ADVANCED HOSPITAL MANAGEMENT INFORMATION SYSTEM STUDY OF MANAGEMENT INFORMATION SYSTEMS (e-Sushrut) AT SGPGI, LUCKNOW [pic] Year 2010 Submitted to:Submitted by: Dr. Sanjay MedhaviSuneet Saxena M. B. A. (e-business) 2nd Semester Roll No. 48 DEPARTMENT OF BUSINESS ADMINISTRATION UNIVERSITY OF LUCKNOW 1. SGPGI (SANJAY GANDHI INSTITUE OF MEDICAL SCIENCES) Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow (India) is a University established under State Act in 1983.
The Institute is located on a sprawling 550 acres residential campus at Raebareli Road, 15 km away from the main city. The institute offers its own degrees, which are duly recognized by the Medical Council of India. The Institute is rated amongst the top medical institutions in the country, delivering state-of-art tertiary medical care, super-specialty teaching, training and research. Dedicated faculty members endeavour to provide quality education, patient care and research and strive to meet the challenges and needs of the society.
The institute offers 8 different post graduate programs in medicine and medical services: 1. DM 2. MCh 3. MD 4. PhD 5. Post Doctoral Fellowships 6. Post Doctoral Certificate Courses (PDCC) 7. Senior Residency(Hospital Services) 8. Fellowships( Bio-statistics) The institute has the following 23 departments: 1. Anaesthesiology 2. Biostatistics 3. Cardiology 4. Cardiology 5. Critical Care Medicine 6. Cardiovascular and Thoracic Surgery 7. Endocrinology 8. Endocrine Surgery 9. Gastroenterology 10. Immunulogy 11. Medical Genetics 12. Microbiology 13. Nephrology 14. Neurology 15. Neurosurgery 6. Hematology 17. Nuclear Medicine 18. Pathology 19. Radio-diagnosis 20. Radiotherapy 21. Surgical Gastroenterology 22. Transfusion Medicine 23. Urology 1. 1Salient features of SGPGI Hospital The hospital works as a referral hospital and patients are required to bring a referral slip from the referring physician. The referring physicians are requested to indicate the nature of patients’ problem, the specialty at the Institute they wish to refer the patient to and the nature of help required from the Institute. The Institute hospital endeavours to work on an appointment system.
Thus, the patients are expected to re-visit the Institute hospital only on appointed days, except in case of an emergency. 1. 2Unique Facility for Investigations The Institute provides facilities for some selected special investigations without the patients attending a clinical department. 2. NEED FOR INFORMATION SYSTEM The management of the hospital was a cumbersome task , since it has 23 departments and a big work force and number of students pursuing postgraduate programs. To overcome this problem, the institute adopted the MANAGEMENT NFORMATION SYSTEM developed by the C-DAC the “e-Susrut” in the year 1998. 2. MANAGEMENT INFORMATION SYSTEMS Management Information Systems (MIS), sometimes referred to as Information Management and Systems, is the discipline covering the application of people, technologies, and procedures — collectively called information systems — to solving business problems. Management Information Systems are distinct from regular information systems in that they are used to analyze other information systems applied in operational activities in the organization. Academically, the term is commonly used to refer to the group of information management methods tied to the automation or support of human decision making, e. . Decision Support Systems, Expert systems, and Executive information systems. 3. “E-SUSRUT”THE Management Information System e-Sushrut C-DAC’s Hospital Management Information System is a major step towards adapting technology to improve healthcare. e-Sushrut incorporates an integrated computerized clinical information system for improved hospital administration and patient health care. It also provides an accurate, electronically stored medical record of the patient. A data warehouse of such records can be utilized for statistical requirements and for research.
