Let’s bowl out Cancer

Shazil Ahmad Lahore School Of Economics

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Contents Inspiration:.................................................................................................................3 Introduction...............................................................................................................4 History....................................................................................................................4 Making of the Hospital...........................................................................................4 Hospital Profile......................................................................................................5 Mission...................................................................................................................5 Vision.....................................................................................................................5 Cancer is curable....................................................................................................6 Slogan:....................................................................................................................6 Corporate Values.......................................................................................................7 Organizational Structure............................................................................................8 SKHCH&RC Hierarchy Structure............................................................................9 Senior Management:..............................................................................................9 Middle Management :..........................................................................................10 Operational Management:....................................................................................10 Decentralized:.......................................................................................................10 Porter’s Five forces Model:.....................................................................................11 Rivalry Among Competitors:...............................................................................11 Threat of New Entrants:.......................................................................................11 1. Bargaining Power of Customers....................................................................12 2. Threat of substitute Services..........................................................................12 Bargaining Power of Suppliers:...........................................................................12 Major Suppliers:...................................................................................................13 Hardware and Software...........................................................................................14 Software...............................................................................................................14 Hospital Information System:..............................................................................14
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Operating System:................................................................................................15 I Tack:..................................................................................................................15 Auxiliary Software...............................................................................................16 Hardware.................................................................................................................17 Switches:..............................................................................................................17 Storage:.................................................................................................................18 Different Types of Operations:................................................................................19 Clinical Module:...................................................................................................19 Physician and Order Management System:.........................................................19 Finance Module:...................................................................................................19 Patient Management System:...............................................................................20 Communication in SKMCH....................................................................................28 Data Marts and Data Mining in SKMCH................................................................29 Security Framework in SKMCH.............................................................................30 Security Frame Solution.......................................................................................31 Security Framework Diagram..............................................................................32 Intrusion Prevention System (IPS).......................................................................33 Supply Chain Management.....................................................................................34 Bullwhip Effect:...................................................................................................35 Enterprise Application in SKMCH.........................................................................36 CRM.....................................................................................................................37 How CRM systems support Marketing................................................................38 E-Commerce in SKMCH........................................................................................39 Conclusion...............................................................................................................40 Recommendation:....................................................................................................41 Recommendation:

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Inspiration:

Imran Khan had always been very close to his mother and had enjoyed her support. In 1984, Imran's mother, Shaukat Khanum became ill to such an extent that once properly diagnosed, she was almost inoperable. She suffered from cancer, which was known to be a rich man's disease in Pakistan in that only well off people could afford to fly to Europe to receive the treatment. Inspite of flying to Cromwell Hospital in 1984, Shaukat Khanum died the following year in acute pain. Imran was by her side during her last days when she suffered terribly. He felt her pain but could not do anything for her. Imran's career was thus determined. When he retired from cricket he would build the first cancer hospital in Pakistan in honor of his mother.

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Introduction
History
Imran Khan made a nation-wide appeal for the collection of funds from a match between Pakistan and India on November 10, 1989 at Gaddafi Stadium, Lahore which raised Rs. 2,902,600. This was followed by a series of more than 50 successful fund raisers held throughout the world. Pakistan's win under Imran's captaincy in the 1992 cricket world cup in Melbourne helped fundraising efforts. He was able to collect one and a half million pounds in just six weeks after the World Cup when the same amount had taken 2 years to collect earlier. He donated his entire prize money of 85,000 pounds for the project. In 1994 when the project required more financing for the ongoing construction, Imran Khan launched a mass contact campaign in which he toured 27 cities in the country and collected Rs. 120 million. During the entire campaign for the construction of the hospital, over a million individual donors from ordinary citizens to the rich and famous pitched in. Everything from cash to jewelry and valuables was donated.

Making of the Hospital
Designing and execution of the master plan was overseen by Dr. Nausherwan Burki (MBBS, PhD, FRCP, FCPS, and FCCP) of the University of Kentucky Medical Center, Lexington, Kentucky, USA in collaboration with an international team of cancer physicians and research workers. Designing and architectural services were provided by Arrasmith, Judd & Rapp, and Architects in Health Planning of Louiseville, Kentucky, USA. Architectural details were handled by Messrs. Nayyar Ali Dada & Associates of Lahore. Local engineering was performed by Messrs. Progressive Consultants, Lahore. Ground was broken in April 1991 and the hospital opened its doors on December 29, 1994.

