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**InHCc HMIS**

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Index - Same Level Subject

Assessing HIS
Change Management
Healthcare Processes
Certification Process
Accounting and Financial
Human Resources
Information Management
Management
Data Analysis and Data Mining
Error detection and Fraud Prevention
Surveillance
Research
External Communication and Reporting
Marketing
Safety and Security
Software and Programming
"Bells and Whistles "
Client and Household Care
Quality of Care
Education and Training
Administrative
Government and Political
Employee Efficiency
 

Index - Child Subjects

Health Care Management

A good HIS provides information for management to manage processes. The System is not concern with any static model but rather it is concerned with obtaining the information needed to Make Changes. Health care is a dynamic process and must be managed day-to-day and event-by-event. Processes that are well- managed, provides a means for coping with change. It provides the ability to create solutions over and over again.

Management use date

More importantly in health care management.

With Bad administrators, no matter how good a program or project may be in itself, it will fail. With Good Managers even a bad program or project may become sustainable. 

You hear from every Donor, "the program must become sustainable." 

It is InHCc's opinion that a health care organization should be managed just as any other business.

"Strategically there is a need to take a more business process view of health care delivery and to identify the appropriate organizational and information infrastructures to support these processes. Grimson J., Grimson W., and Hasselbring, 2000)." 

The health care organization must sell their product (in this case health care or research) just as any other commodity. This means that an organization must offer the best product at the best price. If an organization does not operate effectively and efficiently and produce a product that has value to the community, it will and should fail. It should no longer be the case, that because the organization calls itself a "research organization" that donor organizations should continue funding it. 

The health care organization, be it a NGO or some other organization, must learn to compete in the market.  The driving force of an organization should be “Return on Investment “…in this case the return is the health status of the client. Research organizations should not measure their success on the indicators that they develop but rather they should measure their success on how well they achieve their goals.

Project developers today have designed indicators for higher level reporting with little if any indicators for the management of the individuals units

Many health care projects start out with developing indicators, what they need to learn, is how to manage with these indicators. 

Over and over again when an organization is undergoing a "difficult financial period" the first item on the addenda is to improve the economic situation by getting more "funding." The second item on the addenda is to cut costs. What they have consistently left out is the choice to operate more effectively and efficiently. If their organization products a quality product at the reasonably cost, they would have no trouble selling their products, health care services and their research. 

The Organization must shift their focus away from "getting more grants" and toward controlling costs and improving the efficiency of their “projects.” 

Management Dashboard

Management "Dashboards" can be designed for any type of management, at any level. Dashboards can display all operating data at a single glance for the user to view...usually at when the user logged into their system.

Concurrency of Information

It was once asked of the author of this paper, “how long does it take to collect the data?” 

Not only is this question inappropriate but it shows a lack of understanding of why data is collected. The correct question should have been

“how long does it take from the time of the event when the data is collect to the ability of the managers to be able to use that information.”

 Data has no value until it is used.

If data only takes a few seconds to collect, but then must by summarized, transferred, and finally after six months or so used; how useful is this information even if it is “easy to collect.”

The InHCc System makes data available to managers in real time.

Summarized data can be viewed for any selected time period. If any additional information is needed, the detail data (individual client visit) that makes up the summarized data can be view with only a click of the mouse. Any abnormal event can be investigated from any level of the InHCc system.

When clients are being cared for at two or more locations, information is downloaded from the central database to each location caring for that client. As new information is entered into the local units this information is replicated to the central database. This information is then updated on all local units that care for that client. Therefore each local unit will have their own updated information on the client from all sources that care for that client. 

Monitoring

The InHCc System records every event that affects the resources used by the organization. Because of this, it is not only possible to determine the inventory that is used, but as an example, in the case of drugs, it is possible to determine to whom the drug was given, and why it was given.

Processes

The Healthcare Organization is not run by machines...at least not yet...it is Management that makes things happen. You can put a super computer with all the new "tools" include in front of a group of individuals. If these individuals do not know how to use the computer system, the system has no value. It is only with Management that any organization can function...and it is Management that will make or break the organization...no matter what computer system the Organization has in place.

The successful organization is one where the employees are constantly looking for new ways to make the organization more efficient. "Well, that is the way we have always done it"...is the cry of death.

The easier it is for Management to get information they need when they need it is what the computer is all about...but again...I must emphasis, that it is the Management that is the key to success of an Organization.

Some examples and benefits of the Information System.

• Decision support provides what needs to be done and how it needs to be performed.

