Challenges in implementation of HIS in Indian hospitals
The actual implementation of a Hospital Information System (HIS) has always been a challenge. This scenario is not only true for hospitals in India but also in the West. The implementation challenges in Indian hospitals are multifold and broadly fall in the following categories:
- Setting up right expectations from the management and users in the hospital
- Availability of accurate and exhaustive master data
- User training
- Acceptance and appreciation of computerisation by medical, paramedical and other healthcare specialists
- Quantifying Return on Investment(ROI) and Key performance indicators (KPI)
Implementation of HIS in hospitals is not mere computerisation of the hospital, it is just not about automation of existing paper trail. This approach, if followed will not only lead to failure of the implementation but also transfer the inefficiencies of the manual system to the computerised environment. Proper business processes, re-engineering and accurate definition of workflows incorporating global best practices will improve the effectiveness and efficiency of the hospital and in turn provide better patient care.
A good HIS product should not only cover the functionality of all the business processes in a typical hospital but more importantly have the flexibility of customisation to the specific needs of the hospital through parameterisation and the ability to configure alternative workflows. There will be resistance from users (for instance, from nurses, phlebotomists other paramedical staff, etc) who may feel that feeding information into the computerised system is additional work and not their primary responsibility or core competence.
Rigorous and continuous training, user friendly screens, hand-held devices for data input and most importantly showing tangible benefits are the answers to overcome this initial resistance. Enough cannot be said about the extensive preparation required to collect the initial master data. These master data parameters are the ultimate drivers of your system and please remember the old computer adage Garbage in, Garbage out !!! It is equally important that the right infrastructure in terms of right sizing, the servers and PCs, with good bandwidth network connectivity and clean power supply will go a long way in ensuring smooth and satisfactory implementation.
The return on investment of a HIS implementation can be looked at with both tangible and intangible benefits in mind. A well controlled inventory system can bring in savings of 10 to 15 per cent in the first year itself, thereby justifying the investment for a HIS product in big hospitals. The benefits include improved bed turnover ratio, on line billing to capture all transactions across all departments, drug expiry management, accurate and reliable laboratory test results due to on line interfaces to laboratory equipment, leading to accountability and higher profitability in hospitals.Having the entire patient medical records and history with all attendant details at a click of a button helps doctors to provide better diagnosis and treatment and avoid clinical errors. With our rising costs of qualified manpower and reduction in the prices of computer hardware, we are in a position to quantify the return on investment better in future.
In conclusion, articulating and communicating the right vision and mission for HIS implementation project, committed involvement of the top management of a hospital and assiduous training of the actual end users are a few key critical success factors to ensure success of any implementation of HIS in any hospital.
Author: B K Kulkarni
e-mail : bk.kulkarni@siemens.com