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Hospital Profile
The Shaukat Khanum Cancer Hospital was inaugurated in December 1994 and is the best cancer hospital in the sub-continent. It is located in Johar Town Lahore and its market is whole Pakistan. Its annual budget is 1600 million. There are 44 collection centers in Pakistan. One new walk in clinic is opened in Peshawar, in Karachi the work is in process. The total permanent staff of Shaukat Khanum is 1075 and out of which 350 female and 750 are male. There are 100 physicians out of which 44 consultants and 60 residents. There is 160 nursing staff and 450 allied medical and supporting staff.

Mission
“To act as a model institution to alleviate the suffering of patients with cancer through the application of modern methods of curative and palliative therapy irrespective of their ability to pay, the education of health care professionals and the public and to perform research into the causes and treatment of cancer”.

Vision
Imran was a fine all-rounder cricketer and inspirational captain whose crowning achievement was leading Pakistan in winning the 1992 World Cup. He uses their emotions about cricket and that why he made a slogan related to cricket and that was “Lets Bowl out Cancer”.

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Cancer is curable.
This sentence was first used to aware the people of Pakistan and also try to change the misperception about the cancer.

Slogan:

“ The two crescents in the slogan are representing ‘S” for Shaukat Khanum and the ‘NURSING CAP” stands for serving patients with care, and the “stars” on the crescents stands for glory ,peace, success and new life”.

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Corporate Values
1. Welfare: Our foremost value is welfare of the patients who are suffering from cancer. We want to work for the betterment of humanity. 2. Integrity: We are committed to integrity in all we do, always, everywhere. 3. Respect: We respect every individual. We draw strength from equal opportunity and diversity, at the same time supporting personal growth and development. We value each other and we all benefit from the entrepreneurial spirit of each individual.
4. Team Work: Teamwork is the essence of our ability to succeed as a universal and

international network bank. Our overriding loyalty is to the whole organization, requiring us all to learn from each other and to share our skills and resources worldwide for our customers' benefit.
5. Accountability: We put special attention on accountability because our organization

depends on the funds and donations from the people we have a proper system of check and balances because without that we cannot gain the trust of people. SKMCH& RC accounts are audited by “Messrs A. F.Fergusona” well known international auditing company. 6. Professionalism: We value our patients and provide exceptional services that leave an impression and we try to support our community and provide consistent and quality health services.

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Organizational Structure
The Hospital is the project of Shaukat Khanum Memorial Trust – a nonprofit legal entity established under the laws of Pakistan. The hospital has a board of governance consisting of Bankers, Researches, Businessman and Physicians who formulate policy ensuring that access is provided to the maximum no. of poor patients who are given quality treatment at optimal cost.

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SKHCH&RC Hierarchy Structure:

Senior Management:

• • •

Mr. Imran Khan - (Chairman) Dr. Nausherwan Khan Burki Mrs. Aleema Khanum Dr. Uzma Ahad Mr. Rashid Ali Khan Mr. Ashiq Hussain Qureshi Mr. Ahsan Rashid Mr. Sarfaraz Ahmed Rehman


• • •

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Middle Management:

• • • •

Dr. Faisal Sultan Dr. M. Asim Mr. Tariq Azeem Mr. M Fareedullah Qureshi Mrs. Virginia A. Gumley ( Head of Nursing)

Operational Management:
• • • Consists of staff involved in support activities Includes substantial measurement & analysis of internal processes Nurses, Lab attendants and Clerks

So by looking at the hierarchy of the Shaukat Khanum it is quite clear that Shaukat Khanum has IT flatten hierarchal structure because from the very first day of the organization high level of systems are used in the organization so that’s why shaukat khaum has a flatten organizational structure.

Decentralized:
Shaukat Khanum are following the concept of decentralization .They having divided the ORGANIZATION into different zones and the head of the department take ideas from their subordinates while taking decision.

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Porter’s Five forces Model:

Rivalry Among Competitors:
There is a huge market space in the case of Shaukat Khanum Memorial Cancer Hospital. But there are only two biggest competitors of Shaukat Khanum in the market are Anmol Hospital and Agha Khan.

Threat of New Entrants:
The potential competitors can easily penetrate the market by introducing new equipment’s or same fields in which the Shaukat Khanum specializes. The entry of new competitors is very high because to build a hospital, there are many legislations and equipment cost are also very high.
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Bargaining Power of Customers:
Bargaining Power of customers are low in the case of shaukat khanum because it is a nonprofitable institute and likely cancer patients are being operate their.

