Case Studies

Slicing through the clutter

The International Hospital of Bahrain (IHB) gains in productivity and improves patient care by going entirely filmess and nearly paperless. Sathya Mithra Ashok finds out how.

The International Hospital of Bahrain (IHB) is the kingdom´s first private medical centre. From a small private clinic, it has evolved to a major community hospital over the past thirty years. The hospital prides itself in its some hundred well-trained and skilled physicians of different nationalities covering most of the major specialties. They are inturn supported by more than four hundred administrative and support personnel.

“We have a 100-bed hospital and around 500 people on the staff rolls. The hospital has multiple specialities, supported by various services. We provide both in-patient and out-patient services under one roof. There are seven operating theatres and a separate maternity suite with up-to-date, fully equipped birthing rooms,” says Salian Shrinivas, director of informatics at the hospital.

The hospital sets high ideals of quality and patient care, and information technology has been helping support and  achieve these goals since the inception of the facility. “Like any other organisation we had our own financials and  payroll, and other elementary support systems in place. Sometime in the early, 90’s, we realised that keeping paper  records was not helping us with transparency. We started to toy with the idea of going paperless. Keeping this in mind, we started working on the systems of the lab and the radiology departments in the late 90’s. We initially used FoxPro – a DOS based system that was fast and easy to programme,” says Shrinivas.

Soon after the team began to consider a full-f ledged hospital management system, which was entirely GUI-based. The  hospital went shopping for such a system, and even tried collaborating with a vendor to customise a solution. When  these attempts failed, IHB’s IT team decided to build its own management system.

“In 1999 we decided to develop our own software, and in 2002 we finished the first phase of the development. In February 2003, we took the big bang approach and deployed all the modules that we had created till then – which was around nine. This included in-patient, out-patient, appointments, billing, payroll, operation theatre, ward management, financials and receivables in accounts. We deployed all of these in one day but we had a trial run for an entire year, where it was not mandatory but the system was available for practice,” says Shrinivas.

“By 2003 most users were prepared. Guidance was provided to staff where they required the same. Around 85% of  users were on board with the management system when we went live with it. There were some hitches, but nothing  major,” adds Shrinivas.

The IT team realised that change management would be the biggest problem with the system. People who have always been used to paper will be reluctant to change because they would not understand the necessity of such a change.

Keeping this in mind, the interface and the entire system was made very simple in order to not intimidate users. As  more users came on board and the system becamea clement familiar across the hospital, the IT team could do its own  upgrades and additions in time, building more modules into the system.

“Currently there are 23 modules running on the in-built system. We did the whole thing from scratch and it is still  doing good. We constantly track a user wishlist and try to satisfy them. These might be small changes but ones that  benefit them. When people see that their requirements are being fulfilled they are more willing to use the system and they are happy. This is a key to our continued success with the system at IHB,” says Shrinivas.

Shrinivas provides the example of how they simplified incident reporting in the hospital. Earlier the staff filled out a  complicated paper-based form that demanded so much information that most people were not always willing to fill things out. The IT team found that they were more willing to talk about it, so they set to simplifying the process by making it an online form with just one box with the bare details to be filled out. This would be followed up with a more personalised conversation, which will lead to a solution being found for the incident.

Extending the paradigm
The 12-member IT team is constantly working to improve the system. Except for housekeeping and maintenance, everyone in the hospital uses computers, and so there is a constant push to make everything electronic – which the IT team has been slowly working to enable.

From leave requests, attendance and salary receipts, to incident reports most activities have been digitised, and an internal knowledge management (KM) framework has also been implemented over the last four months. Shrinivas says that the core areas of  patient care and administrative elements, such as medical records, patient information, billing  etc, were digitised.

Over time, the hospital has also started extracting data from these procedures and using it for statistical analysis to  help it with future needs. The hospital went entirely filmless in 2008. IHB bought an off the shelf PACS (picture archiving and communication system) and integrated it into its own system. Now, all the films produced by the hospital can be viewed with just the software.

“Not only has this helped us with efficiency of operations, but it has also saved us a lot of cost on film and chemicals.  The system has also enabled us to automate client billing and links to insurance, and so good is it that we have reduced our insurance rejections to just around1%,” says Shrinivas.

Involving the patient
Apart from internal procedures, the hospital has worked to make more patient activities paperless as well.

“The patient  books an appointment to see a doctor on-line. In the hospital, the cashier checks on payment methods, generates an electronic record and gets an electronic signature from the patient. Vital signs are catalogued into the system at the clinic and then the patient visits the doctor. The doctor gets all this information, along with data from previous visits, on his system interface. He consults with the patient and fills information in to pre-determined templates for diagnosis. This makes the doctor’s job much easier. He just has to tweak the template to different elements, not do entire data fields for every consulting patient,” says Shrinivas.

He adds, “The doctor might prescribe medicine or radiology and closes the visit with a diagnosis. The patient then  heads to the pharmacy or the lab. At both points, information is already available on the system. They check for the payment status after which medicine is dispensed. Once done, the patient walks through the cashier’s desk, collects  claims document if there is one, gives feedback on the monitor and then heads out. If the patient says the visit was unsatisfactory on the feedback form, the cashier will hold them till someone can address the issue.”

IHB has also implemented a fasttrack for patients, whereby the hospital holds a credit balance for them inhouse. The patient calls from home to make the appointment and then uses kiosks placed in key locations at the hospital when he/she comes in. At the kiosk, fingerprint readers are used to ascertain the patient’s identity, and an electronic record is generated. If there is enough credit on balance, the patient then can see the doctor directly instead of going through the cashier.

“We have had this for about a year and it is a big success. Its popularity is growing among patients and we already have around 1,000 using this fast track process. We are also trying to work with banks, whereby patients can top up their hospital balance via their accounts directly,” says Shrinivas.

Looking ahead
With all these efforts, IHB stands as an entirely filmless and almost paperless hospital. Though this year, the IT team will be working on improving services, adding elements and making existing options better.

“We want to become more Web-enabled. We want to provide more remote access to our patients as well as the doctors. The latter can then check on patient records from their home. For patients, this will mean on-line appointments, on-line feedback, and probably they can get a copy of their records through the Web site as well. By enabling this we  will be able to manage our software better and not depend on thick PCs all the time,” says Shrinivas.

The IT team will also try to address two areas – adding to the pharmacy database and enabling barcoding on medicines  and patients to ensure that the correct medicine and dosage is administered to the right patient all the time.
With all these advances to come through, there is no doubt that IHB will continue to touch new heights and set new  trends in healthcare and technology in the years to come.

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