SMU MBAHCS ASSIGNMENT

SEMESTER III

MB0053 HOSPITAL AND HEALTHCARE INFORMATION MANAGEMENT

ASSIGNMENT SET: II

SUBMITTED BY:

J.JERALD JEYAPRAKASH
MBAHCS

ROLL NO :- 531010671

SMU- MBA Semester III

Reg. No: 531010671

HOSPITAL AND HEALTHCARE INFORMATION MANAGEMENT-MH0053

INDEX
Q.No QUESTION Page No

Q.1

EXPLAIN E- HEALTH.

Q.2 Q.3

DISCUSS THE PROCESS OF MEDICAL AUDIT WITH A DIAGRAM DESCRIBE THE VARIOUS BENEFITS OF PACS

6 10

Q.4

WHAT ARE THE STEPS INVOLVED RISK MANAGEMENT PROCESS. EXPLAIN ALL THE STEPS

14

Q.5

KIRLOSKAR HOSPITAL IN NASIK, MAHARASHTRA IS A 200 BEDDED HOSPITAL AND IT IS GETTING DIFFICULT FOR THEM TO KEEP ALL THE MEDICAL RECORDS MANUALLY IN HARD COPIES SO, THE ADMINISTRATOR SUGGESTED IMPLEMENTING EMR IN THEIR HOSPITAL. THE MANAGEMENT IS NOT VERY SURE ABOUT HOW TO CHOOSE EMR. WRITE SHORT NOTES ON HOW TO CHOOSE AND INSTALL EMR EXPLAIN THE SIGNIFICANCE OF CLINICAL INFORMATION SYSTEM

17

Q.6

22

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Reg. No: 531010671

HOSPITAL AND HEALTHCARE INFORMATION MANAGEMENT-MH0053

Q.1. EXPLAIN E- HEALTH Answer E-health is abbreviated from Electronic-health. E-health basically means use of electronic communication and information technology in the health sector wherein digital form of data is stored and retrieved electronically-for various purposes like clinical, educational and administrative, both in local areas as well as at a distance. The word E-health comprises of telehealth, telemedicine, m-health and other health IT components, which are covered in detail in the subsequent sections. In cases where speed is vital in delivering healthcare services, E-health can be used. Suppose a natural disaster has struck some location, E-health can be used to save many lives. Internet and video conferencing is a familiar concept to most of us. E-health provides healthcare using these concepts. Therefore, healthcare services can be provided electronically to areas where natural calamities have struck. E-health has been adopted worldwide. It has made considerable amount of progress in India as well. Definition of E-health E-health is defined as the use of communication and information technology in the field of medicine. Transfer of medical records or other related data takes place through electronic processes. It also enables two professionals at different geographical locations to interact with each other. E-health is a relatively new term introduced in medical science. The concept of E-health is supported by electronic and communication technology. The term covers a wide range of medical and healthcare services like telemedicine and m-health. Some say that E-health is interchangeable with healthcare informatics and is a sub set of health informatics. Few others use it in the narrow sense as using Internet in healthcare practice. E-health covers more than just Internet and medicine. Introduction to E-health

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HOSPITAL AND HEALTHCARE INFORMATION MANAGEMENT-MH0053

E-health is the utilisation of emerging interactive technologies to facilitate health improvement and health care services. The technologies include Compact Disc Read Only Memory (CD-ROM), Digital Video Disc Read Only Memory (DVD-ROM), Personal Digital Assistant (PDA), Internet, interactive television, kiosks and so on. E-health uses the growing technology to upgrade the quality, safety and efficiency of healthcare. While adopting E-health a consumer must keep three things in mind: personal health record, electronic health record and ensure safe sharing of these records between the doctors and patients. E-health provides many advantages in the field of healthcare services. They are: Significant information from your health history is readily available to your doctor, without having to spend time looking through a paper chart and possibly missing something important. Your doctor can receive important awareness based on your specific history, such as whether a new medication will have side effects, or if you require other medications. The health record will be transferred on time if you choose a different clinic site other than the clinic which you normally visit. The healthcare solutions provided by e-health are low cost. Patients who are bedridden or disabled can have access to healthcare services through e-health. Patients are comfortable talking about the healthcare issues to their friends and relatives. This is not the case with mental health issues. Patients are comfortable discussing the mental health concerns through E-health. Clinics are able to electronically and securely send your relevant health information to another doctor you have to consult. This saves you from having to unnecessarily repeated tests and procedures and implies you do not have to fill out health history forms everywhere you go. Challenges in E-health E-health is a rapidly growing technology. However, it faces certain challenges as the population is widespread. Most of the population in India is spread across villages and hilly terrains. Delivering E-health services to these areas could prove a challenge. Let us look into some of the challenges faced by E-health in India.