Threat of substitute Services:
There are many alternatives ways to cure the cancer in Pakistan that includes traditional and conventional methods of treatment. The biggest substitute for the shaukat khanum is Homeopathy. (Hakeem Dhuwakhana).

Bargaining Power of Suppliers:
In the case of bargaining power, the Shaukat Khanum has many suppliers so the bargaining more of suppliers are low. But in the case of equipment most of the equipment comes from only two suppliers so in that case bargaining power of supplier are high. The major Suppliers of Shaukat Khanum includes: 1) JNS IMPEX 2) AMS Sales and Services ( Software and Hardware)
3) Shenzhen Baiyi Technology ( Hardware)

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Major Suppliers:

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Hardware and Software:
Software Hospital Information System:
Shaukat Khanum Memorial Cancer Hospital is using “Hospital Information System” as its main software. This HIS is developed on Oracle 6i and Oracle 11g but it has been customized and developed by the IT department of SKMCH to meet their requirements. This software is inhouse developed and then customized to the needs of SKMCH and their doctors. SKMCH has a total of 650 workstations or terminals which are being operated. SKMCH also uses some productivity software’s for daily base operations that includes: 1) MS Office 2) Outlook 2003 3) MS Vision 4) MS Project Management The development tools which IT department uses include: 1) Oracle 6i Oracle Reports Builder is a powerful enterprise reporting tool used to build reports that dynamically retrieve data from the database, format, display and print quality reports. Reports can be stored in File or Database (Report Builder Tables). 2) Visual SourceSafe (VSS) Visual Source Safe is a source control software package oriented towards small software development projects. Like most source control systems, SourceSafe creates a virtual library of computer files. 3) PL/ SQL Developer: PL/SQL supports variables, conditions, loops and exceptions. Arrays are also supported, though in a somewhat unusual way, involving the use of PL/SQL collections. 4) Toads:
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Toads are actually the tools for Oracle Application Development. Shaukat Khanum Memorial Cancer Hosiptal also sold their software to SHIFA, NISD, Social Security Hospital and Metro cash and Carry.

Operating System:
At the Start of Shaukat Khanum, they were using Windows but in 2003 they converted into Redhat Linux operating system. DBMS Employed: 1) OLTPS (Online Transaction Processing Software) 2) DSS ( Oracle version 11g with open E-DSS)

I Tack:
iTack Solutions is use to meet the needs of information management and integration across the healthcare value chain.

Auxiliary Software
1) Microsoft Email Exchange Server used for intra-office communications/memos
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2) Anti-Virus used is ‘Symantec Endpoint Protection’ 3) DES (Data Encryption Software) is use

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Hardware
1) Main Servers for Database Management System: Shaukat Khanum Memorial Cancer hospital uses four database management systems. Three of the main servers are of Dell and one of HP. Dell servers are used for Clinical Modules, Financial Modules and Administrative modules. HP server is used for Centered database Module. Each server cost more than 40 lac PRs.

Switches:
DIN Rail mounted switches are used by Shaukat Khanum Memorial Cancer Hosipal. Each switch cost more than 1 lac.

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Storage:
a) SAN (Storage Area Network) are used for the storage; it provides more than 17 Tetra byte of space. b) For the Auxiliary storage NAS (Network Attached Storage) for the laboratories to Hospital storage space.
c) DAS (Disk Attached Storage) is also used before NAS. d) Centera storage are also use for the fast access of data.

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Different Types of Operations:
Clinical Module:
This module covers all activates related to patient registration, appointment, death entry, patient search engine and reports to registration and appointment of patients. Different types of patients can be registered in the system, namely Walk in, regular, private, diagnostic, company patients etc.

Physician and Order Management System:
This module covers all the activities related to examine a patient, diagnosis and prescription. Physician can generate orders for all the services that are provided in the hospital for example, pharmacy, pathology, radiology and radiation. Chemotherapy orders which are based on standard protocol are generated through this module. These orders are sensitive to the gender of patients; once all these details are entered in the system along with a selected protocol system automatically generates the chemotherapy order. Physicians can mark there in patient’s visits in the system. Facility for the physician to write referral letters, a patients status can be changed to either resuscitate or do not resuscitate. History of diagnosis, drugs ordered and CPT’s ordered are also available from this module. The physicians can view and add to list of allergies of any patient .This help the physicians while ordering drugs for any patient.

