ICTM 111: HEALTH INFORMATION FOR MEDICAL LABORATORY SCIENCE

Problems faced by hospitals using the According to the Ministry of Health (2010),
traditional manual process includes: HMIS was developed within the framework of the
following concepts:
• No real time data available to monitor the
performance of the hospital THE INFORMATION IS:
• Evidence based program management
• Relevant to the policies and goals of the
was a challenge
healthcare institution, and to the responsibilities of
• Undue delays in receipt of data
the health professionals at the level of collection.
• Retrieval of old manual records was
• Functional; it is to be used immediately for
ineffective and time consuming.
management and should not wait for feedback
• Duplication of records
from higher levels.
• Monthly reports sent as hard copy which
• Integrated; there is one set of forms and
is a real challenge for data analysis/comparison
no duplication of reporting
• Drug inventory/equipment inventory
• Collected on a routine basis from every
maintenance.
health unit. (ensures completeness)
• Lack of standard names and code

COMPLETE It should provide information

on all key aspects of the
health system without
duplication
CONSISTENT If similar information is
provided by different sources,
HEALTH MANAGEMENT INFORMATION SYSTEM
their definitions need to be
(HMIS)
consistent
• Is an information system specially
CLEAR It should be very clear what
designed to assist in the management and
all the elements are actually
planning of health programs, as opposed to
measuring
delivery of care (WHO, 2014)
SIMPLE It should not be
• It is a data collection system specifically
unnecessarily complicated
designed to support planning, management, and
COST The actual usage of each
decision making in health facilities and
EFFECTIVE element should justify the
organizations.
costs of its collection and
analysis
ACCESSIBLE Data should be held in a form
readily accessible to all
legitimate users, and should
be clear who these people
are.
CONFIDENTIAL It should ensure that people
without legitimate access are
effectively denied
 BASIC FUNCTIONS OF THE HMIS BASIC
ELEMENTS OF HMIS
Three fundamental information-processing
phases:
• Data Input - includes data acquisition and
data verification.
• Data Management – also called
processing phase includes data storage, data
classification, data update, and data computation.
• Data Output - includes data retrieval and
data presentation
EIGHT ELEMENTS OF THE HMIS
A. DATA INPUT
1. Data Acquisition
• Generation and the collection of
accurate, timely, and relevant data.
• Input of standard coded formats (e.g.,
the use of bar codes) to facilitate the rapid
mechanical reading and capturing of data.
2. Data Verification
• Authentication and validation of
gathered data.
• The quality of collected data depends
largely on the authority, validity, and reliability
of the data sources
B. DATA MANAGEMENT
3. Data Storage
• Preservation and archival of data may
be regarded as part of the data storage
function.
• When accumulated data are no longer
actively used in the system, a method to
archive the data for a certain period is usually
advisable and
4. Data Classification (aka Data
Organization)
• Critical function for increasing the
efficiency of the system when the need arises
to conduct a data search.
• Most data classification schemes are
based on the use of certain key parameters.
5. Data Computation
• Data manipulation and data
transformation, such as the use of mathematical
models, statistical and probabilistic approaches,
linear and nonlinear transformation, and other
data analytic processes.
• Allows further data analysis, synthesis,
and evaluation so that data can be used for
strategic decision-making purposes other than
tactical and/or operational use.
6. Data Update
• New and changing information is
accounted for through the element of data
update. The dynamic nature of such data
modification calls for constant monitoring.
C. DATA OUTPUT
7. Data Retrieval
• Processes of data transfer and data
distribution.
• Constrained by the time it takes to
transmit the required data from the source to the
appropriate end-user.
8. Data Presentation
• Data presentation has to do with how
users interpret the information produced by the
system.
• Summary tables and statistical reports
may suffice in presentations.
• The use of presentation graphics for
higher-level managerial decision analysis is
particularly encouraged because these appear to
provide a better intuitive feel of data trend
LIST OF FUNCTIONS OF HMIS
FUNCTION DATA
CLIENT DATA Relates to all information of
the client
SCHEDULING Observed to distribute
resources to areas that need
them
AUTHORIZATION Focuses on monitoring of
TRACKING authorized personnel and
their use of the authorized
units
 BILLING Notification of charges for increase the performance of the (RHIS) process
the patient and other related (Routine Health Information Network, 2003).
documents
II. ORGANIZATIONAL DETERMINANTS
ACCOUNTS Ensures customers are
RECEIVABLE properly notified about their
(A/R) bill
MANAGEMENT
REPORTING Refers to reports issued by
the entity which could be
basic
reports or report writer
MEDICAL EHR, a collection of digital
RECORD information about a patient
COMPLIANCE Procedures that should be • Health workers and data collectors work in
followed for the improvement organizations’ environments which have value,
of the condition of the patient norms, culture and practice. The most important
FINANCIAL Performance of the entity organizational factor which affects the RHIS
DATA collected for administering process is related to structure, resource,
purposes (payroll and procedure, support services and the culture which
account payable) is used to develop and improve the RHIS
process.
DETERMINANTS OF HMIS PERFORMANCE AREA • Having a system in place which support
The determinants which affect the HMIS data collection, analysis and transform it to useful
performance may be Behavioural, Organizational information will help in promoting evidence-based
and Technical. decision making. Thus, all components within the
system are ideal in making the RHIS perform
better.

III. TECHNICAL DETERMINANTS

• Technical factors involve the overall

design used in the collection of the information.
• It comprises the complexity of the
reporting forms, the procedure set forward in the
collection of data, the overall design of the
computer software used in the collection of
I. BEHAVIOURAL DETERMINANTS information
• 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.
• Lack of enough knowledge on the use of
data has been found to be a major drawback on
the data quality and information use. Motivating
HMIS users remains a challenge.
• Despite training on data collection and PRISM FRAMEWORK
data analysis, people are still having negative PERFORMANCE OF ROUTINE INFORMATION
attitude on the data, and hence a lot needs to be SYSTEM MANAGEMENT (PRISM)
done to change people’s behaviour, in order to - this conceptual framework broadens the
analysis of routine health information systems to
include the three key factors which were
discussed previously:
1. Behavioural determinants—knowledge,
skills, attitudes, values, and motivation of the
people who collect and use data.
2. Technical determinants — data collection
processes, systems, forms, and methods.
3. Organizational/environmental
determinants—Information culture, structure,
resources, roles, and responsibilities of the health
system and key contributors at each level.
PRISM FRAMEWORK
• Identifies the strengths and weaknesses in
certain areas, as well as correlations among
areas.
• This assessment aids in designing and
prioritizing interventions to improve RHIS
performance—which in turn improves the
performance of the health system.
• 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.
HMIS MONITORING AND EVALUATION
DEFINITION
Monitoring is the systematic collection,
analysis and use of information from programs for
three basic purposes:
(1) Learning from the experiences acquired
(learning function);
(2) Accounting internally and externally for the
resources used; and the results obtained
(monitoring function) and
(3) taking decisions (steering function).
Meanwhile, Evaluation is assessing an
ongoing or completed program or policy as
systematically and as objectively as possible. The
object is to be able to make statements about
their relevance, effectiveness, efficiency, impact
and sustainability.
M&E PURPOSE
The primary aim is to have a strong M&E
and review system in place for the national health
strategic plan that comprises all major disease
programs and health systems.
A robust monitoring and evaluation (M&E)
system is required to assess the effect of
integrated service delivery. Appropriate
indicators, data collection systems and data
analysis to support decision-making help guide
successful implementation of integrated services
and measures the effect on both service delivery
and use of services (FP/Immunization Integration
Working Group, n.d.).
M&E FRAMEWORK
Monitoring and evaluation (M&E) is a
core component of current efforts to scale up for
better health. Global partners and countries have
developed a general framework for M&E of health
system strengthening (HSS).
The framework builds upon principles
derived from the Paris declaration on aid
harmonization and effectiveness and the IHP+,
putting country health strategies, and the related
M&E processes such as annual health sector
reviews, at the center.
The core is the strengthening of a common
country platform for M&E of HSS, which should
result in better alignment of country and global
M&E systems and can be used both for
monitoring:
1. health systems funding platform
2. tracking the performance of specific programs.
The framework addresses indicator
selection, related data sources, analysis and
synthesis practices (including quality
assessment), performance review,
communication and use (World Health
Organization, 2009).
 KEY
PERFORMANCE KEY INDICATOR
AREA
1. Family planning
Acceptance Rate
2. Antenatal Care coverage
3. Proportion of deliveries
REPRODUCTIVE attended by skilled health
HEALTH personnel
4. Proportion of deliveries
attended by HEW
5. DPT-3 (Pentavalent-3)
coverage (>1 children)
6. Measles Immunization
IMMUNIZATION coverage (>1 children)
7. Malaria case fatality rate
The World Health Organization’s M&E of
amongst patients under 5
Health Systems Strengthening Framework
years of age
presents the indicator domains and
8. New malaria cases per
considerations for data collection, synthesis and
1000 population
use along the pathway for achieving health
9. New pneumonia cases
impact at scale.