• Management roles and responsibilities can be more clearly defined thus avoiding conflicts within the organization both in the competition of resources and the avoidance of responsibilities.

• There is the ability to access detail data at each level, evaluate and make comparison with other same-type activities.

• Results are simultaneously returned to the user of the information as well as the government data collection agency.  

• Management has more information in which to made his decisions
• Provide information for more timely and improved management decisions.
• Request for Suggestions can be disseminated throughout the organizations and collaborative solutions can be created.   
• Top Level managers may concentrate their efforts on those clinics that are most in need. This will make more effective use of their time. 
• Goals can be set more realistically through the use of client's profiles and actual service demand.

• Provide a “planner” for system changes thus making fewer costly mistakes

• Ability to set realistic Priorities

• Lower Level managers can more easily access and ask questions of their upper level managers. 
• Improved supervisory support and guidance through real time monitoring of events. 
• Fewer face to face meetings needed allows more time for actual work. 
• Better scheduling of staff through advance analysis with such tools as decision trees and PERT.
• Because individuals are grouped according to their functions, and within their authority, line supervision is make more clear eliminating cases where one individual may be "managed" by two different people.
• Continuously monitoring provides faster response time
• Readily available job manual and job description

• Target groups can be identified more easily and funds can be better managed

• Data can be sorted and printed in multiple formats for better analysis.

• Data can be sorted and filtered by any criteria

• Comparisons can be made between care plans to determine the most efficient and effective pathway.

• Customized views are easily created.

• Identify at-risk patient populations

• Use the database for disease management, clinical trials, and tracking patients’ patterns. For example, run a report to find all patients on a medication recalled by the FDA

• Compare patients with similar conditions and treatment plans

• Support routine health maintenance with automated reminders

• Evaluate practice compliance with government requirement

• Evaluate practice compliance with professional standardized protocols

• Evaluate "wait" time of various services and schedule staff to be able to minimize the wait time.  

• Identify "unusual" events.

Specific Examples

• Better scheduling of and access to resources based on Predictive Modeling (examination areas, rooms, beds, equipment, operating theaters, imaging and laboratory systems)

• Causes in Delay in Transfer of Patients

Provides Information to make objective non-biased decisions 

In a recent edition of "Communications" of the ACM (January 2001) the articles were devoted to the achieving of Democracy through the greater use of technology [an excellent publication for all public health economics to read].  In one article, Ignace Snellen's stated,

“In an information society, the raw data from which the information is derived is more important than the information processed by government...They [objective statistical data] exit with no purpose to convince anyone of anything. Furthermore, data analysis--by hand--would require so much time and effort that the results would be sporadic and available so late that they would hardly influence actual political decisions. With computers, however, such analysis is done easily and routinely. Another attraction of GIS [computer analysis] is they visualize highly complicated relationships between conditioning factors of problematic situations in a very convincing manner. As such, they have become strategic policy support facilities.  " (pg 46-47)

It is the Information System that makes possible this objective complex statistical analysis.

Improve Managerial Efficiency

KPI and other indicators measured daily (or in real time if required)

The InHCc System provides the ability to compare costs across time and locations. By being able to compare these costs, management can determine the best location, at the best prices, and when to provide services to what targeted groups.

Development of more effective indicators. Management cannot occur unless there is some way to measure the success or failure of a project. The more variable that are collected the better the ability to make changes. The old "advice" that there should be as few indicators as possible and they should be easy to collect have no meaning in a good HIS. 

Resource review more accurate due to more detail and easily accessible "real time" information.

Training and Education. Although training and education have been very important in International Development, in many cases it has been ineffective. In large part training has not been effective because once trained, the personnel still have not had the information they need in order to make "informed decisions." Without good information, the best trained managers will not be able to perform their jobs. Managerial efficiency can only be improved by supplying management with information in order to make those decisions. Training must be combined with information. This and this alone leads to “informed decision making.” 

A manage now has an incentive to produce timely and accurate data. A manager at a lower level, by knowing that his supervisor has all the detail information, in real time, has an incentive to produce reliable data. Since Lower level managers know that time stamps and security certificates are used, they will ensure that resources are used appropriately. A manager at a lower level may not have been so responsible in the past if he knew that there was no way to check his data. He will now be accountable for his actions. 

With accurately and relevant data, managers can be more fairly rewarded for accomplishing their goals. Incentives can be given to health care workers, for example, based on the number of children vaccinated in their catchment area. When data was not accurate, this was not possible. 

Communications. The InHCc HMIS provides the ability for all staff members to report any problems/suggestions for improvement immediately. Management can respond to these messages in real time without having to be physically present. These problems and suggestions are all transparent to the staff member of the organization.

• Characterize patient population to better allocate resources

• Perform passive electronic surveillance of signs and symptoms in order to detect harbingers of new diseases in the clinic.

• Clinical data are combined with demographic and financial data and are used in conjunction with the benchmarking database to support iterative clinical performance improvement

• Processes can be benchmark against other institutions thus providing tools for the measurement of success.

• Statistical data helps identify the needs of the population. It helps to identify those areas that are not being served. This helps to refocus resources to those requirement that are of highest priority. This data can be a strong stimulus for change when dealing with administrators, politicians and interest groups

• Data on acuity and predictions of the patients in the organization can help with staffing requirements.

While Communication is the most often found "benefit" of a good HIS the benefit is generally described in terms of communicating information concerning the client. While this is indeed very important, Communication is also very important in the management of the organization.

Healthcare is so complex that it is one of the most difficult of organizations to manage. Understanding the relationship among all the variables that come into play in the management requires a broad knowledge of all the interrelationships. Managers must think in terms of the organization as "whole". Every set of relationships and departments are connected to every other department.

Managers need to communication policies, ideas, strategic and planning to all employees.

• Communication ties the organization together by enabling the sharing of a common set of values.
• Communication enables management to promulgation the plans, direction, and goals of the organization
• Communication can strengthen the culture and integration of the organization
• Communication helps managers coordinate activities within the organization.
• Communication enables managers to communicate both vertically and horizontally to other individuals.
• Communication enables employees to share ideas
• Communication enables management to "see the whole picture"
• Communication allows individuals to how they "fit" in the whole organization and not just their own departments.
• Communication allows better coordination and use of Resources
• Communication helps outline the relationships between individuals and units

As you see, communication "about" the organization may be just as important as the communication about the client. If there were no organization, there would be no healthcare.

These processes increases productivity and job satisfaction.

Problem Management
Problem management is the discover and to manage problems immediately

Problem Analysis
Problem analysis is the result of being able to "see" the problem and explore different solutions through asking "what if" questions and being able to see the results generated by using different possible variables.

Disseminated of Information
Not only is it required to determine that there is a problem and the solution to that problem, it is also important to be able to disseminated that information to all stake holders....immediately.

Monitors Health Care Professionals

The InHCc System provides the following information on each Health Care Professional:

• What was done

• Why it was done

• How it was done

• Client who received the procedure

• What time it was done

• How long it took to do it

• Outcome of the action

• Management plan of the client for the future

The health care professional can be rewarded for the work that was done well and education can be provided to those targeted health care professionals that needed improvement.

Medical Professional Evaluation

In order to manage, managements must be able to know if they are doing a good job; so how do they do that. Management must be able to compare themselves to others. For example, they must be able to determine if their client satisfaction rating is as high as other similar organizations. If they cannot compare, then how can they determine what a rating of “7” means. Today, with national governments decentralizing their services, it has made it next to impossible to compare actual operating data among peer organizations. 

Project developers today have designed indicators for higher level reporting with little if any indicators for the management of the individuals units

Evaluate treatment patterns across providers and better tailor care management program based on those results.

More effective staff reviews and appraisals due to detail data available and automatic detection of "overuse, underuse, and misuse" or resources.

Medical Professional Profiling:
All medical treatments provided by a HCP can be accessed and displayed. Treatments can be sub-grouped and comparisons can be made between peers. Treatment patterns can be used as a basis of comparison of treatments offered by HCPs in different locations, different facilities, at different times, and with International Medical Practice standards.

Optimal Treatment Patterns for Health Care Events Treatment patterns, can then be associated with the best outcomes for types of services within specific diagnosis/injury groups.  Sub-Optima Outcomes that are associated with specific treatment patterns can be eliminated.

Intelligent Reward System

Based on outcome analysis, the HCP can be identified for recognition (not necessarily "more money" which InHCc believes is not cost effective)

Predictive Capabilities

Accurate prediction of medical requirements (based on Client profiling: disease, age, etc) for specific medical and accident care can be made, enabling the health car organization to more effectively allocate their resources.

Event Classification

Events that fit specific patterns (similar to DRG's but more specific) can be distinguished early in the healthcare process, and individualized strategies (Case Management) can be implemented to allow for more efficient allocation of resources.

Legal

Legal requires that medical document must be signed and dated and that changes cannot be made without sufficient documentation. Computer systems prevents "tampering" with any documentation by provides rules as to what, when, how changes occur. The date-time and user is recorded on the record of each and every data entry

Required data must be recorded before the user can close the system.

Information Management

Information Management is the main topic of this paper and provides a list of information needs and uses of this information that supports the organizational goals and objectives.

A health care organization is one of the most complex endeavors that is highly dependent on information.  Information Management is an integral part of the organization which without, the organization could not survive.  Planning and designing the information management system to meet internal and external information needs is the main function of the Health Care Organization.

(See Information Management)

Provides information to make objective non biased decisions 

In a recent edition of "Communications" of the ACM (January 2001) the articles were devoted to the achieving of Democracy through the greater use of technology [an excellent publication for all public health economics to read].  In one article, Ignace Snellen's stated,

“In an information society, the raw data from which the information is derived is more important than the information processed by government...They [objective statistical data] exit with no purpose to convince anyone of anything. Furthermore, data analysis--by hand--would require so much time and effort that the results would be sporadic and available so late that they would hardly influence actual political decisions. With computers, however, such analysis is done easily and routinely. Another attraction of GIS [computer analysis] is they visualize highly complicated relationships between conditioning factors of problematic situations in a very convincing manner. As such, they have become strategic policy support facilities.  " (pg 46-47)

It is the Information System that makes possible this objective complex statistical analysis.

Provides information for management

The InHCc System provides information for management to manage processes. The InHCc System is not concern with any static model but rather it is concerned with obtaining the information needed to Make Changes. Health care is a dynamic process and must be managed day-to-day and event-by-event. Processes that are well- managed, provides a means for coping with change. It provides the ability to create solutions over and over again.

The discussion in the section above on Health Care Reform presents only a very few examples on where and how information is needed to manage long term health care at the National and International levels as well as at the local clinic.. Too many tomes have been written on what “indicators” are appropriate; now what is needed is a system that can actually use this data to manage.

The InHCc System allows the actual detail measurement of the effect of implementing and or changing any variable in the health system processes at the local level as well as to give an indication of the results to the population as a whole. 

Many use the excuse that installing IT systems in developing countries is too expensive and that there are not enough skill personnel to maintain or use these systems. InHCc does not believe this. InHCc believes that the cost in human life, sickness, time, and resources far outweigh any cost for equipment or training that may be involved in installing these systems. The threat to the world population in not being able to monitor and control the newly emerging diseases is too great. It is time to put into place a long term solution instead of just trying to patch the holes. 

Because many young physicals spend there first few years in the rural areas…the following procedures help them in making their health care decisions

•  “Picklist” of pre-selected choices
• Medical Protocols set up by peer
• Navigation through the system is build around standard procedures
• Analysis can identify where a HCP may need more training. Examples are:
• Diagnosis based on symptoms, drugs based on diagnosis

Medical Technology

Medical Technology is expensive and is rarely used efficiently.  Job and Work flow analysis can improve the utilization of medical equipment.

·     Provides Data required to make informed decisions concerning the purchase and maintenance of equipment (not just medical equipment)

Organizational Structure

Improvement in Workflow. Studies from surveys and time and motion studies can be used to improve the workflow of all processes.

Maintaining Core Services . The Organization with a good information system will have the ability not only to examine each core function, but also every position, job, or project. The Organization can work to direct funds to maintain those positions that would increase the efficiency of project research and improve the competitiveness of international grant proposals. Rather than “lowering the costs of research”, and possibly quality, the goal should be to strengthen the returns of research.

By providing data that analysis's what works and what does not work, the structure of the organization can be reorganized with a better staffing ratio.

Allow More Budget Flexibility and Discretionary Funds. The Organization can introduce a system of devolved budgets. Budgets can be continuously developed throughout the year, not only “at the end of the year.” Budget managers will be given the information needed to make informed decisions and they can be trained on how to use this information. The managers will be responsible for their own decisions.  The system can provide for incentives to the project directors to be more efficient. Included in the budgets will be discretionary funds. By providing on-line information regarding their projects, Principal Investigators (PI) can manage their own budgets more effectively. This provides the flexibility needed in today’s world to compete.

Every aspect of the Organization will be run like a business. The Organization must give a quality product (“research”) at the cost the donors are willing to pay.

Policy documents can be obtained from several other research organizations to use as a template for the Organizations own policies. These policies will be reviewed and recommendations can be made.  

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