Management Information System for Process-oriented Health Care

Introduction
The prevention, treatment, and management of illness and the
preservation of mental and physical well-being through the services offered by the
medical and allied health professions.

The term "health care system" refers to a country's system of delivering services for the
prevention and treatment of disease and for the promotion of physical and mental well-
being. Of particular interest to a health care system is how medical care is organized,
financed, and delivered. The organization of care refers to such issues as who gives
care (for example, primary care physicians, specialist physicians, nurses, and
alternative practitioners) and whether they are practicing as individuals, in small groups,
in large groups, or in massive corporate organizations. The financing of care involves
who pays for medical services (for example, self-pay, private insurance, Medicare, or
Medicaid) and how much money is spent on medical care. The delivery of care refers to
how and where medical services are provided (for example, in hospitals, doctors'
offices, or various types of outpatiant clinics; and in rural, urban, or suburban locations).

Today's health care organizations are both highly specialized and structured to rapidly
adapt to changes in social and financial environments. The more complex the
organizations become, however, the more composite is the need for analysis and
decision support methods for organizational problem-solving.

One of the greatest challenges that health care organizations face at present is the
establishment of MIS that are flexible and that have sufficient expressiveness to handle
highly complex environments. In these settings, managers are seldom able to choose a
single method to handle prevalent problems. To analyze health care systems,
consequently, managers require I.S that supply data for sets of different analysis
methods and tools. Today,In punjab, healthcare providers have, in response to
escalating costs, commonly adopted process-oriented organizational model. One
problem with this approach is that a health care organization is distributed over multiple
organizational levels. Such as county councils, hospitals and clinics, and that clinical
practitioners and other staff members in any situation have different duties and
demands with regard to collecting and reporting data, depending on which
organizational level care staff address. The aim of this study is to develop a conceptual
model of a management information system that suits process-oriented health care
organizations. Health care managers increasingly seek opportunities in the field of HIS
to enhance their potential to furnish health care more effectively and efficiently, and to
improve the quality of services provided.When developing HIS for process-oriented
health care organizations, attention has however to be paid to the integrated use of the
information at the hospital,process and functional unit levels.One known difficulty within
I.S is finding a connection between the resources use and actual cost. Hence, the
systems need to support data collection from operational processes and supply health-
service management with information about how resources invested in the
organizations have been used. One solution to problems with primary data collection for
MIS is using pervasive networked devices and extracts from computerized patient
records. In this manner, data can be unobtrusively collected to supply health care
management with information about present medical outcomes, costs, and the status of
patient satisfaction.To take advantage of the large amounts of unprocessed data, the
organizations also need an integrated I.S for rapid data structuring and analysis and for
the distribution of the resulting information to manager and care provider.

Strategy

The study was performed at a county hospital in punjab(Allied hospital).The

hospital had 8 clinics and 856 employees. For quality control, the hospital adopted a
broad quality program in 1996, based on Total Quality Management (TQM) and a Plan-
Do-Check-Act cycle. For cost control, the Balanced Scorecard was introduced in 2000.
The primary study site was a functional unit, the pediatric clinic. The clinic cooperated
with maternity wards and Child Health Centers (CHCs) throughout the county(punjab).
The clinic was also involved in a network of specialist clinics in punjab for an exchange
of knowledge and experience. At the time of the study (2000), the pediatric clinic
employed 12 senior physicians, 21 physicians, 91 nurses, 77 pediatric nurses
(specialized nurse’s aides), and 13 secretaries. During the time of the study, the
pediatric clinic supplied approximately 16,000 bed-days to inpatients, performed 5,000
scheduled surgical in-National hospital et al.1009 terventions, and managed 6,000
emergency room visits by children. The clinic had the responsibility for one surgery and
three wards each with a physician responsible for medical matters and a nurse as ward
manager. The internal strategic objectives of the clinic were to have the patient in focus
and to support co-determination. The management group consisted of six senior
physicians, seven nurses and one secretary, representing the clinic and the wards.