DISEASE amongst under 5 children per
RELATIONSHIP BETWEEN M&E WITH HMIS PREVENTION 1000 population of < 5 years
INDICATORS AND CONTROL 10. TB case detection rate
An indicator can be defined as a: 11. TB cure rate
12. Clients receiving VCT
1. variable whose value changes. services
2. measures the value of the change in 13. PMTCT treatment
meaningful units that can be compared to past completion rate
and future units. 14. PLWHA currently on
3. It focuses on a single aspect of a program ART
or project – i.e., an input, output or the
overarching objective.
15. Trace drug availability (in
There are different HMIS indicators which can be stock)
used for monitoring of key aspects of the health 16. OPD attendance per
system performance. capita
These are from among the five broad categories RESOURCE 17. In patient admission rate
UTILIZATION 18. Average length of stay (in-
1. Reproductive health, patient)
2. Immunization, 19. Bed Occupancy Rate
3. Disease prevention and control, DATA 20. Reporting completeness
4. Resources utilization and QUALITY rate
5. Data Quality 21. Reporting timeliness rate
THE STOP TB PROGRAM
With the vision to have a TB free world, the
goal of the STOP TB Program (STP) is to
dramatically reduce the global burden of TB by
2015, in line with the Millennium Development
Goals and the Stop TB Partnership targets of the
World Health Organization (2006).
 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 the TB remains at the
core of the Stop TB Strategy. Hence one of the
targets linked to the MDGs and endorsed by the
Stop TB Partnership is by 2050 to reduce
prevalence and deaths due to TB by 50%
compared with a baseline of 1990.The following
flowchart puts the HMIS indicators (in green
shaded boxes) in the context of the STOP TB
Program.
HMIS INDICATORS TO MONITOR STOP TB
PROGRAM TB PATIENTS ON DOTS
1 Number of new smear pulmonary TB cases
enrolled in the cohort
2 TB Case Detection
3 Number of New smear positive pulmonary
TB cases detected
4 Number of new smear negative pulmonary
TB cases detected
5 Number of new extra pulmonary TB cases
detected
6 HIV – TB – Co-infection
7 Proportion of newly diagnosed TB cases
tested to HIV
8 HIV+ new TB patients enrolled in DOTS
9 TB Treatment outcome
10 Treatment completed PTB+
11 Cured PTB+, Defaulted PTB+, Deaths PTB+
CHANGE MANAGEMENT IN HEALTH
INFORMATICS
INTRODUCTION
There are generally four kinds of changes that
all kinds of organizations might encounter, with
the likelihood of overlap among the conceivable
outcomes:
Operational changes can influence the way
dynamic business tasks are led, including the
computerization of a particular business segment.
Strategic changes occur when the business
direction, in relation to its vision, mission, and
philosophy, is altered. For instance, changing the
business technique from business growth to
increasing market share in the overall industry is
a case of strategic change.
Cultural changes influence the internal
organizational culture, for example, the way the
business is conducted, such as actualizing a CQI
(continuous quality improvement) framework.
Political changes in human resources occur
primarily due to political reasons of varying types,
commonly changes that happen on top patronage
levels in the government agencies.
Different sorts of changes typically have
dissimilar impacts on different organizational
levels. For instance, the operational changes tend
to have the highest impacts on the lower
organizational levels, because the frontline
employees are mostly affected. Employees
working at the upper-levels might be indifferent as
to the changes, which may cause significant
distress to those attempting the implementation of
change.
Conversely, the effect of the political changes is
more strongly felt on the higher levels of the
organization. When change occurs relatively in a
bureaucratic organization, those working on the
bottom level often notice the change at the top
(Lorenzi & Riley, 2000).
There is no denying that organizational changes
have varying degrees of impact on both the
organization, and in effect, its clientele. This
chapter discusses Change Management
contextualized in Health Informatics, which is
increasingly becoming a course of action that processes
health institutions avail of in order to improve their • Gap analysis
services. • Business case development
• Project management
There are a wide range of change management
process models to explore and consider—each • Problem solving
with their own strategic approaches based on the • Requirements elicitation techniques
expertise and experiences of their developers. A • Negotiation skills.
few of the more common change practice • In addition to these techniques, Downey
examples include: also mentions that it is crucial that progress of
the change initiative can be quantified against
• Kurt Lewin’s three-step “Unfreeze- the objectives set by the organization. For this to
Change-Refreeze” model, proposed by the be successful, the organization needs to set
universally recognized founder of social clear objectives and settle on key performance
psychology in the 1950s. It is still highly relevant indicators (KPIs) that can be used to track and
today and often used as the basis for many evaluate the change initiative against its
change management strategies. objectives. These KPIs might include:
• Proski’s ADKAR® Model: an acronym • Reducing rework by x%
for a strategy that encompasses: “Awareness of • Improvement in stakeholder satisfaction, for
the business reasons for change; Desire to example, customer/employee surveys
engage and participate in the change; • Reduced time to market
Knowledge about how to change, Ability to • Enhanced speed of delivery
implement change, and Reinforcement to ensure • The return on investment, that is, the total
change sticks”. cost to implement the initiative versus total
• Kotter’s 8-Step Model of Change, savings gained from the initiative per period.
developed by Harvard Business School’s John
Kotter, focuses on efficient and effective change
management in a competitive world. Highlights KEY SUCCESS KEY SUCCESS
include building a strong, collaborative team and FACTORS AT THE FACTORS AT THE
a solid strategy; creating effective LEADERSHIP PROGRAM
communication channels; supporting staff LEVEL IN LEVEL
empowerment; using a phased and steady HEALTHCARE
approach; and securing the change within an ORGANIZATIONS
organization’s culture (QuickBase, 2017). 1. Setting vision and 1. Clear and
strategy roadmap frequent
APPLICATION OF CHANGE MANAGEMENT 2. Formation of dissemination of
• Change management is a series of tools, governance board to information
techniques and processes aimed at successfully set direction, to 2. Building a strong
effecting change. These tools and techniques prioritize work, and to project leadership
can be implemented in a variety of contexts, but allocate resources team/steering team
often they support the application of other 3. Designate an and other
initiatives such as Six Sigma, CRM, Total Quality executive sponsor, action/functional
Management or enterprise applications such as departmental teams
SAP. champions, and 3. Providing
• Downey (2008) describes common tools and program manager education and training
techniques that a change management 4. Define reporting on the new changes –
practitioner might use during a change initiative, requirements for workflow and
which include: status reporting in technology
• Questioning skills to gather information order to keep projects 4. Forming
about the ‘as is’ and ‘to be’ status of the business moving forward integrated problem-
process 5. Manage users’ solving teams to
• Process mapping for both ‘as is’ and ‘to be’
expectations; prepare address critical and • Committed to the timely and accurate
them for casualties, complex issues collection of health information and its
stress, and general 5. Empowering staff maintenance, storage, retentions, and
sense of ambiguity and end-users to disclosure.
change things, by • Represents patients’ interest in matters of
removing barriers and privacy and security, information release, and
obstacles issues and guidelines regarding record access.
6. Adoption - make • Certified by the American Health Information
the change stick by Management Association.
reinforcement, until • Ensures confidential patient information is
old traditions are kept private, secure, and in accordance with
replaced with new federal and state laws.
7. Frequently • Health Information Management
celebrate success by professionals are the stewards and guardians of
honoring contributors patient health information. They represent the
to keep the motivation patient’s interests in matters of privacy and
and momentum security, information release, issues and
8. Monitor and guidelines regarding record access, and general
measure key consumer education about personal health
indicators (e.g. using records.
a dashboard to report • They specialize in managing patient health
progress and information and medical records, administering
benchmarks) computer information systems, and classifying
9. Involve those using standard coding systems, the diagnoses,
affected by the and procedures for health care services provided
change in decision- to patients.
making (e.g. choice of • Those with health information management
computer carts, COW) and health information technology careers
10. Other creative manage all aspects of the content of patient
actions e.g. monthly medical records and patient information systems.
prizes for high Job responsibilities can include aspects of
performing teams, clinical information documentation capture and
provide snacks & maintenance, data analytics and interpretation,
drink as well as designing, implementing, and
maintaining health information technology
systems.
THE ROLE OF HEALTH INFORMATION
MANAGEMENT PROFESSIONALS
Health Information Management (HIM)
THE PHILIPPINE HEALTH INFORMATION
professionals, credentialed with their academic
PROFESSION
preparation, work experience, commitment to
• Advancements in ICT (information and
patient advocacy, and professional code of
communication technology) are upsetting not
ethics, have a specialized skill set that uniquely
only traditional businesses, but even those not
qualifies them to assume the role both of privacy
immediately thought of as probable
official and/or security officials who store,
beneficiaries—such as the healthcare sector.
protect, and transmit information in all media and
• From electronic patient records to the
formats (May, 2014).
wireless transmittal of patient files for remote
A HEALTH INFORMATION MANAGEMENT diagnosis, improvements in communication and
PROFESSIONAL: technology will lead to better delivery of
• Collects, aggregates, analyzes, and healthcare services. Telemedicine, or the use of
disseminates patient health information. electronic communications to transmit and
exchange medical information and data to
provide patient treatment, is quickly gaining
momentum within the country and the rest of the
ASEAN region.
• With the increasing popularity of smart
phones, wireless tools and other comparable
technology, primary care and specialist referral
services, as well as remote patient monitoring
and patient medical health information are
undeniably improved with the help of
telemedicine.
• Thailand, Singapore, and Malaysia have
started adopting healthcare IT solutions to bring
the sector to the next level. In 2009, Singapore
developed its National Electronic Health Record
initiative, which permitted healthcare
practitioners in the island state access to a
patient’s records across the healthcare
continuum.
• Malaysia initiated a Hospital Implementation
System in 1993, with its first telemedicine project
in 1996, and Thailand created its National Health
Information Committee in 2010.
• Likewise, the Philippines has developed an
e-Health Strategic Framework and Plan for 2014
to 2020, whose objective is to utilize information
and communication technologies in the health
sector. This will assist in the delivery of health
services and manage health systems for greater
efficacy, with the ultimate goal of providing
universal healthcare for the Filipinos.
• One of the strategic goals of this framework
is to establish unified and coherent health and
management information systems, and also to
take advantage of ICT to reach and provide
better health services and support the attainment
of the UN’s Sustainable Development Goals.
• In line with this, the Department of Health
(DOH) in Region 4Bhas launched the first
interactive telemedicine system in Marinduque,
and seemingly the entire country, at the Dr.
Damian J. Reyes Provincial Hospital. The
system currently provides medical consultations
and diagnostics through video calls (De Dios,
2016)
TELEMEDICINE IN THE PHILIPPINES
• For an archipelago such as the Philippines,
the delivery of healthcare services might prove to
be challenging. Fortunately, the rise of
Telemedicine within the region, as discussed
above, has been a beneficial turn of events for
the Philippine Healthcare sector.
• Multiple players in the Telemedicine scene
in the Philippines currently exist, ranging from
mobile apps to call center services.
• Some providers of over-the-phone
telemedicine services are Medgate and Lifeline.
Common features include 24/7 call centers,
diagnosis using images sent via email, medical
certificates, and treatment plan summaries.
These kinds of telemedicine centers usually
have a corresponding mobile app to facilitate
easier access. Unique to Lifeline, however, is
video consultation with doctors, patient
education, free doctor or nurse home visits, and
delivery of medication and prescriptions in
exchange for a fixed monthly subscription fee.
• Mobile App-based Telemedicine centers, on
the other hand, include MyPocketDoctor and
MyDocNow. These providers are usually in
partnership with other international telemedicine
centers.
• Medway Healthcare Inc., by far, offers the
most comprehensive set of telemedicine
services, being the first medical clinic in the
Philippines to mobilize its Pre-Employment
Medical Examination (PEME) arm into the path
of delivering interactive healthcare. They offer
Telefollow-up and Teleconsultation procedures
which are accessible online and through a
specially-designed computer program.
• In Telefollow-up, patients are notified of the
medical evaluation results via text messages on
their individual cell phones. Within 24 hours of
PEME, patients will already know if they are fit to
work, unfit to work or still with pending workups.
Follow-up visit to the clinic is then advised.
Follow-up of results using traditional landline call
is also accommodated.
• Telemedicine efforts from the government
and other non-profit organizations have also
ensued. The National Telehealth Center is the
leading research unit in the University of the
Philippines responsible for developing cost
effective tools and innovations in the realm of
information and
• communications technology (ICT) for
improving health care. NTHC experienced a
breakthrough, when it first conducted
telemedicine research-cum-service in remote
and undeserved areas from Batanes to
Zamboanga through partners in the then
Commission on Information and
Communications Technology’s (CICT, 2004-
2008) and Department of Science and
Technology - Philippine Council for Health
Research and Development (DOST-PCHRD,
2008-2011). Today, the center partners with
various government and non-government
institutions, engaging them on eHealth research,
training, and service activities (National
Telehealth Center, n.d.).
• The Department of Science & Technology
(DOST)has also begun distributing the
breakthrough “RXBox” telemedicine device
developed by engineers and researchers from
University of the Philippines (UP) Diliman and
UP Manila to 1,000 far-flung municipalities in the
country, focusing on disadvantaged
municipalities to benefit from having affordable
health care in their respective communities.
• The RXBox was collaboration between a
team of engineers, doctors and researchers from
UP Diliman and UP Manila, led by electronics
and communication engineer Nathaniel Cruz,
who is currently with the National Telehealth
Center.
• RXBox has features that enable
teleconsultations via email, video call, or SMS. It
has sensors that can measure a patient’s blood
pressure, temperature, oxygen saturation rate,
pulse rate, and even the electrocardiogram rate,
and this information may all be sent to the
specialist doctor via email or SMS, aiding in
patient care. Afterwards, the RXBox stores and
files data into a community health information
system (Ronda, 2016).
HOSPITAL INFORMATION SYSTEM
• A hospital information system (HIS) is
fundamentally a computer system that could
manage all the information to permit health care
providers to do their jobs efficiently.
• The staff used them generally for dealing
with billing and hospital inventory. All this has
changed now, and today hospital information
systems include the integration of all scientific,
financial and administrative programs
An effective HIS additionally provides benefits
including:
• enhanced facts integrity
• reduced transcription errors
• reduced duplication of facts entries
• optimized report turnaround times
HIS FOR DIFFERENT DEPARTMENTS
1. Nursing Information Systems (NIS)
• these computer-based information systems
are designed to assist nurses offer enhanced
patient care. A good NIS can carry out a number
of functions and supply benefits together with
improving personnel schedules, accurate patient
charting and better clinical data integration.
• Patient charting applications also permit
users to go into details regarding patients’ critical
signs. Nurses also use it for admission
information, care plan and all applicable nursing
notes. All crucial facts are securely saved and
can be retrieved when required.
• Medical information integration is also very
useful, allowing nurses to collect, retrieve and
examine the medical records after which
integrate it to design a patients’ care plan.
2. Physician Information Systems (PIS)
• as the name suggests, PIS systems aim to
enhance the practice of physicians and also are
encouraged by the government for deployment.
• PIS are added thru computers, servers,
networks, and use extensively deployed and
popular programs such as, Electronic Medical
Records (EMRs), Electronic Health Records
(EHRs), and others.
• Most of these offerings have 24/7 support
that enables health professionals to troubleshoot
issues happening at some point in their use.
3. Radiology Information System (RIS)
• these systems are also popular for their
capability to provide radiology billing services,
appointment scheduling as well as reporting and
patient database storage. The radiology practice
has become more complicated with advances in
technology and more hospitals now turn to RIS to
control the commercial enterprise side of their
practices.
4. Pharmacy Information Systems (PIS)
• Designed to cope with the demands of a
pharmacy department, PIS enables pharmacists
monitor how medicine is utilized in hospitals. A
PIS facilitates users supervise drug allergies and Their products Visual MEDSYS for Hospitals and
different medication-related complications. The MEDSCHO for Schools provide integrated,
system enables users to identify drug comprehensive, and proven solutions.
interactions and also helps administer the
appropriate drugs based on the patient’s
physiologic conditions. 3. COMLOGIK
• Comlogik Business Systems, Inc. is a
Philippine based software development company
SELECTING A HOSPITAL INFORMATION SYSTEM that established its operation in the year 1999
1. Total cost of package – discuss the with a vision to be a Global Technology
necessities of your hospital with you. Solutions Company. Comlogik led the way in developing
are available for hospitals of all sizes and innovative applications like online hospital
budgets. services wherein patients can access their billing
2. Web based system – in addition to the as well as the examination results, while your
user-friendly features, an excellent HIS system Administrators can access their reports and your
ought to be available on the internet. Availability Doctors their patient’s records anywhere and
on the internet means authorized employees can anytime they need to.
access the information whenever they need from
anywhere. this does not bind all caregivers to
their office desks and additionally offers them
with statistics
3. Implementation and support–Change
is continually resisted by people and deploying
or upgrading a hospital information system can
also invite employee criticism. It is always good
to invite the vendor for assistance in an
implementation and request for staff training.
Select a vendor that gives 24/7 support thru the
telephone or web, so your hospital staff can at
once access support.

HIS PROVIDERS IN THE PHILIPPINES

1. BIZBOX
• The founders of Bizbox, Inc., started twenty-
five (25) years ago with the goal of helping
PROCESSES:
people improve their work efficiency through
I. Help Desk
software. With the first hospital project in 1994,
BizBox evolved into one of the top IT companies • A help desk is a useful resource meant to
focused on the healthcare industry. offer the customer or end user with information
and guide associated with a company's or
• All the healthcare solutions developed by
institution's products and services.
