E –Hospital Management & Hospital Information Systems – Changing 1

Published Online May 2013 in MECS (http://www.mecs-press.org/)

E –Hospital Management & Hospital

Information Systems – Changing Trends
Premkumar Balaraman, Kalpana Kosalram
School of Management, SRM University, Vadapalani, Chennai 600026, INDIA
premkumar.b@vdp.srmuniv.ac.in,kalpax4@gmail.com

Abstract — The rapid growth in Information & Index Terms — Information & Communication
Communication Technology (ICT), and the power of Technology (ICT), Health Level Seven (HL7),
Internet has strongly impacted the business and service Healthcare Insurance Portability and Accountability Act
delivery models of today‘s global environment. (HIPAA), E
E-Hospital Management Systems provide the benefits of – hospital management solutions (E – HMS), Hospital
streamlined operations, enhanced administration & Information systems (HIS)
control, superior patient care, strict cost control and
improved profitability. Globally accepted health care
systems need to comply with Healthcare Insurance I. INTRODUCTION
Portability and Accountability Act (HIPAA) standards of
Hospital Information systems are in high demand to
the US and that has become the norm of the Healthcare
handle increasing population needs and also aids the
industry when it comes to medical records management
practicing doctors and hospital service and support staff
and patient information privacy. The study is focused on
with timely service and precision. There are varied
understanding the performance indicators of Hospital
metrics available to assess the performance of services
information systems (HIS), summarizing the latest
like hospital industry, and the successful implementation
commonly agreed standards and protocols like Health
and usage of Hospital information system forms a crucial
Level Seven (HL7) standards for mutual message
role. Hospital information systems are available in the
exchange, HIS components, etc… The study is
software market which in most cases needs to be
qualitative and descriptive in nature and most of the data
customized and in some cases HIS needs to be developed
is based on secondary sources of survey data. To arrive at
as a customized software based on specific hospital
a conclusive idea of the larger picture on E- Hospital
requirements (user requirements). The paper looks at
Management and Hospital information systems, existing
assessing and identifying the key components of E –
survey data and specific successful case studies of HIS
HMS as its needs and management varies across the
are considered in the study. With so many customized
globe. Also identification of the key performance
versions of E – hospital management solutions (E – HMS)
indicators of E – HMS / HIS is also attempted from a
and Hospital Information systems (HIS) available in the
benchmarking perspective.
market, a generic module wise version of E – Hospital
management system is charted out to give a clear 1.1 Objective of the study
understanding for researchers and industry experts. From  To identify the key performance indicators and
the specific successful case studies analyzed in the study, standards of E - Hospital Management (E –
the success factors and challenges faced in successful E- HMS) & Hospital Information Systems (HIS).
HMS implementation are highlighted. Some of the  To identify the key components of E - Hospital
mandatory standards like HIPAA are discussed in detail Management solutions.
for clarity on Healthcare system implementation
1.2 Need for E – Hospital Management & HIS
requirements.

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Hospital Services are needed on an emergency and

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 E –Hospital Management & Hospital Information Systems – Changing 3

daily basis and HIS plays a crucial role. Hospital services information processing and information storage
are customer and society sensitive and the quality of HIS subsystem of a hospital, whereby it is not just about
and service of hospital staff needs to be precise and of computer systems and networks and the computer-based
highest standards. Today‘s hi-tech Hospital services are application systems that are installed on them, but it is
predominantly provided by private players in the market about the information in a hospital as a whole.
at increased costs despite low cost competition by public HIS consist of different softwares that are integrated in
sector hospitals. OECD report (2012) finds that attempts order to capture data in specific sections of the hospital
to control costs by regulatory means, such as reducing [Garrido, Raymond, Jamieson, Liang and Wiesenthal
fees paid to healthcare providers and rationing user [2004:21-22]], handle the workflow of daily medical
access, have typically only been temporarily successful. services and also assist in managing financial,
E-Hospital Management System provides the benefits administrative and clinical data. From the various
of streamlined operations, enhanced administration & definitions of HIS, it is understood that HIS is a very
control, superior patient care, strict cost control and broad area as it encompasses services catering to varied
improved profitability. Due to business and legal departments and personnel of an hospital and finally
demands—like the Healthcare Insurance Portability and satisfying the patient care in its true sense. Hospital
Accountability Act (HIPAA) of the United States as a Information Systems (HISs) are supposed to make the
Global norm —healthcare organizations are fully right information and knowledge available to the right
realizing the urgency to integrate their businesses. people, in the right place, at the right time and in the right
Unfortunately, most of the health information systems are form.
still proprietary and often only serve one specific
department within a healthcare business. This represents IV E – HOSPITAL MANAGEMENT / HIS
a significant obstacle to business integration. STANDARDS & TECHNOLOGIES