SMU- MBA Semester III

Reg. No: 531010671

HOSPITAL AND HEALTHCARE INFORMATION MANAGEMENT-MH0053

India is highly populated country spread over a wide area. There are 600,000 villages in India and about 27,000 villages have no road or rail facilities, 51,000 villages are deprived of power connections. Few villages are yet to get a simple analogue telephone. Telecom facilities do not exist. At this rate, providing E-health would definitely prove a challenging task. Nowadays, highly advanced communication systems are available. To utilise these resources, a minimum level of education is expected. India has a large population of over one billion out of which approximately 400 million are illiterates. In rural areas the literacy rate is very less. Providing access to E-health to illiterates is a challenging task. The number of healthcare centres across our country is not satisfactory. As per census done in the year 2001[1], we require another 21,983 Sub-centres, 4436 PHCs and 3332 CHCs approximately to provide better healthcare facilities across villages and other states. Only about a quarter of the population in villages have access to healthcare services. Approximately 40% of the rural population sell their assets to meet their medical expenses. There are about 15 official languages in India. The culture differs from state-to-state in our country. It is a challenge to impart knowledge to the people in such cases. The developer of E-health modules must keep in mind the difference in culture while developing the modules. The other challenges are: Coping with the rapid advancement in technology Determining the quality and effects of E-health applications. Investigating the research approaches for E-health programs. Developing the credible information sources on research tools and findings. Protecting the records of patients is vital. Health information should not be revealed to unauthorised person. By doing so, the information could be tampered with or put to wrong use which could risk the life of the patient.

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Reg. No: 531010671

HOSPITAL AND HEALTHCARE INFORMATION MANAGEMENT-MH0053

Q.2. DISCUSS THE PROCESS OF MEDICAL AUDIT WITH A DIAGRAM Answer

Medical audit is the review and evaluation of healthcare procedures and documentation. It is done to compare the quality of care provided with the accepted standards. Audit is conducted after the discharge of patients. An audit includes studying charts of discharged patients and examining the amount of nursing care given to patients, conducting patient interviews and surveys. In addition, a medical committee reviews the professional standards of doctors.

Medical audit is a proven method to improve both the process as well as the quality of care given to patients. In this evaluation system, when problems are identified corrective actions are taken. After a fixed interval of time, performance is measured again. Medical audits help understand the validity of procedures conducted in the past as they are the future sources of reference.

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Reg. No: 531010671

HOSPITAL AND HEALTHCARE INFORMATION MANAGEMENT-MH0053

Stages of Audit Processes Process of Audit In the previous section you learned the objective of medical audit. Let us now learn the processes of medical audit. Medical audit is a cycle that has several procedures. This cycle consists of methodical procedures. They include setting up of best practices, taking necessary actions to enhance health systems, and monitoring improvements. The various audit processes are depicted in figure . The process of audit involves the following steps: 1. Recognise Problem or Issue In this phase, the issue to be audited is chosen. It also involves evaluating adherence to healthcare procedures that have shown best results for patients. Selection on a topic for audit is dependent on the following factors:

