Review of TrakCare at Sir Ganga Ram Hospital: Workflow and User Success

1. A Review of HIS (TrakCare )atSir Ganga Ram Hospital:Its Workflow and success at user-end YogitaThakral IIHMR New Delhi

2. Introduction • Comprehensive  information system dealing with all aspects of information processing in a hospital. • Integrated, computer-assisted system designed to store, manipulate and retrieve information concerned with the administrative and clinical aspects. • So far, any studies focusing on reviewing the TrakCare (the HIS at SGRH) from the user’s perspective have not been carried out.

3. SGRH - Profile • 675-bedded multi-specialty state-of-the-art hospital [1] • Initially founded in 1921 at Lahore by Sir Ganga Ram • NABH accredited • SGRH’s expectations : • Better inventory control • Rapid access to lab results • Reduced allergy and drug interactions • Efficiencies Through Automated Billing • Savings Through Better Inventory and Medical Package Control • Substantial Cost Savings Through Pharmaceutical Substitution

4. Intersystems’ TrakCare • Unified healthcare information system that lets authorized healthcare professionals access and work with complete patient records. [2] • Leading Web-based HIS • Provides a full range of clinical, administrative, lab capabilities • Enables timely and more informed decisions about patient care, based on up-to-date information.

5. Rationale of study Having a good HIS is crucial for the success of hospitals. • enhances information integrity • reduces transcription errors • reduces duplication of information entries • optimizes report turnaround times The HIS should also be patient centric, medical staff centric, affordable and scalable.

6. This study aims at reviewing TrakCare insofar as it’s success from the user-end is concerned, explaining how the various modules are interconnected and mapping the workflow involving patient care, as seen on TrakCare.

7. Review of literature The International Perspective : • Methods for evaluating hospital information systems: a literature review [6] • Assessing User Satisfaction of using Hospital Information System (HIS) in Malaysia [7] • Hospital Information Systems In Nigeria: A Review Of Literature [8]

8. The Indian Perspective: • Hospital Information System in Medicare – An Experience at Tata Main Hospital,Jamshedpur[9] • A study of the Hospital Information System (HIS) in the Medical Records Department of a Tertiary Teaching Hospital [10] • Evaluation of computerized health management information system for primary health care in rural India. [11]

9. Objective General objective • To review the existing HIS (TrakCare) at Sir Gangaram Hospital from the end-user’s perspective. Specific objectives 1. To map the workflow of the hospital as seen on TrakCare in various departments, by creating a fictitious patient. 2. To determine whether CPOE is being used judiciously at SGRH by clinicians. 3. To assess the knowledge and behavior of employees towards TrakCare.

10. Methodology • Study design: Cross sectional , Descriptive • Study area: Sir Gangaram hospital • Study population: Doctors / consultants , Nurses / Paramedics, Front office executives, Billing executives and pharmacists • Sampling and sampling design : Sample size 51 ,Convenience. • Data collection tool : Questionnaire (close ended, Likert scale) • Duration of study : 2 months (2nd Apr – 31st May) • Information thus obtained from the above questionnaire entered in SPSS software and analyzed.

11. Advantages & Disadvantages Adv. OPD : • An episode number created for each visit. • Easy and convenient identification of patient • All the categories have been segregated very meticulously. Disadv. OPD • Appointments are not be maintained. • During downtime, the whole process has to be maintained manually.

12. Adv. ADMISSIONS • System can recalculate the charges if a patient downgrades or upgrades his plan. • Unique identification number • Process of room allocation has become easy. Disadv. • The waiting list for the patients is not being maintained in the HIS. • Often the system takes a lot of time to update new information.

14. Adv. WARDS • “Abnormal results” removed. • A ward list showing all the current patients and their details can be seen by any nurse • Nurse has now full control of the final discharge. • The nurses can order medicines, medical consumables and tests for patients from a single menu. Disadv. • Patient’s details are not entered at each patient visit.  • Clinician’s notes and nurse’s notes menu is not being utilized.  • System capable of showing an alert if wrong dosage of a drug is entered into the system.

15. Adv. of LabTrak in Laboratories andCIC • All the previous and present test reports of a patient on a graph available. • No sample mixing now because of separate barcodes for different labs, patients and tests. • One lab can not see and scan the sample of other. •  Report distribution is decentralized.

16. Adv. PHARMACY • Handwriting errors have reduced to a great extent. •  The system doesn’t allow packing of expired medicines. •  The system shows alert for allergies and drug interaction at the pharmacy as well. Disadv. PHARMACY A pharmacist cannot challenge the doctor’s prescription.

18. Adv. BILLING • Billing errors have been reduced greatly. • Control on pricing. • Option of reverse financial discharge is available. •  An order can be cancelled from the billing department only, once it has been executed.

19. Study Findings 15 9 8 7 6 6 6 7 8 15 9 6

20. Disagree 5.9% Neutral 17.6% Strongly Agree 17.6% Agree 58.8%

21. Rarely 3.9% VF 11.8% Sometimes 47.1% Frequently 37.3%

22. YES 31.4% NO 68.6%

24. 49.0% 41.2% 9.8%

26. Discussion • Unique registration number and episode creation. • The EPR is at the centre of patient management. • System well-equipped to show various important alerts. • No sample mixing is ensured by Labtrak and barcoding. • Certain features of TrakCare are not being capitalised upon fully. • No record in case a doctor acts upon an allergy alert shown by the system.

