Health Informatics Practical

Attachment
outline
Adare General Hospital
Challenges & possible solutions on EMR implementation
IMPLEMENTATION OF DHIS2
Adare General Hospital
• Observations
1. Tena-care software
2. Bit-care software
3. Bahmni software
Registration
For registration purpose both bit-care and bahmni are utilized.
Data collected on the registration are demographic information.
Now they are using Bahmni software for the registration purpose.
Triage
• After registration, patients undergo an initial assessment by a triage
nurse or healthcare professional.
• The patient's vital signs, symptoms, and chief complaint are evaluated
in order to know where to assign based on the health status of the
patient.
Emergency
• The data from the central triage is used for decision to which
department the patient should go next.
• Then the emergency department staffs check the history of the
patient, write the chief compliant, diagnosis that was made,
consultation they underwent and order prescribed and they send
these information to the financing department for billing services.
General OPD
• The GOPD play a vital role as screening OPD to triage patients who
require secondary or tertiary care, refer them to appropriate OPD and
manage the ones that do not need such referral.
• Following the selection of the required test, the physician proceeds to
save the order.
• Upon saving, the order is promptly transmitted to the laboratory,
radiology or Pharmacy department, where the designated test is
conducted or receive the prescribed medication. Subsequently, the
results are relayed back to the physician for review and analysis.
Laboratory department
• When the doctor requests a laboratory test and saves it, the order is
promptly sent to the medical laboratory department.
• The lab technician then receives the specific order from the physician
and carries it out.
• Once the results are obtained, they are sent to the ordering physician.
Cont…
• If the patient wishes to receive a hard copy of the report or has been
directed to have it interpreted at another diagnostic center, it can be
printed.
radiology department
• The procedure is similar for the radiology department as it is for the
laboratory department.
• The doctor at the OPD will send a test request to the radiology
department by selecting from various options available in the
software.
• Subsequently, the orders specified by the physician for a particular
patient's tests within the radiology department are visible on the
dashboard of the radiology specialists.
Cont…
• And the MRT will run the test and use the Radiant DICOM Viewer which
is a software application that is used to view and manipulate medical
images in DICOM format.
• DICOM stands for Digital Imaging and Communications in Medicine,
which is the standard format used for medical images such as X-rays, CT
scans, and MRI scans.
• The Radiant DICOM Viewer allows users to open and view DICOM
images from various sources such as CDs, USB drives, and PACS (Picture
Archiving and Communication System) servers.
• The software supports a wide range of DICOM image types including
grayscale, color, and multi-frame images.
Pharmacy department
• Dagu is an inventory management system designed to manage
daily transactions at service delivery points.
• It provides a systematic recordkeeping system for managing
health commodities and facilitates the use of standard
operating logistics procedures.
• It also helps store and generate timely stock reports for
decision-making.
 The invoice
feature is used
for creating and
managing
invoices for the
products or
services
provided by a
business.
 The inventory
feature is used for
managing and
tracking the stock
of products or
materials that a
business holds.
Receipt feature
IT department
• On the IT department we have tried to see the networking system
and infrastructure, computer system, and the health information
system in the facility.
• Network system and infrastructure
• Adare hospital have a Local Area Network (LAN) inside there was a
RAC which consists servers.
• The servers inside use RAID 3 for backup system. it is a type of data
storage system that uses striping with dedicated parity.
• In this system, data is divided into blocks and each block is written to
a different disk in the array.
Cont…
• If we are talking about networking the most familiar name could be a
switch.
