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Implementation of the InHCc Health Care Management System

InHCc HMIS is built around Microsoft's Standards. We believe that this produces greater value for our users than trying to find the "best of breed" and trying to piece together open-source programming applications that are here today and gone tomorow.

The HMIS Integrated system has the following cost savings:

• Easier to teach the use of the system producing lower training costs
• Lower cost for installing the system.
• Less cost in upgrading the software components.
• Less cost in trying to "mix and match" components that are not designed to work together.
• Less system Maintenance staff
• Less help desk and system support
• Better analytical data from having a unified system

Introduction

Many Organizations are afraid to implement any thing new (Management of Change).

As stated in this report, a new information system has many benefits beyond duplication of what the organization is currently doing. A model Information is something very different and leads to new processes.

The cost and time to implement a new system not only will be less that trying to adapt the existing system plus give you many more opportunities.

Plan

It is envisioned that the implementation of the InHCc Care Management System will be implemented in stages in order to minimize initial cost and provide for the integration of the system into the organization and national accounts.  A proposal:

• Before the any project is begun, a general survey of the target population is taken. This survey is not only taken to become familiar with the target population but also introduce the project. This is may be only time that a survey will be required.

• Single clinical systems may be implemented in sentinel areas…areas of concern to the local government.  This system will provide on-line analysis processing (OLAP) to users that may telephone, “call in,” to the system to view all the results of the data collection in real time.

• Other clinical systems may be implemented in other sentinel areas.

• A centralized database and management center may be created.

• The individual clinical systems will “replicate” their data to the centralized database nightly through a telephone remote access connection.

• Additional clinical systems may be created with each replicating their data to the centralized database.

The priorities of the InHCc Health Care Management System reflect the belief that health care information should focus on the client and the household. This means that when a health care professional is offering care, the client’s and the client’s household information should be available quickly and accurately and must be available across time, place and clinical perspective.

The InHCc system has been designed as a completely normalized database. This provides the ability of each healthcare professional, at any level of the organization, and for each stakeholder to view data the way that he or she wants to view the data. There are no predefined sets of rules other than rules for access rights and security measures.

The presentation of the data to the user is built around Microsoft’s standards designs and procedures. Data will be available both at the local level and also in a centralized database. The centralized database provides that all information will be available across all operating systems and hardware configuration. InHCc takes the approach that it is impossible to manage a distributed health care system across all manner of operating systems and locations (it is impossible to know where the client may have visited) and has instead opted for a centralized database warehouse. The centralized database eliminates many problems that exist with existing systems and provides for many advantages that are not present on existing systems. (Discussed on the InHCc web site).

Security is enhanced in the InHCc system because all identifying data is “hidden” in the client record once it is saved in the centralized database. By hiding all identifying information, researchers and administrative managers may access the data without concerns for confidentiality. An identifying number is assigned to each client such that information can be traced over all events, but the identity of the client themselves is available only to the health care professionals directly treating the client. (Discussed on the InHCc Web site).

Data is easily viewable across languages. Because all data is numerically coded, only the descriptions of the codes need to be translated in the database (which is static). Once the descriptive tables are translated in the database, for example, a researcher in English can view all data entered by an organization in Spanish. Clinicians may use their own local descriptions of events without the need to learn new terms…the code in the background will always be the same for that event across all languages.

Data can be easily shared between two or more care givers. When a client is being cared for at two sites, such as a hospital and a local clinic, the information captured by either site can be automatically replicated to the centralized database. Either site may then request that information on any client be replicated to that site.

The system as implemented in a multiple clinical system in several locations in Mexico

Training

InHCc believes that the key to the success of any IT system is the training of the users. Specially difficult is the training of individuals that have never used a computer system.

We at InHCc supply a complete implementation package that includes not only the hardware but also the training program. We teach users not only "How" to use the system but also "Why" the information they collect can save human lives.

It is the use of the data that is emphasized and training is built around this.

The presentation of the data to the user is built around Microsoft’s standards designs and procedures. This makes it easy for users to learn and use the system. There are several training tools:

• Hands on introduction training (Initial training for those with limited computer experience)

• CD training presentations on each of the major topics

• Concept training that focus on “why” the data is being collected and data quality issues

• Detail live training for the major sections of the system.

• Problem focused training (concentration on problem handling and data anomalies)

• Management and Researcher training

• Reviews and on-going education

The important thing is that training be appropriate to the user. If the user does not  understand the data, he can not use it effectively.

Solutions

• Packaging interactive software applications
• Telemedicine
• On line References
• Flow charts
• frequent skills education.
• Given the authority and Held accountable...after passing examinations or educational
• NOT to put new graduates in rural areas...

Data Conversion

Converting paper data to computer records, while rather easy, is very time consuming. InHCc suggests a phased system

Documents are scanned first based on the clients that are currently in the system. This allows the data to be corrected and managed at the same time that the HCP's require the information. Documents can be easily scanned using an Optical Character Reader (OCR) that is attached to the InHCc HMIS System and be stored in the database automatically after indexing.

The InHCc HMI system allows very little free-form data. The system does not allow HCPs to continually to use their system of recording data which may be completely inefficient and incompatible with the existing data structures. By using atomic structured data, the data becomes more standardized and can be used in Data Analysis and Data Mining.

Data Analysis an Data Mining is the Most Important Reason for Computerized Data.

Organization Structure

While decentralization is something that is often spoken about as being a way to empower local managers to make decisions based on local conditions, it is not about giving up the management at the higher levels of these local units.

Integration with Existing Systems

The InHCc HMIS System is built on Microsoft's SQL Server which is a standardized Relational Database Management system. Any other conforming third-party content providers can be attached to the system.

The InHCc HMIS System does not provide within its own software for direct Integration with older legendary systems. However, the Microsoft SQL Server's Integration Services provides easy to use data integration from a wide variety of types of data.

Data

The InHCc Information System will implement the following:

• All data will be collected in Detail at the Lowest Level of direct client contact using a Clinical Information System. 

• The Clinical Information System User's Interface will allow the collection of data either through Web technology if connected directly to the network or through a simple desktop relational database system such as MS Access for those organizations that are not directly connected to the network. 

• This information will be transferred to a middle tier staging area in order to provide for quality control and data mapping. This will be a site specially created for "Data Cleaning" and will also be used for "back-up" of the individual reporting sites. 

• After Cleaning the data, the data will be transferred to a Centralized Data Warehouse.

• OLAP services will use information in the Data Warehouse for the creation of an interactive analysis model to be used by Management for analysis.

• Data Mining applications will access the Data Warehouse to use the raw data for Research.

• Users will access information appropriate for their level of authority by Web technology.  

Links

Microsoft Integration Services Overview (2008)

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