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HOSPITAL AND HEALTHCARE INFORMATION MANAGEMENT-MH0053

Where national standards and strategies are present. There is proof of effective medical practice Where issues encountered in health practice What the patients and the public have suggested when they faced problems Where there is comprehensible potential for continuing service delivery. Areas where there is a scope for improvement like areas of high risk or cost or even high volume 2. Set Criteria and Standards Decisions relating to the overall purpose of the audit should be written as a series or a statement of tasks that the audit targets. The decisions are based on the following questions: What is expected from the result of the audit? What questions should the audit answer? These questions collectively form the audit criteria. These criteria are statements that define measurable entities, and represent elements of care that can be measured subjectively. The aspects of care to be evaluated are standardised and must be based on the best evidence available. 3. Data Gathering To make sure that the data gathered is accurate, and that only necessary data is gathered, certain details of what is to be audited must be recognised from the beginning. They consist of the following: The user groups that have to be included, with any exclusion noted. The medical care professionals engaged in the users care. The time over which the criteria is applicable. Sample range for data gathering is often a concession between the statistical validity of the results and practical problems of data gathering. Data to be gathered can be obtained from a computerised process, or in other cases it can be manually gathered from the results being measured. In any case, what information is to be gathered, where the data will be available, and who does the gathering of data are considered. The gathered data must be

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Reg. No: 531010671

HOSPITAL AND HEALTHCARE INFORMATION MANAGEMENT-MH0053

used only for audits. Personal information of the patients and employees must be kept confidential. 4. Compare Performance with Criteria and Standards This phase is for data analysis. Here results of the data gathered are compared with criteria and standards. The final phase of analysis is concluded on how well the standards were met and where applicable, why the standards were not met. These reasons are included to the exception condition for the standard in future, or a better solution for improvement is recommended. 5. Applying Change When the outcome of the audit has been circulated and discussed, an agreement is reached on how to implement the changes. Using an action plan to mark these suggestions is a good practice. The action plan should contain details on who has decided to do what and by when. Each statement requires to be well explained, with an individual named responsible for it, and an agreed timeline for its completion. The action plan may require modifications if the actions used are unsuitable or wrongly calculated. In other cases new procedures or methods may be required or links to other departments or persons may be included. Frequently at the end of an audit, an organisation or individual are criticised even without their active participation. Joint audit is much more beneficial in such cases and the medical audit heads must promote this. 6. Re-audit: Sustaining Improvements Audits are repeated after a specific time period. The same plans for recognising the sample, methods and data analysis should be used to ensure that it is comparable with the original audit. The re-audit has to exhibit that the suggested alterations are done and that the enhancements are made. Additional modifications may be required, that results in another re-audit. This phase is crucial to the successful result of an audit process. It validates whether the changes applied have the intended result. It also checks if additional developments are necessary to change the standards of healthcare delivery recognised in phase 2.

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Reg. No: 531010671

HOSPITAL AND HEALTHCARE INFORMATION MANAGEMENT-MH0053

Q.3. DESCRIBE THE VARIOUS BENEFITS OF PACS Picture Archival Communication Systems Picture Archival Communication Systems (PACS) is a digital image management and storage system used in managing medical imaging. PACS is a collection of hardware and software committed to the short and long term storage, retrieval, distribution, presentation, and management of images. Electronic images and reports are transferred digitally through PACS thereby eliminating the need of manual filing, retrieval, or transportation of film jackets. The universally accepted format for image storage and transfer in PACS is DICOM (Digital Imaging and Communications in Medicine). Non-image information like scanned documents are incorporated in DICOM using common and standard formats like PDF. PACS consists of high-resolution monitors, specialised computer workstations and electronic storage documents. PACS links the medical images with the respective reports making it easy to view both the images and the associated report at the same time. Some of the examples of images stored in PACS are CT scans and MRIs. A PACS consists of four major components. They are the following: Imaging modes such as CT and MRI A secured network to transmit patient information Workstations to interpret and review images Archives to store and retrieve images and reports

Combined with the ubiquitous Web technology, PACS delivers timely and efficient access to images, interpretations, and other related data. PACS crosses the physical and time barriers associated with the retrieval, distribution, and display of traditional film-based image. .1 is an image stored in a PACS. Figure.2 depicts the changes made on the image by the PACS. The image has been modified by performing contrast adjustment,sharpening and measurement tags added by the system.

