Hospital Information System (HIS) is a comprehensive, integrated information system designed to manage all the aspects of a hospital’s operation, such as medical, administrative, financial and legal issues and the corresponding processing of services. With the advent of Digital India and the push by the government to move most healthcare systems to digital records, many small and medium hospitals will undertake this exercise this year and this article is mainly to help provide some guidance to the IT teams at these hospitals. This assumes more significance and most elements of our National Health Policy will be delivered through local rural district medical centers and hospitals.

Key STEPS OF HIS IMPLEMENTATION PROCESS :

STEP 1: HIS Orientation.

HIS orientation is conducted on an as needed basis to Hospital IT teams to provide an overview of HIS, as well as benefits and requirements for participation.

STEP 2: HIS Technical Assessment and Installation. After the orientation, IT service providers interested in implementing HIS will sign the Memorandum of Agreement and will be provided with a copy of HIS Policies and Procedures including materials for posting and other forms. Hospital IT team staff visits the service provider for site inspection.

STEP 3: Outcomes Management Training. Establishing Milestones and Performance Targets.

This training is conducted with the program manager or case manager to identify milestones and performance targets. This includes services provided to hospital IT team with a detailed description of how those services assist participants to achieve the milestones and ultimately complete the program. This Milestone/Performance is customized for each participating department.

STEP 4: User Training.

User Training is conducted on an as needed bases All HIS users are required to attend this training before utilizing HIS. After the training, participants are given Certificate of Completion, user name and password.

STEP 5: Go Live! and Technical Support.

With the completion of Steps one to four, the Hospital is now ready to “Go Live” or start using the system.

Now these are just basic steps and each hospital might have  different approach to adoption of the HIS. While conducting a survey for my research project, I spoke to many local India based IT organizations about the challenges they faced while implementing HIS systems. Below is a short summary of my findings from the research.

• Master Data Management 

One of the more common issues that come up during HIS implementations. Master Data is the key to any implementation. Master data is list of departments, list of employees, list of doctors, list of lab tests with specimen reference, ranges, observations, methods etc, drug list, inventory list, list of prices for each and every item for OP and IP bed wise, list of wards, list of rooms, list of beds, list of specialities, list of bedside procedures, list of surgeries, list of packages with all inclusions and exlusions, list of TPA, list of corporate, list of insurance with plans and pricing.  Sasikiran, Healthcare Integration Expert at Innovvar Inc said  that major challenge faced him was master data. Data porting, network issues and data security issues were also some of the other challenge faced by him.

He added “Every application has it’s own format of data. We will give our masters data format to hospital team, but at times they are not able to provide master data in the format required for import in our system.”. As a result, implementation  gets delayed.  He also added, “As software contains bugs, so when going for new implementation, we have to test entire application and as every hospital has their own business logic, it takes time to implant in the application.

• Communication

Most of the users at local hospitals are native language speakers so sometimes there are issues understanding the  language and terminology and that affects the functionality. They also do not have everything recorded in a systematic manner, so configuring data manually is a challenge.

Dr Ashok, working as HIS implementation consultant in Klouddata said, “According to me, as major challenge faced is in the earlier stages of implementation, there exist unclear ideas about output required by doctors, resistance from staff, lack of co-ordination between developers and Business Analyst and if it’s time bound, quality of products and services are jeopardized.”

Other challenges include frequent requirement changes by doctor, lack of vision from hospitals and budgets.

• Network

Bandwidth issues plague most implementations in hospitals. According to Shubham, working as Senior Implementation expert at Eli, the biggest challenge is network connectivity, specially if implementing web based HIS solutions. configuration issue is also another major challenge faced by him.

Other  challenges include load testing, getting adaptive with the software and interface issue which are again connected to the internal bandwidth of the hospitals.

• ICD Nomenclature

The other challenge faced by some implementation teams are the incorrect ICD nomenclature. There is chances of data loss, data validation issues and errors in demographic data. For example, ‘Jyoti’ can be the name of male patient, but we may enter the gender as female.

• Skills of the hospital IT Team

According to Mr Vikram, Senior Implementation Expert at Tata Advance Systems, major challenges includes educating user’s who do not have adequate computer skills knowledge, generating after live request and  data standardization issues.

On interviewing few implementation experts in Attune Technologies, implementation engineers face challenges like limited funding resources to address the many technological gaps, especially in rural ares. Design cost-efficient, scalable HIS that require minimal technical competencies to perform adequately when high-speed Internet service are not available.On the other hand, on interviewing implementation engineers in Birla Medisoft pvt Ltd, challenges include geographical barriers that prevent implementation of training, technical assistance, services and support strategies in remote areas, technological aptitude, project management expertise and “best practices” in implementing and maintaining HMIS.

Based on these challenges I feel hospital IT teams and service providers can make the following changes for better implementation and to reduce some of the challenges.

RECOMMENDATIONS AND SUGGESTIONS:

• Provide local assistance on current funding opportunities, training information, and engagement strategies for the diverse range of local agencies and coalitions.

• Revisit HIS policies to ensure that any requirements which go above and beyond the federal mandate are manageable to smaller and more resource restricted agencies.

• Provide regular communication and a representative to visit rural agencies providing consultation on how to best capture program data for HIS entry.

• Ensure service providers participate in CoC meetings to represent needs specific to rural areas and to offer all CoC representatives the opportunity to learn from each others’ experiences.

About the author

Purva Gupta is a Management Graduate in Hospital and Healthcare Management, with specialization in Healthcare Informatics from International Institute of Health Management Research, New Delhi. She is highly motivated professional who loves challenges, possesses decision making, leadership and problem solving skills. Please direct all questions and comments on this article to purvagupta456@gmail.com