The developments in technology and internet speed

II. RESEARCH METHODOLOGY
made services like Telemedicine a dream come true for
The study is qualitative and descriptive in nature and today‘s patient care needs. Telemedicine can be referred
most of the data is based on secondary sources of survey to as the provision of medical services from a distance
data. Such an approach is adopted in the study as the area [Wooton, Craig and Patterson, 2006:1]. This includes
of research is very broad and sources of data are also diagnosis, treatment and prevention of diseases. The
spread across multiple locations. To arrive at a conclusive types of telemedicine can be categorized as real-time or
idea of the larger picture on E- Hospital Management and pre-recorded telemedicine. Also the growing technology
Hospital information systems, analyzing the existing and varied solutions in the hospital management domain
survey data and specific successful case studies of HIS necessitated for the development of common protocols
would give a better result in finding the answers to the and standards at global level. Such standards and legal
research question framed. requirements are discussed in further sections.
III. DEFINITION OF HOSPITAL INFORMATION According to Belgium Federal Public Service – FPS
SYSTEM (HIS) report (2002), high quality of Data storage, data speed,
data exchange and networking for Hospital information
According to Paul R. Vegoda (1987), Hospital systems (HIS) is mandatory for efficient performance of
Information System (HIS) is defined as, ‗an integrated Hospital Information Systems (HIS). Especially data
information system which improves patient care by storage requirements of departments like radiology are
increasing the user‘s knowledge and reducing uncertainty very challenging.
allowing rational decisions to be made from the
4.1 3LGM2 – Modeling tool for HIS
information provided. Haux, Schmücker and Winter
(1996) view the hospital information system as the entire 3LGM2 (Three-layer Graph based meta model) is a
structured and in some countries already validated

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 5 E –Hospital Management & Hospital Information Systems – Changing

approach for modeling and analyzing HISs.‘3LGM2

combines a functional meta model with technical meta
models and is represented using the Unified Modeling
Language (UML)‘ (Winter, Brigl and Wendt., 2003). In a
study by Björn Schreiweis (2010) , on HIS modeling it
adopts the 3LGM2 model with three layers named
domain layer, logical tool layer and physical tool layer.
These layers represent different views on a HIS.
According to Hübner -Bloder et al., 2005, the domain
layer describes a hospital independently of its
implementation by its enterprise functions. The logical
Fig. 1 – HIPAA Privacy rule De – identification Methods
tool layer shows the application components. Application
components support enterprise or hospital functions 4.3 HL7 / RIM Development Framework
and ‘are responsible for processing, storage and
Health Level Seven (HL7) is one of several American
transportation of data. On the physical tool layer there ‘is
National Standards Institute (ANSI) accredited Standards
a set of physical data processing components‘ that
Developing Organizations, operating in the healthcare
are ‘used to realize the computer-based and the paper-
arena worldwide. ("Level Seven" refers to the highest
based application components‘
level of the International Standards Organization's (ISO)
4.2 HIPAA privacy guidelines for Medical Records and communications model for Open Systems
patient information. Interconnection (OSI) —the application level.) According
to Mauro Regio (2005), the HL7 vision is to create an
One of the key aspects of HIPAA guidelines which
infrastructure for interoperability in the healthcare
need to be complied with by all Hospital management
domain. HL7 uses the reference information model (RIM)
system implementing E – Health management systems of
to derive domain specific information models and refine
global standards is the privacy rule in HIPAA. The
them into HL7 message specifications. Traditionally
HIPAA Privacy Rule protects all "individually
engaged in modeling clinical and administrative data, the
identifiable health information" held or transmitted by a
most recent version, HL7 version 3.0, is extending its
covered entity or its business associate, in any form or
reach to various healthcare business domains such as
media, whether electronic, paper, or oral. The Privacy
pharmacy, medical devices, and imaging.
Rule calls this information "protected health information
For a given healthcare domain, an HL7 version 3
(PHI).
specification is based on the Reference Information
A detailed guidance manual on de – identification
Model (RIM), a common and underlying modeling
methods to be adopted for PHI content in Hospital
framework, and includes artifacts like: Use Case Models,
records and information systems management is given by
Information Models, Interaction Models, Message
U.S. Department of Health & Human Services (Bradley
Models, and Implementable Message Specifications.
Malin, 2010). The process of de-identification (refer
Leading software industry architects like Microsoft are a
figure 1), by which identifiers are removed from the
longstanding member of the healthcare development
health information, mitigates privacy risks to individuals
domain, involved with HL7 for ten years and a
and thereby supports the secondary use of data for
Healthcare Information and Management Systems
comparative effectiveness studies, policy assessment, life
Society (HIMSS) member since 2002. The Reference
sciences research, and other endeavors.
Information Model (RIM) (HL7, 2012) is the cornerstone
of the HL7 Version 3 development process. RIM is an
object model created as part of the Version 3
methodology, the RIM is a large, pictorial representation
of the HL7 clinical data (domains) and identifies the life

