LESSON 6

Health Management Information System

Health Management Information System

Traditionally, health care administrations have been managed manually, starting from patient
registration to consultation. The creation of documents proved to be time-consuming and posed the risk of
having duplicate records. Improper storage of these documents was also a concern because of difficulty in
retrieval and the high cost of maintaining proper storage. Getting an overview of the number of patients visiting
the hospital, or consolidating the nature of problems that need immediate action, and providing pertinent reports
were very difficult to achieve. Tools such as snapshots and dashboard which are necessary in the analysis of the
performance of hospitals were unavailable.

Hospitals using the traditional manual process do not have real-time data and delays in the receipt of
data pose a challenge to evidence-based program management. Accurate and real-time records of equipment
and drugs could not be obtained in a timely manner resulting in problems in accountability, monitoring of
expiry dates, stocks, and auto indenting. Inventory of medicine and equipment was a tedious task due to lack of
standards in filing names and codes in the institution.

The need to enhance the management of health care services and to have real-time data to monitor the
hospital performance thus calls for a health information management system that will address these concerns.

As defined by the World Health Organization (2004), health management information system
(HMIS) is "specially designed to assist in the management and planning of health programmes, as opposed to
delivery of care." The refers to clinical studies to understand medical terminologies, clinical procedures, and
database processes; management refers to the principles that help administer the health care enterprise; and
information system refers to the ability to analyze and implement applications for efficient and effective
transfer of patient information. An HMIS is one of the six building blocks essential for health system
strengthening. It is a data collection system specifically designed to support planning, management, and
decision-making in health facilities and organizations.

HMIS is a set of integrated components and procedures organized with the objective of generating
information that will improve health care management decisions at all levels of the health system. It is a routine
monitoring system that evaluates the process with the intention of providing warning signals through the use of
indicators. At the health unit level, HMIS is used by the health unit in-charge and the Health Unit Management
Committee to plan and coordinate health care services in their catchment area.

HMIS was developed within the framework of the following concepts (Republic of Uganda Ministry
Of Health Resource Centre, 2010):
 The information collected is relevant to the policies and goals of the health care institution, and to the
responsibilities of the health professionals at the level of collection.
 The information collected is functional as it is to be used immediately for management and should not
wait for feedback from higher levels.
 Information collection is integrated for there is one set of forms and no duplication of reporting.
 The information is collected on a routine basis from every health unit.
Roles of HMIS

The major role of HMIS is to provide quality information to support decision-making at all levels of the
health care system in any medical institution. In addition to encouraging the use of health information in
hospitals, it also aims to aid in the setting of performance targets at all levels of health service delivery and to
assist in assessing performance at all levels of the health sector (Republic of Uganda Ministry of Health
Resource Centre, 2010).

An HMIS needs to be complete, consistent, clear, simple, cost-effective, accessible, and confidential
(Janneh, 2002). It should be complete with all information but avoiding duplication and consistent in assigning
definitions to similar information from various sources. It should also be simple to use and clear as to what is
measured by the elements. The eligible users must have access and should be able to use the system with ease.
The confidentiality of patient information and data privacy should always be a top priority. While providing all
these benefits, the system must prove its cost-effectiveness through its operations.

Functions of HMIS

The information from an HMIS can be used in planning, epidemic prediction and detection, designing
interventions, monitoring, and resource allocation (Republic of Uganda Ministry of Health Resource Centre,
2010).

Historically, all information systems, including HMIS, are built upon the conceptualization of three
fundamental information-processing phases: data input, data management, and data output. Each phase
comes with elements (Tan, 2010) that perform specific functions.

1. Data input includes data acquisition and data verification.

a. Data acquisition refers to the generation and collection of data through the input of standard coded
formats (e.g., bar codes) to assist in the faster mechanical reading and capturing of data.
b. Data verification involves data authentication and validation. The authority, validity, and reliability
of the data sources help ensure quality of gathered data.

2. Data management, also called processing phase, includes data storage, data classification, data update,
and data computation.
a. Data storage includes preservation and archiving of data. It is advisable that data which are no
longer actively used should be archived. At time s, it is mandatory and part of legislation.
b. Data classification is also called data organization which sets the efficiency of the system. Key
parameters should be used for data classification schemes for easier data search.
c. Data computation requires various forms of data manipulation and data transformation (e.g.,
mathematical models, linear and nonlinear transformation, statistical and probabilistic approaches, and
other data analytic processes). This function allows data analysis, synthesis, and evaluation so that data
can be used not only for decision-making but also for other tactical and operational use.
d. Data update facilitates new and changing information and requires constant monitoring. For HMIS,
the mechanism for data maintenance must be in place for updating changes for manual or automated
transactions.
 3. Data output includes data retrieval and data presentation.
a. Data retrieval pertains to the processes of data transfer and data distribution. The transfer process
considers the duration of transmittal of required data from the source to the appropriate end-user.
The economics of producing the needed information is a significant criterion.
b. Data presentation is the reporting of the interpretation of the information produced by the system.
Summary tables and statistical reports are expected but the use of visuals is encouraged especially
for high-level managerial decision-making because they provide a better intuitive perspective of the
data trend.

List of Functions of HMIS

Listed below are the possible functions in an HMIS with the corresponding type of information that
can be captured and tracked in the system (Behavioral Health Collaboration Solutions, 2006).

1. Client data relates to all the information of the client data.

2. Scheduling is observed to distribute resources areas that need them. An example is linking the schedule to
the billing of the entity.
3. Authorization tracking focuses on monitoring of the authorized personnel and their use of the authorized
units.
4. Billing refers to the notification of the charges for the patient and other related documents such as the
compliant electronic claim.
5. Accounts receivable (A/R) management ensures that customers are properly notified about their bill and
will settle it accordingly. Data for A/R management include tracking aging of unpaid services, tracking reasons
for denials, and aged receivable report by payer source.
6. Reporting refers to reports issued by the entity which could be basic reports or report writer.
7. Medical record, also called an electronic health record (EHR), is a collection of digital information about a
patient. Aside from patient registration, the data could include assessment, treatment plan, and
progress/encounter notes.
8. Compliance refers to procedure that should be followed for the improvement of the condition of the patient
or the service provided such as treatment plan and progress note.
9. Financial data refers to information relating to the performance of the entity collected for administering
purposes. These include financial reports, general ledger, payroll, and accounts payable.

Determinants of HMIS Performance Area

The determinants affecting the performance of an HMIS may be behavioral, organizational, and
technical.

Behavioral determinants
The data collector and users of the HMIS need to have confidence, motivation, and competence to
perform HMIS tasks in order to improve the routine health information system (RHIS) process. The chance of
the task being performed is affected by the individual perceptions on the outcome and the complexity of the task
(Aqil, Lippeveld, & Hozumi, 2009). Lack of motivation and enough knowledge on the use of data has been
found to be a major drawback in the data quality and information use. Changing people's attitude towards data
collection and analysis is necessary in order to maximize the performance of the RHIS process (Routine Health
Information Network, 2003).

Organizational determinants
 The important factors that affect the development of the RHIS process are the structure of the health
institution, resources, procedures, support services, and the culture within the organization (Aqil, Lippeveld, &
Hozumi, 2009). However, other factors which include lack of funds, human resources, and management support
contribute to the determinant of the RHIS process.