BizBox uses the latest technology from Microsoft.
Leveraging on Windows Server, SQL Server and II. Scheduling
Net. BizBox builds mission-critical applications • Managers and employees can access work
for the healthcare environment. Bizbox is proud schedules from everywhere and effectively
to be a Microsoft Gold Certified Partner and the discuss their scheduling preferences. An
recipient of the ISV of the Year Award. employee scheduling software could save you
2. KCCI MEDSYS time and make employee scheduling less
difficult.
• Kaiser – dela Cruz Consulting, Inc.
(est.1990) specializes in application development
for hospitals, industrial clinics and medical
related educational institutions in the Philippines.
 III. Patient Registration
• A patient registration form needs to be filled
up whenever a patient visits a hospital or clinic to
avail of medical treatment.
• The data is used for record keeping and
administrative use. If the patient calls for any
prompt medical attention for the duration of an
emergency, the form can be filled up by any
relative, friend, or guardian.
IV. Admission
• Before you are admitted to the health facility,
an admissions counselor will call you to gather
preliminary information, offer vital information
concerning your hospital stay and answer your
questions. Your physician additionally may
schedule recurring medical exams, such as
laboratory tests or X-rays, before your
hospitalization. Other routine tests can be carried
out at the day of your admission.
V. Discharge
• Discharge from the hospital is the point at
which the patient leaves the health facility and
either returns home or is transferred to some
other facility including one for rehabilitation or to
a nursing home. Discharge entails the medical
instructions that the patient will need to fully
recover. Discharge planning is a service that
considers the patient's needs after the hospital
stay, and may involve numerous exceptional
services which includes visiting nursing care,
physical therapy, and home blood drawing.
VI. Transfer
• The term "transfer" means the movement
(along with the discharge) of an individual outside
a hospital's premises at the instruction of any
person employed by (or affiliated or related,
directly or indirectly, with) the hospital. This,
however, does not encompass movement of an
individual who (A) has been declared lifeless, or
(B) leaves the facility without the permission of
any such authorized person.
VII. Billing
• Itemize all of a purchaser's invoices and
payments, and maintain a rolling balance of how
much they owe.
• Statements are valuable for customers that
order from you on a frequent basis.
• Through generating statements on a regular
basis (at least monthly), you'll be able to keep
track of who owes you and how much.
• The HIS will display a list of those customers
that have outstanding balances, and you can
page through each statement and quickly isolate
someone if their payment is overdue.
LABORATORY
RADIOLOGY AND CARDIOLOGY REPORTING
A. LABORATORY REPORTING
• Despite the differences in presentation and
from, all laboratory reports must possess
common elements as required by federal
legislation or by company policies.
• It may also contain supplementary items not
specifically required, but which the lab chooses
to report to aid in the interpretation of results
(American Association for Clinical Chemistry,
2017)
FOR IDENTIFICATION AND FILING PURPOSES,
SOME LAB REPORTS DISPLAY ELEMENTS WITH
ADMINISTRATIVE OR CLERICAL INFORMATION:
• 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 report 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 lab report more
meaningful:
• Specimen source, when appropriate
• 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

B. RADIOLOGY REPORTING
• A radiology report is a clinical and source
document that provides interpretation and
describes any radiology procedure conducted by
a radiologist. The only person who is privileged
to prepare and document a radiology report is a
qualified physician who has been granted
specific clinical privileges in that hospital or
clinical settings.
1. The length of the report should have
some relationship to the complexity and cost of
the exam.
2. It should have pertinent positive and
negative findings and address any specific
clinical concerns.
3. All important findings need to be stated
first and any incidental findings are reported at
the end.
The radiology report's main premise is to
answer the clinical question from the radiology
request. The main components are:
1. Patient's demographics. Name, social
security number, etc.
2. Relevant clinical information and ICD-9
code.
3. Body of the report.
4. Impression (conclusion or diagnosis)
C. CARDIOLOGY REPORTING
• Vascular sonography reports can be created
with a touch of a few buttons if software
designed for cardiology is used. Vascular
software programs understand the needs of the
medical staff that prepare and read these reports
and are quite intuitive.
• Vascular sonography reports will indicate
valuable information about the results of the
ultrasonic ultrasound and might include diagrams
of the veins and arteries to help determine and
measure items such as blood flow, presence of
plaque, narrowing and the presence of clots
DISCHARGE SUMMARY
• A discharge summary is a clinical report
arranged by a health practitioner or different
health expert at the conclusion of a hospital stay
or series of treatments.
• It outlines the patient's main complaint, the
diagnostic findings, the treatment administered
and the patient's response to it, and guidelines
on discharge.
LABORATORY INFORMATION SYSTEM
LABORATORY INFORMATION MANAGEMENT
SYSTEM
• A laboratory information management
system (LIMS) is software designed to make
labs more efficient and effective, especially those
that process massive amounts of samples for
research and development (R&D),
manufacturing, and medical research
FUNCTIONAL REQUIREMENTS AND FEATURES
OF LIMS
1. Sample Management
As samples move from person to person and
place to place, it’s easy for them to get lost or
mixed up. Accurate, detailed records are
essential to making sure everything gets done
and done right. For example, a good record
should tell you whether a sample meets project
criteria, but they can be a pain to create and
maintain.
When you create a sample, most LIMSs will
record and store information such as:
• Who or what the sample was taken from?
• Which researchers/providers are working
with it?
• Where it’s been, and where it needs to go
next?
• How to store it?
• When it needs to move?
2. Workflow Management
• You should use an LIMS to automate
workflows for the same reason you should use it
to automate records keeping, but instead of
saving work, this function saves you time.
• When you codify existing methods and
procedures in a LIMS, you delegate decision-
making to the software. For example, it can
automatically assign work to scientists and
suggest instruments based on preset rules. And
instead of looking up what you need to do with a
sample and where it needs to go next, a good
LIMS will automatically provide this information.
3. REPORTING
• It’s good to be able to quickly pull reports
that can answer questions such as which
instruments get used the most, how long your
sample backlog is, and how long it takes your
lab, on average, to process a sample. This kind
of data is extremely useful for data analysis
auditing and audit trail.
• Some LIMS will be more granular in their
reporting than others. For example, one LIMS
might be able to tell you what your average
sample processing time is, but another might tell
you your average time broken out by type of
sample. It’s helpful to know what kind of
reporting and level of reporting you need before
you begin comparing vendors.
• Keep in mind, just because a LIMS can run
a report doesn’t mean it’s easy. Some reports
require custom coding to set up and run. And
some systems can export to Adobe PDF and
Microsoft Word, but not Google Drive.
4. EMR/EHR
• Electronic health records (EHR) is its own
type of software, but some LIMSs have EHR
functionality built-in, including patient checkin
and billing. If you don’t have a software package
offering these features, choosing a LIMS with
this kind of functionality can be a huge asset
when managing your clinical lab.
LABORATORY STANDARDS
• The Occupational Safety and Health
Administration (OSHA) released an
“Occupational Exposure to Hazardous
Chemicals in Laboratories standard (29 CFR
1910.1450)” in 2011 to facilitate laboratory
safety.
• “Laboratory” means a facility where the
“laboratory use of hazardous chemicals” occurs.
It is a workplace where relatively small quantities
of hazardous chemicals are used on a non-
production basis.
• “Laboratory use of hazardous chemicals”
means handling or use of such chemicals in
which all of the following conditions are met:
• “Protective laboratory practices and
equipment” are available and in common use to
minimize the potential for worker exposure to
hazardous chemicals.
• Any hazardous chemical use which does
not meet this definition is regulated under other
standards. This includes other hazardous
chemical use within a laboratory.
For instance:
• Chemicals used in building
maintenance of a laboratory are not covered
under the Laboratory standard.
• The production of a chemical for
commercial sale, even in small quantities, is not
covered by the Laboratory standard.
• Quality control testing of a product is
not covered under the Laboratory standard.
• If the Laboratory standard applies,
employers must develop a Chemical Hygiene
Plan (CHP). A CHP is the laboratory’s program
which addresses all aspects of the Laboratory
standard.
• A CHP must address virtually every aspect
of the procurement, storage, handling, and
disposal of chemicals in use in a facility.
• Primary elements of a CHP include the
following:
• Minimizing exposure to chemicals by
establishing standard operating procedures,
requirements for personal protective equipment,
engineering controls (e.g., chemical fume hoods,
air handlers, etc.) and waste disposal
procedures.
• Responsible persons must be designated
for procurement and handling of Material Safety
Data Sheets, organizing training sessions,
monitoring employee work practices, and annual
revision of the CHP.