Finance Module:
Financial modules provide the necessary interface to clinical modules to cater for the billing of services offered by the hospital. In the finance module all the information related donations and zakat are also kept. In this module the free patient’s entities are also kept. 1. Payroll Management and Provident Fund System: • • • • Managing all financial areas of employees including permanent, contractual, temporary etc. Customizable payroll structure for different employees Customizable banks/ branches linkage with the employees Customizable allowance/ deduction feature
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• • •

Linking all the employees with cost centers Automatic payroll processing based on the data coming from HR system Employees advances refunds with installment cases, stop deduction features etc.

Patient Management System:
1. Patient’s admission and discharge from the hospital is entered 2. Availability of bed in the different rooms and reservation facility 3. Patient’s history and duration of the stay at the hospital 4. Information such as patient’s history, investigations on their cases, recommendations and discharge time and drugs used 5. Expected discharges can be entered, which makes the discharge process more efficient

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Communication in SKMCH
For the communication purpose three major types of servers are use: 1. Microsoft DNS ( Domain Name System) Server 2003: DNS is use for connecting the system to the internet. PTCL is the organization’s ISP with a bandwidth of more than 24 MB (8*3). 2. Microsoft ISA ( Internet Security & Acceleration) Server: Act as firewall to block malicious activity and helps the organization to ensure the safety of sensitive information and systems. Provides protection against spam and viruses. 3. Microsoft Exchange Server: Microsoft Exchange Server is used for exchanging emails, calendaring, contacts and tasks. Different Kinds of Communications:
1. The organization maintains a website for its patients and donors

http://www.shaukatkhanum.org.pk/ 2. Patients can check lab reports online by using their MR (Medical Record Number) assigned to them. 3. Regular donors have specific user names & passwords to log on to the organization portal. 4. The portal is also used by various labs & donation centers scattered across country to update the records in the database.

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Data Marts and Data Mining in SKMCH
Data Marts and Data Mining facilitates the Data warehouse. 1. Business Intelligence: Shaukat Khanum Memorial Cancer Hospital uses Oracle 11.1.1.5. SKMCH manages all its metrics, calculations and hierarchy through this BI. 2. Data Warehouses : Two different types of data Warehouses are used by Shaukat Khanum Memorial Hospital:
a) 17 Terabyte warehouses which contains all the information of MRI Scans, PET, CT

Scans, X-Rays and Achieves. b) 3 Terabyte warehouses which contains all the text records of employees, patients and departments. 1. Backup System: The primary system contains HIS in the Shaukat Khanum if it stops working then automatically two parallel stands-by HIS servers work as a backup system. All these systems are synchronized with each other.

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Security Framework in SKMCH
SKMCH as others organization facing many types of the virtual and physical threats which includes: 1. Virtual Threats: I. Internal Threats: a) Bundled Infected Software b) Unauthorized Access c) Program Code defects I. External Threats: a) Wi-Fi Penetration b) Wired network penetration c) Trojans d) Viruses e) Hacking 1. Physical Threats: I. Internal Threats: a) Employees I. External Threats: a) Corporate Spying b) Terrorist Threats All these are the virtual and physical threats which Shaukat Khanum Memorial Cancer Hospital is facing. To counter all these threats Shaukat Khaum has latest Security Framework.

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Security Frame Solution
1. Virtual Threats:
I.

WPA2 Wi-Fi is use for Wi-Fi protection in Shaukat Khanum Memorial Cancer Hospital. WPA stands for Wi-Fi Protection Access. EPA (Extensible Authentication Protocol) is also uses besides WPA with the help of this all the wireless networks are secured. WPA2 works with the firewall.

II. IP Address Recognition is also use for Virtual Threats. III. Linksys E2000 routers are used for the Hardware firewall, it filters all the data and

filtered packaged data is moved to the servers or client computers. IV. “Smooth way” is use as a software firewall for the systems. Smooth way is the built in firewall used in the Linux operating systems.
V. Layer 2 Forwarding is for the VPN (Virtual Private Network) in the Shaukat Khaum

because it provides the tunneling facility of protocols. Through the Tunneling Protocol one can easily provide the secure pathway when there is load on one Protocol. VI. Norton Symantec antivirus is use to protect the computers from the viruses. VII.Microsoft SQL 2005 is used for encrypted database. It is designed to provide a protection to entire database at rest without affecting the entire applications. VIII.Guttmann Method is used for a Secure Content Deletion. IX. Login & Passwords are assigned to each computer for further securitization.