Having a system in place which supports data collection and analysis and transforms it into useful
information will help in promoting evidence-based decision-making. Thus, all components within the system
are ideal in making the RHIS perform better. An improved RHIS performance means an effective
organizational culture that promotes information use by collecting, analyzing, and using information to
accomplish the organization's goals and mission (Sanga, 2015).

Technical determinants
Technical factors involve the overall design used in the collection of information. It comprises the
complexity of the reporting forms, the procedure set forward in the collection of data, and the overall design of
the computer software used in the collection of information (Sanga, 2015).

PRISM Framework

The Performance of Routine Information Systems Management (PRISM) is a conceptual framework that
broadens the analysis of HMIS or RHIS by including the three determinants of HMIS performance, namely:

 Behavioral determinants - knowledge, skills, attitudes, values, and motivation of the people who collect
and use data,
 Organizational/environmental determinants - information culture, structure, resources, roles, and
responsibilities of the health system and key contributors at each level, and
 Technical determinants - data collection processes, systems, forms, and methods.

This framework identifies the strengths and weaknesses in certain areas, as well as the correlations among
these areas. This assessment aids in designing and prioritizing interventions to improve RHIS performance,
which in turn improves the performance of the health system.

The PRISM framework, founded on performance improvement principles, defines the various components
of the routine health information system and their linkages to produce better quality data and continuous use of
information, leading to better health system performance and, consequently, better health outcomes (Aqil,
Lippeveld, & Hozumi, 2009).
 LESSON 7
HMIS Monitoring and Evaluation

HMIS Monitoring and Evaluation

A health management information system aims primarily at assisting in the planning and management of
a national health strategy plans; thus, continuous monitoring and evaluation is for it to be effective. By
definition and function, monitoring and evaluation are complimentary.
Monitoring refers to the collection, analysis, and use of information gathered from programs for the purpose of
learning from the acquired experiences, accounting the resources used both internal external, and obtaining
results and making decisions. These purposes correspond to three functions: learning, monitoring, and
steering. Meanwhile, evaluation is the systematic assessment of completed necessary completed programs or
policies. The objective is to gauge the effectiveness of the program so that adjustments can be made in areas
that need improvement. An evaluation has both a learning function in which the less learned need to be
incorporated into future proposals, and a monitoring function which means that the concerned parties review the
implementation of policy based on the objectives and resources.

Purpose of M&E
A robust monitoring and evaluation (M&E) system is required to assess the effect of an integrated
service delivery. Appropriate indicators, data collection systems, and data analysis to support decision- making
help guide the successful implementation of integrated services and measure the effect on both service delivery
and use of services (FP/Immunization Integration Working Group, n.d.).

M&E Framework
A general framework of M&E of health system strengthening (HSS) was developed by various global
partners and countries. Derived from the Paris Declaration on aid harmonization and effectiveness and the
International Health Partnership (IHP+), this framework places health strategy and related M&E processes of
each country at the center. The strengthening of a common country platform for the M&E of HSS is the core of
the framework. In doing so, there is better alignment and the monitoring of fundings for health systems is easy.

There are four components of the framework as provided by WHO, namely, the indicator domains,
data collection, analysis and synthesis, and communication use, intended for achieving greater health impact.
For monitoring medical services, indicators should be tracked to assess processes and results associated with the
various indicator domains. In this way, the strengths and weaknesses of implementation are provided and can be
used for troubleshooting in the system. In terms of outcomes and impact indicators, the changes may not be
directly caused by service delivery efforts for there are other factors to consider. However, these data are still
useful in understanding the current health status and context within a country (FP/Immunization Integration
Working Group, n.d.).

It should be noted that shifts in outcome and impact indicators may not be directly attributable to
integrated service delivery efforts, as there are many other factors which influence these indicators. However,
where possible, it can be useful to collect these data in order to understand the broader health context within a
country, and the ways in which packages of interventions can lead to impact over time (FP/Immunization
Integration Working Group, n.d.).
M&E Plan

An M&E plan addresses the components of the framework and establishes the foundation for regular
reviews during the implementation of the plan for the national level. Local M&E systems generate information
for global monitoring based on the health sector review processes which are considered key factors in
monitoring the progress and performance of the entire system. Medical institutions are monitored and evaluated
through the assessment of reports, surveys, HMIS, and other evaluation studies. Specifically, the National
Health Mission of India identifies strategies which help in the successful implementation of the framework. The
framework should (1) be localized, (2) address the needs for multiple users and purposes, (3) facilitate the
identification of indicators and data sources, and (4) be able to use the M&E in disease-specific programs.

M&E and HMIS Indicators

An indicator is a variable which measures the value of the change in units that can be compared to past
and future units. The focus is on a single aspect of a program such as input, output, amongnothers. HMIS uses
various indicators to monitor key aspects of health system performance. The United States Agency for
International Development (USAID) classifies these indicators (Table 7.1) into five broad categories, namely,
reproductive health, immunization, disease prevention and control, resource utilization, and data quality.

Table 7.1 Categories of HMIS Key Indicators

Key Performance Area Key indicator

Reproductive Health 1. Family planning acceptance rate
2. Antenatal care coverage
3. Proportion of deliveries attended by skilled health personnel
4. Proportion of deliveries attended by HEWs
Immunization 5. DPT-3 (Pentavalent-3) coverage (>1 child)
6. Measles Immunization coverage (>1 child)
Disease Prevention and 7. Malaria case fatality rate among patients under 5 years of age
Control 8. New malaria cases per 1,000 population
9. New pneumonia cases among children under 5 per 1,000 population of
<5 yrs
10. TB case detection rate
11. TB cure rate
12. Clients receiving VCT services
13. PMTCT treatment completion rate
14. PLWHA currently on ART
Resource Utilization 15. Trace drug availability (in stock)
16. OPD attendance per capita
17. In-patient admission rate
18. Average length of stay (in-patient)
Data Quality 19. Bed occupancy rate
20. Reporting completeness rate
21. Reporting timeliness rate
Source: HMIS Information Use Training Manual (USAID, 2013)
Table 7.2 provides specific indicators, data sources, and purposes for tracking each indicator for
monitoring family planning and immunization service delivery and assessing the integration of services. This
table includes a variety of quantitative indicators coupled with qualitative techniques in order to better
understand the basics of the integration processes and solicit feedback on the approach.
Table 7.2 Quantitative indicators for monitoring family planning/immunization integration

Indicator Data Source Purpose

INPUTS
Vaccine stockouts in a single HMIS, Service statistics Monitor vaccine stockouts
HMIS, Service statistics
Monitor vaccine stockouts.
month (YES/NO, by type of
vaccine)
Contraceptive stockouts in a single HMIS, Service statistics Monitor contraceptive stockouts
month (YES/NO, by type of
contraceptive)
Number of service providers Training records Monitor reach of EPI/FP
trained in provision of EPI/FP integration training as an input for
integrated services effective integrated services
OUTPUTS
Number of service delivery points Service statistics and Supervision Coverage of integrated service
offering integrated FP and delivery
immunization services
Number of days per month when Service Statistics and Availability of co-located FP/
both immunization and family Supervision immunization services
planning services are offered at (Observation + Interviews)
the same site
Number/percent of women Supplemental tracking column that Quality/continuity of
attending routine child can be added to existing implementation of integrated
immunization services who immunization register service delivery
received information on family
planning from a vaccinator [Monitored for
demonstration/pilot programs
only]

