1

A Review of HIS (TrakCare) at

Sir Ganga Ram Hospital:

Its Workflow and success at user-end

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TABLE OF CONTENTS

1.0 List of abbreviations 3

2.0 Acknowledgement 4

3.0 Introduction 5

4.0 Rationale of Study 8

5.0 Review of Literature 9

6.0 Objectives 18

6.1 General objectives

6.2 Specific objectives

7.0 Methodology 19

7.1 Study Design

7.2 Study Area

7.3 Study Population

7.4 Sampling & Sampling Design

7.5 Data Collection Tools & Techniques

8.0 Work map of Sir Ganga Ram Hospital 20

9.0 TrakCare Modules 23

10.0 Advantages and disadvantages 46

11.0 Study Findings 49

12.0 Discussion 63

13.0 Recommendation 65

14.0 References 66

15.0 Annexure

16.0 Case study : Significance of Bar coding and stickers used at SGRH 67

17.0 Case Study : PACS (Picture Archiving and Communication System) 73

implementation at SGRH : Process of vendor selection

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LIST OF ABBREVIATIONS

AIIMS - All India Institute of Medical Sciences

CCU - Cardiac Care Unit

CIC - Central Investigation Centre

CPRS - Computerized Patient Record System

CPOE - Computerized Physician Order Entry

CQA - Center Quality Assurance

EPR - Electronic Patient Record

HIS - Hospital Information System

HMIS - Hospital Management Information System

ICT - Information and Communication Technology

IPD - In Patient Department

IT - Information Technology

OPD - Out Patient Department

OPM - Out Patient Management

SGRH - Sir Ganga Ram Hospital

SPSS - Statistical Package for the Social Sciences

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ACKNOWLEDGEMENT

First and foremost, I would like to express my sincere gratitude to my mentor, Mr Sanjay Singh ,

Head IT, Sir Ganga Ram Hospital, for his constant guidance, encouragement and critique

throughout my internship period.

I would also like to thank Dr Karanvir Singh , the then Head Medical Informatics, Sir Ganga

Ram Hospital, who shared his valuable knowledge and insight about the HIS on numerous

occasions.

My sincere appreciation also extends to my mentor at IIHMR New Delhi, Mrs Anandhi

Ramachandran, who was a constant guide and critic throughout the making of this project.

Last but not least, I express heartfelt gratitude to everyone at SGRH who helped me in

understanding the working and nuances of the HIS , all the while lending valuable time to

answer my questions. Among those were Mr John Mathews, Mrs Sunita Sunda , Mr Gandhi

Rana and Mrs Vandana Gupta.

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INTRODUCTION

Sir Ganga Ram Hospital - Profile

Sir Ganga Ram Hospital is a 675-bed multi-specialty state-of-the-art hospital in Rajinder

Nagar, Delhi. It provides comprehensive medical services to patients from all over Southeast

Asia and is regarded as one of the leading healthcare institutions in India. It is the only hospital

in the private sector that has maintained nearly 100% bed occupancy due to its high reputation in

New Delhi and neighboring regions. [2]

Vision of the Hospital

To be leaders in healthcare delivery, medical education, training and research and to meet the

changing expectations of the community.

Mission Statement of the hospital

Sir Ganga Ram Hospital is committed to provide world class healthcare, teaching, training and

research by a team of highly qualified doctors, dedicated nurses, Para-medical and non-medical

staff with the help of state-of-the-art diagnostic, therapeutic services in a comfortable, caring and

safe environment at an affordable cost to all sections of society including free treatment to the

economically weaker section as per vision of the Founder.

Following the ideology of the founder, Sir Ganga Ram, the hospital spends extensively on its

charitable healthcare delivery program. Over 2.5 lakh out patients are examined in the General

OPDs annually, while there are over 100 dedicated free beds for economically weaker section of

the society. A strong Community Outreach Program is in place for conducting regular free health

check up camps in and around Delhi where free consultation and medicines are dispensed. The

Ladies Welfare Society, an integral part of the Programme, is dedicated to provide social

assistance by establishing and running vocational centres in resettlement colonies and to

motivate deserving students by generating and providing appropriate assistance.

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History

The hospital was initially founded in 1921 at Lahore by Sir Ganga Ram (1851-1927), a civil

engineer and leading philanthropist of his time. After the Partition of India in 1947, the present

hospital was established in New Delhi on a plot of land approximately 11 acres (45,000 m2). The

foundation was laid in April 1951 by the then Prime Minister of India Shri Jawahar Lal Nehru

and was inaugurated by him on April 13th, 1954. The hospital nearly closed due to lack of funds

in the 1970s. It was restructured in 1981.

Sir Ganga Ram Hospital’s Information System

Sir Ganga Ram Hospital needed to replace its 20-year-old HIS.

But first it had to overcome a number of factors which might hinder implementation. These

included the hospital’s 35 specialties, many with different workflows which have hardened over

the hospital’s 50 year history, making them difficult to change.

• Increased outpatient throughput

• Better inventory control

• Rapid access to lab results

• Reduced allergy and drug interactions

• Efficiencies Through Automated Billing

• Savings Through Better Inventory and Medical Package Control

• Substantial Cost Savings Through Pharmaceutical Substitution

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TrakCare

InterSystems TrakCare is a unified healthcare information system that lets authorized healthcare

professionals access and work with complete patient records on tablets, smart-phones, or

computers – anywhere they have access to the Internet.[3]

TrakCare is the world’s leading Web-based healthcare information system. It enables authorized

healthcare professionals to look at a complete patient record from anywhere they have access to

the Web.

TrakCare provides a full range of clinical, administrative, lab and community care capabilities,

unified by a single data repository. Which means patient information can be shared securely and

seamlessly across all major departments and care settings.

TrakCare's analytics enable timely and more informed decisions about patient care, based on up-

to-date information.

This breakthrough system includes clinical, administrative, laboratory, and community care

capabilities, unified by a single data repository. Each patient's consolidated history can be shared

securely across all care settings.

TrakCare is used in 25 countries, with deployments that range from single hospitals to

nationwide network.

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RATIONALE OF THE STUDY

Hospital Management information system is indispensable for any hospital for strategic

planning, programming, budgeting, financial resource allocation, maintaining patients' record,

personnel development, distribution and management of equipment, supplies, drugs and

supervision of the services.[4] Having a good HIS is crucial for the success of hospitals now-a-

days.

But an HIS is useless if it confuses the hospital employees. The system must be user friendly and

should include training by the vendors. The HIS should also be patient centric, medical staff

centric, affordable and scalable. The technology changes quickly and if the system is not flexible

it will not be able to accommodate hospital growth. An effective HIS also delivers benefits such

as:

• enhances information integrity

• reduces transcription errors

• reduces duplication of information entries • optimizes report turnaround times [5]

We have tried to enumerate the various benefits as well as drawbacks of TrakCare as

experienced by the end-users, because we felt that such a study had not been conducted at SGRH

earlier.

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REVIEW OF LITERATURE

The International Perspective:

1 )Methods for evaluating hospital information systems: a literature review

Vassilios P. Aggelidis, Prodromos D. Chatzoglou [6]

PURPOSE -It is widely accepted that the use of information and communication technology

(ICT) in the healthcare sector offers great potential for improving the quality of services

provided, the efficiency and effectiveness of personnel, and also reducing organizational

expenses. This paper seeks to examine various hospital information system (HIS) evaluation

methods.

METHODOLOGY – In this paper a comprehensive search of the literature concerning the

evaluation of complex health information systems is conducted and used to generate a synthesis

of the literature around evaluation efforts in this field. Three approaches for evaluating hospital

information systems are presented – user satisfaction, usage, and economic evaluation.

FINDINGS – The main results are that during the past decade, computers and information

systems, as well as their resultant products, have pervaded hospitals worldwide. Unfortunately,

methodologies to measure the various impacts of these systems have not evolved at the same

pace. To summarize, measurement of users' satisfaction with information systems may be the

most effective evaluation method in comparison with the rest of the methods presented.

PRACTICAL IMPLICATIONS – The methodologies, taxonomies and concepts presented in this

paper could benefit researchers and practitioners in the evaluation of HISs.

ORIGINALITY / VALUE – This review points out the need for more thorough evaluations of

HISs that look at a wide range of factors that can affect the relative success or failure of these

systems

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2) Assessing User Satisfaction of using Hospital Information System (HIS) in Malaysia

Indah Mohd Amin et al [7]

ABSTRACT : Hospital Information System (HIS) has been successfully being implemented in

Malaysia since 1998. However, there is little research being conducted to evaluate the level of

satisfaction among the system’s user. There is a need for more investigation and researches being

conducted to investigate the quality of the system. The main objective of this empirical study is

to investigate the level of user satisfaction of using HIS in Malaysia. The data was analyzed by

using kruskal-wallis. Survey data of 248 respondents from two different hospital in Malaysia that

uses similar HIS were used.The users include physicians, nurses, laboratory technologies,

pharmacists and others

The results show that there are significant differences between different types of users for HIS in

Malaysia in terms of the (i) quality of HIS interface, (ii) quality of HIS Function, (iii) quality of

HIS Performance and (iv) quality of HIS (combination of HIS interface, HIS Function and HIS

Performance). Thus, provide indication for customization and better understanding for different

type of HIS users to improve the quality of HIS from end-user’s perspectives. HIS managers and

developers may attain benefits from this study towards better understanding of the different

requirements and level of satisfactions among HIS’s users. The result can be used a guidance to

improve the quality of HIS and meet different expectations and demands from different types of

HIS users. It is important to

be able to quantify user satisfaction to justify the cost, implementation time, user involvement

and testing in the development, implementation and maintenance stage of HIS. Collaboration

with the users, training and support by the technical personnel may well be feasible for future

HIS development methodology and implementation.

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3) Hospital Information Systems In Nigeria: A Review Of Literature [8]

Author: Ayodele Cole Benson, MB BCH, PhD, DHA

ABSTRACT : This literature review was developed to examine empirically the factors hindering

adoption of hospital information systems in Nigeria. The study was focused on the perceived

paucity of health information technology policy in Nigeria and the causes of poor

implementation of hospital information systems in the country. The findings of the literature

review highlighted hindrances to the adoption of hospital information systems to include; the

high cost of full implementation of a hospital information system, inadequate human capital,

corruption, and problems associated with poor infrastructure in Nigeria. The recommendations

were that the Nigerian government needs to provide stable electricity, basic communication

infrastructures, and Internet access to boost private initiatives in the adoption of health

information technology across the country.