The real time e-Sushrut streamlines the treatment flow of patients and simultaneously empowering workforce to perform to their peak ability, in an optimized and efficient manner. It is modeled on the unique combination of a ‘patient centric and medical staff centric’ paradigm, thus providing benefits to both the recipients and the providers of healthcare. It ensures dramatic improvement in performance along with reducing the costs. e-Sushrut can be customized for a variety of hospitals such as medium sized clinics, large sized hospital which could be Government hospitals, Super specialty hospital or Purely Private hospitals. . 1Advantages • Connects people, processes and data in real time across all the hospital on a single platform. • Workflow routes documents and Information electronically. • Flexibility and Integration abilities manage change. • Customized Clinical data according to each Department, Laboratory etc • Access to Financial information and Performance indicators help in managing resources, costs and margins. • Fast and reliable information storage, querying and retrieval. Retrieval could be either for generation of reports based on demographics, gender, and age or for research & library classification. 3. Business Opportunities • System already deployed and working in a number of hospitals across the country • CDAC HIMS solutions are well accepted in the country • Teaming partners required for : o Setting up of hardware infrastructure o System installation and test-out o User training and hand-holding o Maintenance Support o Future Up gradations • Business Model o Teaming Partner required to be located near the hospital in question o Acceptance of the teaming partner by hospital concerned is required o Partner is to be involved in order realization from other nearby hospitals as well 3. Technical Specifications • Based on C-DAC’s n-tier Internet Architecture. • Takes Full advantage of extensive markup Language (XML). • Provides Bar coding Interface for areas such as patient Registration, Stores, Sample collection etc. • Provision for Machine Interface • Integration with Code sets like ICD (International Classification of Diseases), SNOMED etc • Based on RDBMS for easy retrieval and better performance • Portable across a variety of platforms • Easy GUI interface • Based on Windows – 95/98/2000 and NT front end with NT/Unix/Solaris as backend • Audit logging of transactions Comprehensive User Management & Security. • Integration with PACS and Telemedicine. 3. 4Features 3. 4. 1Registration Every patient who approaches a hospital has to get registered prior to getting any consultation, treatment, and investigations done from the hospital. Registration of patients involves accepting certain general and demographic information about the patient and assigning a unique central registration number (CR No) to the Patient. 3. 4. 2Out Patient Management The outpatient module deals with the entire gamut of activities pertaining to the management of out-patients.
It consists of the creating Patient Visit and storing details like complaints, history, clinical summary, provisional diagnosis, drugs etc corresponding to each visit. 3. 4. 3Pharmacy Management The Pharmacy Module deals with the maintenance of drugs and consumables in the hospital. The functions of this module include, online drug prescription, inventory management of drugs, consumables and sutures. 3. 4. 4Billing The Billing module deals with collection of money for services availed by a patient. 3. 4. 5Investigation In the routine functioning of a hospital, various types of investigations are carried out.
The module handles the processes right from raising investigations to making the results available. 3. 4. 6In Patient Management The In-patient module commences when the patient is being allotted a bed in the ward and ends after preparing the final discharge for a patient. In Patient Management deals with the complete treatment administered during the patient stay in the hospital. 3. 4. 7Operation Theatre The Operation Theatre module contains information about the availability of all the theatres, Equipment/Tools etc. Scheduling of operations is the main function of this module.
Provides provision for raising and validating an operation. Automatic preparation of Operation dossier Entering and validating the detailed Operation and Anesthesia record along with the provision for maintaining Post-op progress. 3. 4. 8Appointment This module deals in allotting appointments to patients for a visit to the hospital. It keeps track of available slots in various categories of appointments. This module also deals with cancellation of existing appointments. The module deals with two types of appointments • Consultant Appointment • Equipment Appointment. 3. 4. 9Central Sterile Services
The Central Sterile Services Department’s (CSSD) main function is to provide sterile items, linen, equipment to wards and OT’s. This could be reusable equipment, linen from various wards and OT’s for sterilization or it could be fresh sterilized items, which is issued to wards/OT’s as per the requisition received from their side. 3. 4. 10Diet Kitchen The functionality of the kitchen module is to manage the patients’ meal services. This module depends on the In-patient module. The diet can be prescribed only to the In-patients. The salient features of Diet Kitchen are Meal Scheduling, Meal Cancellation and Prescribing Therapeutic Diet . 4. 11Patient Medical Records The Patient Record Management Module is crucial in the overall integrated hospital management system. The rationale behind computerization of PMR is to maximize the usage of the patients’ medical information. 3. 4. 12Blood Bank The Blood Bank is one of the major components of a hospital, concerned with various related activities including donor registration, physical examination, blood grouping, blood infectious tests, component separation, blood requisition and cross match. 3. 4. 13Central Stores This module deals with Hospital Equipment/Material/Inventory Purchase and Supply to different Departments.
Requisitions for different items/equipment are sent to this store from different departments and accordingly the CSD issues items/equipment to various departments. The CSD also maintains records of purchases, stock, and supplier list, item/equipment/material master tables, and also takes care of the inspection details. 3. 4. 14Bio-Medical Engineering Department The Bio-Medical Engineering Department (BMED) module keeps track of the details of the Bio-medical equipment of the hospital. The details include equipment code, category, department name, location, and vendor’s name and purchase details.