Date Collection and Analysis

Data collection and analysis were based on a qualitative research strategy, using case
studies for the collection of primary data. In a case study, it has been suggested that it
is important for the researcher to have contextual data available to understand the
setting for the case. The primary type of data in this mode of analysis should be the
qualitative, and the primary level of analysis should be holistic. Each case is, thus, seen
as a bounded system. In this study, the primary data from two case studies were used
to develop a MIS model for process-oriented health care organizations. The first study
addressed the information requirements of health care managers, while the second
study focused on organizational and work activities. In both case studies, data was
collected from documents and archives, interviews, observations and focus groups. It
has been suggested as desirable in interpretative studies to preserve a considerable
degree of openness to field data, and a willingness to modify initial assumptions and
theories. These approach results in an iterative process of data collection and analysis,
with initial theories being expanded, revised or abandoned altogether. Therefore, the
data was first preliminarily categorized. Thereafter, the health care management
activities were modeled. Finally, the data were structured to reports that were sent to
participants in the case studies for

reflection and critique. The reports supported a feedback loop for refining the findings in
a process between researchers and practitioners.
Results

System-organization interface
The model MIS is interfaced to the process-oriented health care organization at three
levels.

Hospital management
Hospital management focussed on supplying emergency and specialist medical care
and rehabilitation services to the population at a county level. The county council
formally required that hospital management controlled and reported on service
production with regard to quality and cost. The objective was to increase cost-efficiency
ratios and patient empowerment. As a result, hospital management requested
information about the use of resources and the quality of health care from the hospital
organization. Data requested: Cost and quality data delivered from functional units.
Information delivered: Specification of allocated resources, quality indicator profiles and
templates for cost summaries to functional units.

MIS module: Healthcare Control System. Hospital management was in need of a

system that would support control over quality and cost. Information systems that can
support methods, such as TQM and the Balanced Scorecard are therefore suitable for
this level of management. To obtain control over cost and quality, hospital management
requested data from the functional units, but hospital management first had to define
which data the functional units were to produce.

Process unit management

Process unit management focussed on the development and maintenance of a level of
high quality in the medical and nursing care processes. The process unit had the
responsibility for at

least one PNGP, including documentation and quality control operations. The size of the
units differed, but they always included at least one physician, one nurse and one
secretary.
Information requested: Medical and nursing quality level directives from the functional
unit management. Medical and nursing data collection templates from the functional unit
management. Information produced: Medical and nursing quality data to the functional
unit management. Best practice guidelines and deci-Organizational output Management
level.

The MIS and the health care management

Hospital

management

Functional unit

management

MIS module: Service Quality control system. Management of the process units was in
need of an information system that could extract data from and support decision-making
in medical and nursing care.

Functional unit management

Hospital management provided the functional units with a specification of resources

available and methods for planning, over time, the amount of these resources the units
could spend. Hence, the cost control tools that were used by hospital management
were distributed as tools of analysis even to the functional unit management. Functional
unit management comprised both managers of the clinic and ward managers. Clinic
management organized monitoring the resources invested in the clinic and the ward
managers managed the exchange of information at the wards.

Information requested: Specification of resource allocation and templates for

expenditure reports from hospital management. Templates for collection of patient
satisfaction and staff work

satisfaction data from hospital management.

Data produced: Resource spending, patient satisfaction and staff work satisfaction data
to hospital management. Medical and nursing quality level directives sent to process
managers.

System requirements: Functional unit management was in need of data concerning the
perception of patients and staff of the services provided at the unit. Functional unit
management also needed to put its expenditures in relation to resources used. This
level of management was therefore mainly in need of data collection, storage and
access tools. It needed data from clinical activities, but not at an individual and
contextual level. Instead, it needed systems that could provide data for use at a
composite level, e.g about how much labor hours and financial and human resources
were used in specific care activities.

Management information system architecture

To control service delivery, the management units in the process-oriented health care
organizations need data from three areas:

(1) the medical and nursing care of patients

(2) patient flows

(3) Use of human and material resources.