Number/percent of women (with Supplemental tracking column Quality/continuity of

children <12 months) going for added to immunization ledger implementation of integrated
family planning who receive service delivery
information on immunization from [Monitored for demonstration/pilot
the family planning provider programs only]
Number/percent of women Supplemental tracking column Acceptance of FP referrals
attending routine child by added to immunization Ledger provided by the vaccinator
immunization services who accept
a referral to family planning [Monitored for demonstration/pilot
services programs only]
Number/percent of women Comparison of supplemental Follow through on FP referrals
attending routine immunization tracking column added to immu provided by the vaccinator
who follow through on a FP nization ledger and, supplemental
referral from a vaccinator tracking column added to FP
ledger

[Monitored for demonstration/pilot

 programs only]
Number/percent of women Comparison of supplemental Follow through on immunization
attending family planning services tracking column added to FP referrals provided by the family
who follow through on referral to ledger, and supplemental tracking planning provider
immunization services from a column added to immunization
family planning provider ledger

[Monitored for demonstration/pilot

programs only]
OUTCOMES
Number of Children receiving Immunization ledger/HMIS, and Use of immunization services,
DTP 1, DTP 3, measles1, and DTP population-based Survey Data dropout
1-3 dropout.
Immunization coverage for DTP1, HMIS and population-based Percentage of children <12
1
DTP3, and measles Survey Data months in a given population who
have received DTP1 and DTP3
Number of new family planning Family planning ledger/HMIS Uptake of family planning
acceptors by method type and services
demographic/age group
Contraceptive Prevalence Rate Population Survey Data Contraceptive use within a given
population
Total financial cost of inputs Program data/Special costing Cost of inputs required for
required to integrate FP and studies integration. This maybe helpful in
immunization services (per planning for decisions related to
facility, per client exposed, per sustainability and scale-up of
new FP acceptor) integrated services
IMPACT
Maternal, infant, and child Studies on maternal and infant Measure improvement in health
mortality rates mortality status

In many countries measles coverage is higher than DTP3 coverage, even though measles is supposed to be given later. Analysis and
Interpretation of findings for measles coverage should be done within the context of individual country circumstances.

HMIS Indicators and Health Programs

HMIS is a source of routine data necessary for monitoring different aspects of various health programs
implemented in a country. The HMIS indicators should be carefully selected to meet the essential information
necessary for monitoring the performance of various health programs and services and to present an overview
of available health resources.

This section explains the relationship of HMIS indicators and some of the health programs on
communicable and non-communicable diseases. These disease data provide an in-depth understanding of how
HMIS can be used for monitoring program performance and how it encourages similar in-depth analysis for all
health programs and services such as maternal survival intervention, child mortality and child survival
intervention, and Stop TB program.

Maternal Survival Interventions

The fifth millennium development goal targets to reduce the maternal mortality ratio by 75 percent and
to achieve universal access to reproductive health. Despite this set goal, none of the maternal survival
intervention alone can reduce the maternal mortality rate. As Campbell and Graham (2006) explained, the
complexity of the country contexts and maternal health determinants makes it complicated to choose the best
strategies in achieving this goal. However, they found that packaging of health facility-oriented interventions is
highly effective and has high coverage of the intended target group.

In order to routinely monitor the progress towards implementation of a highly effective package of
maternal survival interventions, HMIS is designed to provide some of the core input, process, and output
indicators.

The HMIS indicators are related to the following:

1. pregnancy care interventions
 1st antenatal care attendances
 4th antenatal care attendances
 Cases of abnormal pregnancies attended at out-patient departments (OPD) of health facilities
 Institutional cases of maternal morbidity and mortality due to antepartum hemorrhage (APH),
hypertension and edema reported by in-patient departments (IPD) of health facilities
 Cases of abortion attended at health facilities
 Cases of medical (safe) abortions conducted at health facilities

2. intrapartum care
 Deliveries by skilled attendants (at health facilities)
 Deliveries by health extension workers (HEW) (at home of health posts)
 Institutional cases of maternal morbidity and mortality due to obstructed labor

3. postpartum care
 1st postnatal care attendance
 Institutional cases of maternal morbidity and mortality due to postpartum hemorrhage (PPH) and
puerperal sepsis

4. interpartum period
 Family planning method acceptors (new and repeat)
 Family planning methods issued by type of method

These indicators, although not complete to monitor all aspects of maternal survival strategies, capture
data related to pregnancy, such as intrapartum and postpartum care, and are sufficient to give a broad indication
of the performance of the package of maternal survival interventions. More so, using these indicators help
prompt further investigations when problems on issues arise.

Child Mortality and Child Survival Interventions

The leading cause of under-5 child mortality in the Philippines in 2012, as reported by the Department
of Health (DOH) in its top 10 leading causes of child mortality report, was pneumonia with 2,051 reported
cases. Figure 7.1 shows data on other causes of child mortality, such as diarrhea and gastroenteritis, congenital
anomalies, septicemia, other diseases of the nervous system, accidental drowning and submersion, dengue fever
and dengue-hemorrhagic fever, chronic lower respiratory diseases, meningitis, and leukemia.

Figure 7.1- Leading cause of under-five child mortality in the Philippines

 The Philippine government through DOH launched various strategies to help ensure good health of
Filipino children by 2025.

1. Child 21 - Child 21 or the Philippine National Strategic Framework for Plan Development for Children
2000 to 2025 serves as a framework for policymaking and program planning and as a roadmap for
interventions aimed at safeguarding the welfare of Filipino children. This is part of the Philippines'
commitment to the United Nations Convention on the Rights of the Child (UN CRC).

2. Children's Health 2025 - This is a subdocument of Child 21 which focuses on the development of
Filipino children and the protection of their rights by utilizing the life cycle approach.

3. Integrated Management of Childhood Illness (IMCI) - IMCI is a strategy that aims to lower child
mortality caused by common illnesses.

4. Enhanced Child Growth - This is an intervention aimed to improve the health and nutrition of Filipino
children by operating community-based health and nutrition posts all throughout the country.

Stop TB Program

Envisioning a tuberculosis-free world, the goal of the Stop TB Program (STP) is to dramatically reduce
the global burden of tuberculosis (TB) by 2015. This is in line with the WHO's millennium development goals
and the Stop TB Partnership which aims to push TB up the world political agenda. One of the main objectives
of the program is to achieve universal access to high-quality care (i.e., universal access to high quality diagnosis
and patient-centered treatment) for all people with TB (including those co-infected with HIV and those with
drug-resistant TB).

TB case detection and successful completion of the treatment/cure of TB remain at the core of the Stop
TB Strategy. Thus, by 2050, one of the targets of the strategy is to reduce the prevalence of and deaths due to
TB by 50 percent compared with the 1990 baseline.

The HMIS indicators to monitor Stop TB Program are:

 TB patients on DOTS (Number of new smear-positive pulmonary TB cases enrolled in the cohort)
 TB case detection (Number of new smear-positive pulmonary TB cases detected, number of new smear-
negative pulmonary TB cases detected, number of new extra-pulmonary TB cases detected)
 HIV-TB co-infection (Proportion of newly diagnosed TB cases tested for HIV)
 HIV+ new TB patients enrolled in DOTS
 TB treatment outcome (Treatment completed PTB+, Cured PTB+, Defaulted PTB+, Deaths PTB+)
 LESSON 8
HMIS Data Quality

Data Quality

Over the years, data quality has become a major concern for large companies especially in the areas of
customer relationship management (CRM), data integration, and regulation requirements. Aside from the fact
that poor data quality generates costs, it also affects customer satisfaction, company reputation, and even the
strategic decisions of the management.