27. Recommendations • It is the doctor who needs to enter all the patient details and at each patient visit. • Brief training on TrakCare for every new employee. • There has to be a feature that can calculate mathematical equations in the system , this would be of great help in laboratories. • Since slow processing seems to be one of the major grouses that employees have with TrakCare, steps should be taken to speed up the system.

28. PACS (Picture Archiving and Communication System) implementation at SGRH : Process of vendor selection

29. Disagree 5.9% Strongly agree 17.6% Neutral 17.6% Agree 58.8%

30. Introduction • Sound HIS system; but the hospital did not have a Medical Image and archiving solution. • PACS has the ability to deliver timely and efficient access to images, interpretations, and related data. • Breaks down the physical and time barrier associated with traditional image retrieval, distribution, and display.

31. PACS • A Picture archiving and communication system is a medical imaging technology which provides economical storage of, and convenient access to, images from multiple modalities such as X-ray, CT, MRI, etc. on computers, within the hospital as well as in doctors clinics and homes.

32. Objective • To study the process of vendor selection for PACS at SGRH. • To determine the advantages of PACS for clinicians and the imaging departments.

33. Methodology • Interviews • Observation • People interviewed were- Head IT, Head medical informatics, FUJIFILM’s representatives, Head of radiology department. • The workflow of the radiology departments was observed.

34. Process of vendor selection • Preliminary demonstrations and discussions with various vendors • RFP prepared , had all technical and functional specifications • RFP was sent to 9 vendors. • Proposals received were compared, second RFP was then floated • An initial evaluation was done based on functionality providedand number of installations and support base in India • 4 vendors were excluded after the initial evaluation • A team of 4 experts went for site visits.

35. Each hospital was visited for about 4 hours. The hospital team was accompanied by a member of the PACS provider company. • A four page questionnaire was used to gather relevant information

36. Advantages For Imaging Department • Better radiologist reporting accuracy • Imaging data can be stored for lifetime at the hospital. • In MLC case, hospital will be able to print out fresh copies of the previous image as and when required

37. For clinicians • Clinicians themselves can alter image contrasts, brightness, window levels, magnification, etc. on the viewing computer, allowing tm to detect finer details • Different images of the patient to be viewed side-by-side • Patient’s images can be seen/accessed by the clinician from wherever he is, at whatever time • The orthopedic department can use its inbuilt computerisation (Trauma CAD) for advanced planning of hip replacements, deformity corrections etc • Neurosurgeons can use the inbuilt computerised measurement facilities to guide their stereotactic and robotic systems to that brain lesions can be operated upon with greater accuracy.

38. Cost savings • Patients can be issued with a whole series of x-rays, CT scans, MRIs, etc. on a single CD without having to print them • In the ICU ,images can be viewed via the IU doctors on their monitors without the need to print films daily. • Manpower requirement to carry films from one location to another will be reduced

39. Conclusion • Fuji ranked second place in RIS and third place in PACS, which is very rare. Fujifilm has been selling PACS in Indian market for 3years now (10+ years globally) • Other hospitals who also have Fujifilm PACS say that it has good functionality, professional approach , commendable support and services and seamless and quick integration with HIS.

40. Case Study:TYPES OF STICKERS AND BARCODING USED AT SGRH AND THEIR BENEFITS

41. Introduction • Whenever any new patient comes to SGRH : Unique registration number, episode creation. • Information is printed on to stickers , pasted on to the patient’s forms at various points in time. • Unique barcodes for each patient, visit and departments.

42. Methodology • Study design : Cross sectional, Descriptive • Study area : Sir Ganga Ram Hospital • Study population : SGRH employees at OPD Reg.,Front Office, Biochem and Microbiology labs, Nursing stations • Sampling design : Convenience. 25 people were interviewed • Data Collection tools and techniques : Interview

43. REGISTRATION STICKER

44. EPISODE STICKER

45. LABORATORY STICKER

47. Advantages of Barcoding and Stickers • Efficient bar-coding and sticker generation system reduces the chances of sample mixing. • Reduced time consumption at each step. • Important patient information is available in condensed form at all times. • Reduction in medication errors, increased accuracy.

48. Discussion • Proved to be a milestone in improving quality at SGRH • Reduces sample mixing, makes patient identification easy and saves time at each step.

49. References 1.http://www.lexic.us/definition-of/hospital_information_systems 2.http://www.sgrh.com/ 3.http://www.intersystems.com/trakcare/index.html 4.http://www.jbtdrc.org/Symposium/Topics/Role_hospital.htm 5.http://www.emrconsultant.com/education/hospital-information-systems 6.http://www.emeraldinsight.com/journals.htm?articleid=1728173 Vassilios P. Aggelidis, Prodromos D. Chatzoglou 7. http://www.ipedr.com/vol5/no2/45-H10139.pdf Indah MohdAmin et al 8.http://www.j.kdnc.org/index.php/j/article/view/73 Ayodele Cole Benson 9. http://medind.nic.in/haa/t01/i1/haat01i1p70.pdf Mohanty Rajesh, RanaSarosh D, KolaySaroj K 10.http://fkilp.iimb.ernet.in/pdf/Healthcare_Quality/Assessment_of_Quality_of_Health_Facilities_&_Services/Kumar&Gomes_study_of_HIS.pdf Praveen Kumar A, Gomes L.A 11. http://www.ncbi.nlm.nih.gov/pubmed/21078203 Krishnan A et al

50. Thank you