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 E –Hospital Management & Hospital Information Systems – Changing 5

cycle that a message or groups of related messages will • Communication by Laboratory Information
carry. But a summarized view of the basic components of System
RIM / HL7 is given in figure 2. • Registration of human resources and their
properties

(3) Financial Aspects:

• Efficient administration of finances
• Use and monitoring of medicines and
effectivity of the ordering process
• Expected and actual treatment costs are listed
and reported
• Automated representation of the needs of the
nursing staff
Fig. 2 – RIM / HL7 model
• Status analysis of bed occupancy and overall
V. E – HOSPITAL MANAGEMENT TASKS performance in the hospital information system
& FEATURES In the public sector domain, some of the successful e -
hospital management solutions include that of the, e-
To carve out a comprehensive E Hospital management
Hospital solution by National Informatics Center, India
/ Hospital information systems model, some of the
(NIC, 2013). It is a Hospital Management System that is
various E – Hospital management system tasks are
a workflow based ICT solution for Hospitals specifically
discussed and summarized in the context of the current
meant for the hospitals in Government Sector. This is a
study.
generic software which covers major functional areas like
The most important tasks in hospital information
patient care, laboratory services, work flow based
systems can be summarized as follows,
document/information exchange, human resource and
(PayamHomayounfar (2012)):
medical records management of a Hospital. It is a patient-
(1) Storage and monitoring of patient‘s condition: centric system rather than a series of add-ons to a
• Accurate and electronically stored medical financial system.
records of patients (e.g. drug allergies) are E Hospital management solution (E-HMS) is designed
provided for multispecialty hospitals, to cover a wide range of
• Visual and auditory warning systems are hospital administration and management processes. It is
generated in the event of abnormal test results or an integrated end-to-end Hospital Management System
other important data that provides relevant information across the hospital to
• Time intervals and / or testing periods for tests support effective decision making for patient care,
on patients to be specified hospital administration and critical financial accounting,
• Data Processing and analysis for statistical in a seamless flow. Some of the salient features of this e-
purposes and research oriented purposes Hospital solution of NIC, India are summarized in table
1.
(2) Management and Data Flow:
• Support automated patient data transfers
between departments and institutions
• Enable graphic or digitized diagnostic images
from the hospital database based on the
integrated retrieval system
• Digital signatures, in order to create internal
orders electronically

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 5 E –Hospital Management & Hospital Information Systems – Changing

Table 1. NIC, India - E – Hospital Management Solution Table 2 – Fujisoft HIS Modules
Special Features

S.No Features S
.
1 ISO / IEC 9126 Certified Module Name Function
N
2 Based on HDF(HL7 Development Framework) o