• They use a KVM switch (keyboard, video, and mouse switch) which is
a device that allows network administrators to control multiple
servers or computers from a single console.
• The administrator can then use the keyboard, mouse, and monitor to
control any of the connected servers or computers.
• The server in which the Bahmni software is installed runs on Ubuntu
Linux Operating System (OS) which is a popular operating system
choice for server deployment due to its stability, security, and ease of
use.
• And there is another server which run by Windows server some
advantages of using windows server.
• They also have an internet connection that is subscribed from an ISP
(internet Service Provider) which comes on fiber cable for the matter
of speed and greater efficiency.
Challenges & possible solutions on EMR implementation
Challenges Possible solutions
• lack of compatibility between the • Development of a unified single software
various systems being used, leading to containing all the necessary tools.
significant inconsistencies. • Give the hospital all staffs that are
• lack of appropriate space and connected to the utilization of the
ventilation required for the server and software adequate training.
the working staffs. • Providing the appropriate space that is
required and ventilation required for the
• lack of training of healthcare servers to run.
professionals to adequately know and
utilize the deployed system • Providing the hospital with equipment
needed to provide the nursing care
• Network problems causing the system inpatients like tablet for taking of
to go down since it is a web based progress note
system
IMPLEMENTATION OF DHIS2
• At Adare Hospital, planning is conducted using the guidelines
recommended by the FMOH.
• The upcoming year's key performance is strategized based on the
previous year's report serving as a foundation. Planning involves
increasing by 10% from the previous year if there is a positive
outcome for the key performance indicator, or decreasing by 50%
from the previous year's annual report if the outcome is negative.
• They get reports from each department by sending the manual that
have similar format in relation to their department in a dhis2 for each
department.
Cont…
• data value or a data captured in DHIS 2 needs at least three
dimensions that answer three questions:
• Where(Organization Units)
• When(Periods)
• What(Data Elements )
Below is a DHIS2 demonstration
Cont…
• DATA ENTRY
• The Data Entry app is where you manually enter aggregated data in
DHIS2. You register data for an organization unit, a period, and a set of
data elements (data set) at a time.
• ROUTINE DATA ENTRY: is the process of entering and recording routine
health data into the DHIS2 platform. Which means it is an entry of a
regularly and systematically collected of data on a routine basis.
• DISEASE REGISTRATION: enables systematic collection, management,
and analysis of disease related data to support effective disease
surveillance, response planning, and public health intervention.
Cont…
• Custom Data Report : in DHIS2 it allows users to generate reports
based on the data stored in the system. It provides a way to extract
and present data from DHIS2 without performing any calculations or
analysis within the app itself.
• Data Analysis in DHIS2 done by:
1. Pivot Table
2. Data Visualizer
1. Pivot Table
in DHIS2, a pivot table is a powerful tool for analysing and visualizing
data. This app allows to aggregate and summarize data from different
data elements,
indicators,
dimensions, and periods in a tabular format.
Cont…
2. Data Visualizer
• is a powerful tool that allows users to create various types of
visualizations. This app allow us to choose the methodology that align
with our data.
Challenges faced during implementation
• The utilization of ICD 11 codes for the most frequently reported
diseases.
• Department may submit incomplete and inconsistent data
• Departments may not submit their reports in a timely manner.
• Integrating data from different departments into a cohesive and
comprehensive
• Ensuring the quality and accuracy of the data received.
Possible solutions
• Give appropriate training for the Physicians and healthcare providers
• Create awareness about data quality in different departments
• Implementing consistent EMR reporting system
 Alatyon General Hospital is nestled in Hawassa City
around Welde Amanuel village in sidama region .

 The location offers proximity to public transportation and

major roadways, ensuring convenient travel for
individuals seeking quality healthcare services.

 Alatyon General Hospital is committed to providing a

comprehensive array of healthcare services .
SERVICES PROVIDED

Emergency Care
 Inpatient and Outpatient Care
Diagnostic Imaging and
 Laboratory Services
Activities and Observations
Patient Flow:
The patient flow in Alatyon hospital's SMART EMS system typically
follows a structured order to ensure seamless continuity of care and
the efficient management of patient information.

 Here's a detailed breakdown of the patient flow in a SMART EMS

system:
Patient Registration:
• When a patient arrives at the hospital, the registration process
begins.
• Registration staff enter the patient's demographic details and
insurance information(this service identified by different colour ) and
the reason of the visit .
• This step initiates the creation of the patient's electronic record
within the smart EMS.
cont..
Triage EMERGENCY
• From the registration area, the patient proceeds to the • The Emergency Ward utilizes SMART EMS
triage or assessment area, where their vital signs and software to efficiently manage patient care.
initial clinical data are recorded.
• The software enables the seamless collection of
• This information is entered into the smart EMS and then
assign the physician according to their load and patient information and vital signs from the
availability of the physician triage department.
• need for urgent attention if necessary ( Emergency). • Additionally, it allows for electronic orders to
the laboratory department and prescriptions to
the pharmacy department. However, before
receiving treatment, patients are first directed
to the finance department for administrative
processing.
• This streamlined approach enhances the overall
workflow and coordination of care in the
emergency ward.
cont..
OPD
• Once the patient is triaged, they are seen by a
Treatment Planning and Medication Orders:
healthcare provider. • Based on the assessment and
• During this encounter, the provider reviews the diagnostic findings, the provider
patient's medical history, conducts a physical
examination, and discusses the reason for the visit make a treatment plan.
• . Findings from the consultation, along with the • This may include medication
patient's medical history and current complaints, are
documented in the smart EMS. prescriptions, care instructions, or
referrals for further evaluation.
Diagnostic Ordering and Results Capture: • The corresponding orders are
• If diagnostic tests are required, such as blood tests,
imaging studies, or other procedures, the provider entered into the SMART EMS to
places orders in the SMART EMS system. facilitate communication with the
• After the patient is complete the billing process.
The results of these tests are subsequently entered
pharmacy, care coordinators, or
into the SMART EMS . other involved departments.
cont...
PHARMACY
• Before accessing the pharmacy, patients are required to make
SURGICAL WARD
payments at the finance department.
• The pharmacy utilizes software that provides information on the • The service providers in this team ensures the
expiration dates of the drugs and is connected to the hospital's smooth transition of patients from pre-operative
stock management system for efficient inventory control.
preparation to post-operative recovery.
• This software also facilitates communication and quick response • for ICU patients, the system keeps the
in cases of drug shortages. Additionally, it serves as a reporting
system, giving pharmacists access to information to all drugs that information in red color .
are sold. • the surgical ward ensures that the stay time and
discharge details are accurately recorded and the
system convertes the patients information from
black to pink during discharge .
• Finally, all relevant information is to be sent to the
finance department for further processing.
CONT...
MRI FINANCE
• The Medical Radiology Ward at Alatyon Hospital consists of three • Patients are required to visit the finance department before
rooms: a CT scan room, an MRI room, and X-ray room. accessing any services or treatment that incur costs.
• All three rooms utilize the software for data exchange with other • This includes transfers from the emergency, outpatient, and
wards, they employ the DICOM standard and file format for inpatient wards to the laboratory, pharmacy, and MRI
viewing images.it has high quality . departments.
• Due to the large space requirements of DICOM, daily backups are • Upon completion of administrative procedures and payment at
conducted by the ICT department to free up storage space. the finance department, patients can proceed to receive the
necessary services in the respective wards.
• This process is designed to streamline financial transactions and
ensure that patients can access the care they need in an efficient
manner.
CONT...
Inpatient Admission or Outpatient Discharge
• Depending on the nature of the visit, the patient may be admitted to an inpatient
unit or discharged home after outpatient care.
• The corresponding documentation, including admission orders or discharge
summaries, is recorded in the SMART EMS to ensure a seamless transition of care.

Reporting and Data Analysis:

• As patient encounters are documented in the SMART EMS, the system enables
the extraction of data for reporting, performance analysis, and regulatory
compliance purposes, supporting ongoing improvements in care delivery and
patient outcomes.
ICT DEPARTMENT
• The ICT room is equipped with a ventilator and has recently
upgraded to a 1GB/s transfer rate and manageable switch.
• The room hosts a Windows server that performs regular
backups, including every 5 TRF files and a 24-hour full
backup.
• The system includes two processors with 3.1GB storage, 7th
generation RAM of 120GB, 8 hard disks of approximately 2
terabytes each, and a Cisco Catalyst.
• The use of a Cisco router enables external communication,
and a laboratory management system with QR codes
ensures error-free service.
• There is an uninterrupted power supply (UPS) that can
sustain the system for up to one hour in case of failure.
• The retrieval and analysis of reports are performed using
Microsoft Excel, connected to the server.
• Specific roles and access permissions can be assigned to
individuals within the system.
 DRAWBACK SOLUTION

 Reliable Network Infrastructure: Invest in robust and reliable

network infrastructure, inclusive of high-speed internet
connectivity, secure wireless networks, and network redundancy to
mitigate network-related downtimes.
1. System Downtime and Technical Issues: system downtime, or slow
system response times can impact patient care and operational  Load Balancing and Server Optimization: to distribute workloads
efficiency, especially during critical emergency situations. efficiently, preventing server overload and improving system
responsiveness.