REGISTRATION, BILLING, CONTRACT
MANAGEMENT, ACCOUNTS RECEIVABLES, ETC
A. PATIENT REGISTRATION
• When you arrive at the hospital, the
Admission Clerk will take some basic information
and then will guide you to a registration window.
B. BILLING
• The process of generating SOAs or Billing
Statements of Inpatients, Outpatients, and
Emergencies are the same. In this example, we
used Inpatients.
C. CONTRACT MANAGEMENT
• Most Laboratory Information Management
Systems allow the laboratory professional to
manage the billing and payment aspects of their
activities and create statistical and billing reports
at par with the laboratory and management
needs.
 D. QUALITY CONTROL manual entry. This can result in a considerable
• Diagnostic tests executed inside the clinical enhancement in analyzer productivity. Newer
laboratory may yield two kinds of results, a random-access testing, bi-directionally interfaced
patient result or a quality control (QC) result. The analyzers also incorporate bar code specimen
result can be quantitative (in numbers) or label scanning which provides automatic positive
qualitative (positive or negative) or semi- specimen ID capability. This can further
quantitative (limited to a few different values). eliminate manual entry of specimen IDs and/or
Quality control results are used to verify whether coding of specimens by tray/cup position
or not the instrument is working within prescribed (Selmyer and Cloutier, 1996).
parameters, confirming that patient test results
are reliable (Bio-Rad Laboratories, 2008).
G. ACCOUNTS RECEIVABLES
• LIMS have functions that enable users to
set standards about the relevant range of patient Because of the integration of the LIMS, the
personnel in charge of managing Accounts
test results, or extract test result information for
the purpose of quality assurance. Outliers and receivables can easily extract information which
was already available from the invoicing and
deviations can be flagged, and appropriate
contract management procedures. Additionally,
warning signals can notify users of issues which
might involve the quality of the samples or the the LIMS can:
equipment currently in use. • Generate specific or complete Accounts
Receivable reports
E. BARCODE-GENERATION, PRINTING AND
• Monitor balances for reconciliation and audit
READING
purposes
• LIMS modules are commonly linked to a
• Export data to other accounting systems
bar-coding label generator, enabling a fast and
• Customize reports according to
easy method to identify tubes, samples,
specifications
documents, among many others. Simply print it
H. WORK LIST AND WORKFLOW
on labels stickers to place on whatever item
• LIMS assist laboratories in setting priorities
needs identification. A barcode editor also allows
of current workloads, based on analyst and
multiple labels to be printed at a label printer.
The barcode series can usually be customized to instrument availability. This function allows user
suit your organization or classification needs. to track a sample, a batch of samples, or a "lot"
of batches through its lifecycle. Queuing can also
With this kind of technology, you can effortlessly
be done by sample or by workflow, a block of
find and retrieve information about a tube, a
repetitive procedures in a certain process. The
specimen, or equipment within the laboratory
using a barcode scanner. queuing and work list feature provides an insight
into when an event occurred, how long it was,
F. IN-BUILT BI-DIRECTIONAL INTERFACES
and who was involved.
WITH EQUIPMENT
• In addition, other features in the Laboratory
• A bi-directional interface (Figure 10.6)
Information Management System also enable
involves true two-way communication between
personnel and workload management, allowing
the analyzer (equipment) and information system
users to plan workload schedules and
interface. The LIMS interface downloads
assignments, and employee information and
specimen ID and test orders, while the analyzer
training. Ultimately, the work list and workflow
uploads specimen ID and test results. More
functions operate to facilitate more efficient
recently, bi-directional interface capability has
laboratory processes.
been implemented into various microbiology,
immunoassay, coagulation and hematology
instruments.
• A bi-directional interface application saves
the technologist the time to program test orders
into the analyzer, and eliminates errors in
 WEEK 13: OTHER HOSPITAL INFORMATION
CARDIOLOGY INFORMATION SYSTEM (CIS)
Cardiology Information Systems (CIS)
are mainly focused on the storage and retrieval of
Cardiology-centric images. CIS usually receive an
order with patient demographics from other
information management systems, and once the
images are acquired from imaging modalities,
they are profiled against the order and stored for
further distribution, viewing, and long-term archive
(Katipula and Ireland, 2013).
• The information used by cardiologists for
diagnosis and treatment of their patients
varies from
A. personal notes (history, physical
examination), to signals
(electrocardiograms),
B. images (echocardiograms, angiograms,
CT, MRI) and
C. reports from investigations and from
procedures. All this information can
currently be provided in digital format, and
Cardiology Information Systems serve as
a repository which houses these forms of
imagery. Unfortunately, most CIS are
limited to their storage capabilities and do
not include post-processing functions.
11.1.3. BENEFITS AND FEATURES
Different vendors have varying degrees of
available features. However, the following are the
most common benefits they enumerate:
1. Ease of access while maintaining data
security
2. Flexibility in the workflow
3. Enhanced Comparability
11.1.4. FUNCTIONALITIES
• Editing, Viewing and Storing Multi-
Modal Cardiology Data – different types
of data, including computed tomography
(CT), cardiac ultrasound
(echocardiography), magnetic resonance
imaging (MRI), nuclear imaging (PET and
SPECT), and angiography, may be
managed on a single platform with the
help of the CIS.
• Remote Access – the use of networks
and integrated information systems,
coupled with the availability of the internet
SYSTEM
and tablets and smart phones, offer
flexibility to Cardiology Information
Systems.
• Visualization and Reporting
Capabilities – one of the main benefits of
Cardiology Information Systems is the
ease and consistency of reporting.
Virtually real-time information retrieval is
possible with just a couple of clicks and
queries, and is possible from multiple
locations.
• EHR Integration – since a CIS may be
integrated with existing Electronic Health
Record Systems, it can enhance the
quality of services offered by health
professionals by offering a more
comprehensive view of the patient care
spectrum.
RADIOLOGY INFORMATION SYSTEM
A Radiology Information System (RIS)
is a networked software system for managing
medical imagery and associated data. An RIS is
especially useful for tracking radiology imaging
orders and billing information, and is often used in
conjunction with Picture Archiving and
Communication Systems (PACS) and Vendor
Neutral Archivals (VNA) to manage image
archives, record-keeping and billing within a
Hospital Information System (HIS) (Rouse, 2017).
HOSPITAL INFORMATION SYSTEMS (HIS)
• A hospital management information
system or hospital information system
(HIS) is an element of health informatics
that focuses mainly on the
administrational needs of hospitals.
PICTURE ARCHIVING AND COMMUNICATION
SYSTEM (PACS)
• It is a healthcare technology for short and
long-term storage, retrieval, management,
distribution and presentation of images.
VENDOR NEUTRAL ARCHIVAL (VNA).
• In a health information technology context,
it is as medical imaging used by the
healthcare professionals that stores
images in a standard format and interface,
making medical imaging data accessible
 through different picture archiving and
communication systems (PACS)
11.2.2. ADVANTAGES OF USING AN RIS
BETTER COMMUNICATION WITH REFERRING
DOCTORS
• An RIS can integrate with the referring
doctor’s electronic health record or EHR
system, so you can access patient data
easily and quickly. The result is a better
experience for referring doctors, which
dramatically increases the likelihood they’ll
refer more patients to you.
FASTER PAYMENTS
• A chief benefit of a RIS is that you can use
it to verify insurance before a patient visit.
The electronic payments you are now
capable of receiving means that you get
paid faster.
IMPROVED EFFICIENCY
• It’s much faster to find, input, and create
reports from patient data when the records
are computerized. With the information
digitized and no longer needing to be
entered into records a second or third time
11.2.3. FUNCTIONS OF AN RIS
FIGURE 11.1: BASIC FUNCTION OF AN RIS
Rouse (2017) describes the following
functions of an RIS:
PATIENT MANAGEMENT
• An RIS can track a patient's entire
workflow within the radiology department;
radiology providers can add images and
reports to EHRs, where they can be
retrieved and viewed by authorized
radiology staff.
SCHEDULING
• The RIS allows staff to make
appointments for both inpatients and
outpatients.
PATIENT TRACKING
• Using a RIS system, providers can track a
patient's entire radiology history from
admission to discharge and coordinate the
history with past, present and future
appointments.
RESULTS REPORTING
• A RIS can generate statistical reports for a
single patient, group of patients or
particular procedures.
IMAGE TRACKING
• Traditionally, radiology providers use RIS
to track individual films and their
associated data. But as EHRs have
become standard across the healthcare
industry and digitized images and PACS
have been widely adopted, radiology
departments and their RIS-PACS systems
have been more drawn into the clinical
workflow of the entire medical enterprise.
BILLING
• RIS systems provide detailed financial
record-keeping and process electronic
payments and automated claims, though
these functions are becoming
incorporated into medical organizations'
overall EHR systems.
WEEK 14: MATERIAL MANAGEMENT SYSTEM
MATERIALS MANAGEMENT SYSTEM
• The management function of hospital
materials—making sure that services go
successfully from one source to an end
user—includes several areas of the
hospital and could drastically affect
medical institution expenses.