This module also handles complaints and service details of different equipment. 3. 4. 15Enquiry This module provides information related to enquires regarding the hospital or the patients admitted or registered in the hospital. 3. 4. 16Master Management The functioning of the Hospital Information System depends on a large set of data that remains static for a long period of time. The Master module is used to enter, modify and validate the Master data that is used by all the other modules. It is the responsibility of the System Administrator to maintain the integrity of this data. 3. 4. 17User Management
User Management is Instrumental in assigning Privileges to users according to their Roles and Work Area. The Privileges are of two kinds Application Level and Data Level. 3. 4. 18Personnel Management Information System The PMIS Module deals with the maintenance of employee records in the hospital. The function of this module includes Employee Personnel Information, Employee Service Details, Leave Management, Disciplinary Action, Recruitment Process, Manpower Planning, and Management Module, which specifically looks after Vehicle Management & Accommodation Management, Training Management.
The PMIS Module is integrated with Payroll System. 19. Finance Management System The FMS module consists of Payroll System, which deals with generation of salary of employees with dues, deduction and income tax processing. Bill Processing System, which generates various types of bills (both employee specific and office related). The Asset Management Module which deals with purchase, allotment, location tracking, maintenance, contract details of assets and generation of Fixed Asset register. The Account Module maintains accounts, generation of Accounts Book such as Bank Book, Journal Book, and Cash Book etc.
It also includes Voucher generation, Ledger, Trial Balance, Sub-Trial Balance, Balance Sheet, and Profit-Loss account for the accounts section. 3. 4. 20Stores Management System The Stores Management System keeps the inventory of various items such as stationary, furniture etc. It also keep record of items in the inventory, reorder level of items, items allotted to various department, no of items that can be allotted to the department, vendor details, bill details of the items, item requisition, request approval and generating various reports. 3. 4. 21Library Management System
The Library Information System comprises of the following sub modules: Books acquisition, cataloguing, circulation, serialization, OPAC( Online Public Access Catalogue), Funds and accounts and Printing Desired Reports. 4. Experience in health care • SGPGI Lucknow – Since 1998 • GTBH Delhi – Since 2000 • Central Hospital, Northern Railway, New Delhi – Since 2002 • GB Pant, Port Blair – Since July 2004 • General Hospital, Chandigarh, Implementation in progress • MGIMS, Sevagram (Nagpur), Customization in Progress [pic] Fig: The Manaement information system view 5.
SGPGI and e-SUSRUT (History) The Institute initiated the process of hospital computerization in September 1992 by floating tender in national newspapers. A considerable number of companies in the related field responded and finally six vendors were short listed for the project. On the basis of the advice of the governing body and with due consent of president SGPGI, the institute started exploring the possibility with government organization and could interact with C-DAC, an organization under DOE, Govt. of India and finally SRS was given to C-DAC at the end of year 1994.
C-DAC completed the study and submitted the same to SGPGI in 1995. The computer network at SGPGI was established in 1997. Development work of the software was started in 1996 and commissioned in 1998. The HMIS database has a large number of patient records which can be known from records of 429701 patients’ registration till March 31st 2007. The database is managed through Oracle. Every day, on an average, 250 new registrations are done on the system. The number of investigation requisitions raised daily on the system is around 2000 and on an average 3500 investigations validated daily.
Thus, to the best of the knowledge, SGPGI has the largest HMIS database in the country. The Institute is in the process of procuring new desktop computers, which will replace old P-I machines used in HMIS to improve the processing speed and efficiency of hospital functioning in these areas. The Center maintains the following: – Hardware and software of about 300 computer nodes – Approximately 160 printers – Hospital-wide computer network – Internet link, – System administration of HMIS database etc. – User-related problems Email, intranet server and proxy server system administration – Institute website, including making available application forms for courses, forms for faculty positions, results of entrance examinations, advertisements for other positions, etc. The faculty and staff from the Computer Center participates as faculty in 01 Foundation Course for new resident doctors. As a part of this teaching course, they provide training on basic use of computers, Windows operating system and on the use of HMIS, Internet and E-mail. As and when needed, training is also provided to other new users.
