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IPA/2012/283-805 (EC); 00080065 (UNOPS) HIS Implementation Guide EU-IHIS, Šumat

IPA/2012/283-805 (EC); 00080065 (UNOPS) HIS Implementation Guide EU-IHIS, Šumatovačka 78-80, Beograd, Serbia, +381 11 2449 565 1/11 HIS Implementation Guide Introduction The main goal of the Integrated Health Information System (EU-IHIS) Project is to implement and integrate hospital information systems (HIS) in 19 beneficiary hospitals and link these systems with the unique, standardized Electronic Health Record (EHR) system, which would lead to increased efficiency and improved quality of patient centred health care. The EU-IHIS Project is being carried out under the leadership of the Ministry of Health of the Republic of Serbia and financed by the Delegation of the European Union to the Republic of Serbia. World Health Organization (WHO) for Europe is in charge of the project implementation through the WHO Country office in Serbia with administrative support of the UN Office for Project Services (UNOPS). HIS implementation in hospitals covered by the project is designed to provide a rounded set of elements that allow the improvement of work process of the vast majority of health professionals, and to enable users to obtain a functional entirety that will improve the quality of hospital business. The implemented solution will improve the internal communication and availability of information, allow the avoidance of multiple entry or transcription, data entry at the source with appropriate coding and better track of items invoiced to the health insurance. The restrictions of project scope were also considered, as well as the need to avoid dealing with the particular subsystems that are used in some hospitals (mostly diagnostic and non-medical ones). Certainly, the possibility to subsequently cover these specifics, beyond the EU-IHIS project, is left open. Information systems planned to be implemented by the EU-IHIS project in hospitals are two accredited software, with source code owned by the Ministry of Health as result of previous projects. Manufacturers of these software are ComTrade (HIS1) and Bit Projekt (HIS2), companies that provide upgrade, support and maintenance services. It is assumed that both hardware and LAN network existing in the beneficiary hospitals, that were provided either through the IPA 2008 HIS Project or through other means, are adequate for the deployment of one of the HIS software. By implementing the hospital information system, the equipment and network infrastructure provided to hospitals through the IPA 2008 HIS Project will be put into full operation. Hospital Information System Why Healthcare - Hospital Information System? • Data is entered at the source. • All data are centralized in one place. • Allows quick finding of information on the patient, the doctor, the diagnosis. • Allows easy browsing of patient history. • Allows easy monitoring of medicines and materials expenditure. • Reduces the volume of documentations kept on paper and retains only what is required by the law. • Raises the level of patient care. IPA/2012/283-805 (EC); 00080065 (UNOPS) HIS Implementation Guide EU-IHIS, Šumatovačka 78-80, Beograd, Serbia, +381 11 2449 565 2/11 • Shortens the time required to collect the information needed for important decision making. • Increases efficiency and effectiveness in work. Why HIS1 and HIS2? They are: • Standardized and certificated by the Ministry of Health of the Republic of Serbia, • Used in more than 20 hospitals, • Upgradable according to the needs and requirements of users. The main goal of HIS is to provide the best possible support to the treatment of patient and concomitant administration by electronic data processing. HIS will encompass following functionalities that will enable automation of the treatment process that follows the patient flow through the health care institution: • Scheduling and initiating specialist-consultative examination including the verification and recording of patient's insurance status, with possibility to choose a doctor and available date, define types of medical examinations, doctors’ working hours and scheduling in outpatient rooms. • Admission of patients to inpatient treatment, referral to departments, and discharge from the inpatient department, possibility to print anamnesis, matriculation list and hospitalization report. • Keeping electronic medical records with a formed structure of printable documents, in accordance with the law (specialist consultative examinations, admission and discharge list, medical history, decursus morbidi, surgical operation report, discharge summary, treatment invoice).Possibility to define document templates. • Insight into the history of diagnoses and chronic diseases of patients and access to a complete history of patient's treatment, ICD-10 classification used for coding of diagnoses. • Prescription of therapy with use of the drug classification system, with dosing and form of drug administration. • Recording of therapy administered to the patient in the inpatient and outpatient department with a complete overview of the history of proscribed and provided therapy, with the ability to export data on drug consumption in predefined format. • Monitoring of expenditures in departments and the ability to produce reports on expenditures in a predefined format, as support to the work of departmental pharmacies. • Importing of all the NHIF code lists into the system. Mapping of internal code lists of medical services, drugs, medical supplies and the diagnosis on the NHIF code lists. • Distributed data entry for electronic invoicing to the NHIF at all points where health care services, supplies and drugs are provided to the patient. The possibility of generating a centralized electronic invoice (in XML format) with integrated validation system, as well as the ability to export collected data in standard XML format, for possible imports into the special software for invoicing. • Statistical reporting with large number of general and statutory reports, which provide an insight into the entered data for a given period of time, by various criteria. • Ensured data security through assigning a set of roles for each user with specified rights on data access and actions in the system. IPA/2012/283-805 (EC); 00080065 (UNOPS) HIS Implementation Guide EU-IHIS, Šumatovačka 78-80, Beograd, Serbia, +381 11 2449 565 3/11 Expected benefits of the HIS implementation in hospitals are: • Better quality of patient care, • improvement of the efficiency of hospital management , • Improvement in information quality, • Reduction in operating costs. Challenges and Success Factors In order to implement successfully the new HIS, it is necessary to conduct change management process that will help hospitals in preparing its organization for the usage of new tools and working environment. The factors that influence mostly the successfulness of HIS implementation are in the direct or indirect relation with the change management, pointing out to the necessity of setting up the effective communication channels and the vision for change, among both hospital management and staff. Two factors are involved in HIS implementation through change management process: social and technical factors. The relationship between the technical and social factors is determined by four components: structure, people, technology and processes. Although each of the four components can result in success or failure of the HIS implementation, social factors are more crucial than the technical ones, as people play the vital role in the success or failure of any change process. The implementation of HIS is very complex, intense in terms of dedicated work required and challenging. Thus, it is important that risks are identified, understood, and managed. Also, it is important that the change management plan include: • Good practices, deriving from the previous projects of HIS implementation in healthcare institutions; • Preparatory activities related to challenges associated with the acceptance of the system by end users. Based on the socio-technical approach, key factors to be addressed during the HIS implementation, are: • Leadership: Strong leadership in support of the HIS implementation is crucial in order for implementation to be successful and must ensure strong support for the change. Dedication from the top-level management is one of the most important success factors. Certain obstacles have to be expected to arise during the implementation process. It is necessary for the health management to deal with the overcoming of these obstacles with care and efficiency. It is of outmost importance to endure in these efforts and to provide motivation for all participants in the implementation process. Messages coming from the top are crucial for the success of the implementation. It is necessary to harmonize the additional time needed for training and initial usage of the system with regular obligations of staff, while clearly emphasizing that these activities, related to HIS, represent the integral part of their duties. IPA/2012/283-805 (EC); 00080065 (UNOPS) HIS Implementation Guide EU-IHIS, Šumatovačka 78-80, Beograd, Serbia, +381 11 2449 565 4/11 The concerns of the care providers who use the systems must be respected and considered throughout the transitional period, before moving to the production environment. For example, in case that there are restrictions related to the infrastructure and additional expectations from users, hospital team together with the implementation team should make a conscious effort to find opportunities to use existing functionality in the system to run or complete the specific business process. Management should promote the use of the system in timely manner, in order to avoid problems related to the lack of information on HIS implementation and overcome the resistance of end-users. The level of reluctance by staff is expected to rise proportionally with uploads/Sante/ his-implementation-guide.pdf