Data quality is the overall utility of a dataset(s) as a function of its ability to be processed easily and
analyzed for a database, data warehouse, or data analytics system,

Aspects of Data Quality

 accuracy
 completeness
 relevance
 consistency
 reliability
 presentability
 accessibility

Data quality signifies the data's appropriateness to serve its purpose in a given context. Having quality data
means that the data is useful and consistent. Data cleansing can be done to raise the quality of available data
(Rouse, 2005).

Lot Quality Assurance Sampling (LQAS)

Lot Quality Assurance Sampling (LQAS) is a tool that allows the use of small random samples to
distinguish between different groups of data elements (or lots ) with high and low data quality. For health
managers and supervisors, using small samples makes the conduct of surveys more efficient. This tool has been
widely applied in the health care industry for decades and has been primarily used for quality assurance of
products.

The concept and application of LQAS have been adopted in the context of District Health Information
System (DHIS) data quality assurance. The adoption was comprised of designating health facilities, monthly
reports, sections of monthly reports, and group of data elements as “lots' to provide representative samples for
data quality assurance of DHIS.

Steps in applying LQAS:

1. Define the service to be assessed (e.g.. DQA of DHIS).

2. Identify the unit of interest (e.g., a supervisory area, facility, hospital, a district).
3. Define the higher and lower thresholds of performance based on prior information about the expected
performance of the region of interest.
4. Determine the level of acceptable error.
5. Determine the sample size and decision rule for acceptable errors to declare an area as performing "below
expectations."
6. Identify the number of errors observed (mismatched data elements will be reliably determined if the facility is
performing above or below expectations).

Routine Data Quality Assessment (RDQA)

The Routine Data Quality Assessment (RDQA) tool is a simplified version of the Data Quality Audit
(DQA) tool which allows programs and projects to verify and assess the quality of their reported data. It also
aims to strengthen data management and reporting systems.

The objectives of RDQA are as follows (RDQA User Manual, 2015):

1. Rapidly verify the quality of reported data for key indicators at selected sites.
2. Implement corrective measures with action plans for strengthening data management and reporting
system and improving data quality.
3. Monitor capacity improvements and performance of data management and reporting system to
produce quality data.

The RDQA is a multipurpose tool that is most effective when routinely used. Following are the uses
for the RDQA tool (RDQA User Manual, 2015):

RDQA Use Case Example

Routine data quality checks as part of on-going
supervision
Initial and follow-up assessment of data
management and reporting systems
Strengthening of the program staff’s capacity in
data management and reporting
Preparation for a formal data quality edit
External assessment by partners of the quality of
data
Routine data quality checks can be included in
already planned supervision visits at the service
delivery sites.
Repeated assessments (e.g., biannually or annually)
of a system’s ability to collect and report quality data
at all levels can be used to identify gaps and monitor
necessary improvements.
Monitoring and Evaluation (M&E) staff can be
trained on the RDQA and sensitized to the need to
strengthen the key functional areas linked to data
management and reporting in order to produce
quality data.
The RDQA tool can help identify data quality issues
and areas of weakness in the data management and
reporting system that would need to be strengthened
to increase readiness for a formal data quality audit.
Such use of the RDQA for external assessment
could be more frequent, more streamlined, and less
resource intensive than comprehensive data quality
audits that use the DQA version for auditing.

Development Implementation Plan

An implementation plan is a project management tool that illustrates how a project is expected to
progress at a high level. It helps ensure that a development team is working to deliver and complete tasks on
time (Visual Paradigm, 2009). It is also important in ensuring the efficient flow of communication between
those who are involved in the project so as to minimize issues that would delay delivery of the project. It
validates the estimation and schedule of the project plan.
An implementation plan is developed through the following key steps (Smartsheet, 2017):

 Define goals/objectives. Address the question, "What do you want to accomplish?"

 Schedule milestones. Outline the deadline and timelines in the implementation phase.
 Allocate resources. Determine whether you have sufficient resources, and decide how you will procure
those missing.
 Designate team member responsibilities. Create a general team plan with overall roles that each team
member will play.
 Define metrics for success. How will you determine if you have achieved your goal?

Data Quality Tools

A data quality tool analyzes information and identifies incomplete or incorrect data. Data cleansing
follows after the complete profiling of data concerns, which could range anywhere from removing
abnormalities to merging repeated information.

By maintaining data integrity, the process enhances the reliability of the information being used by an
organization. Usually, these data quality software products can share features with master data management,
data integration, or big data solutions.

Gartner (2017) explains how these data quality tools are used to address problems in data quality:
 Parsing and standardization refers to the decomposition of fields into component parts and formatting
the values into consistent layouts based on industry standards and patterns and user-defined business
rules.
 Generalized "cleansing" is the modification of data values to meet domain restrictions, constraints on
integrity, or other rules that define data quality as sufficient for the organization
 Matching is the identification and merging of related entries within or across data sets.
 Profiling refers to the analysis of data to capture statistics or metadata to determine the quality of the
data and identify data quality issues.
 Monitoring refers to the deployment of controls to ensure conformity of data to business rules set by the
organization.
 Enrichment is the enhancement of the value of the data by using related attributes from external sources
such as consumer demographic attributes or geographic descriptors.

As data quality continues to become increasingly all-encompassing, data integration tools are further
developed to include data quality management functionality.

Application/Scope of Data Quality Tools

The first generation of data quality tools was characterized by dedicated data cleansing tools designed to
address normalization and reduplication. However, in the last 10 years, it was observed that there is a
generalization of Extract, Transform, Load (ETL) tools which allow the optimization of the alimentation
process. Recently, these tools started to focus on Data Quality Management (DQM), which generally integrates
profiling, parsing, standardization, cleansing, and matching processes (Goasdue, Nugier, Duquennoy, and
Laboisse, 2007).
Root Cause Analysis
A root cause analysis is a problem solving method that identifies the root causes of problems or events instead
of simply addressing the obvious symptoms. The aim is to improve the quality of products and services by
using systematic ways to address problems in order to be effective (Bowen, 2011),

Techniques in Root Cause Analysis

Root cause analysis is among the core building blocks in the continuous improvement efforts of an organization
in terms of its operation dynamics, especially in the way it handles information. However, root cause analysis
alone will not produce any valuable results. The organization should seek to improve at every level and in every
department for this to work. The analysis will help develop protocols and strategies to address underlying issues
and reduce future errors. Bowen (2011) suggests that “to address the root cause of a problem, one must identify
the problem and ask "why five times to determine the proper strategies to address its root cause."

1. Failure Mode and Effects Analysis

The failure mode and effects analysis (FMEA) aims to find various modes of failure within a system and
addresses the following questions for execution:
a. What is the mode in which an observed failure occurs?
b. How many times does a cause of failure occur?
c. What actions are implemented to prevent this cause from occurring again?
d. Are these actions effective and efficient?

FMEA is used when there is a new product or process or when there are changes or updates in a product and
when a problem is reported through customer feedback.