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Security Framework Diagram

The diagram shows that the internet is firstly secured by outer firewall which is Linksys E2000 router which filters all the data and moved it to the webserver and after that by default firewall activated which is Smooth way and then at last all the filtered packaged data is moved to the corporate system.

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Security Framework

Intrusion Prevention System (IPS)
SKMCH also uses Intrusion Prevention System. Actually intrusion prevention system is the network security appliances that monitor the network activities for malicious activity. Shaukat Khanum Memorial cancer Hospital uses four different types of Intrusion Prevention System which includes:
I.

Network Based Intrusion Prevention (NIPS): In SKMCH, NIPS monitors the entire network for suspicious traffic by analyzing protocol acticity.

II. Wireless Intrusion Prevention System (WIPS): In SKMCH, WIPC monitors a wireless network for suspicious traffic by analyzing wireless networking protocols.
III. Network Behavior Analyses (NBA): In SKMCH, NBA examines network traffic to

identify threats that generate unusual traffic flows, such as distributed denial of service (DDoS) attacks, certain forms of malware, and policy violations. IV. Host Based Intrusion Prevention (HIPS): In SKMCH, HIPS monitors a single host for suspicious activity by analyzing events occurring within that host.

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Supply Chain Management
The Supply Chain Management in the SKMCH is very complex. It is very hard to understand and there is too much bullwhip effect in that because Shaukat Khanum holds inventory 1.5 times more than the inventory used. If say in this week 1500 patients are admitted and forecast results shows that requirement of inventory is say 2500 equipment but instead of 2500, Shaukat Khanum order more than 3000 equipment. Material Management Department is handled through the Hospital Information System.

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Bullwhip Effect:

There is the pre-decided fluctuation in the demand. Because it’s the policy of the SKMCH that he keeps stock more than its requirement. So all these operations are properly monitored through the Hospital Information System because all the servers’ computers are properly linked with that and all the orders first come into it than through H.I.S server inventory is checked than for further inventory order it goes to the finance module it that why the H.I.S works in the case of Supply Chain.

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Enterprise Application in SKMCH
Shaukat Khanum Memorial Cancer Hospital only consists of one centralized enterprise application called H.I.S or HOPE. All the other servers are the subset of that enterprise application. H.I.S is the management information system which Shaukat Khanum Hospital are currently uses. It is the fully customized system, Oracle 6i, Oracle 11g is used in that enterprise system. Hosiptal Information System includes the modules of all departments such as Finance, Administrative, Supply Chain, etc.

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Enterprise Application

CRM

For the relationship between customers and patients, H.I.S is customized into three major components that are sales which include donations, Lab, MRI Scans, Radiology Tests and XRays. Services component covers the cancer treatment, consultancy and other. And marketing module is responsible for the advertisement, promotion, seminars and concerts.

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How CRM systems support Marketing

Through the Time series analysis CRM supports the Marketing.

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E-Commerce in SKMCH
1. B2C Communication:
I.

Through Shaukat Khanum Website

II. Patients can easily access their reports online. III. Awareness through Print Media IV. Seminars for Donations 1. B2B Communication:
I.

Shaukat Khanum also sells their software to other businesses through their website.

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Conclusion
I.

Shaukat Khaunam Memorial Cancer Hospital is using best information system as compare to its competitors.

II. SKMCH has third biggest MIS after Atomic Energy of Pakistan and Anmol.

III. Hospital Information System is fully customized according to the requirement of the hospital.
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IV. All the modules are properly attached to the main server. V. There is no discrimination factor in the software means for the paying and non-paying patients. VI. Supply Chain is properly handled by H.I.S. VII.H.I.S is also called HOPE, this is use to create hope in the cancer patients. VIII.All the slogan of SKMCH is “lets the bowl out cancer” so to fulfill that vision all the MIS systems are properly working. IX. High level of security framework is available for all the information systems. X. As Imran Khan War is against two things “Cancer” and “Corruption”, so Imran khan is using the weapon of H.I.S to attach on them.

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Recommendation:
I. Built a separate Enterprise system for Research Centre. II. Built software which can easily handle all the operational activities. III. Improve quality of data across several disease sites. IV. Promote dissemination information to professional who treats the cancer patients and the public concerning the problems and needs of cancer survivors & their families. V. Separate donation system should be made.

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