Hospital Management Support

3 Unicode based Indian Multilingual Support FSHosPAck
1 System - Daily data handling
4 Vocabulary- ICD-9, LOINC etc. Management
and management
Comprehensive Reporting on various
5 Hospital
customizable parameters
Comprehensiv
Total goods physical
Comprehensive Role based Access control and e Physical
6 2 distribution management –
Security distribution
purchase costs management
7 Data Security and Privacy Management
System
8 Audit logging of transactions
Hospital Specific incident
Powerful Search facility and tracking of patient 3 FS - Incident
10 reporting system
history
Cash
Complete Sales / Cash collection
11 Touch Screen Kiosk interface 4 Collection
management
12 Available on Linux and Windows platform Solution
SOURCE: http://tsu.trp.nic.in/ehospital/ 6.2 Challenges in implementation of E – Hospital
Solutions / HIS
VI. CASE: FUJISOFT – HIS
A ―Multi-vendor‖ management system or system
Fujisoft is a leading software product company based
integrator is needed which can select and combine
in Japan. With its rich legacy in developing customized
suitable products from those of various manufacturers in
software right from the the 1970s, it provides one of the
accordance with the needs of each E – Hospital
world‘s best Hospital management solutions. According
Management system (customer). Technology inclusion,
to Fujisoft (2012), the management environment of
exclusion and hybrid combination decision are crucial to
hospitals is entering into a phase of major change. For
success of latest E – Hospital management solutions.
example, new Hospital Accounting Regulations have
Such efficient and precise decision in choice of
revised the system of financial statements (including cash
technology and E – hospital solution management is
flow statements) and hospitals are converting to a
possible only based on know-how and technological
Medical Inclusive Payment System based on DPC
excellence accumulated through longstanding
(Diagnosis Procedure Combination). Furthermore,
engagements in system design and construction in the
securing management resources by means of a new fund
medical area.
procurement system (such as the securitization of medical
treatment fees and the issuance of hospital bonds) is VII. HIS - SUCCESS FACTORS
being adopted.
According to Garrido et al., (2004), some of the
6.1 Fujisoft HIS modules success factors of HIS deployment are discussed in
The various modules of Fujisoft Hospital solutions can further sections.
be summarized as below table 2. The success of the HIS deployment depends on a
number of critical factors. First, the commitment of

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senior leadership to implement clear targets and And wasteful duplication has been eliminated because
expectations is crucial to the success of the business case. doctors can see what tests have been done already and
Changes to operational processes, job roles, and access results immediately.
organizational culture will require resources and the Digitization has also been lauded to improved safety.
strong and consistent support of leadership. All levels of Bumrungrad has an e-prescription system that helps to
management should be clearly informed and accountable eliminate errors from illegible handwriting, and allergy
for the key actions that need to be undertaken to alerts that warn doctors against medications unsuitable
maximize system benefits. for patients and can suggest alternatives based on the
Second, timely implementation of the inpatient symptoms observed.
information system is imperative because the consequent
impact of delays on benefits realization is costly. VIII. SUMMARY
Third, because the majority of annual expenses are
According to the Health Evidence report of the WHO
from labor costs, senior management will need to partner
(Shaw, 2003) it recommends that, there are in principle
with labor to take advantage of the efficiencies
five different types of measurement of hospital
introduced to the workflow by the HIS. Fourth, internal
performance, as below:
policies must require physicians and frontline staff to
• Regulatory inspection
comprehensively and accurately codify all hospital
• Surveys of consumers‘ experiences
discharges and procedures. Finally, workflows must be
• Third-party assessments
redesigned to incorporate and exploit the system‘s
• Statistical indicators
functionality.
• Internal assessments.
7.1 Non-Financial Benefits
Also, based on the above case studies and various
There are many benefits that are less tangible. Though deliberations on E – Hospital Management Solutions and
non-financial, they are no less important to an overall HIS, the various components of an E – Hospital
investment decision. These include mission critical management solution are detailed below for easier
benefits such as quality of care, patient safety, and understanding of future researchers and industry experts.
member service enhancement. Improved communication
8.1 E – HMS / HIS - Basic Modules
and expedited decision-making not only increase
efficiency but also help to reduce errors. Likewise, the 1. Patient Registration and Appointment Scheduling
ready availability of patient information will prove Module - The Registration module is an integrated patient
extremely beneficial to assure continuity of care during management system, which captures complete and
the patient‘s transitions from one care setting to another. relevant patient information. The system automates the
patient administration functions to have better and
7.2 CASE: Successful E – Hospital Management -
efficient patient care process.
Bumrungrad International Hospital, Thailand.
2. Outpatient Management Module - The Outpatient
Alice Kok (2009) reports, Thailand‘s Bumrungrad module serves as an entry point to schedule an
International Hospital has digitised as many aspects of appointment with the Hospital Resident Doctor or
hospital work as it can—enabling it to more than double Consultant Doctor for Medical Consultations and
the number of patients it can handle each day, increase diagnosis. This module supports doctors to take better
safety and cut its patients‘ bills. and timely consultation decisions by providing instant
Bill payment, human resources, record keeping and access to comprehensive patient information.
inventory management are now all done electronically,
3. Patient Billing & Insurance Module - The Patient
allowing the hospital‘s staff to get more work done.
Billing module handles all types of billing for long-term
Doctors no longer wait around for patient records, such
care. This module facilitates cashier and billing
as X-ray or blood test results, to be delivered by hand.
operations for different categories of patients like