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Figure 1 Sample Image stored in PACS

Most Picture Archival Communication Systems process images from various medical imaging instruments like Magnetic Resonance (MR), Ultra-Sound (US), Positron Emission Tomography (PET), Computed Tomography (CT), Endoscopy (ENDO), Mammograms (MG), Computed Radiography (CR) and Digital Radiography (DR).

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HOSPITAL AND HEALTHCARE INFORMATION MANAGEMENT-MH0053

Figure 2 Image Interpreted by PACS

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HOSPITAL AND HEALTHCARE INFORMATION MANAGEMENT-MH0053

Benefits of PACS PACS has many benefits and hence most of the hospitals are now using PACS. The benefits of PACS can be categorised as the following: Hard copy replacement Remote access Electronic image integration platform Radiology

Hard Copy Replacement: PACS replaces the hard-copy method of storing like film archives. PACS provide cost and space advantage over film archives. It also provides instant access to prior images at the same price. Remote Access: It expands the possibilities of conventional systems by enabling offsite viewing and reporting. It enables practitioners to simultaneously access the same information irrespective of their location. Electronic Image Integration Platform: PACS provides an electronic platform for radiology images interfacing with other medical automation systems such as Hospital Information Systems (HIS), Electronic Medical Records Systems (EMR), and Radiology Information Systems (RIS). Radiology Workflow Management: PACS is used by radiology technicians to manage the workflow of patient exams. Apart from the aforementioned benefits, PACS provides various other benefits. They are as follows: o PACS is offered by all the major medical imaging equipment manufacturers, medical IT companies and many independent software companies. o PACS has the ability to deliver timely and efficient access to images, interpretations and related data.

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HOSPITAL AND HEALTHCARE INFORMATION MANAGEMENT-MH0053

o Electronic images and reports are transmitted digitally through PACS which reduces the need to manually file, retrieve, or transport film jackets. o Clinicians and other hospital employees do not have to spend a lot of time searching for medical images. o The cost of film, processing, chemicals and other related supplies will disappear. Many support staff activities will also disappear, resulting in additional savings. These activities include starting new film folders, printing film, and delivering film, hanging and removing film from viewing boxes, filing films, and finding lost films. Q.4. WHAT ARE THE STEPS INVOLVED RISK MANAGEMENT PROCESS. EXPLAIN ALL THE STEPS Risk Management Healthcare services are prone to various risks. Risk is an event or situation that could potentially result in any event, or situation that could potentially result in an injury to an individual or financial loss to the healthcare organization. Effectively managing those risks is a major activity in any quality assurance program. Systemic risk management activities are intended to achieve the following objectives: Minimize the potential for injuries occurring Minimize the Potentially compensable events (PCEs) Respond appropriately to the injured patient Anticipate and plan for ensuring liability when injuries occur Prevent or reduce financial loss.

An effective Risk Management program should perform the following activities: Risk identification. Risk analysis Risk evaluation Risk reduction or elimination.

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HOSPITAL AND HEALTHCARE INFORMATION MANAGEMENT-MH0053

Risk identification Risk identification is the first process in a risk management program. Risks need to be identified for prevention and reduction of risks. Risk identification starts with identifying problem prone and high risk areas and collection of data on past events which led to PCEs. The primary tool used in identification of risks is the incident report. It is a written description of any event not consistent with routine operational procedures or patient care activities. Incident reporting provides early detection of problems or PECs and helps in early investigation of serious incidents. Most healthcare organizations have some type of incident reporting, and incident reporting systems concurrently identify the incident that occurs. The following are common examples of reportable occurrence: Needle sticks Patient or employee fall Medication error Patient refusal to accept treatment.