In addition to the above, the Computer Center staff assist in the conduct of various examinations and other Institute activities, whenever called upon to do so. 6. Hardware Main Servers: Fault-tolerant system with two servers (E 450 and E 220R) and two storage arrays (A1000) has been installed. The earlier Oracle 8. 0 (35 named user licenses) has been upgraded to Oracle 9i (70 named user licenses), which has been installed on the Sun server. Terminals: Initially 200 Acer-Entra machines (P-I) were being used for the users to access the HIS and other facilities. Later on 100 Spice net machines (P-IV) were procured to replace the old machines.
Also 30 HP and Compaq (P-II & P-III) machines have been installed and configured on the network. Local area network (LAN): The LAN for the Institute covers various areas of the Main Hospital, General Hospital, Administrative Block and other blocks. All the blocks and buildings are connected through a total length of about 3000 m fiber-optic cable, which serves as the backbone of the network. The backbone connects the HIS and other servers to user end machines through a 10/100 MBPS switch (Lanplex 2500) and 32 3-Com super stack hubs to the peripherals CAT-5 network with about 240 terminals.
The up-gradation of hospital wide network was completed in May 2005. A total of 325 additional network points were added. This would meet the requirements of all the faculty members, seminar rooms, labs, wards, completed areas of newly constructed blocks and other areas. All the existing hubs and mini-hubs were replaced by CISCO and 3-COM switches and existing 100 Mbps central switch was replaced by a 1Gbps, layer 3, managed CISCO switch. A new fiber-optic cable was also laid from the server room to the Shruti auditorium. 7. Software
The Institute’s Hospital Management Information System (HMIS) software was developed as joint venture by SGPGIMS and Center for Development of Advanced Computing (C-DAC). All the modules including Registration, Billing, Appointment, Outpatient management, Investigations, Inpatient Management, Operation theatre management, Central Stores, Hospital Revolving Fund, Diet Kitchen, Central Sterilization, Blood Bank, Biomedical Engineering and Patient Medical Records (PMR), have been running satisfactorily and approved by the end users.
However, with increased usage, a few bugs have been identified in some modules. As the users have become familiar with the hospital Information System (HIS), they have requested for several additional facilities, which had not been envisaged earlier. The growth in the size of the database over time has been considerable. Because of this, the system access speed has become very slow and this is a major concern as it affects the day-to-day functioning of the hospital. 8. Internet and Email Services: HP net server E-800 machines are being used as Intranet, E-mail, Web and proxy servers.
Earlier, Internet services were being provided through a 64 kbps leased line link. Earlier Internet connectivity was being provided to all academic departments, one for each department and E-mail facilities have been provided to all the faculty members, residents, students and some officers of the Institute. During the year 2004, the Institute has bought an additional 512 Kbps (1:4) broadband wireless leased line from M/s Sify Limited. This has led to a major improvement in Internet access speed, allowing better access to medical literature.
This increased access has allowed us to provide Internet access at more terminals in the Central Library of the Institute. Later on 512 kbps (1:4) Internet broadband link has been upgraded to 1024 kbps (1:4) in 2005 to meet the additional bandwidth requirements. Earlier, the institute had a CISCO 2500 series router which is being used for routing 64 Kbps leased line. Later on a higher end router has been procured for configuring the Internet link. 9. CONCLUSION Thus it is evident that use of HMIS by SGPGI has: 1.
Improved its efficiency, working capabilities and response time to the problems of the institute, patients and staff. 2. Made collection and retrieval of patient care and administrative information (from various departments for all hospital) easier to satisfy the functional requirement of the users. 3. Connected people, processes and data in real time across all the hospital on a single platform. 4. Made the workflow of documents and Information electronically. 5. Developed flexibility and Integration abilities to manage change. . Customized Clinical data according to each Department, Laboratory etc 7. Facilitated direct access to Financial information and Performance indicators that help in managing resources, costs and margins. 8. Facilitated fast and reliable information storage, querying and retrieval. Retrieval could be either for generation of reports based on demographics, gender, and age or for research & library classification. 9. Provided facilities for some selected special investigations without the patients attending a clinical department.
Thus HMIS helps as a decision support system for the hospital authorities for developing comprehensive health care policies. Thus making it advanced and centre of MEDICAL services excellence. 10. REFRENCES [1]. “Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow”, www. sgpgi. ac. in [2]. “Management information system – Wikipedia, the free encyclopedia”, www. en. wikipedia. org/wiki/Management_information_systems [3]. “CDAC “Centre for Development of Advanced Computing”, www. cdacnoida. in/MoU_WS/HMIS. html [4]. “About departments”, http://www. sgpgi. ac. in/departments. html
