f ft CHAPTER 1. INTRODUCTION % i Introduction Chapter-1 INTRODUCTION 1. Introduction to Hospital Management. Hospitals are the key institutions in providing relief against sickness and disease. They have become an integral part of the comprehensive health services in India, both curative and preventive. Significant progress has been made in improving their efficiency and operations. Effectiveness of a health institution, hospitals or nursing homes, depends on its goals and objectives, its strategic location, soundness of its operations, and efficiency of its management systems. The administrator's effectiveness depends upon the efficiency with which he is able to achieve the goals and objectives. Some of the major factors determining the effectiveness of a health institution include patient care management and patient satisfaction. Hospitals are very expensive to build and to operate. Administrators and professionals have to be extremely cost conscious. Effective computerized systems and procedures need to be implemented to ensure proper utilization of limited resources toward quality health care.' though diagnosis, treatment & post discharge guidance and finally rehabilitation are done in hospitals. The fifth objective is that of providing information is an area which needs improvisation. This can be done by the extensive use of computers. Needless to say that the first four objectives also require the assistance of computers in order to serve the patients better, as here we cannot overlook the fact that hospitals are not primarily profit making organizations but one of rendering service. It becomes more difficult a task as they are dealing with cases where it is a matter of life and death and not only that of monitory loss. If a patient who has to undergo a blood test where his glucose intolerance has to be diagnosed goes to the hospital where he enquires about the test, the attendant tells him to proceed with the test but tells him that the test has to be done on an empty stomach which he was not aware, so he had to come back the next day nil by mouth, he was also not aware that the test would take three hours where he has to come back after lunch and then there after consuming glucose, and also he was not aware of the cost of the test. He not only has to waste a day's leave but also underwent a lot of inconvenience. If only there would be a printout given to him stating the cost, duration, and type of test his task would have ' 'Essentials of Management'. By Joseph L Massie 2005. 1 Introduction been easier. This simple information is not available to most of the patients, and the doctors concerned are very busy to sit and counsel patients. Knowledge Management can be applied here. So the use of computer would come in handy at a time like this. We have stated only a regular situation for a small issue but there could be many more cases, where information would come in handy to patients. We do not want to undermine the first four objectives of the hospital either. Where computers would be the best assistant a doctor could have in preparing case papers of the patient where all his past history of diagnosis etc. is stored, his blood group, allergies to penicillin, sulphur, medicines given etc. discharge card etc. Medico legal cases need special form of recording. 1.1 Need for the study & Relevance in Today's Era Any hospital has five main objectives:- 1. a. Patient history (signs and symptoms of disease) b. Investigations. c. Diagnosis. 2. Treatment. 3. Prevention and Post discharge guidance. 4. Rehabilitation. 5. Information. 1) Though diagnosis, treatment & post discharge guidance and finally rehabilitation are done in hospitals. The fifth objective is that of providing information is an area which needs improvisation. Also considering the rapid expansion of the healthcare industry, the number of patients are increasing due to population expansion and also stressfial lifestyles due to urbanization, the patient data has to be stored as it is voluminous where details Hke patient history like blood group, allergies, diagnosis treatment given are recorded. 2) Medico legal cases need special form of recording as the goverrmient directions requires that patient data needs to be stored, till the date of the court hearing is not concluded. 3) Medical error is reduced to a large extent because of computerization. 4) Awareness of technology can be generated among hospital authorities by carrying out this research. 2 Introduction 5) The existence of electronic medical record of a patient makes on- line access from anywhere on the globe easier and a lot of paper work is reduced. 6) Medical tourism will be enhanced due to electronic medical records, which will be a great advantage for the economy of India. 7) Hospitals will become more hospitable. 