HOSPITAL AND HEALTHCARE INFORMATION MANAGEMENT

HOSPITAL AND HEALTHCARE INFORMATION MANAGEMENT

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 carriers 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 firms 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-

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

of living" standard of living of its people and the improvement of public health as among its primary duties". The

exist)" 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 2017In 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 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.

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 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.

(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 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 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 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 system allows users to detect drug interactions and also helps administer the proper drugs based on the patients physiologic factors.

Selecting a Hospital Information SystemTotal 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.

RAHUL GUPTA, MBAHCS (3RD SEM), SUBJECT CODE-MH0042, SET-1Page 1