Even though the management units can share access to a common data warehouse,
the requirements on data analysis and presentation are considerably
different.Correspondingly, data collected in daily work routines from the health care
organization can be shared, but primary data must be converted into information that is
useful for health care managers. Data collection should preferably be located in places
where data are available in ordinary health care activities For instance, networked
devices can be used to register the use of pharmaceuticals.Smart devices can also be
connected to equipment to keep track of their use, and materials storage and use (i.e.,
diapers, sheets, etc.) can be traced, for instance, with bar-code systems. Furthermore,
patients and health care staff can be registered by using smart cards when they arrive
and leave the health care setting. However, for data collection from the clinical setting,
the computerized patient record (CPR) is the natural central resource. Data that are
documented in the records can be used to monitor the clinical actions that have been
performed. The CPR can also provide data about work activities that have accrued at
the health care organization. Such data from a single patient is of little interest. Instead
it is useful to analyze generalized data, for example, the number of radiology
investigations that have been conducted on leukemia patients. The purpose of the data
warehouse is to maintain the data that have been collected from the different data
sources. The application interface and the application are those parts of the MIS that
health care managers interact with and are those parts that users think of as the MIS.
The applications therefore must support health care managers’ use of information and
must supply the right information from the databases to the appropriate health care
managers. Also, the applications must be able to support the specific analysis methods,
tools and data formats required by the actual organizational analysis procedures, such
as the Balance Scorecard or quality assurance methods.

Health care Management Information System

Little attention has beenpaid to how integrated administrative, financial and clinical
systems could be configured to optimally support process-oriented health care
organizations. In other words, the organizational interface of these systems has been
neglected. To address this shortcoming, the aim of this study was to develop a
conceptual model of a management information system for process-oriented health care
organizations. Results show, first, that the different management levels in process-
oriented health care organizations require the same type of primary data, but presented
in different ways. Second, results show how a management

information system in the process-oriented health care setting can follow the structure
and practice activities of the latter. These observations are relevant for system
developers attempting to develop management information systems, including
pervasive computing components, for future health care organizations. Moreover, CPRs
and other devices can be used for collecting management data directly where and when
the activities take place, but the data is only useful if available in the analysis tools used
by health care management. Therefore, future studies must also address the methods
and tools that are required to refine the primary data into information that is appropriate
for the organizational analysis and decision-making tools . In studies that evaluate
success factors for hospital-wide clinical computing systems, items such as coded
laboratory results and problem lists have been identified as important, mainly due to that
these form a basis for decision support applications. It is noteworthy that even though
computerized ordering systems, for instance, are mentioned, the degree of fit between
organizational models and information system models is not identified as a success
factor. There is clearly a need for systems that optimize clinical workflow on the one
hand, and systems that support maintenance of equipment and supplies, on the other.
Nevertheless, the systems will deliver optimal organizational value only if they support
an integrated organizational model and business plan. The results of this study can be
seen as the basis for developing such integrated models at local levels. In these efforts,
specific local strategies to achieve this integration must be based on the needs, goals
and cultures of each particular institution.

Discussion
The areas in which information systems are expected to contribute to enhanced delivery
of care, range from access to medical knowledge bases and improved patient and
clinician communication to a reduction of medical errors. Although information systems
have traditionally been most extensively used in administrative and financial transaction,
little attention has been paid to how integrated administrative, financial and clinical
systems could be configured to optimally support process-oriented health care
organizations. In other words, the organizational interface of these systems has been
neglected. To address this shortcoming, the aim of this study was to develop a
conceptual model of a management information system for process-oriented health care
organizations. Results show, first, that the different management levels in process-
oriented health care organizations require the same type of primary data, but presented
in different ways. Second, results show how a management information system in the
process-oriented health care setting can follow the structure and practice activities of
the latter. These observations are relevant for system developers attempting to develop
management information systems,including pervasive computing components, for future
health care organizations. This study has several limitations that have to be taken into
regard when interpreting the results. The model only describes the degree to which
systems and technology are integrated with each other and with the organizational and
business models within process-oriented health care organizations. Future studies need
to address the external interfaces, e.g., between management information systems,
consumers and external institutional stakeholders.

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