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 5 E –Hospital Management & Hospital Information Systems – Changing

Outpatient, Inpatient and Referral. It provides automatic 4. Electronic Medical Record (EMR) - The EMR Module
posting of charges related to different services like bed is a fully integrated knowledge repository that caters to
charges, lab tests conducted, medicines issued, Medical and clinical records of patients in the hospital.
consultant's fee, food, beverage and telephone charges etc. The system supports medical professionals of various
This module provides for credit partly billing and can be departments of the hospital with relevant information like
seamlessly integrated with the Financial Accounting medical examinations, diagnoses, treatment histories, test
Module. results and so on. The module provides access to critical
4. Services Module - The service module provides for and complete patient data that leads to high quality cost
effectively managing all the services available in the effective and efficient patient care. The EMR has the
hospital and the charges for each of these services are following features.
securely entered and handled. 5. Dietary Module - The dietary module in the hospital
5. User Manager Module (security workflow) - The User management system software is designed to assist the
Manager module basically deals with security through hospital kitchen in providing meals to inpatients as per
controlling the access to the information available in the the instructions of the dietician.
application. Any user associated with a user group can 6. House Keeping Module - Housekeeping in any
access only those screens for which the user group has hospital is defined as the provision for a clean,
rights. It also deals with the System Related Activity like comfortable and safe environment in the hospital for
User Monitor, Creating User Group Master, User Master patients and general public. Housekeeping in the hospital
and view the User Group Lookup of employee database, management system software involves the maintenance
Maintenance of company documents, User defined error of beds in wards, rooms, cubicles. The various
message, Generating Daily Statistical Summary. housekeeping tasks can be planned, assigned and tracked
8.2 E – HMS / HIS - Optional Modules in the module.

1. Pharmacy Module - Pharmacy module deals with the 7. Nursing Module - Nursing module is a tool provided in

automation of general workflow and administration the hospital management system software to the nurses to

management process of a pharmacy. The pharmacy manage their routine tasks with the objective of

module is equipped with bar coding facility, which makes improving patient care. It is tightly integrated with the

the delivery of medical items to the patient more Inpatient module and other clinical modules for smooth

efficient. flow of information.

2. Laboratory Information System - The Laboratory 8. Emergency Management - Emergency module in the

module automates the investigation request and the hospital management system software allows fast

process involved in delivering the results to the registration of patients by the capture of key and very

concerned department/doctor of the hospital. Laboratory specific registration details such as demographic

module starts with receiving the online request from information, keeping in mind the critically of this

doctors and also allows laboratory personnel to generate function. This module also collects information related to

requests. The Laboratory module supports to perform Medico Legal Cases (MLC) which is subsequently used

various tests under the following disciplines: for reporting to local authorities.

Biochemistry, Cytology, Hematology, Microbiology, 9. Machine Maintenance - The machine or equipment

Serology, Neurology and Radiology. maintenance module in the hospital management system

3. Radiology Management Module - Radiology module software facilitates breakdown processing and preventive

caters to services such as X-ray, Scanning, Ultra sound maintenance scheduling and recording.

etc. Scheduling of Radiology resources is possible. The 10. CSSD - CSSD, or Central Sterile Supply Department
system stores all the result details of various tests and is an important and crucial function of most of the mid-
makes a Report based on the Test Results. size and large hospitals. In certain countries, CSSD

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 E –Hospital Management & Hospital Information Systems – Changing 5

is even mandatory to meet with the government

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