2. Pareto Analysis

The Pareto analysis uses the Pareto principle which states that 20 percent of the work creates 80 percent of
the results. It is used when there are multiple potential causes to a problem. The Pareto chart was created using
the Excel software. It lays down the potential causes in a bar graph and tracks the collective percentage in a line
graph to the top of the table. The reflected causes from the table should account for at least eighty percent of
those involved in the analysis.

3. Fault Tree Analysis

The fault tree analysis (FTA) is used in risk and safety analysis. It uses boolean logic to determine the root
causes of an undesirable event. The undesirable result is listed at the top of the tree and then all the potential
causes are listed down to form the shape of an upside down tree.

4. Current Reality Tree

 The current reality tree (CRT) is used when the root causes of multiple problems need to be analyzed all at
once. The problems are listed down followed by the potential cause for a problem. By doing so, a cause
common to all problems will appear.

5. Fishbone Diagram

Figure 8.3 Fishbone Diagram Showing Patient Dissatisfaction with Health Care Services

The fishbone diagram is also called the Ishikawa or cause-and-effect diagram. The diagram looks like a
fishbone as it shows the categorized causes and sub-causes of a problem. This diagramming technique is useful
in grouping causes (e.g., people, measurements, methods, materials, environment, machines) into categories
Categories could be the 4 Ms (manufacturing), the 4 Ss (service), or the 8 Ps (also service) depending on the
industry.

6. Kepner-Tregoe Technique

The Kepner-Tregoe technique breaks a problem down to its root cause by assessing a situation using
priorities and orders of concern for specific issues. The various decisions that should be made to address the
problem are then outlined. Then, a potential problem analysis is made to ensure that the actions recommended
are sustainable.

7. Rapid Problem Resolution (RPR Problem Diagnosis)

Another technique for root cause analysis is the rapid problem resolution (RPR problem diagnosis) which
diagnoses the causes of recurrent problems by following the three phases below:
 Discover - data gathering and analysis of the findings
 Investigate - creation of a diagnostic plan and identification of the root cause through careful analysis of
the diagnostic data
 Fix - fixing the problem and monitoring to confirm and validate that the correct root cause was
identified

Sustaining a Culture of Information Use

Choo, Bergeron, Detlor, and Heaton (2008) state that information culture affects outcomes of
information use. The information culture is determined by the following variables: mission, history, leadership,
employee traits, industry, and national culture. It can also be shaped by cognitive and epistemic expectations
which are influenced by the way tasks are performed and decisions are made.

The result suggests that in order to have a sense of information attitudes and values, managers should
consider taking the pulse of information of their own organizations. The sets of identified behaviors and values
could account for significant proportions of the variance in information use. Thus, management plays an
important role in sustaining a culture of information and should continuously work on maintaining and
improving the quality of data and information used in daily operations.
 LESSON 9
Hospital Information System

Hospital Information System

Health care plays a vital role in a society and people expect efficiency from health care providers and
health institutions which face the challenge of handling the numerous patients that seek their services Proper
management of clinical and operational records is therefore necessary Presently, most hospitals have shifted
from tedious manual recording to the use of a hospital information system (HIS) to assist them in maintaining
the different records of the institution.

Hospital information system (HIS) is a computer system structured to manage all the records of health
care providers to make available information and reports useful to health care personnel in doing their job more
efficiently. HIS was introduced in the 1960 and has evolved since then to cope with the changes and demands of
the modern times. Back then, the features of HIS were used mainly for billing and inventory. However, all of
these have changed through time. Today's system is also integrated with other financial, scientific, and
administrative programs.

The modern HIS has applications built to address the needs of the various departments of health
facilities such as nursing, pharmacy, finance, radiology, and pathology. There are hospitals with as many as 200
disparate systems integrated into their HIS. Hospitals using the HIS experience efficiency in accessing reliable
patient information with just a few clicks. However, advancements and new developments will be rendered
useless if the system is not user-friendly and training is inadequate.

While HIS delivers high quality patient care and better management of financial records, it needs to be
affordable, scalable, and centered on the needs of patients and medical personnel. It should be adaptable to rapid
technological changes. An effective HIS also provides enhanced integrity of facts, minimization of transcription
error and duplication of records, and shorter turnaround times for reports.

HIS available today links computers that are capable of quickly optimizing operations and delivering
quality service. The systems gather, process, retrieve patient information, and provide hospital stakeholders
with relevant information through reports for better decision-making.

The system also guarantees delivery of information required by the health care personnel because of the
optimized core library. It can also be customized to consider the particular needs of the departments and
centralize them into the system. However, a hospital should provide the requirements in detail to the HIS
provider during the initial stages of scoping so that its needs will be met and accurately provided. For example,
the institution could ask that the solution be based on RDBMS (relational database management system) or ask
for a multilingual interface for better handling of information (EMR Education Center, 2013).
HIS for Different Departments

1. Nursing Information Systems

Nursing information systems (NIS) are developed to enhance patient care by providing nurses with
accurate information to assist them in performing their duties more efficiently. An NIS carries out numerous
functions including the handling of personnel schedules, accurate patient charting, and better clinical data
integration.

Agenda packages help enhance the management of the workforce by helping managers hand overtimes and
absences. They can also be used to obtain cost-effective staffing and show Patient charting applications allow
better analysis of critical signs. Nurses could check information, and care plans along with applicable nursing
notes. Crucial information is kept be retrieved when needed. This is also useful in designing the patients' care
plan since the medical information integration function allows nurses to collect and examine retrieved medical
records.

2. Physician Information Systems

Physician information systems (PIS) are designed to improve the practice of physicians. Electronic
medical records (EMRs) and electronic health records (EHR) are some programs where PIS 1s deployed and
extensively used. Most systems offer support 24/7 to facilitate easier usage of the system by health care
professionals.

3. Radiology Information Systems

Radiology information systems (RIS) are capable of providing billing services and appointment
scheduling aside from reporting and database storage. Technological advances have made the practice of
radiology more complicated such that more and more hospitals turn to RIS to address the commercial concerns
of their radiology departments.

4. Pharmacy Information Systems

Pharmacy information systems (PIS) help monitor the utilization of medicines in health institutions. The
system also handles information on medication-related complications and drug allergies of patients. It provides
information to identify drug interactions which helps in administering the appropriate drugs by considering the
physiological conditions of the patient (EMR Education Center, 2013)

Selecting a Hospital Information System

The following are the aspects needed to be considered in selecting an HIS (EMR Education Center,
2013):

1. Total cost of package - HIS is available for all sizes and budgets. For hospitals with smaller budgets,
providers may reduce upfront and maintenance fees by using a design that requires fewer servers and
hardwares.

2. Web-based system - The system is available on the internet which means that authorized personnel can
access the information anywhere and anytime. It also allows data sharing between hospitals. A hospital with
updated patient history in its system can facilitate access to information from other health facilities upon
request.
3. Implementation and support - During the deployment or upgrade of the HIS, it is imperative that the
vendor provides ample training and assistance to the users of the system. Consider vendors that offer 24/7
support through telephone or web services.