8) Patient Relationship Management (PRM) becomes easier as the future check up dates etc. will be informed to the patients by the hospitals due to the data available with them. This strengthens the bond between the hospital and the patients. This will lead to patronage, branding of hospitals and building a reputation of timeliness of treatment. 9) Epidemic Preparedness will increase due to data interchange and sharing by the way of Health Information Exchanges (HIE) to support nations public health needs and for early detection and rapid response to potentially catastrophic infectious disease outbreaks and other public health emergencies like the recent swine flu and monkey fever epidemic. 10) The HIS can incorporate digital dictation, voice recognition for medical staff to enter data accurately thereby reducing medical error, reducing time for correspondence and medical transcription. 11) Compliance to various government accreditations like PPACA (Patients protection and Affordable Care Act) can be done as this leads to transparency of transactions and adheres to standards laid by different medical bodies. 12) The software industry also gets an important insight into the information needs of the hospitals and various hospital processes and functions carried out by them as a result of this research. 13) Right to Information has been implemented and data needs to be stored to comply with the law. Computerization of hospitals will definitely help in this regard. 14) HIS is ERP (Enterprise Resource Planning) for hospitals, which will help in resource planning, preparing for fixture planning, having central control, data warehousing and data mining, informing vital statistics of the hospital and improving work efficiency. 15) Financing healthcare becomes easier as insurance companies can also access the data if a central database is created with the help of computerization like the banks have a sibyl list for bank loan customers. 3 Introduction 16) The ultimate aim of the hospital is achieved due to computerization - Better patient care with Efficiency. Hence the research study undertaken is of utmost utility for the hospitals, patients, government, researchers as well as the software industry who are catering to the needs of computerization of hospitals in present times as well as the future needs. The present study aims at: 1) To study the available Hospital Information System Software in the market as regard to whether it is covering all the aspects needed by the hospitals. 2) To find out the training aspects given to the users in the hospitals as regards to the usage of the software. Suggestions about improving the training program would be stated. 3) The study flxrther investigates how the usage of the software supports in MIS and aids in effective decision making by providing relevant reports. 4) The study also aims to find out that if there is a direct connection between the size of the hospital and the extent of computerization. 1.2 Early History of Hospitals As early as 4000 BCE, religions identified certain of their deities with healing. The temples of Saturn, and later of Asclepius in Asia Minor, were recognized as healing centres. Brahmanic hospitals were established in Sri Lanka as early as 431 BCE, and Introduction JCing Ashoka established a chain of hospitals in Hindustan about 230 BCE. Around 100 BCE the Romans established hospitals (valetudinaria) for the treatment of their sick and injured soldiers,gladiators, chariotors, their care was important because it was upon the integrity of the legions that the power of ancient Rome was based. In ancient cultures, religion and medicine were linked. The earliest known institutions aiming to provide cure were Egyptian temples. Greek temples dedicated to the healer- god Asclepiads might admit the sick, who would wait for guidance from the god in a dream. The Romans adopted his worship. Under his Roman name Esculapius, was provided with a temple (291 EC) on an island near the Tiber River in Rome, where similar rites were performed. Roderick E. McGrew^ (1985). The loss of monastic hospitals in England caused the secular authorities to provide for the sick, the injured, and the handicapped, thus laying the foundation for the voluntary hospital movement. The first voluntary hospital in England was probably established in 1718 by Huguenots from France and was closely followed by the foundation of such London hospitals as the Westminster Hospital in 1719, Guy's Hospital in 1724, and the London Hospital in 1740. Between 1736 and 1787, hospitals were established outside London in at least 18 cities. The initiative spread to Scotland, where the first voluntary hospital, the Little Hospital, was opened in Edinburgh in 1729. The early hospitals were primarily almshouses, one of the first of which was established by English Quaker leader and colonist William Penn in Philadelphia in 1713. The first incorporated hospital in America was the Pennsylvania Hospital, in Philadelphia, which obtained a charter from the crown in 1751. 1.3 History of Hospitals (1800-2012) Upto 18* century Vaidyas and Hakims were the order of the day.