 Deploy Monitoring and Alerting Systems: to detect performance

degradation, system irregularities, or potential failures, enabling
proactive intervention to prevent downtime.

2. Cost constraints; due to cost constraints nursing progress note,  BYOD (Bring Your Own Device) Policy: allows employees to use
family planning and immunization services still apply manually. their personal devices for certain tasks, potentially reducing the
demand for new hardware.
Yanet Internal Medicine
Higher Clinic (YIMHC)
Overview
• . LIYANA Healthcare Plc. (LHC) is an integrated health care solutions
company located in Hawassa, Ethiopia
• YIMSC is a division of LIYANA Healthcare that specialized in and offer
advanced internal medicine clinical services
• Currently, YIMSC offer round the clock specialty and sub-specialty
Neurology, Gastroenterology, ENT, Dermatology, Women’s health,
Cancer (Chemotherapy), Hemodialysis, and Psychiatry services
• The center on average caters for 250-300 patients in a given day.
health information system
• The health information system of yanet Hospital is fully electronic
• . Currently all patient information, including medical history, test
results, and treatment plans, is now stored and managed digitally
• The facility uses the software called Medax for both administrative
and clinical purpose.
Exptional cases for paper uses
• If the medicine prescribed by the doctor is not available in the
hospital pharmacy
• If the patient wants to buy the prescribed medicine from another
pharmacy, he will be given a paper
• Referral
MEDAX system
• The facility uses the software called Medax for both administrative
and clinical purpose.
• MEDAX is user friendly software that provide the function for
medical, administrative & financial activities
• . Each units within the organizational structure uses this software
• IPD, OPD, Imaging, Finance...
how to use
• The role that given grant them some permission with respect to their
profession and withhold which is not related with them.
• Each individual that access the system have its own unique username
and password.
THE application of MEDAX in various units
as it observed
Triage
The nurses in this unit :

• Patient Data Collection

• Access to Patient Records
• Assign the physician according to the current complaint
OPD
The Physician in this unit

• Access patient medical history and previous visit

• Create and manage treatment plans
• Communicate with other healthcare professionals
• Document the current visit, including chief compliant, symptoms,
physical exam findings, and treatment plans
• Generate and send electronic prescriptions to the patient’s preferred
pharmacy.
• Order diagnosis: this can be laboratory, imaging
IT Unit
• This unit run by the IT professional of the hospital.
• The IT professional is the Admin.
The function of IT professional is:-
• Monitor/ adjust the system failure
• Registered newly recruited professional to the system
• Grant the tasks according to his/her role
• Maintain the hardware and software
• Managing and maintaining the hospital's electronic healthrecords
(EHR) system, including implementing updates and troubleshooting any
technical issues.
•Providing technical support for hospital staff to ensure that they can
effectively use the hospital's technology systems.
• Implementing and maintaining secure networks and systems
network system of the institution
• the network system of the hospital is local area.
• Medax system deployed in each units with in the organization are
connected using the LAN.
Eg. 3 branches- Not enteroperable

 YANET Internal Medicine Specialized Center (YIMSC)

 Yanet Trauma and Surgical Specialized Center (YTSSC)
Divine Touch Nursing, Rehabilitation, and Palliative
Care Center (DTNRPCC)
Servers
• On this hospital we have seen 3 servers.
 Medax server
 radiAnt server
 Senet server
Medax server
• The MeDax server is the server which have MeDax EMR system that
runs in all of the computers
• The MeDax server situated in IT room.
• all the computers connected to the switches installed in different
corners.
RadiAnt
• RadiAnt also offers a RadiAnt Server application, which allows for
easy sharing of medical images across a network.
• The server application provides a platform for storing, accessing, and
communicating medical images and related data within a healthcare
facility or network.
Senet server
• This server is the billing server in which all the finance and tax process
runs.
• And it is controlled by governmental body.
Group Members
• NAME ID NO
• Zebiba Miftah……………………….. 2790/13
• Tsinuemnet abiyu…………………… 2500/13
• Yohannes bassa …………………….. 2697/13
• Wassihun Tesfahun………………… 2530/13
• Tsegaye Mesfin…………………… 2491/13
• Simon Sitotaw……………………… 2263/13
• Tesfeab Abayneh…………………… 2389/13
• Tihitna Yebeltal………………… 2446/13