HIS Providers in the Philippines

BizBox
BizBox, Inc. was founded 25 years ago. Its very first hospital project was completed in 1994. The goal
of the company is to improve work efficiency in health care institutions through software systems, and to
produce advanced solutions for better patient care. Today, it is among the top IT companies in the health care
industry. Aside from being a certified Microsoft Gold Partner, it has also received the Independent Software
Vendor (ISV) of the Year Award. It has fully integrated systems such as electronic health records (EHR) and
document management system (DMS) that will streamline tasks and help provide better health services
(BizBox, 2017).
KCCI Medsys
Kaiser-dela Cruz Consulting, Inc. specializes in application development for hospitals, industrial clinics,
and medical-related educational institutions in the Philippines. Its products, Visual MEDSYS for hospitals and
MEDSCHO for schools, provide integrated, comprehensive, and proven solutions for efficient health care
practices.

Comlogik
Comlogik Business Systems, Inc. is a Philippine-based software development company that was
established in 1999, with a vision to be a global technology company. Comlogik led the way in developing
innovative applications like online hospital services in which patients can access their billings and examination
results, while administrators can access reports and doctors can access patients' records anywhere and anytime.

HIS Functions
Help Desk, Scheduling, Patient Registration

Help desk
The help desk becomes more efficient through the HIS because the manual retrieval of information is no
longer needed. Clients are provided with information and guidelines associated with a company's or institution's
products and services without any hassle.

Scheduling
Managers and employees can access work schedules from anywhere they are and effectively discuss
their scheduling preferences through the HIS. An employee scheduling software helps save time and makes
employee scheduling less difficult.

Patient Registration
The HIS patient registration form records the name, age, gender, marital status, and other relevant
information regarding the patient. These pieces of information are used for record keeping and account
management purposes. This form is usually filled out during the patient's visit or consultation but if the patient
is unable to complete the form due to the need for prompt medical attention, the form can be filled out by a
relative or guardian.

Admission, Discharge, and Transfer Procedures

Admission
Before a patient is admitted to a health facility, an admissions counselor will call him or her to gather
preliminary information, offer vital information concerning the hospital stay, and answer questions if there are
any. Additionally, the physician may also schedule recurring medical exams, such as laboratory tests or X-rays,
before hospitalization. Other routine tests can also be carried out on the day of admission. All these can be done
more efficiently through the HIS.

Discharge
Through the HIS, instructions that accompany a patient's discharge or transfer are more efficiently
provided. These instructions may include discharge planning which details services needed to be administered
after the hospital stay to ensure the full recovery of the patient.

Transfer
The term "transfer" means movement (along with the discharge), of an individual outside of the hospital
premises at the instruction of any authorized hospital personnel. This, however, does not encompass movement
of an individual who (a) has been declared lifeless, or (b) leaves the facility with the permission of any such
authorized person (Louisiana State University, 1993). If a patient is transferred from the emergency room,
employees must fulfill the statutory requirements for a proper switch. With the HIS, patient transfer details are
easily accessed and processed.

Billing, Contract Management, and Package Deal Designer

Billing
Billing statements show all records pertaining to the invoices, payments, and the of a patients account.
HIS is very useful for patients who require frequent health care services because numerous invoices can be
combined and a lump sum payment can be made. It is good practice to generate the billing statement on a
regular basis so that the institution could keep track of its collectibles. HIS lists the outstanding balances of the
patients. Any overdue payments may be checked easily. In addition, balances of patients who only have
minimal transactions are kept updated.

Contract Management
Goodrich (2013) defines contract management as the process of managing contract creation, execution,
and analysis to maximize the operational and financial performance of an organization while reducing financial
risk Organizations constantly encounter pressure to reduce costs and improve company performance. Contract
management proves to be a very time-consuming element of business, which facilitates the need for an effective
and automated contract management system.

When a contract management strategy is successfully implemented, organizations can expect to see
following:
 realization of expected business benefits and financial returns
 cooperation and responsiveness of the supplier to the organization's needs
 no contract disputes or surprises
 satisfactory delivery of services to both parties

Package Deal Designer

 Posting diagnostic medical packages for in-patients, out-patients, and emergencies requires the same
process, the difference is that for emergencies, this is called post-diagnostic package deal. HIS helps in
accessing information regarding package deals without going through the hassle of paperwork.

Laboratory, Radiology, and Cardiology Reporting

Laboratory Reporting
Despite differences in presentation and form, all laboratory reports must possess common elements as
required by institutional and company policies. They may also contain supplementary items not specifically
required, but which the laboratory chooses to report to aid in the interpretation of results of medical testing
(American Association for Clinical Chemistry, 2017).

For identification and filing purposes, some laboratory reports display elements with administrative or
clerical information such as the following:
 Patient name and identification number or a unique patient identifier and identification number
 Name and address of the laboratory location where the test was performed
 Date when report was printed
 Test report date
 Name of doctor or legally authorized person ordering the test(s)

Information about the specimen and the test itself, such as those included below, are other elements that
make a laboratory report more meaningful:
 Specimen source (if applicable)
 Date and time of specimen collection
 Laboratory accession number
 Name of the test performed
 Test results
 Abnormal test results
 Critical results
 Units of measurement (for quantitative results)
 Reference intervals (or reference ranges)
 Interpretation of results
 Condition of specimen
 Deviations from test preparation procedures
 Medications, health supplements, etc. taken by the patient

Radiology Reporting
According to the University of Virginia /2013) a radiology report is an official medical document that
provides the details of the requested radiology examination and the procedure conducted by the radiologist A
qualified physician authorized by the health care institution interprets the report. The main objective of the
report is to address the queries in the request. The findings in the report should take into account both positive
and negative findings. Important findings should be stated followed by incidental findings
The basic sections of a radiology report enumerated in the American College of Radiology's practice
guideline on communication must include administrative information, patient identification, clinical History.
imaging technique, comparison, observations, summary or impression, and signature of the radiologist. The
length of the report is dependent on the complexity and cost of the examination.
Cardiology Reporting
Cardiology reports, like other laboratory reports, contain important medical information based on the
test results of the patient which are set against past medical records. Doctors are able to write vascular reports
much faster since access and retrieval of information are made more convenient through computer systems.
Using the cardiology information systems (CIS), vascular sonography reports are accurately created
with only a few clicks. Information on these reports could include ultrasonic ultrasound and diagrams
Nowadays, physicians opt to provide automated reports through the use of information systems. The medical
staff can process laboratory reports for the approval of the physician. This means that results are generated more
efficiently which translates to improved patient experience.

Materials Management System-Pharmacy, Main Stores, and Purchase

Materials management is primarily concerned with planning, identifying, purchasing, storing
receiving, and distributing materials. Its purpose is to guarantee that the right and sufficient materials are in the
right location when needed.
As such, the automation of an inventory or a materials management system is necessary for a hectic
health center to streamline the hospital supply chain. Computerized stock management systems include
technologies for tracking inventories and devices used each day in a health care setting. Generally, they utilize
barcodes and RFID tags with precise identification numbers assigned for each inventory object to enable
accurate tracking and control Automated stock management systems also assist health care institutions in
figuring out whether merchandise has been recalled or damaged and should not be given to patients. They
enable isolation of drugs and devices that are used regularly and forecasts capacity shortages (Pontius, 2018).
Virtually, every health care institution has a materials management department that is accountable for
receiving materials, retaining central stock, and delivering supplies within the institution. Typically, this is
where the responsibility of the materials management department ends. inspection of a nursing unit, suite, or
exam floor will reveal a smaller, self-managed inventory in supply closets, nurses' stations, and individual
rooms. These inventories are essential in maintaining supplies conveniently available for use.