CONCLUSION : The analysis presented in the literature review provided insight into the

enormous health care benefits of hospital information systems, and their usefulness as

educational tools in training clinicians. The literature review brought to the fore the disparity in

adoption of hospital information systems between Nigeria, the United States, and some other

countries. In Nigeria, poverty, poor government funding, lack of appropriate government policies

on adoption of health care technologies, human capital flight to developed countries, the low

technological base of the country, inadequate electricity supply, and corruption are among

common assertions that authors believed are responsible for poor adoption of hospital

information system (Apter, 2007; Arikpo et al., 2007). Contextual issues constituting barriers to

adoption of hospital information systems formed a major part of the literature review, and there

seemed to be more impediments to adoption in Sub-Saharan Africa than in the developed

western world. The high cost of implementation of all the components of hospital information

systems appears to be a global challenge. Apart from a lack of infrastructural requirements for

adoption of hospital information system in Nigeria, the neo-cultural influence of materialism and

individualism have added to an environment of corruption, thereby creating a vicious cycle

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.Chapter 2 also provided insight into the effects of the paucity of health care policy on health

care delivery in Nigeria with an emphasis on poor e-health applications in the country. The high

cost of implementation of hospital information systems and other barriers are concerns to most

authors. A positive correlation has been found between the adoption of health care information

technology and positive financial performance both in general organizational and operational

processes (Furukawa et al., 2006; Weimar, 2009). Some suggestion is that the Nigerian

government enacts policies aimed at widespread implementation of HIS and provides funding

support to health care organizations across the country to facilitate adoption of HIS in their care

processes. Analysts further clamored for improvement in rural electrification to power

information communication infrastructures in suburban communities (Arrow et al., 2009; Ouma

& Herselman, 2008; Moore, 2009). Others argue that the Nigerian government needs to invest

heavily on infrastructure to facilitate any attempt at catch up with the developed world in the

adoption of hospital information technologies (Ayo et al., 2008; Ouma & Herselman, 2008).

ABSTRACT : The use of integrated Hospital Information Systems is related with many benefits

for the healthcare system, increasing the effectiveness of the provided services and assuring

quality of care. Aim of this study is to investigate the types of Information Systems, the level of

integration and the problems identified during the implementation phase, in three public

hospitals. The above are expected to contribute to the understanding of the organizational,

human resource and technical factors related with the successful implementation of a hospital.

METHODOLOGY : In order to investigate those elements, an assessment questionnaire was

developed and completed by nine hospitals IT employees of the three hospitals. In addition, open

interviews were organized with the same employees to further formulate an overall aspect, while

in one hospital case, observation and discussion with four different categories of involved staff

was undertaken.

RESULTS : It was found that the implementation problems are mainly related with the

underfunding, inadequate use of standards, lack of skilled IT experts, insufficiently trained

personnel and users' reserve. The problems may be tackled with a supportive hospital

administration committed to the successful implementation. The external contracting company

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working on its own, without any participation of the hospital IT department seems to be a failure

recipe. It is evident that an active management support and skillful hospital IT employees, ar

expected to result to success stories during the implementation of integrated hospital information

systems

The Indian Perspective :

1) Hospital Information System in Medicare – An Experience at Tata Main Hospital,

Jamshedpur

Mohanty Rajesh, Rana Sarosh D, Kolay Saroj K [9]

ABSTRACT : 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 includes 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 computerised systems and procedures need to be implemented to ensure

proper utilisation of limited resources toward quality health care. It becomes even more

important when an in-house medical facility is provided by an industry for it’s employees, as is

the case for Tata Steel. Patient care management in Tata Steel has fully utilised the power of

computers in Medicare, whereby network of integrated systems maintaining patient database for

the hospital services in the areas of Pathology, Radiology, Medical Research, In-patient

Admissions and Billing, Medical Stores & Pharmacy are operational. The implementation of the

above modules have evolved user-friendly computerized systems which are loved and cared by

all. This paper tries to cover giving an insight to the Hospital Information system implemented at

the Tata Main Hospital, which is being fully utilised to provide quality service. The

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computerised system has enabled the medics to serve their customers with a smile and to meet

the corporate objective set by the founder.

METHODOLOGY ADOPTED: As per the ISO 9000 standards a Project team was formed for

monitoring and managing the computerisation project on schedule. The team comprised of Head

of Departments, Key users consisting of doctors, Accountants etc, each from various functional

areas along with IT personnel. General Manager (Medical Services) called sponsor set directives

and reviewed project. Technical guidance was provided by Senior IT personnel.The project

execution methodology was carefully designed to incorporate almost all the essentials of

comprehensive methodology of ITS, which is an ISO 9001 certified unit. Main emphasis is given

to Joint Application Development (JAD) where approach was participative, user driven, highly

interactive,stress on quality, use of productive tools, phase approach etc. Each phase end was

certified by key users, Steering Committee members, and finally by Central Quality Assurance

(CQA) group at ITS.

CONCLUSION : It can thus be seen that deploying IT can help the medical profession in

improving its quality of service and thus automatically increasing the preparedness and

defensiveness. Of course, it is of vital importance that the software must have the right type of

modularity and openness so that it is manageable, maintainable and upgradable. The hardware

should also be reliable, available and have the necessary performance capacity. Certainly,

computers with their intrinsic power can play a major role in a hospital. Computers can act as a

communication link between departments and allows the common database to be shared by

them. They can perform the complex task of matching, tabulating, calculating, retrieving,

printing and securing the data as required. Well designed, integrated computer system can be a

great tool in the hands of the hospital management in improving services, controlling cost, and

ensuring optimal utilisation of facilities.

