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The development and implementation of Hospital Information

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The development and implementation of Hospital Information System: Experience from PPUKM Ahmad Taufik Jamil, MD, MPH, MSc(IT) Head, IT Center, PPUKM – PowerPoint PPT presentation

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Title: The development and implementation of Hospital Information


1
The development and implementation of Hospital
Information System Experience from PPUKM
  • Ahmad Taufik Jamil, MD, MPH, MSc(IT)
  • Head, IT Center, PPUKM

2
Outline
  • Background
  • Our Plan
  • Development
  • Deployment
  • Finding
  • Conclusion
  • Future plan

3
Background
  • To share our experience in
  • Developing
  • Deploying
  • Hospital Information System in a major teaching
    hospital in Malaysia (PPUKM)

4
The Hospital
  • Tertiary referral center
  • Teaching hospital
  • 1050 bed
  • 3500 staff
  • 50,000 out patient per year
  • 65,000 AE visit per year
  • 40,000 inpatient per year

5
The Hospital
  • Established hospital, operated for 10 years
  • Undergraduate (Medical Nursing 1000)
    postgraduate students800
  • Partial implementation of information system
    departmental information system
  • Laboratory
  • Radiology
  • Pharmacy

6
Why the project started
  • Encourage research in medical informatics
  • Encourage teaching of medical informatics
  • To have integrated information system for
    services
  • Encourage to use of standard in developing
    hospital information system
  • To own the system
  • To reduce cost

7
What is HIS?
  • Collen
  • The goal of an HIS is to use computer and
    communication equipment to collect, store,
    process, retrieve and communicate patient care
    and administrative information for all
    hospital-affiliated activities and to satisfy the
    function requirement of all authorized users.

8
Outline
  • Background
  • Our Plan
  • Development
  • Deployment
  • Finding
  • Conclusion
  • Future plan

9
Objectives of hospital information systems
  • To improve efficiency of hospital operation
  • To improve quality of medical care
  • To enable data and information sharing between
    healthcare providers ? CDA HL7
  • To support case-mix system
  • To support research and education in medical
    informatics
  • To support implementation of Healthcare IT
    project by the Ministry of Health, Malaysia.
  • To have an Integrated Hospital Information System
    ? HL7/DICOM

10
What weve planned
  • Some system need to be replaced
  • InfoMed (Patient management system)
  • Radiology Information System
  • Order Management System
  • Some system we will maintain, use upgrade
  • Laboratory Information System
  • Pharmacy information system
  • Picture Archiving Communication System (PACS)
  • Integration is required, and we will do the
    integration process using internationally
    accepted standard.
  • To start in-house development project of HIS

11
  • 100 in-house

12
The Plan
  • Phase 1-Completed/Deployed (2004-2007)
  • Core HIS/ADT (Resource management)
  • Phase 2-On going project (2008-2009)
  • Computerized Physician Order entry (CPOE)
  • Integration-Using HL7 version 2.5
  • Phase 3-planning(2009-2012)
  • Electronic Medical Record
  • Phase 4-planning(2012-2015)
  • Research module, Case-based learning module etc

13
Preparation
  • Convince the management
  • Secure some budget
  • Employ new staff
  • Train IT staff
  • The technology to be used-J2EE
  • System admin
  • DBA
  • New working culture
  • Form domain expert team

14
Outline
  • Background
  • Our Plan
  • Development
  • Deployment
  • Finding
  • Conclusion
  • Future plan

15
Project Team
  • Technical 40 (System analyst, System admin,
    DBA, programmer)
  • Domain Expert 40 (Clerk, Nurse, Doctor etc)
  • Advisory Panel

16
Standard
  • Integration Standard
  • Health Level 7 (Health application integration
    standard)
  • DICOM (Medical imaging standard)

17
Terminology Classification
  • Classification
  • ICD 10 (Diagnosis Coding)
  • ICD 9 CM (Procedure Coding)
  • Terminology
  • SNOMED CT
  • LOINC
  • MAMPU MOH data set (Demographic data)

18
Technology Used
  • J2EE
  • 3 tiers, web-based application
  • Web tiers JSP/JSF/AJAX
  • Middle tier EJB
  • Database tier Oracle 10g RAC

19
Development Process
  • Requirement study (Use case)
  • Analysis Design
  • Implementation, Coding debugging
  • Testing
  • Alpha test
  • Simulation test
  • Beta testing/pilot test
  • Roll-out

20
Modules (Phase 1)
  • Patient Registration
  • Emergency Department registration
  • Ward management (Admission, discharge transfer)
  • OT Scheduling
  • Clinic Management (Appointment Scheduling)
  • Medical Record
  • Case-mix
  • Patient accounting
  • Users profile

21
Outline
  • Background
  • Our Plan
  • Development
  • Deployment
  • Finding
  • Conclusion
  • Future plan

22
Deployment
  • Phase 1 project has been deployed on 6th December
    2006 A year ago.
  • Big bang approach
  • Point of implementation includes
  • All point of patient registration 3
  • All wards intensive care 40
  • All clinics 20
  • All day cares 4
  • All Operating theatre 20

23
Users involved
  • Nurse 1500
  • Clerk 70
  • Doctors/Specialist 300

24
Module Vs user
25
Preparation
  • Testing
  • white box
  • Simulation test
  • Pilot test at 2 major cluster (ENT OG)
  • Users training

26
Administrative preparation
  • User registration
  • Road show to each and every department
  • Support (24 hrs)
  • Hotline
  • Operation room
  • Onsite support (application technical)

27
Outline
  • Background
  • Our Plan
  • Development
  • Deployment
  • Finding
  • Conclusion
  • Future plan

28
Planning outcome
29
The milestone
  • Phase 1 delayed by 1 ½ years
  • Reduce the scope of phase 1 (CPOE was moved to
    phase 2)
  • Reasons
  • Overestimate the potential of our resources
  • Changing of scope, esp Patient accounting
  • Skill of staff with the technology J2EE UML

30
Duration taken
  • Requirement study 4 months
  • Analysis Design 8 months
  • Coding 1 year, 3 months
  • Testing 5 months
  • Pilot test 4 months

31
PPUKM
STANDARD
32
Training
  • Clerk, nurse will attend training, 70-80
    attendance.
  • Clinician usually dont have time for training
    (attendance almost 0)
  • We go to each clinical department for
    demonstration discussion

33
Aduan-Total
34
Aduan mengikut Module
35
User error Vs Application error
36
(No Transcript)
37
Result
  • No of call reduce month by month
  • ADT User profile most no of call
  • Error is mainly by the user
  • Module used by clerk Nurse have less problem

38
Outline
  • Background
  • Our Plan
  • Development
  • Deployment
  • Finding
  • Conclusion
  • Future plan

39
Challenges
  • New staff-fresh graduate
  • We cannot run away from big bang approach in
    phase 1
  • Many user are not ready to use new system
  • Many user do not realize that we are changing new
    system.
  • Get used with old system (many shortcut keys
    without mouse)
  • Many user do not attend training, esp doctor
  • Bug fixing request changes-last minutes request.

40
Recommendations
  • Avoid big bang approach incremental
  • Champion among clinician
  • Working culture
  • Web based need better technology
  • Quality
  • Project management

41
Conclusions
  • Focus on Training, training, training, training
  • Early awareness
  • Support/hotline 24hrs a day, onsite!
  • Use what ever measures available to encourage the
    doctor to use the system
  • Their involvement as early as possible

42
Outline
  • Background
  • Our Plan
  • Development
  • Deployment
  • Finding
  • Conclusion
  • Future plan

43
Next in the milestone
  • Implementation of Patient Accounting (2009)
  • Continue Phase 2 development (2008-2009)
  • Radiology Information System
  • Computerized Physician Order Entry
  • Laboratory
  • Radiology
  • Pharmacy
  • Procedure
  • Diet
  • Nursing
  • Rehabilitation
  • Social worker
  • Patient portal
  • Integration
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