In recent years, Hospital Information Systems (HIS), including Electronic Health Records (EHRs) have been implemented by an ever-increasing number of hospitals around the world. Often, these initiatives have been driven by government regulations or financial stimulations, for example in the USA, the UK and Denmark. More recently, the Ministry of Health (MOH) of Singapore made it compulsory for all healthcare providers from large hospitals all the way down to the neighbourhood GP clinic to upload data to the National Electronic Health Record (NEHR). The sharing of medical information in a national electronic repository is expected to make for more seamless treatment, and to save money for patients.
Nonetheless, there are still hospitals who are not planning to use it. They choose to continue to rely on manual processes, whether in the administration area (registration and billing), or patient records and prescriptions.
There are several possible reasons of this reluctance. Firstly, hospital software may be considered costly, especially for start-up businesses who would rather invest in other assets. Secondly, the implementation of a hospital-wide HIS sounds challenging, because it involves a range of organizational and technical factors including human skills, organizational structure, culture, technical infrastructure, financial resources, and coordination. There are often security and confidentiality concerns. And last but not least, there is still general lack of awareness of the benefits of having a great HIS.
To highlight the importance of good software in a hospital, we have compiled a list of how HIS can improve the daily operations, and eventually lead to improved service quality and patient satisfaction.
With a HIS, the complex scheduling processes involved with appointments and registrations can be greatly simplified, so that the ordeal of patients waiting endlessly for their turn can be all but eliminated. It enables doctors to reduce their dependence on staff regarding such issues.
There is also a growing trend of utilizing patient self-service tools. For example, many patient forms can be filled out beforehand through online portals or at a computer kiosk in the waiting room. This can save a lot of staff time, while reducing the patients’ waiting time.
Other critical aspects than can be supported by a HIS are the processing of patient billing, medical insurance claims, and other reimbursements. With the help of a HIS, these processes can be seamlessly managed, as all the required data & information is available with just the click of a button.
2. Patient Record/Medical History
Using a HIS, comprehensive patient records will be readily available and easily accessed. This includes examination results of previous visits, treatments and medications, medical and family history, and patient’s habits. Cohort data can also be provided, for example by compiling data of a baby’s delivery, the follow-up visits, vaccination records, and growth history. This can help to establish proper diagnosis and to define appropriate treatments, which eventually lead to a better quality of service.
EHR can also enhance communication between healthcare professionals. Data can be entered not only by physicians, but also nurses, nutritionists, physiotherapists, and other professionals. Evidence-based standardized care plans can also be introduced, which improves the quality of care.
3. MIMS Decision Support
Prescribing faults and prescription errors are major problems. Although rarely fatal, they can impact patients' safety and quality of healthcare. Prescription errors encompass those related to the act of writing a prescription, whereas prescribing faults encompass irrational prescribing, inappropriate prescribing, under-prescribing, overprescribing, and ineffective prescribing, arising from erroneous medical judgement or decisions concerning treatment.
Most e-prescribing systems include medication decision support (MDS), which helps providers avoid errors in prescribing. This program, usually connected with a medicines database such as MIMS, checks for drug-drug, drug-allergy, and drug-disease interactions, as well as drug cost and dosing recommendations. Prescribing errors can be minimized by enforcing users to enter appropriate medicine names, dosages, and administration notes.
CPOE (Computerized Physician Order Entry) is a process by which physicians can place orders regarding patient care through an electronic system which communicates with the various departments. They commonly include medication orders to the pharmacy, lab tests for blood work, radiology orders and other instructions relating to patients.
With CPOE, patient charts are not likely to be misplaced or misfiled. Errors due to handwriting and miscommunication are also averted. Clear and legible electronic orders do not need further clarification and leave no room for interpretation. Order recipients do not have to interrupt the prescribing doctor’s workflow, a practice which can dramatically increase the probability of errors. There is a substantial reduction in the time taken to place orders as well as receive results from the laboratories or medications from the pharmacy. Efficiency is also improved with the reduction of paper records. CPOE may have even more impact when integrated with other applications such as practice management tools and E-prescribing modules.
5. LIS & RIS Integration
LIS (Laboratory Information System) is software used to manage all of a modern laboratory’s operations that consist of the order entry, patient check-in, specimen processing, result entry, and reporting. Radiology Information System (RIS) is a similar concept, used to manage processing of Radiology orders, including medical imagery and associated data (in conjunction with PACS and VNAs).
Both LIS and RIS can be integrated to a HIS, which results in the following benefits to the hospital:
• More work, less paper: Staff can focus more on patient care, rather than wasting time doing paperwork.
• Improved accuracy: LIS and RIS will help your staff to work more accurately, leading to fewer medical errors and transcription mistakes.
• Improved turn-around times: Reduces work times from hours to minutes by automating manual processes.
• Real-time tracking of orders: Once orders are retrieved and processed, the statuses can be tracked easily, including by the ordering physicians.
• Integration with billing process: Orders that are processed can be automatically sent to billing, generating an invoice to be paid by the patients.
• Well-managed image files: When RIS is integrated with PACS, instant access to images and patient data can be provided. The use of digital files instead of physical films also improves efficiency and lowers the cost.
6. Data for research
Electronic health records may include a range of data such as demographics, medical history, medication and allergies, treatments, diagnostic support results, etc. These records can be shared easily across the healthcare system with doctors, hospitals, pharmacies, insurers and research institutions. When used appropriately, EHR data creates crucial opportunities for researches, which can fundamentally change the diagnostics and treatment of patients.
Another data-based use can be found in new therapies allowing the advanced adjustment of treatments. So-called 'precision healthcare and medicine' is a medical model that proposes the customization of healthcare, with medical decisions, practices, treatments, drugs or devices being tailored to the individual condition of patients. In this approach, diagnostic testing is often employed for selecting appropriate therapies based on the context of a patient's genome or other molecular or cellular analysis.
Customer relationship management (CRM) is a valuable method for establishing long-term customer relationships across different business areas. A CRM system stores and analyzes a vast amount of customer information and provides alternatives to meet customer expectations using data warehouses and on-line analysis processing technology. When integrated with HIS, a CRM helps the hospital to develop closer patient-provider relationships. One simple way is by providing reminders/alerts to patients about upcoming appointments/treatments. Other examples are by sending birthday cards, managing complaints and inputs, and conducting customer satisfaction surveys.
A CRM can also be used to manage relationships between referring health facilities, for example by providing programs to boost their loyalty. This can help generate patient traffic to the hospital.
In conclusion, having a proper HIS can improve the quality of the overall patient service. There are certainly challenges when implementing HIS. Effectively communicating the benefits of HIS, training everyone properly and providing strong technical support can help organizations encourage the use of a HIS. Choosing software that has been properly designed by medical professionals and proven to be effective will minimize issues. Close coordination and collaboration with the software vendor should be undertaken to program, plan, and execute the implementation effectively. It is vital to hire a vendor that is experienced, dedicated, trusted, and willing to be committed to a long-term relationship with your hospital.