The United Republic of Tanzania Ministry of Health
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THE UNITED REPUBLIC OF TANZANIA MINISTRY OF HEALTH AND SOCIAL WELFARE Integrated Hospital Management System (iHMS) Implementation Feasibility Study Report Version 1.1, January 2015 i Abbreviations and Acronyms ERP Enterprise Resource planning HMIS Health Management Information System HQ Headquarters ICT Information Communication and Technology iHMS Integrated Hospital Management System LAN Local Area Requirements LMIS Logistics Management Information System M&E Monitoring and Evaluation MOHSW Ministry of Health and Social Welfare SDP Service Delivery Point SDP System Development Plan SO Strategic Objective SOMD System Operation Maintenance Document SOP Standard Operating Procedure SRS System Requirements Specification TZ Tanzania ii Table of Contents Abbreviations and Acronyms ......................................................................... ii Table of Contents .......................................................................................... iii 1.0 Introduction .............................................................................................. 1 1.1 Background .............................................................................................. 1 1.2 An Overview of the iHMS ......................................................................... 3 1.3 Terms of References (ToR) of the Consultancy ....................................... 4 1.4 Objectives of the Consultancy .................................................................. 5 1.5 Deliverables of the Consultancy ............................................................... 6 1.6 Structure of the Report ...................................................................... 7 2.1 Hospital Business Process Analysis and Areas for Improvement ......... 13 2.2 Patient Care Management (Core) Processes ........................................ 14 2.3 Pharmacy & Inventory Management Processes .................................... 31 2.4 Patient Billing Process ........................................................................... 40 2.5 Account, Financial and Human Resource Management ........................ 45 3. Functional Requirements for iHMS ........................................................ 48 3.1 High level Requirement Summary ........................................................ 48 i. Patient Care Management .............................................................. 48 ii. Laboratory ....................................................................................... 48 iii. Billing .............................................................................................. 49 iv. Pharmacy and Inventory Management ........................................... 49 v. Medical Record Management ......................................................... 49 vi. Human Resource Management ...................................................... 49 vii. Management Information System (MIS) ...................................... 50 viii. Financial Management ................................................................ 50 ix. Integration and Information Exchange ............................................ 50 x. Security and Confidentiality ............................................................ 50 4.1 Detailed Functional Requirements .................................................. 51 4.1 Patient Care Management ..................................................................... 51 4.2 Laboratory .............................................................................................. 54 4.3 Billing Business Process ........................................................................ 57 4.4 Pharmacy and Inventory Business Process ........................................... 61 4.5 Medical Record Management ................................................................ 70 4.6 Human Resource Management ............................................................. 71 Section 71 Functional Description ................................................................................. 71 iii Priority 71 4.7 Management Information System .......................................................... 71 4.8 Financial Management ........................................................................... 72 5. iHMS System Architecture and Information Exchange .......................... 73 5.1 iHMS System Architecture .............................................................. 73 5.1.1 Architectural Choices ............................................................... 73 5.1.1.1 Best-of-Breed Model ........................................................................ 73 5.1.1.2 Full-Integrated Model ................................................................ 75 5.2 iHMS Deployment Architecture ....................................................... 77 5.2.1.1 Facility-based Decentralized system model ..................................... 77 5.2.1.2 Cloud-based Centralized system model ........................................... 78 5.3 iHMS and the National HIS Architecture ......................................... 79 Standards..................................................................................................... 82 5.3.1 Contents Standards ............................................................................ 83 5.3.2 Data Format Standards ....................................................................... 83 5.3.2.1 Health Level 7(HL7) ......................................................................... 84 5.3.2 Coding Standards ..................................................................... 84 5.3.2.1 ICD and SNOMED CT ..................................................................... 84 6. Assessment of Existing Information Systems in Health Facilities ............ 85 6.1 Characteristics of Surveyed Health Facilities and Assessment Tool ...... 85 6.2 Findings of Existing Information Systems ....................................... 85 6.3 Conclusion and Recommendations ....................................................... 87 7.0 Acquisition and Implementation of an iHMS ........................................... 89 7.1 Acquiring an iHMS ................................................................................. 89 7.2 Recommendations during acquisition .................................................... 89 7.3 Make and Build from scratch or customization of an existing software .. 90 7.4 Purchasing an existing software (Commercial-off-the-shelf software)................................................................................................ 90 7.5 Implementing the iHMS .......................................................................... 92 7.5.1 Introduction.............................................................................. 92 7.5.3 Testing phase ........................................................................... 96 7.4 Computing Infrastructure Requirements ................................................ 97 7.4.1 Data Centre /Server room .......................................................100 7.4.2 Networks and Internet Connectivity .........................................102 7.4.3 Workstations............................................................................103 7.4.4 Computer training room ...........................................................104 iv 7.4.5 Physical and logical security of ICT infrastructure ...................104 7.5 Human Resource Requirements ...........................................................105 7.6 Training Requirements ...................................................................109 7.7 Managing and Supporting HMS Operations ..................................116 8 Governance Model and Policy ..............................................................119 8.1 iHMS Project Steering Committee ........................................................121 8.2 Change management and adaption ......................................................129 8.7 Appendix A: Implementation Plan ..................................................132 8.8 Appendix B: Visited Health Facilities ..............................................132 8.9 Appendix C: Implementation Budget ..............................................132 8.10 Appendix D: Evaluation of existing HMS Functionalitie..................132 8.11 Appendix E: Example Schematic Network Design………………132 v LIST OF TABLES Table 2.1 : Patient registration process details ............................................ 16 Table 2.2: Admission Process/detail ............................................................ 21 Table 2.4: Appointment business process details ........................................ 26 Table 2.5 : Pharmacy & Inventory Management business process ............. 32 Table 2.6 Medical supplies distribution process details................................ 36 Table 2.7: Dispensing process detail ........................................................... 39 Table 2.8: Patient Registration and admission process ............................... 42 Table 2.9: Patient outstanding account process details ............................... 46 Table 6.2: Characteristics of Existing Systems ............................................ 87 Table 7.1: Computing Infrastructure requirements ........... Error! Bookmark not defined. Table 7.2: Recommended estimates for key ICT cadres for each hospital level: ........................................................................................105 Table 8.1: iHMS Steering Committee: