilities_&_Services/Kumar&Gomes_study_of_HIS.pdf
Praveen Kumar A, Gomes L.A
11. http://www.ncbi.nlm.nih.gov/pubmed/21078203
Krishnan A et alSlide50
Thank you