2) A study of the Hospital Information System (HIS) in the Medical Records Department of

a Tertiary Teaching Hospital

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Author: Praveen Kumar A, Gomes L.A. [10]

ABSTRACT : Hospital Information System (HIS) is vital to decision making and plays a crucial

role in the success of the organization. Computerization of the medical records and

documentation has resulted in efficient data management and information dissemination for the

users. Managers, Clinicians and other healthcare workers can now access the information

without delay or errors. Present study reveals, the existing system requires up gradation to meet

the requirements of the managers and the clinicians.Participants feel HIS assists in decision

making, and medical audit. Participants felt that the existing HIS resulted in longer time for OPD

consultation and delay in investigation results. Majority of the participants feel that HIS helps in

education and research.

METHODOLOGY: The study was conducted in 1200 bedded tertiary care teaching hospital.

The Medical Records Department of the hospital was studied for assessing the Hospital

Information System. Descriptive research approach as adopted for this study. Descriptive

statistics have been used to find out the deficiencies, if any, in the existing Hospital Information

System. The target population consisted of managers, doctors and patients in the hospital. The

data were collected from a sample of 60, consisting of 10 managerial heads, 20 doctors and 30

patients selected by the disproportionate stratified sampling technique. The inclusive criteria for

selecting the sample, were the managers who involved in decision making process, doctors with

experience of more than one year, and the computer literate patients, willing to participate in the

study. The tool used to collect the data was a structured, closed ended questionnaire. The

questionnaire was constructed with emphasis on the content, clarity and simple language. The

scoring for the managers and the doctors has been done on a four-point scale and the scoring for

the patients is on a three-point scale. The scoring has been given according to the nature of the

questions. A pilot study was conducted for the patients, to check the validity and feasibility of

the study. The tool was administered to subjects, for ascertaining the reliability. The reliability

calculated by using split method r = 0.73, 0.86 and 0.76, for managers, doctors an the patients

respectively, which was high and satisfactory.

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CONCLUSION : The present scenario in India is that most of the Medical Records Department

are partially computerized10. This system exists in some Health Care facilities, where entries are

made by different Health care providers, such as Physicians, Nurses and therapists, into the

computer in different nodes in a local area network. The survey conducted in the hospital reveals

the importance of information networking between the departments. Majority of the beneficiaries

of Hospital Information System, are aware about the advantages of computerisation in the HIS in

providing better health care. All of them agree that only in an efficient system the information

can be readily available. The exciting possibility of a modern and computerised information

system is not too far. In the coming years we can visualize the patient record existing in

electronic medium, where a patient can have a single record from birth to death that can be

assessed from anywhere in the world.

3) Evaluation of computerized health management information system for primary health

care in rural India.

Krishnan A et al [11]

BACKGROUND : The Comprehensive Rural Health Services Project Ballabgarh, run by All

India Institute of Medical Sciences (AIIMS), New Delhi has a computerized Health Management

Information System (HMIS) since 1988. The HMIS at Ballabgarh has undergone evolution and

is currently in its third version which uses generic and open source software. This study was

conducted to evaluate the effectiveness of a computerized Health Management Information

System in rural health system in India.

METHODS: The data for evaluation were collected by in-depth interviews of the stakeholders

i.e. program managers (authors) and health workers. Health Workers from AIIMS and Non-

AIIMS Primary Health Centers were interviewed to compare the manual with computerized

HMIS. A cost comparison between the two methods was carried out based on market costs. The

resource utilization for both manual and computerized HMIS was identified based on workers'

interviews.

RESULTS : There have been no major hardware problems in use of computerized HMIS. More

than 95% of data was found to be accurate. Health workers acknowledge the usefulness of HMIS

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in service delivery, data storage, generation of workplans and reports. For program managers, it

provides a better tool for monitoring and supervision and data management. The initial cost

incurred in computerization of two Primary Health Centers was estimated to be Indian National

Rupee (INR) 1674,217 (USD 35,622). Equivalent annual incremental cost of capital items was

estimated as INR 198,017 (USD 4213). The annual savings is around INR 894,283 (USD

11,924).

CONCLUSION: The major advantage of computerization has been in saving of time of health

workers in record keeping and report generation. The initial capital costs of computerization can

be recovered within two years of implementation if the system is fully operational.

Computerization has enabled implementation of a good system for service delivery, monitoring

and supervision.

OBJECTIVE

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General objective

To review the existing HIS (TrakCare) at Sir Ganga Ram Hospital from the end-user’s

perspective.

Specific objectives

1. To map the workflow of the hospital as seen on TrakCare in various departments, by creating

a fictitious patient.

2. To determine whether CPOE is being used at SGRH by clinicians.

3. To assess the knowledge, behavior and attitude of employees towards TrakCare.

METHODOLOGY

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Study design: Cross sectional , Descriptive

Study area: Sir Gangaram hospital

Study population: Doctors / consultants , Nurses / Paramedics, Front office executives,

Billing executives and pharmacists

Sampling and sampling design: This study was conducted at Sir Gangaram Hospital,

Rajinder Nagar, New Delhi. Employees from various departments, who use TrakCare, were

selected as study participants. Originally, the study included 75 people, out of which 51 people

responded. The study participants were selected according to convenience.

Data Collection Tools And Techniques:

A questionnaire was developed which consisted of various questions as per the objectives of the

study. A likert scale was used to assess the knowledge and behavior of the employees related to

TrakCare and the user friendliness of the same. The questionnaire consisted of all close-ended

questions.