• Executing this function in a manner that -
lessens expenses and - ensures adequate
cash flow
• * requires effective management of a large
amount of information from several
sources.
 PURCHASE REQUEST
• A purchase request could be used as a
first step in the process of purchasing.
This is used internally to identify a need
for an item.
• A purchase request generally is a
document which is made by a user to
notify the purchasing department
regarding needed items and services.
• This document specifies:
a. quantities, as well as a
b. timeframe for the items requested.
c. authorization information needed to
proceed with the purchase.
THINGS TO CONSIDER ON PURCHASING ITEMS:
INVENTORY CONTROL
• Johnston (2014) states that inventory is
one of the biggest expenses for most
medical institutions. Inventory control
plays an important part in refining the
quality of healthcare services, since the
lives of the people are on the line, as well
as because medical costs are increasing.
Moreover, Johnston details the strategies
on how to improve inventory control within
healthcare facilities:
MAKING SURE SHIPPERS ARE ACCURATE
• Tracking medical inventory must involve
checking shipments for accuracy. Most
medical suppliers use third-party shippers,
and the tracking system must ensure that
the correct supplies were loaded at the
warehouse. Even if items are ordered
correctly, tracking can catch any errors in
filling those orders. It can also reveal
whether medical supplies have been
properly handled in transit.
ALIGNMENT WITH SALES PROJECTIONS
• In the field of medicine, sales projections
can be wildly inaccurate. It is difficult to
predict disease and accident patterns, and
patients are notoriously reluctant to switch
doctors, hospitals and health insurance.
Tracking inventory in comparison to actual
sales is essential. This prevents waste,
frees up cash that would have gone to
excess inventory and helps medical
companies identify trends they might not
have seen before.
COMPLIANCE WITH REGULATIONS
• The medical field is heavily regulated. A
company that routinely fails to serve the
best interests of patients can quickly find
itself being investigated, sued or simply
shunned by health-care consumers.
Tracking inventory can be extremely
important in maintaining the
responsiveness of a medical company.
This applies not only to front-line health
providers but also to the suppliers of those
providers. Knowing what inventory is on
hand and what items are needed can
keep a medical company responsive and
prevent closer scrutiny by regulators.
ESTABLISHING BUYING CYCLES
• Inventory control helps medical
companies understand buying cycles.
Instead of responding to needs for
supplies and equipment, inventory
personnel can anticipate needs based on
previous cycles. Smoothing ordering out
to fit predictable cycles can eliminate
shortages and overages. Buying cycles
can also be tracked to determine whether
trends are shifting and need to be
adjusted. In this way, tracking inventory
can make inventory ordering into a
manageable process that is proactive
instead of reactive.
ITEM MASTER MAINTENANCE - MEDICAL AND
NON-MEDICAL INVENTORY ITEMS
• Because the importance of inventory
control has been recognized, the usage of
a materials management system could
bring an advantage.
• In Material Management Systems, the
“Inventory Item Maintenance” screen
has many sections. The upper portion
contains master information. Additional
options appear after the selection of an
existing item.

• “Item Tab” is used for maintenance of the
attributes of an inventory item, such as
product type, item class, item type, etc. If
the balance and order activity is zero (0),
items can be deleted using this option.
• Users could set the product type to group
similar items for sales analysis and
inventory reporting. Most of the inventory
reports are based on a certain product
type.
• The “Item Availability” form specifies
inventory levels across all warehouses
ITEM INDENTS AND ISSUES
• In some cases, there are instances where
items are damaged either upon receiving
from the supplier or during the move from
the source to another location.
• Some suppliers allow returns of the said
goods that have indents or the like, with a
guarantee of replacement without any
additional payments. This applies to
distribution and retail industries where the
goods for sale are fast-moving. Normally,
damaged items are moved to another
warehouse for them to be monitored.
RE-ORDER LEVEL, RE-ORDER QUANTITY,
MINIMUM AND MAXIMUM LEVELS FOR EACH
STORE
• In a typical material management system,
Re-order level is the minimum quantity of
an item that a company has in stock, so
when the stock reached the minimum
quantity stated, the item must then be re-
ordered (Purchase Order/Production
Order).
• A basic re-ordering method implemented
in many ERPs and other inventory
management software is the Min/Max
inventory ordering method. The “Min”
value is representative of a stock level that
prompts a re-order, and the “Max” value is
representative of a new targeted stock
level that follows the re-order. The main
difference of these two—Max and Min—is
often interpreted as Economic Order
Quantity (EOQ). Although the Min/Max
method is an unpolished method for
inventory ordering, the Min/Max settings
could be adjusted to provide better
inventory performance (Vermorel, 2014).
DOCUMENTATION NEEDED IN MMS:
ENQUIRIES
• Enquiries are the start point of a sale or
purchase process. Enquiries lead to
getting information from a vendor/supplier
for the requirement at hand. Enquiries
lead to establishing a connection with the
right vendor / supplier in order to get a
quotation, place the order and receive the
requirements.
QUOTATIONS
• Quotations consist of various pieces of
vital information of a requirement towards
a sale /purchase. Quotations state
important information such as price,
delivery times, delivery details, payment
terms, taxation etc. On a quotation being
accepted an order is placed for the
requirements.
ORDERS
• In business or commerce, an Order is a
stated intention, either spoken or written,
to engage in a commercial transaction for
specific products or services. From a
buyer's point of view, it expresses the
intention to buy and is called a purchase
order. From a seller's point of view, it
expresses the intention to sell and is
referred to as a sales order. When the
purchase order of the buyer and the sales
 order of the seller agree, the orders
become a contract between the buyer and
seller.
INVOICES
• An invoice or bill is a commercial
document issued by a seller to the buyer,
indicating the products, quantities, and
agreed prices for products or services the
seller has provided the buyer. An invoice
indicates the sale transaction only.
COMPARISON OF QUOTATIONS AND
following basic elements:
PREFERRED VENDOR FOR EACH ITEM
PURCHASE QUOTATIONS
• A purchase quotation is a document for
requesting prices and delivery information
from a vendor before the purchase order.
• One could create a purchase quotation,
then send the document to a vendor;
when a response from the vendor is
received, with a list of prices and delivery
dates, one can enter the information in the
purchase quotation. This way, one can
store in the system the complete history of
the sourcing process.
• From the quotation, the information
tracked enables one to choose the right
vendor for the purchase. Using the
quotation helps in lessening expenses,
improving the quality and increasing on-
time delivery. A purchase quotation report
allows one to compare offers in order to
pick the appropriate vendor for the
purchase scenario. Afterwards, one can
create the purchase order from the
selected quotation.
Preferred Vendors Companies typically
maintain a list of preferred vendors, from which
inventory items are usually purchased. Several
qualities of a preferred vendor that a company
looks for are:
• On-time performance
• Reasonable costs
• High quality of products and services
• Fully licensed, bonded, and insured
• Good Business practices
PURCHASE REQUESTS, ORDERS CREATION
AND APPROVAL PROCESS
PURCHASE ORDERS
• A Purchase Order, on the other hand, is a
document which records a business
transaction between the buyer and the
seller. A buyer issues his order, and upon
seller acceptance of the order, a legally
binding contract is created between the
parties (SAP, 2012).
A simple Purchase Order will identify the
• Buyer: name, address, and contact info of
party giving money for goods
• Seller: name, address, and contact info of
party receiving money for goods
• Order Number: a unique ID number to
track each business transaction
• Item Description: details, quantity of
goods, cost per unit, and total price of
goods
• Shipping Address: where the goods will
be shipped
• Shipping Date: when the goods will be
delivered to the final location
• Billing Address: location of where the
invoice should be sent so the Buyer can
pay
• Signature: signature of Buyer offering to
buy and signature of Seller accepting
• Order Date: when the business
transaction occurred
APPROVAL PROCESS
• The person who creates the document,
either a purchase request or order, is the
originator. Upon adding documents to the
material management system, the system
checks for any approval requirements. If
the document fails to meet the requisites
for an approval, the originator is notified
that the document needs approval. The
document is temporarily saved as a draft.
• An internal request is immediately sent to
the first approval stage when the approval
process is launched. This request is
received in the Messages/Alerts Overview
window, and the approver can access the
document. Approval can be done through
a mobile phone if the devices are
 integrated. A internal notification goes
back to the originator with a link to the
rejected document should the approver
reject the document. The originator can
amend the document, and the approval
procedures will continue until the approval
conditions are adequately satisfied (SAP,
2012).
INSPECTING A SHIPMENT
• Persons receiving shipments should, upon
acknowledging receipt of an order,
conduct an inspection to verify the
following minimum conditions:
• The products conform to the purchase
order requirements and other relevant
documents (for example: correct model
number, description, size, type, color,
ratings, etc.)
• The quantity ordered against the quantity
shipped or delivered.