Management Reporting
Today, management reporting is not limited to data retrieval. It has become a platform for reporting and
controlling information valuable to the institution. Recent technological advancements help management reports
to provide non-monetary information which enables the management to have an oversight of its operations. In
the same way, these advancements pave the way for the emergence of management reporting systems. These
systems capture the necessary data required by management to operate more efficiently. With this, data
redundancy and data quality issues are minimized. Employee headcount, customer account information,
funding, and overall performance are some of the data that can be retrieved through the system. Thus, a good
management reporting system enhances the capability of an institution to be more responsive, efficient, and
effective in decision-making which affects the performance of the institution as a whole. These systems offer a
single holistic view which highlights high value sources and eradicates the lack of visibility in reviewing the
performance of the institution (Kumar, 2017).

In-Built Tally Interface

 Tally ERP9 is a software that provides simplified solutions to operations in health institutions such as
registration, accounting, inventory management, tax management, among others. Tally is easy to learn and can
be implemented with minimum resources. It is reportedly used by over 1000000 entities across the globe.

LESSON 10
Laboratory Information Management System

Laboratory Information Management System

The laboratory information management system (LIMS) is designed to help process information in
medical research to improve the efficiency of the departments, services and laboratory operations bu reducing
manual tasks and procedures. For example, a LIMS records information automatically which saves time and
reduces typographical error. This is commonly used in conjunction with laboratory information systems (LIS)
in the medical and pharmaceutical industries.
According to Gartner's 2016 Hype Cycle for Life Sciences, most of the top pharmaceutical laboratories
use LMS. The system is also useful for biobanks and genomic testing centers and laboratories that study drugs
and develop formulations. However, the health care institution must consider the data capture process, storage,
and retrieval in selecting the solutions provider because some are more suitable than others (Reisenwitz, 2017).

Functional Requirements and Features of LIMS

According to Reisenwitz (2017), the functionality of LIMS includes sample management, workflow
management, reporting, electronic medical records (EMR)/electronic health records (EHR), mobile, and
enterprise resource planning (ERP).

Sample Management
Accurate and detailed records are necessary to make sure that samples are not lost or mixed up. A
record should show whether the sample meets the acceptable values.

LIMS records and stores the following information about the sample:
 Who the sample was taken from?
 What is the sample taken?
 Who is working with it (researcher or provider)?
 Who handled the sample?
 Where does it go next?
 How do you store these samples?
 When does it need to move?
 LIMS automates most of these by using radio-frequency identification (RFID) or barcodes in recording
and updating logs and track the chain of custody of the sample.

Workflow Management
LIMS can be used to automate records and workflows which saves time. Extsting coding methods and
procedures enable the system to take part in the decision process. Using prevet rules, it can suggest instruments
needed for the procedure and assign the medical laboratory technician or specialist to complete the test.

Reporting
Using LIMS, reports can be run and exported to make them standard and customized Reports on the
most frequently used instrument, the average handling time of sample, and list of backlogs are useful in data
analysis and formulation of recommendation for future policymaking.

EHR
Some LIMS have a built-in electronic health records (EHR) functionality which is capable of handling
patient records and billing information. A health Institution should consider this during acquisition because this
feature will greatly help in managing clinical laboratory procedures.

Mobile
Gartner's (2016) reports that mobile LIMS offerings are limited. But with the accepted use of
smartphones in the laboratory, it is better for LIMS to be mobile-friendly.

ERP
A LIMS that can handle inventory functions is recommended. The enterprise resource planning (ERP)
solution is especially useful in viewing current supplies, calculating storage capacity, and managing location.

Core Components of LIMS

LIMS software suites usually involve multiple components to provide a variety of functions for different
levels of the laboratory. IEEE GlobalSpec (2015) specifies the components of a LIMS software but are not
limited to the following:
 Electronic laboratory notebooks
 Sample management programs
 Process execution software
 Records management software
 Applications to interface with analytical instruments or data systems
 Workflow tools
 Client tracking applications
 Best practice and compliance databases
 ERP software
(View the complete components of a laboratory information management system in McDowalls Risk Based
Validation of Laboratory Information Management Systems.)

Laboratory Standards
 To help promote laboratory safety, the Occupational Exposure to Hazardous Chemicals in Laboratories
Standard (29 CFR 19101450 was released in the United States by the Occupational Safety and Health
Administration (OSHA) in 2011.
Some important provisions from the standard are cited below:

Laboratory is a workplace where hazardous chemicals are used. It is also a facility that stores small
quantities of hazardous chemicals which are not intended for production use. On the other hand, the laboratory
use of hazardous chemicals should meet the conditions listed below:
 The manipulations of chemicals should be on "laboratory scale" only and can be handled by one
person
 There is the use of multiple chemicals and procedures.
 The procedures should not simulate any production process.
 Protective laboratory tools are available and proper practices are followed to minimize potential
exposure to harmful chemicals
 Any hazardous use of chemicals which does not meet this definition is regulated under other
standards. Examples are:
 chemicals used in the maintenance of the laboratory building,
 production for commercial sale, and
 testing of a product for quality control.

A Chemical Hygiene Plan (CHP) which discusses all aspects of the laboratory standards should be
formulated if the standards apply. The employer must implement the provisions which address the proper
purchase, storage, handling, and disposal of the chemicals used in the facility

The primary elements of a CHP include the following:

1. establishment of standard operating procedures (SOP) to minimize exposure to chemicals and dissemination
of information on the requirements for personal protective equipment, waste disposal procedures, and
engineering controls;
2. monitoring of the work environment to provide the action and medical attention required for some chemicals;
3. statement of plan on how to obtain free medical care for work-related exposures; and
4. designation of personnel who will handle CHP-related activities such as handling data sheets, organizing
trainings, monitoring adaption, and revising CHP if deemed necessary.

LIMS Application

Patient Registration
When a patient arrives at the hospital, the admission clerk will take some basic information and will
guide him or her to a registration window.

Billing
The process of generating SOAS (statement of accounts) or billing statements of in-patients, out-
patients, and emergencies are the same. In the following example, an in-patient's billing statement is used.

Contract Management
Most LIMS allow the laboratory professionals to manage the billing and payment aspects of their
activities and to create statistical and billing reports on a par with the laboratory and management needs They
provide parameters for a flexible price schedule and enable heightened attention on customer needs They
automate billing processing, hasten collections, and after marketing tools which reduce the time spent on
standard flow and allow billing and accounting personnel to focus on improving collection of problematic
accounts (Infomed, 2017).

In addition, the common features of IMS for invoicing and contract management include:
 customer customizable invoices including history analysis of balance and charges, history
balance detailed services, and participation when in insurance coverage, discounts, among
others,
 different electronic formats for invoices to allow interfacing with customer electronic systems,
 customizable information completion reports for customers
 managerial reports which display laboratory billing status for payer groups including projected
return values for each payer group
 ability to change the insurance organization of a patient per visit:
 ability to select which tests are covered by insurance and which have automatic modification of
the prices accordingly,
 supervision of financial data management of the senders;
 reminder for amounts due from past visits:
 immediate access to the billing card of each patient and .
 consistency with international laws
Accounts Receivables
Through the integration of the LIMS, the personnel in charge of managing accounts receivables can
easily extract information which was already available from the invoicing and contract management procedures.
Additionally, the LIMS can
 generate specific or complete accounts receivable reports
 monitor balances for reconciliation and audit purposes
 export data to other accounting systems, and
 customize reports according to specifications.

Worklist and Workflow

LIMS assists laboratories in setting priorities of current workloads based on analyst and instrument
availability. This function allows the user to track a sample, a batch of samples, or numerous batches through
their lifecycle Queuing can also be done by sample or by workflow which is a block of repetitive procedures in
a certain process. The queuing and work list feature provides insights about when an event occurred, how long
it was, and who was involved.

In addition, other features also enable personnel and workload management, thereby, allowing users to
plan workload schedules and assignments, and employee information and training. Ultimately, the worklist and
workflow functions operate to facilitate more efficient laboratory processes.

Quality Control
Diagnostic tests executed inside the clinical laboratory may yield two kinds of results, a patient result or
a quality control (QC) result. The result can be quantitative (in numbers), or qualitative (positive or negative) or
semi-quantitative (limited to a few different values). QC results are used to verify whether or not the instrument
is working within prescribed parameters, Based on the said results, reliability of a patient's test results will be
determined (Bio-Rad Laboratories, 2008).

LIMS functions enable users to set standards about the relevant range of patient test results or to extract
test result information for the purpose of quality assurance. Outliers and deviations can be flagged and
appropriate warning signals can notify users about issues which might involve the quality of the samples or the
equipment currently in use.

Barcode-generation, Printing, and Reading

LIMS modules are commonly linked to a barcoding label generator which enables a fast and easy
method to identify tubes, samples, documents, and many others. The code can simply be printed on a label
sticker to be placed on any item which needs identification. A barcode editor also allows multiple labels to be
printed at a label printer. The barcode series can usually be customized to suit the organization's or classification
needs. With this kind of technology, information about a tube, a specimen. or equipment within the laboratory
can be found and retrieved effortlessly using a barcode scanner.

In-built Bi-directional Interfaces with Equipment

Figure 10.4 shows the interface of a bi-directional equipment used in medical laboratories. A two-wee
communication between the information system and the clinical instrument is required. LIMS download the test
orders and specimen ID for each test. On the other hand, the clinical instrument uploads the same information
for analysis. The same method is also used by instruments for microbiology, hematology and other areas.

When a health institution uses this type of application, productivity is enhanced because it minimizes the
time spent in programming the order into the analyzer and ensures accuracy due to the elimination of errors
usually committed in the manual process. Nowadays, these machines also have the random access testing
feature and barcode label scanning for specimen (Selmyer & Cloutier, 1996).

LESSON 11
Other Hospital Information Systems

Cardiology Information System

Definition
The cardiology information system (CIS) is mainly focused on the storage and retrieval of Radiology
Centric images This system usually receives an order with patient demographics from other information
management systems. Once the images are acquired from imaging modalities, they are profile based on the
order and stored for further distribution, viewing and long term archiving (Katipula & Ireland, 2013).

The information used by cardiologists for the diagnosis and treatment of illnesses varies from personal
notes (history, physical examination), to signals (electrocardiograms), images (echocardiograms angiograms,
CT MRI), and reports from investigations and procedures. All these types of information can currently be
provided in digital format, and the system serves as repository of these forms of images Unfortunately, most
systems are limited by their storage capabilities and do include post-processing functions.

Evolution of CIS
Decades ago, the requirements for an electronic medical information system were restricted by the
availability of equipment. A good database schema combined with a functional user interface was deemed
adequate. In the 1970s, available cardiology information systems originated from mainframe environments,
whose technical specifics would be considered ridiculous in today's context In the 1980s, modular systems that
emphasized the use of real-time applications and mini computers became the trend (Turney & Kohls, 1997).
Over the years, the trend for smaller computers remained, but the introduction of the internet became a turning
point that shifted the focus of most systems towards creating networks and facilitating integration Cardiology
information systems nowadays have unique features that enable remote access and easy retrieval. Some systems
have also attempted to integrate radiology information systems (RIS) to involve more administrative processes
and go beyond storage purposes.

Benefits of ClS
Different CIS, coming from different sellers, vary in their available features. However, the following are
the most common benefits:
1. Ease of Access while Maintaining Data Security
CIS consolidates multiple types of patient cardiology information, thus eliminating the need for doctors
to request different imaging results from different departments
2. Flexibility in the Workflow
Availability of mobile technology allows cardiologists to assess a wide array of information without
having to leave the patient's bedside Having cardiological data in a single platform offers mobility to physicians
and nurses, thereby improving the efficiency of providing service
3. Enhanced Comparability
CIS is an essential repository of cardiology imagery results, thereby retrieval of past data is convenient.
This comparability enables health care professionals to make more informed decisions on their patient's
treatment.

Functionalities of CIS

1. Editing, Viewing, and Storing Multi-Modal Cardiology Data - With the help of CIS, different types of
data, including those of computed tomography (CT), cardiac ultrasound echocardiography, magnetic resonance
imaging (MRI), nuclear imaging (PET and SPECT), and angiography may be managed on a single platform.
2. Remote Access - The use of networks and integrated information systems, coupled with the availability of
the internet and tablets and smart phones, offers flexibility to CIS.
3. Visualization and Reporting Capabilities Two of the main benefits of CIS are the ease and the consistency
of reporting. As a result, virtual real-time information retrieval is possible anytime and anywhere with just a
couple of clicks.
4. EHR Integration - CIS may be integrated with existing electronic health record systems this results in the
enhancement of the quality of services of the health professionals by offering a more comprehensive view of the
patient care spectrum

Radiology Information System

A radiology information system refers to a network system used in managing imagery and associated
data in the radiology department. The system tracks the orders and billing information of the requesting
department. It uses picture archiving and communication systems (PACS) for the storage and management of
medical images and vendor neutral archive (VNA) to manage image archives and for record-keeping and billing
within a hospital information system (HIS) (Rouse, 2017).

The use of RIS in health care institutions has many advantages in the context of improving overall
operations of the institution. The system enables easier access to patient information because it can be
integrated in referring to the doctor's electronic health record (EHR) system, resulting in better patient
experience. It also allows faster processing of payments because the insurance plans of patients may be verified
prior to their visit and electronic payment is an available option. It also permits reports to be easily generated
and sent to the requesting department which dramatically improves the efficiency of the workflow of the
institution.
Functions of RIS
Rouse (2017) describes the following functions of an RIS:
 Patient Management - The system tracks the patient's entire workflow within the radiology department.
It can add images and generate reports to EHRs for easy retrieval and viewing by the authorized
radiology staff.
 Scheduling The system allows staff to schedule appointments for in-patients and out-patients.
 Patient Tracking Patient tracking means tracing the patient's radiology history starting from admission to
discharge and coordinating it with his or her past, present, and future appointments.
 Results reporting - Results reporting is possible through the statistical reports generated by RIS. The
reports may be done for a single patient or a group of patients, as well as for specific procedures,
depending on the needs.
 Image tracking - RIS was traditionally used to track individual films and associated data. Nowadays,
RIS-PACS systems managed by radiology departments cover the entire clinical b workflow of the
medical enterprise.
 Billing - Billing is made convenient through the system's financial record keeping and processing of
electronic payments and automated claims.