The other method of risk identification is occurrence screening. Occurrence screening is very useful mechanism to identify risks, specifically liabilities resulting from physicianrelated occurrence. Occurrence screening allows concurrent or retrospective identification of physician and hospital related adverse patient occurrences. In short we accountable if the patient seeks to take legal recourse. Occurrence screening is sometimes termed as generic screening because the process is applicable to all patients, regardless of the patients diagnosis or procedure. Examples of occurrence screening are: Admission for adverse results of outpatient management. Admission for a complication resulting from incomplete management of a pervious hospital admission. Adverse reaction to medications, transfusions, and anesthetics. Unplanned transfer to another acute care facility. Unscheduled return to operating room. Perforation, laceration, tear, or injury of an organ during an invasive procedure.

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Neurological deficit not present on admission Post surgical death Patient discharge against medical advice. Unplanned organ removal or repair subsequent to or during surgery.

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Reg. No: 531010671

HOSPITAL AND HEALTHCARE INFORMATION MANAGEMENT-MH0053

In incident reporting mechanism the risks are analyzed and evaluated during the patients stay in the hospital and potential liability is assessed. Occurrence screening data are used in a similar way as in incident reporting. If the mechanism is on concurrent basis, an event is

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HOSPITAL AND HEALTHCARE INFORMATION MANAGEMENT-MH0053

analyzed and evaluated while the patient is admitted. In retrospective occurrence, screening system cases are reviewed by medical staff committees or departments and inappropriate physician practices are handled within the medical staff peer review structure. Risk reduction or elimination Once various risks are analyzed and evaluated, the next step is to eliminate or reduction of such risks in future. In many instances the events led to PCEs being discussed with those involved, and serve as an educational device to prevent future problems. The incident report is a tool to eliminate or reduce future adverse occurrences. The data from incident reports are also collected and analysed to identify high risk areas which require more care or restructuring to eliminate future risk. The hazard surveillance function as a part of risk identification and is a helpful mechanism in reduction or elimination of risk through prior identification of areas of potential environmental risk prior to an adverse occurrence. The adverse patient occurrences identified through generic screening are usually physician related, and it are co-ordinated with the medical staff peer review and credentialing function. Q.5.KIRLOSKAR HOSPITAL IN NASIK, MAHARASHTRA IS A 200 BEDDED HOSPITAL AND IT IS GETTING DIFFICULT FOR THEM TO KEEP ALL THE MEDICAL RECORDS MANUALLY IN HARD COPIES SO, THE ADMINISTRATOR SUGGESTED IMPLEMENTING EMR IN THEIR HOSPITAL. THE MANAGEMENT IS NOT VERY SURE ABOUT HOW TO CHOOSE EMR. WRITE SHORT NOTES ON HOW TO CHOOSE AND INSTALL EMR Electronic Medical Record (EMR) also known as Electronic Health Record (EHR) or Computerised Patient Record (CPR) is a medical record produced in a hospital or clinic. EMR is a software database application, which is designed to automate the medical office workflow. Each phase of the patient encounter is duplicated by the EMR through which efficiency and productivity is gained. It provides electronic information sharing system over the Internet for both doctors and patients. This enables doctors to update their data, research, or prescriptions into this web-based system as well as access them from anywhere in the world.

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Reg. No: 531010671

HOSPITAL AND HEALTHCARE INFORMATION MANAGEMENT-MH0053

This software product is designed mainly for the healthcare industry. It works as a standalone health information system that allows storage, retrieval and maintenance of records. How to Choose an EMR There are many factors to consider before implementing an Electronic Medical Records/Electronic Health Records (EMR/EHR). You must plan to spend many months and hours of work to gather data and to evaluate each system. It is crucial to have an organised and specific plan. You cannot just depend on your EMR vendors to make a right implementation recommendation. Below are some tips that you can use for the implementation of EMR software: Realistic Goals: Take a good look at your office to decide the needs. Consider the categories such as transcription, digital imaging, and billing. The right EMR software enables you to reduce your office operating cost, medical errors, documentation cost/time and number of staff. To meet all these benefits, you need to compare all the different software packages available. You need to set milestones and implement the right plan. Cost-Benefit Analysis: As the cost of EMR software ranges between $1000 and $45,000, there should be clear idea of the amount of money available for making a purchase of an EMR. You should have realistic expectations of type of Return on Investment (ROI)[2] you need. Evaluate the cost against the current expenses in the office which might reduce upon the implementation of an EMR. You should also consider the costs that are mostly overlooked such as office supplies, chart management, and storage.

Sources of Information:

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Reg. No: 531010671

HOSPITAL AND HEALTHCARE INFORMATION MANAGEMENT-MH0053

Marketing material supplied by the EMR vendors provide partial information on EMR software. You need to consult the expertise of IT Company to help you in selecting the right vendor. Some vendors provide on-site demonstration while others offer working demonstration disc and have Internet-based information with example screens. On-site visits: Site visits to clinics which are using EMR software brings you clearer picture to take a final decision. This helps you to see the actual function of the software and meet users to know their views about this program. Certified EMR Industry: In 2006, Certification Commission for Healthcare Information Technology (CCHIT) organisation took initiative to certify EMR products. This helped to eradicate many bad EMR products in the market. Organizations such as CCHIT, TEPR, AC Group, KLAS and MS-Hug have started ranking EMR vendors. You can use this CCHIT certified vendors list as an added advantage to select the right vendor for the implementation of EMR software. Return on Investment (ROI): The concept of Return on Investment (ROI) is similar to that of Cost Benefit Analysis. This is considered as final steps in the selection process. You must be overlook the publicity of some vendors claims and must concentrate on some practices that have experienced their ROI related claims. At the same time, you must look after the general costs in EMR implementation such as billing, networking and other computer systems. Implementation of EMR software will also incur some additional costs such as hardware and software maintenance and upgradation.

Figure 1 shows US medical groups adoption of EHR in 2005:

SMU- MBA Semester III

Reg. No: 531010671

HOSPITAL AND HEALTHCARE INFORMATION MANAGEMENT-MH0053

US Medical Groups Adoption of EHR-2005

Installation and Testing of EMR Software Once the EMR software is purchased, the next step is implementation. The installation process is a joint effort by your IT consultant and the vendor. The implementation process differs from vendor to vendor. Some offer training and installation guide, while others offer onsite services. Some vendors give you the option of both. Once the implementation process is complete, the IT consultant will then be able to properly maintain the system. Testing is the crucial step to ensure successful implementation of EMR software. All aspects of system are tested including the workflow, labs and pharmacies. If the testing process is incomplete then it affects the training process, which in turn affects the office workflow. Training your office staff As new development is added so frequently to the EMR systems, you should have ongoing training process after implementation. Your office should receive proper training to

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HOSPITAL AND HEALTHCARE INFORMATION MANAGEMENT-MH0053

take advantage of these new features which helps to standardise your office workflow. New staff hired should get trained on the EMR by the vendor instead of your office member. This will ensure you that the new hires understand the workflow of your office as well as make the best use of all the EMR features while maintaining the workflow. Give your staff sufficient time to learn each module before moving on to new one. Vendors do not rush through training to cover up one module and move on to the next module. You can arrange a classroom setting to train your staff members. Doing remote training over the internet is cost-effective and conducting classroom training for more then 10 staff members can reduce the training load. To create a single point of contact between the vendor and the organisation, you should have someone with strong understanding on computers as well as capable to train others during the implementation phase. Identifying Key People to Lead After implementing an EMR, you need to appoint a tech-savvy, who could monitor your EMR system. This person should also have the ability to embrace any kind of changes and focus on the long term goals set by the company. To get the right benefit of EMR, you should select the right product and implement it properly. The biggest mistake physicians make are selecting the wrong product or not making an effective use of purchased product. You need to change systems, set goals, analyse the data, and review progress to maintain efficiency. Electronic Medical Record (EMR) is developed to meet the goals of reducing errors in diagnosis, improving safety and cutting costs of healthcare. It offers an opportunity to run a clean and paperless clinic by consolidating information across your clinical operations. Standalone Software and Online Software are the two the two options available in its digital form. Electronic Medical Record (EMR) provides completeness in the patients data, which consists of both past and current medications. To implement an EMR a thorough job gathering data and evaluating each system is significant. EMR software adds more value to graphics. Doctors have direct access to the EMR software record, which enable them to view X-rays or examine EKGs or other medical tests. CCHIT certified vendors add an advantage to select the right vendor for the implementation of EMR software.

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Reg. No: 531010671

HOSPITAL AND HEALTHCARE INFORMATION MANAGEMENT-MH0053

Electronic Medical Record saves time from drafting referral letters or dictating over typing for medical transcription. It also allows you to insert data in either free text format or structured data format. EMR is all about providing quality patient care by integrating and retaining your patient information.

Q6. EXPLAIN THE SIGNIFICANCE OF CLINICAL INFORMATION SYSTEM Clinical Information System A Clinical Information System (CIS) is an information technology application system designed to collect, store, manipulate and make available clinical information important to the healthcare delivery process. Clinical Information Systems may be deployed throughout the hospital and may include all aspects of clinical information like in creating complete electronic medical records. CIS may also be deployed in a single entity within the hospital environment like in laboratories, and ECG monitoring and managing systems. Laboratory Information Systems document results from laboratory tests. It also directly captures information from laboratory machines. Pharmacy Information Systems controls the pharmaceutical inventory, automatically compare the drug prescriptions with dosage of drugs, provide information on medicines, etc. CIS provides a clinical data repository that stores clinical data such as the history of the patients illness and the patients interactions with healthcare providers. The repository processes information in a way that it assists physicians make decisions about the patients condition, treatment options as well as the status of decisions, course of treatment taken and other relevant information that can help physicians with treatment.

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HOSPITAL AND HEALTHCARE INFORMATION MANAGEMENT-MH0053

Some of the areas addressed by CIS are the following: Clinical Decision Support: It provides users with the means to collect, manipulate, apply and present appropriate information to help make correct, timely and evidence-based clinical decisions. Clinical Decision Support Systems search for unusual patterns or possible adverse effects of drugs, recommend optional actions to remedy situations, predict and alert for drugdrug interactions. It also provides a complete plan to provide better patient care based on the patients health history and clinical assessment. It helps save lives, reduce healthcare costs, increase clinician and patient satisfaction, improve communication, and enhance the overall process of care. Electronic Medical Records: It contains information about the patient including patient details like name and age along with every aspect of care given by the hospital, for example, from routine checkups to major operations. Training and Research: Patient information is made available to physicians for training and for conducting research. Data mining the information stored in the repositories can provide insights into the state of the illness and how to manage it. Benefits of CIS Research has highlighted the benefits of Clinical Information Systems. Some of the benefits are as follows: Easy Access to Patient Data: CIS provides convenient access to medical records at all points of care. This is particularly advantageous at ambulatory points, thereby enhancing continuity of care. Internet-based access improves the ability to access such data remotely. Structured Information: The clinical information captured in CIS is well organised, thus making it easier to maintain and quicker to search for relevant information. Since the information is in digital format, it is less likely that mistakes are made due to illegible writing.

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HOSPITAL AND HEALTHCARE INFORMATION MANAGEMENT-MH0053

Improved Drug Prescription and Patient Safety: CIS improves drug dosing and this in turn leads to a reduction in adverse drug interactions while promoting more appropriate pharmaceutical utilisation. Challenges in CIS There are some challenges in effectively implementing CIS. Some of them are high cost, the need to change the work pattern, need for new skills and challenges in capturing clinical data within a short time and with lesser effort. The following are some of the challenges: Initial cost of acquisition: The high cost of setting up CIS has proven an obstacle to many healthcare organisations. Privacy and Security: Privacy of patient data on computer systems and the means to keep such information secure is still a huge concern in the healthcare industry. The HIPAA for the USA and Data Protection Act for UK were introduced to address some of these concerns. Clinician Resistance: Clinicians usually have a limited time to consult their patients and if their use of CIS during these sessions takes up more time than required, there will be resistance to the use of CIS. Integration of Legacy Systems: This poses a strong challenge to many organisations.