• There is no damage or breakage.
• The unit of measurement count is correct
(e.g. if the unit of measurement on the
purchase order is one dozen, there should
be 12 in the package).
• Delivery documentation (packing list,
certifications, etc.) is acceptable.
• Perishable items are in good condition
and expiration dates have not been
exceeded.
• Products are operable or functional.
PARTIAL DELIVERIES
• Departments should contact the
appropriate Purchasing Agent whenever a
purchase is received as a partial delivery
without acknowledgement or notification
from the supplier. This information is
typically noted on the packing list.
TRACKING OF GOODS
• Goods can be easily tracked /traced when
they are managed by Serial or Batch.
Aging of products can also be done if the
items are slow moving/stay longer in the
warehouse.
EXPIRED STOCK AND QUARANTINE EXPIRED
STOCK/INVENTORY
• Upon reaching their expiration dates,
some goods, such as food and medicine,
can no longer be utilized. In rare
instances, it may be sold to other parties
at a lower cost. However, as soon as
inventory expires and its value falls below
its original cost, this must be reflected in
the financial records so as not to misstate
the financial statements. The amount that
reduces inventory in your records is
recognized as a loss that is a reduction in
profit (Keythman, 2017).
QUARANTINE STOCK/INVENTORY
• When undecided about how to handle
defective goods, whether to be sold as
scrap, reworked, returned, or used as it is,
a quarantine location or warehouse can
be used to temporarily house them until a
final decision has been reached.
• Inventory is put into quarantine if initially
rejected during:
• Production, upon completion of an
operation, when specified as Move
Rejected End Item to Quarantine.
• Inbound inspection upon receipt of:
– Manufactured end items
– Purchased items
– Sold items on sales return orders
– Enterprise Planning distribution
orders
– Outbound inspection upon issue
of:
– Materials to production (Infor LN
Warehousing, 2018)
LIFO, FIFO, FEFO ISSUES METHODS:
Inventory management is a crucial
function for any product-oriented business.
Common inventory handling methods include:
• First In, First Out (FIFO) – Inventory
items are sold in the order they are
purchased. This is the most common
technique.
• Last In, First Out (LIFO) – Last to enter
the system are sold first. This is common
among non-perishable items like
petroleum, minerals, and metals.
• First Expired, First Out (FEFO) –
Materials are sold based on date they
should be consumed, regardless of when
it was purchased.
PERIODIC PHYSICAL STOCK TAKING AND
ADJUSTMENTS WITH TRACKING
• An inventory count is a process where a
business physically counts its entire
inventory. A physical inventory may be
mandated by financial accounting rules or
the tax regulations to place an accurate
value on the inventory, or the business
may need to count inventory so
component parts or raw materials can be
restocked. Businesses may use several
different tactics to minimize the disruption
caused by physical inventory.
• Inventory services provide labor and
automation to quickly count inventory and
minimize shutdown time.
• Inventory control system software can
speed the physical inventory process.
• A perpetual inventory system tracks the
receipt and use of inventory, and
calculates the quantity on hand.
• Cycle counting, an alternative to physical
inventory, may be less disruptive (CTI
Reviews, 2016).
depict the same sample across different points in
• Fortunately, these are all features and
time, from varying sources both within and
benefits offered by the Material
outside the health institution. Common kinds of
Management System. Barcode and RFID
available information in the CDR are listed below:
are supplementary technologies that can
be used in combination with the Material
Management System in order to have
more accurate and less burdensome
inventory counts.
WEEK 15: CLINICAL DATA REPOSITORIES
CLINICAL DATA REPOSITORIES (CDR)
• in electronic or written format
• to represent an aggregated database of
clinical information
• It usually houses a multitude of laboratory
results, diagnostic reports, and various
clinical documentations.
• The data are readily searchable and
exportable, often because the information
is gathered from standard clinical care
procedures
• The CDR integrates physician-entered
data with data from different existing
information systems including laboratory,
radiology, admission, and pharmacy
among others.
• It is a location where both clinical data and
other data of interest, such as external
data sources and financial data, are
assimilated
CLINICAL DATA REPOSITORIES
A clinical data repository can successfully
– Patient Demographics
– Patient’s Primary Care Provider
– Medication List
– Allergies
– Hospital Inpatient Visits
– Emergency Department Encounters
– Outpatient Practice Visits
– Immunizations
– Diagnoses
– Procedures
– Lab Results
– Social History
– Vitals
REPOSITORY DEFINITION
TYPE
STUDY A database that collects
observations for a specific
clinical research study.
ELECTRONIC A database of observations
HEALTH made as a result of direct health
RECORD care
REGISTRY Observations collected and
organized for the purpose of
studying or guiding particular
outcomes on a defined
population. Associated studies
are either multiple or long-term
and evolving over time.
WAREHOUSE Aa repository that adds levels of
integration and quality to the
primary (research or clinical)
data of a single institution, to
support flexible queries for
multiple uses. Is broader in
application than a registry.
COLLECTION A library of heterogenous data
sets from more organizations
than a warehouse or more
sources than a registry.
Organized to help users find a
particular data set, but not to
query for data combined across
data sets.
FEDERATION A repository distributed across
multiple locations, where each
location retains control over
access to its own data, and is
responsible for making the data
comparable with the data of
other locations.
MULTIPLE VIEWS FOR PATIENT MEDICAL
RECORD
• Information for patients is typically
scattered across multiple subsystems. A
clinical data repository standardizes data
from disparate sources into a cohesive
format. It comprises numerous tables,
each offering a partial view of patient
information.
• The structure of clinical data repositories
allows data to be extracted along
dimensions such as time (by year, month,
week, or day), location, or diagnosis
among many others. This data can often
be accessed in smaller units within the
same dimension. For instance, a user can
view the number of patients with having a
certain type of diagnosis, lab result, or
prescription within a year, then a month in
that year, and further into a day in that
month.
GRAPHICAL REPRESENTATION OF LAB
RESULTS AND VITALS
• Data collected through an electronic
health record system may be retrieved at
the request of an authorized user, whether
a physician, medical technologist, nurse or
radiologist. The electronic health record
may present patient care information as
text, tables, graphs, sounds, images, full-
motion video, or signals on an electronic
screen, phone, pager, or paper (Bronzino
and Peterson, 2014).
• Unfortunately, analyzing trends and
patterns from large data sets can be a
challenging process. This is where data
visualization, the art of representing data
in a pictorial or graphical format, becomes
useful.
• Data visualization helps in simplifying a
wide array of information, and it allows
decision-makers to derive analytical
results from information presented
visually. Correlations, patterns, and trends
which might be undetected from text-
based clinical data can be revealed and
recognized with more ease because of
data visualization.
• Visualization is increasingly becoming an
important tool in decision making. The
graphical representation feature of most
clinical data repositories enables scenario
analysis, which helps users use different
kinds of filters in order to change the level
of information that may be seen. Common
filters include age and gender, in order to
assess how the outcomes of a certain
intervention will be based on isolating
certain factors.
WEEK 16: ETHICS, PRIVACY, AND SECURITY
INTRODUCTION
• Modernization in healthcare has led to the
tendency of most practitioners to rely on
the use of mechanical aids throughout the
process of providing patient treatment.
However, the fact remains that human
values should continue to govern research
and practice in the healthcare profession.
• Healthcare informatics encompasses
issues of proper and improper behaviour,
honourable actions, and of right and
wrong.
• Ethical questions in medicine, nursing,
human subject research, psychology, and
other related fields continue to become
more twisted and complex, but some
overarching issues are common among
them.
• Ethical issues in health informatics, on the
other hand, are less familiar, even if some
of them have been controversial for
decades.
• Informatics also raises questions about
various legal and regulatory requirements.
• A computer program should be used in
clinical practice only after appropriate
evaluation of its efficacy and the
documentation that it performs its
intended task at an acceptable cost in
time and money.
• All uses of informatics tools, especially in
patient care, should be preceded by
adequate training and instruction, which
should include review of applicable
product evaluations.
• Users of most clinical systems should be
health professionals who are qualified to
address the question at hand on the basis
of their licensure, clinical training, and
experience.
GUIDING PRINCIPLES OF GENERAL ETHICS:
1. AUTONOMY
• Autonomy is defined as either allowing
individuals to make their own decisions in
response to a particular societal context,
or as the idea that no one human person
does not have the authority nor should
have power over another human person.
• Electronic health records (EHR) must
maintain respect for patient autonomy,
and this entails certain restrictions about
the access, content, and ownership of
records.
• Limiting patient access and control over
patient records improve document quality
because they can become proofreaders of
their own patient history (Mercuri, 2010).
GENERAL ETHICS
2. BENEFICENCE AND NON-MALEFICENCE
• These two principles are respectively
defined as “do good” and “do no harm.” In
health informatics, beneficence relates
most significantly with the use of the
stored data in the EHR system, and non-
maleficence with data protection.
• Deeply-integrated EHR systems will
contain substantial amounts of raw data,
and great potential exists for the
conduction of groundbreaking biomedical
and public health research. These kinds of
research will be beneficial to both the
individual patient, and to the entirety of
society.
• With this in mind, new EHR systems
should be developed with the capacity to
allow patients to release information from
their EHRs which can be valuable to
 researchers and scientists. Similarly, the
available consolidated from clinical data
repositories will be able to allow
healthcare professionals to provide the
best possible treatments for their patients,
further upholding the principle of
beneficence.
4. INFORMATICS ETHICS
• Informatics ethics, on the other hand,
involves the ethical behaviour required of
anyone handling data and information, as
prescribed by the International Medical
Informatics Association (2016). It covers
seven principles: privacy, openness,
security, access, legitimate infringement,
least intrusive alternatives, and
accountability.
5. PRINCIPLE OF INFORMATION-PRIVACY AND
DISPOSITION
• All persons and group of persons have a
fundamental right to privacy, and hence to
control over the collection, storage,
access, use, communication,
manipulation, linkage and disposition of
data about themselves.
6. PRINCIPLE OF OPENNESS
• The collection, storage, access, use,
communication, manipulation, linkage and
disposition of personal data must be
disclosed in an appropriate and timely
fashion to the subject or subjects of those
data.
7. PRINCIPLE OF SECURITY
• Data that have been legitimately collected
about persons or groups of persons
should be protected by all reasonable and
appropriate measures against loss
degradation, unauthorized destruction,
access, use, manipulation, linkage,
modification or communication.
8. PRINCIPLE OF ACCESS
• The subjects of electronic health records
have the right of access to those records
and the right to correct them with respect
to its accurateness, completeness and
relevance.
9. PRINCIPLE OF LEGITIMATE INFRINGEMENT
• The fundamental right of privacy and of
control over the collection, storage,
access, use, manipulation, linkage,
communication and disposition of
personal data is conditioned only by the
legitimate, appropriate and relevant data-
needs of a free, responsible and
democratic society, and by the equal and
competing rights of others.
10. PRINCIPLE OF THE LEAST INTRUSIVE
ALTERNATIVE
• Any infringement of the privacy rights of a
person or group of persons, and of their
right of control over data about them, may
only occur in the least intrusive fashion
and with a minimum of interference with
the rights of the affected parties.
11. PRINCIPLE OF ACCOUNTABILITY
• Any infringement of the privacy rights of a
person or group of persons, and of the
right to control over data about them, must
be justified to the latter in good time and in
an appropriate fashion.
SOFTWARE ETHICS
• Health informatics ethics heavily relies on
use of software to store and process
information. As a result, activities carried
out by software developers might
significantly affect end-users. The
software developer has ethical duties and
responsibilities to the following
stakeholders: society, institution and
employees, and the profession.
• Activities should be carried out with the
best interest of the society in mind.
Developers should be mindful of social
impacts of software systems. This
includes disclosing any threats or known
defects in software.
PRIVACY, CONFIDENTIALITY AND SECURITY
• Privacy generally applies to individuals
and their aversion to eavesdropping,
whereas confidentiality is more closely
related to unintended disclosure of
information.
• There are numerous significant reasons to
protect privacy and confidentiality. One is
that privacy and confidentiality are widely
 regarded as rights of all people which
merits respect without need to be earned,
argued, or defended. Secondly, protection
of privacy and confidentiality is ultimately
advantageous for both individuals and
society. Patients are more likely to be
comfortable to share sensitive health care
data when they believe this information
would not be shared inappropriately.
• This kind of trust is essential in
establishing a successful physician-
patient or nurse-patient relationship, and it
enabled practitioners to perform their jobs
better. • Privacy and confidentiality
protection also benefits public health.
When people are not afraid to disclose
personal information, they are more
inclined to seek out professional
assistance, and it will diminish the risk of
increasing untreated illnesses and
spreading infectious diseases (Goodman,
2016)
LEVELS OF SECURITY IN THE HOSPITAL
INFORMATION SYSTEM
• It is important to note that the types of
safeguards you choose may be prescribed
or restricted by law. Another important
consideration is the cost-benefit principle.
If it is not cost effective for your practice to
avail of an expensive technology to
mitigate a risk to electronic health
information, an alternative may be
requiring your staff to follow a new
administrative procedure that equally
reduces that risk.
• Conversely, if you cannot afford to place
additional burden on your staff due to
possibilities of human error, you may
choose to purchase a technology that
automates the procedure in order to
minimize the risk.
• Regardless of the type of safeguard your
practice chooses to implement, it is
important to monitor its effectiveness and
regularly assess your health IT
environment to determine if new risks are
present.
• The National Research Council (1997)
emphasizes that technological security
tools are essential components of modern
distributed health care information
systems, and that they serve five key
functions:
• Availability—ensuring that accurate and
up-to-date information is available when
needed at appropriate places;
• Accountability—helping to ensure that
health care providers are responsible for
their access to and use of information,
based on a legitimate need and right to
know;
• Perimeter identification —knowing and
controlling the boundaries of trusted
access to the information system, both
physically and logically;
• Controlling access —enabling access for
health care providers only to information
essential to the performance of their jobs
and limiting the real or perceived
temptation to access information beyond a
legitimate need; and
• Comprehensibility and control —ensuring
that record owners, data stewards, and
patients understand and have effective
control over appropriate aspects of
information privacy and access.
PHILIPPINE DATA PRIVACY ACT OF 2012
• Business Process Management,
particularly involving Health Information
Technology, is an increasingly growing
industry within the Philippine economy.
With total IT expenditure reaching $4.4
Billion in 2016, the industry is forecasted
to more than double itself by the year
2020. In addition, Filipinos utilize social
media heavily, with a whopping 3.5 Million
users on LinkedIn, 13 Million on Twitter,
and 42.1 on Facebook (Wall, 2017).
• Given the rapid evolution of the digital
economy and heightened international
data trading, the Philippines has decided
to strengthen its privacy and security
protection by passing the Data Privacy Act
of 2012, with an aim “to protect the
fundamental human right of privacy, of
communication while ensuring free flow of
information to promote innovation and
growth.” (Republic Act. No. 10173, Ch. 1,
Sec. 2).
 • The Data Privacy Act applies to
individuals and legal entities that are in the
business of processing personal
information. The law applies
extraterritorially, applying both to
companies with offices in the Philippines,
and even those located outside, but which
use equipment based in the Philippines. It
covers personal information of Filipino
citizens regardless of the place of
residence.
The main principles that govern the
approach for the Data Privacy act include:
• Transparency;
• Legitimacy of purpose; and
• Proportionality.
• Consent is one of the major elements
highly-valued by the Data Privacy Act. The act
provides that consent must be documented and
given prior to the collection of all forms of
personal data, and the collection must be
declared, specified, and for a legitimate purpose.
• Furthermore, the subject must be notified
about the purpose and extent of data processing,
with details specifying the need for automated
processing, profiling, direct marketing, or sharing.
These factors ensure that consent is freely-given,
specific, and informed.
• However, an exception to the
requirement of consent is allowed in cases of
contractual agreements where processing is
essential to pursue the legitimate interests of the
parties, except when overridden by fundamental
rights and freedom. Such is also the case in
responding to national emergencies.
• Processing of sensitive and personal
information is also forbidden, except in particular
circumstances enumerated below. The Data
Privacy Act describes sensitive personal
information as those being:
• About an individual’s race, ethnic origin,
marital status, age, color, and religious,
philosophical or political affiliations;
• About an individual’s health, education,
genetic or sexual life of a person, or to any
proceeding or any offense committed or alleged
to have committed;
• Issued by government agencies
“peculiar” (unique) to an individual, such as social
security number;
• Marked as classified by executive order
or act of Congress.
• The exceptions are:
• Consent of the data subject;
• Pursuant to law that does not require
consent;
• Necessity to protect life and health of a
person;
• Necessity for medical treatment;
• Necessity to protect the lawful rights of
data subjects in court proceedings, legal
proceedings, or regulation.
• The provisions of the law necessitate
covered entities to create privacy and security
program to improve the collection of data, limit
processing to legitimate purposes, manage
access, and implement data retention
procedures.
PENALTIES
• The act provides for different penalties for
varying violations, majority of which
include imprisonment. These violations
include:
a. Unauthorized processing
b. Processing for unauthorized purposes
c. Negligent access d. Improper disposal
d. Unauthorized access or intentional breach
e. Concealment of breach involving sensitive
personal information
f. Unauthorized disclosure; and
g. Malicious disclosure.
h. Any combination or series of acts
enumerated above shall make the person
subject to imprisonment ranging from
three (3) years to six (6) years, and a fine
of not less than One million pesos
(Php1,000,000.00) but not more than Five
million pesos (Php5,000,000.00) (Republic
Act. No. 10173, Ch. 8, Sec. 33)