Every third employee was chosen randomly from each department. The doctors / consultants

were given questionnaires according to their availability.

Participants were explained in detail regarding the purpose of the study; informed consent was

obtained and questionnaires were distributed. Necessary steps were taken to maintain anonymity.

Information thus obtained from the above questionnaire was entered in SPSS software and

analysed.

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TRAKCARE MODULES

OPD

TrakCare OPM, when installed with other TrakCare modules, is fully unified so information

related to pre-assessment, clinic attendances, emergency attendances, past admissions, and the

services provided as part of these events is available for viewing in the patient’s EPR. For any

clinic attendance, patient demographics and admission, clinical, and billing processes are linked,

facilitating real-time management of the patient’s care. [12]

OPD at SGRH is divided into two, depending on the payor – General and Private. OPM, like all

other TrakCare modules, is built with the Electronic Patient Record (EPR) at its center, allowing

the capture, display, and analysis of patient centric information to facilitate better patient care.

OPD functions include primarily registering new patients, episode creation, sticker printing.

• When a patient who isn’t registered with SGRH comes to the OPD , first of all, a

registration number is generated by filling in the patients particulars

The white banner on top of the screen shows the patient’s information at all times.

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On the next screen, an episode number can be created for that visit.

Depending on the payor for the patient (Patient or SGRH or Company), on the next screen, the

patient is charged.OPM functions include :

• Registration

• Referral

• Worklist

• Medical Records Management

• Labels

Now, ID stickers can be printed.

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ADMISSIONS

Under the IPD Admission tab, the patient’s registration number can be entered, which then opens

the following screen. The patient’s particulars can be filled in here.

Once the above screen is updated, the episode creation screen appears, where an episode for that

visit is created. Here, details like ward, bed and room category etc are filled in.

Once this is done, the patient’s plan and payor details are filled in.

26

On the ward map, the patient can now be seen in the spare bed list.

27

Stickers containing the particulars of the patient and other relevant details can be printed from

under the ‘Sticker’ tab.

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The functions of Admissions Department include [13] :

• Registration

• Bookings

• Admission

• Patient inquiry

• Leaves

• Movements

• Discharge

• Ward lists and Ward maps

• Patient labels

• Bed management

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WARDS

Once the patient is adimitted ,the nurse can order the following for the patient under the order tab

• Medicines

• Medical consumables

• Tests

• The quantity of order is dependant upon the frequency and duration for which it is to be

used by the patient

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The system shows alerts for the following:

• If a medicine has been ordered twice – the system shows duplicate order error

• If the doctor prescribes a drug that interacts with the ones that the patient is already on,

the system shows an alert saying ‘Generic Interaction’.

• If the doctor prescribes a drug that the patient is allergic to.

On this screen, there is also an option for filling in the reason why the doctor thinks any of the

above drugs should be prescribed anyway.

The next screen shows the outstanding amount of the patient.

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Under ‘EPR’, all the orders of the patient can be seen. The status of a particular order can be

tracked under ‘status of order’. Also, the pharmacy status of various orders can be checked from

time to time. The lab results and Imaging results can also be checked.

In case a patient needs to be moved from one place to another, for example, from CCU to ward,

the same can be done under ‘Movements’.When the patient is fit to be discharged ,a message can

be sent to the patient from the medical discharge menu.

In case the patient has died ,the date and time of death has to be entered.

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CIC (Central Investigation Centre)

CIC caters to all the private OPD patients. Following three processes are being carried out at

CIC:

• Sample collection

• Report generation and distribution

• Cash collection

Patients bring the doctor’s prescription and the recommended tests. Those tests are

ordered under the order tab.

All the tests to be performed are selected and the list is updated.

The patient is billed according to the tests orderd and the plan.

The cashier then collects the payment.

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CIC sample collection

Samples are collected in the sample collection room. once the sample has been collected ,a lab

request number is generated.Now stickers can be printed out which are then pasted on to vials

and sent to the respective labs.

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LabTrak

Using TrakCare Lab, as soon as the test is finished, results are made available with an alert sent

to notify the doctor, highlighting any abnormal findings. It is designed specifically to streamline

the diverse activities of laboratories in the areas of:

• Blood bank

• Clinical biochemistry

• Hematology

• Histology/cytology

• Immunology/serology

• Microbiology

• Specimen and request registration

• Work sent out [14]

TrakCare Lab meets all of the operational needs of the modern pathology laboratory and is

specifically designed to streamline its diverse activities.

• Customizable data entry screens

• Printing of reports

• Integration with Microsoft Word

• Export of information to other systems

• Patient management

• Specimen pre-registration

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There are two types of machines in the labs at SGRH

1) Unidirectional :

2) Bidirectional

In the unidirectional type of machines, sample name type has to be fed and the results have to

be transferred to the HIS.But in the bidirectional machines, the sample type is identified

automatically and the test is done.

After the test is completed , the machine name and the test group is fed.

The system then shows the results for all the samples that had been fed in that particular

machine.

• The HIS has a feature of showing alerts for abnormal results.

• In case a patient’s tests have to be done urgently, the HIS has a feature for setting the

priority of the test to be done.

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Pharmacy

TrakCare Pharmacy manages safe prescription dispensing and inpatient dispensing directly from

drug medication orders or ward stock.

Pharmacy functions include:

• Electronic Prescriptions received directly into the system

• Full Prescription Dispensing

• prioritized patient lists with current clinical information

• Patient Alerts [15]

Pharmacy Dispensing Workbench includes the following features:

• Prescription Search

• Prioritized Worklist displays prescriptions ranked according to assigned order entry

priority. Color coding is also available to assist with identification of urgent prescriptions.

• Pharmacy Queue facilitates workload management by sorting prescriptions according to

status. Defined queues include Pending, Accepted, Packed, Collected, Rejected, Ready

for Return, Completed, and Check.

• Barcode Packing uses the barcode on the prescription and the drug package to quickly

locate and pack prescription items; stock levels are automatically reduced and expiry

dates checked.

• Drug Interaction and Allergy Messages are displayed on the workbench..

In MedTrak , a list of all ordered medicines in a particular day can be obtained by entering the

date of order. A list of all the drugs and medical consumables that had been ordered for a patient

can also be obtained.

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A list of all the drugs and medical consumables that had been ordered for a patient can be

obtained by entering the prescription number.

In pharmacy, MedTrak offers following services-

1) Stock inquiry

2) Stock transfer

3) Stock adjustment

4) Stock consumption

5) Stock location

6) Stock return

7) Stock transfer acknowledge

8) Stock transfer inquiry

9) Stock receive

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STOCK TRANSFER REQUEST

The Stock Transfer Request module is used to request stock for a specified location within a

hospital. Examples of locations that may require stock replenishment are following:

Requesting Location to Replenish Location

A Ward Store to In Patient Pharmacy Store

Cardiac Main Store to Main Pharmacy Store (Basement)

Finance Department to Central Store

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STOCK TRANSFER

The Stock Transfer module is used to transfer stock from one location to another. A stock

transfer request no. must be flagged as complete before the stock transfer can be processed. It

deals with the following types of stock transfers:

• Stock transfer against a request

• Transfers without requests

Replenish Location to Requesting Location

In Patient Pharmacy Store to 2A Ward Store

Main Pharmacy Store (Basement) to Cardiac Main Store

Central Store to ICU Ward Store

Central Store to Finance Department

STOCK TRANSFER ACKNOWLEDGEMENT

The Stock Transfer Acknowledge module is used to acknowledge the stock transferred

by replenishing location to requesting location. A stock transfer no. must be flagged as

complete before the acknowledgement can be processed.

41

STOCK TRANSFER INQUIRY

This module allows the user to make inquiries about the status of a Requests and transfers. A

search can be performed using the any of the following search criteria:

Request Location

Replenish Location

Date Range Type – Request Date, Transfer Date

Request Date Range

Transfer Status – Completed, Not Completed

Acknowledge Status – Completed, Not Completed

You can also view the original Stock Transfer Request and Stock Transfer using this module.

Either select the request dates and transfer dates by click on the circle and select the date range in

request dates.

Select the requesting/replenish location for which you want to see the requests/transfers then

click on find button the following screen will appear select the desired request\transfer and right

click on it to see the request\transfer detail of that particular request\transfer.

42

STOCK INQUIRY

Enables the users to perform Stock inquiries based on following search criteria:

Stock code or description

Order Item description

Stock Category

43

Billing

The TrakCare Patient Billing module enables staff to coordinate and manage bills for different

patient types, including inpatients,same-day patients, outpatients, emergency patients. It

automates the billing process, produces on-demand billing, and reduces the time required to

discharge a patient.

Core functions of Patient Billing include:

• Patient/Payer Bills (Total and Interim) displays all bill-related information and

performs patient-related transactions

• Payment Agreement defines all levels of the contract by combining the payer, plan,

tariff, contract and charging method for each payer

• Charges are generated via administrative and clinical activity that results in an order

being raised for a patient. The charge associated with an order is based on the payer’s

payment agreements [16]

Types of charges include:

• Standard: Based on consumption or utilization

• Incremental: Based on time. For example, theater or intensive care services may

levy an initial base fee plus an incremental charge depending on duration of use.

• Ad hoc: Allows a user with a valid security group to override/modify a contract

for a patient for a specific episode of care

• Episodic: Charges billed for the episode

• Variable Room Rates: TrakCare allows different room charges (if applicable) to

be raised based on the type of room the patient is occupying. Additionally,

accommodation step down charges can be applied for a defined number of days

(e.g., a higher fee for the first x number of days followed by a lower fee the longer

the patient remains in the hospital)

44

The patient’s files are received at the billing department first.They are then sent for checking and

verification. Any pending dues are billed here. Then the file is sent for verification from the

senior authority. The files are segregated according to payor, i.e. corporate , insurance or self

paying.

The patient is then called to the billing department and the whole bill is explained to him by the

executive at the counter. The remaining amount is to be paid by the patient now.

Once the patient pays the bill, he is considered to be financially discharged.

45

46

ADVANTAGES AND DISADVANTAGES OF USING TrakCare IN DIFFERENT

DEPARTMENTS

ADVANTAGES in OPD :

• Now each visit to the doctor is only possible after an episode number for that visit is created

at the OPD registration. This makes sure that the patient is charged for each visit, therefore,

less chances of fraud on the patient’s part.

• Easy and convenient identification of patient by just entering the registration number or other

particulars of the patient in the search menu.

• All the categories have been segregated very meticulously. Green cards are being issued for

for SGRH employees’ .Yellow cards for economically weaker sections and blue cards for

senior citizens.

DISADVANTAGES in OPD

• Appointments are not be maintained in the TrakCare HIS.

• During downtime, the whole process has to be maintained manually.

• The process is very time consuming.

ADVANTAGES in ADMISSIONS

• A new feature of the TrakCare is that the system can recalculate the charges, if a patient

downgrades or upgrades his plan.

• Every patient is given a unique identification number which remains same although

his/her life.And an episode number is generated at each patient visit. For OPD patients

the episode number starts with “OP” , for inpatients ,the number starts with”IP” and for

emergency patients ,the number starts with “EM”.Earlier there was no link between the

patient’s previous and present visits and no comprehensive EPR.

• As the patient gets discharged ,the room automatically goes under housekeeping .Once

the room is done with housekeeping,the room is ready for reallocation.

DISADVANTAGES in ADMISSIONS

• The waiting list for the patients is not being maintained in the HIS.

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• During downtime, the whole process has to be maintained manually.

• The process has become very slow as compared to when it was manual.

• Often the system takes a lot of time to update new information.

ADVANTAGES in WARDS

• “Abnormal results removed”. Earlier the system could show an alert for an abnormal

result, even if the values were only slightly outside normal limits .As a result of this ,the

system started showing alerts for every patient because of which it was very difficult to

identify the real urgent cases.This feature has been rectified now.

• A wardlist showing all the current patients and their details can be seen by any nurse.

• The nurse has now full control of the final discharge.

• The nurses can order medicines, medical consumables and tests for patients from the

HIS. The pharmacy receives the order and packs the drugs or the medical consumables

required for the patient.

DISADVANTAGES in WARDS

• The patient’s details are not entered at each patient visit. Either they are entered

whenever convenient or at the time of discharge

• Clinician’s notes and nurse’s notes menu is not being utilized.

• The system is capable of showing an alert if the doctor prescribes the wrong dosage of a

drug. But this feature cannot be utilized because in order to calculate the drug dosage the

patient’s body weight is required .Such details are either entered as per the convenience

of the nurse or at the time of the discharge by the doctor.

• Since most times the doctor does not enter prescription etc into the system himself, he

does not come to know if the patient is allergic to that particular drug or the drug

interacts with other drugs the patient is on.This information is entered by the nurse who

does not get back to the doctor if the system shows any alert and overwrites it.

ADVANTAGES of LabTrak in Laboratories and CIC

• LabTrak has a feature of showing all the previous and present test reports of a patient on

a graph. Comparison between the present and previous reports has become easy.

48

• No sample mixing now because of separate barcodes for different labs, patients and tests.

• One lab cannot see and scan the results of other lab.eg- a sticker from Biochemistry lab

will not show any information when scanned in Hematology lab.

• Report distribution is decentralized.

ADVANTAGES of MedTrak in PHARMACY

• Handwriting errors have reduced to a great extent.

• The system doesn’t allow packing of expired medicines.

• The system shows alert for allergies and drug interaction at the pharmacy as well.

• The whole process of stock exchange has become very meticulous.

DISADVANTAGES of MedTrak in PHARMACY

• A pharmacist cannot challenge the doctor’s prescription.

ADVANTAGES in BILLING

• The billing errors have been reduced greatly.

• There is a control on pricing.i.e once the price of a particular service/item has been fed in,

it remains the same throughout the system.

• In case of death of the patient, even the final discharge of the patient is done from the

billing department which is otherwise done by nurses.

• Option of reverse financial discharge is available.

• An order can be cancelled from the billing department only, once it has been executed.

DISADVANTAGES in BILLING

• The whole process is very cumbersome and time consuming.

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Study findings

6 7 8

15

9

6

50

Can HMIS increases work efficiency?

Strongly agree

58.8%

Strongly agree

17.6%

Neutral

17.6%

Disagree

5.9%

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Can HMIS help I reducing medication errors?

Strongly disagree

5.9%

Disagree

3.9%

Neutral

11.8%

Strongly agree

31.4%

Agree

78.4%

52

Can you differentiate between HIS and EMR?

Yes

31.4%

No

68.6%

53

Do you find it easy to use HMIS application for clinical practice?(for doctors and nurses only)

Moderate

25.5%

Difficult

21.6%

Very difficult

5.9%

Very easy

19.6%

Easy

80.4%

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How frequently do you experience problems while using TrakCare?

Frequently

37.3%

Very frequently

11.9%

Rarely

3.9% Sometimes

47.1%

55

Are those problems resolved on time?

Yes

47.1%

No

52.9%

56

What are the limitations of TrakCare, if any?

NA

43.1%

Not user friendly

2%

Slow processing

31.4%

Long

Downtime

5.9%

Cannot calculate Complex mathematical equations

17.6%

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How much downtime does the system experience usually?

49%

41.2%

9.8%

58

How frequently does the breakdown occur?

Several times a week

37.3%

Insignificant

19.6%

Several times a month

62.6%

59

Do you enter the patient details (prescription, diagnosis etc) yourself? (For Doctors/Consultants

only)

84.3%

9.8% 5.9%

60

Do you enter the patient details (prescription,diagnosis etc) yourself? (For Nurses Only)

70.6%

21.6%

7.8%

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When are these details entered in HIS?

52.9%

27.5%

15.7% 3.9%

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If you have worked on another HIS, how do you rate TrakCare in comparison to that?

NA

82.4%

Worst

5.9%

NEUTRAL

2% SATISFACTORY

3.9%

EXCELLENT

5.9%

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DISCUSSION

The study participants included 6 front office executives,7 billing executives,8

consultants/doctors,15 staff nurses ,9 pharmacists and 6 others.

21.6% people find it difficult to use TrakCare.49% people say they experience problems with

TrakCare.52.9% people say that these problems are not resolved on time.

31.4% people of those who answered this question say that slow processing is one of the major

limitations of TrakCare and 17.6% people say that the biggest limitation is that it can not

calculate complex mathematical equations.

49% of the people say that the downtime is few minutes,41.2% people sat that the downtime is

few hours and 9.8% people say that the downtime is as long as 1 day.

62.7% people say that the breakdown occurs several times a month and 17.6% say that it occurs

several times a week whereas 19.6% people think that breakdown is almost insignificant.

Only 17.6% of the respondents had worked on some other HIS previously. 5.9% of those say that

TrakCare is excellent in comparison to other HIS. And 5.9% say it is the worst.

62.5% doctors say that they enter the patient details into the system themselves whereas 73.3%

nurses say that they enter the patient details into the HIS.

27.5% of doctors and nurses say that the patient details are fed into the system at each patient

visit.15.7% say it is entered whenever convenient and 3.9% say it is entered at the time of

discharge.

The research findings indicate that only 31.4% people could differentiate between HIS and

EMR.

76.5% people think HIS has increased work efficiency. 78.4% people think that HIS reduces

medication errors. 58.% people think that HIS helps in reducing duplication of medical

records.Only 19.6% doctors find it easy to use HIS in clinical practice and 90.2% people think

that HIS helps in assuring quality.

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Each patient is given a unique registration number that remains his identification at SGRH for

life. Also, each visit is denoted by an episode. The EPR is at the centre of majority of TrakCare’s

processes as far as patient management is concerned. This makes keeping a track on every detail

related to the patient very easy. The system is well-equipped to show various important alerts.

No sample mixing is ensured by Labtrak and barcoding. However, certain features of TrakCare

are not being capitalised upon fully. For eg, features like Clinician’s notes, Nurse’s notes etc

were left blank in almost all the patient records we saw.

Another drawback is that In case a doctor acts upon an allergy alert shown by the system and

prescribes a substitute, there is no record for the same.

The biggest drawback remains that doctor’s do not fill in the patient details in to the system

themselves. This is majorly done by the nurses, who, most times, overwrite if any alert pops up.

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RECOMMENDATIONS

• First and foremost, it is the doctor who needs to enter all the patient details into the

system and this needs to be done at each patient visit.

• Every new employee should be given a brief training on how to use TrakCare.

• There has to be a feature that can calculate complex mathematical equations in the system

, especially because such a afeature would be of great help in laboratories.

• Since slow processing seems to be one of the major grouses that employees have with

TrakCare, steps should be taken to speed up the system.

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REFERENCES

1.http://www.lexic.us/definition-of/hospital_information_systems

2.http://www.sgrh.com/

3. http://www.intersystems.com/trakcare/index.html

4. http://www.jbtdrc.org/Symposium/Topics/Role_hospital.htm

5. http://www.emrconsultant.com/education/hospital-information-systems

6.http://www.emeraldinsight.com/journals.htm?articleid=1728173 EuroMed Journal of Business,

Vol. 3 : 1, pp.99 – 118

7. http://www.ipedr.com/vol5/no2/45-H10139.pdf 2011 International Conference on Social

Science and Humanity IPEDR vol.5 (2011) © (2011) IACSIT Press, Singapore

8. http://www.j.kdnc.org/index.php/j/article/view/73 Ayodele Cole Benson, MB

BCH, PhD, DHA , Ustawi global journal

9. http://medind.nic.in/haa/t01/i1/haat01i1p70.pdf

10.http://fkilp.iimb.ernet.in/pdf/Healthcare_Quality/Assessment_of_Quality_of_Health_Facilitie

s_&_Services/Kumar&Gomes_study_of_HIS.pdf Journal of the Academy

of Hospital Administration

11. http://www.ncbi.nlm.nih.gov/pubmed/21078203

Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India.

12. http://www.intersystems.com/trakcare/solution/section-02_3.html#two32

13. http://www.intersystems.com/trakcare/solution/section-02_3.html#two31

14. http://www.intersystems.com/trakcare/solution/section-02_4.html#two412

15. http://www.intersystems.com/trakcare/solution/section-02_4.html#two48

16. http://www.intersystems.com/trakcare/solution/section-02_4.html#two49

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CASE STUDY : SIGNIFICANCE OF BARCODING AND STICKERS

USED AT SGRH

INTRODUCTION

With the implementation of TrakCare , patient registration and various other processes have

become very convenient and user friendly. This has also helped in reducing manual

documentation and chances of errors.

Whenever any new patient comes to SGRH, he is given a registration number that is unique and

remains same throughout the life. Each visit is denoted by an episode number. This information

is represented by a barcode. OPD, IPD and casualty departments have different episode numbers

and different codes.

The above information is printed on to stickers that are pasted on to the patient’s forms at various

points in time.

The different types of stickers used in SGRH are

1) Registration stickers

2) Episode sticker

3) Laboratory stickers

Each sticker carries different types of information about the patient.Bar-coding and sticker

generation has made it possible to move the patient’s file from one department to another

with reduced manual documentation and also helps to identify important information related

to the patient available in condensed form at all times. This also means time saving for both

the patient as well as the hospital.

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TYPES OF STICKERS

Various stickers which are issued to the patient at SGRH have their own importance.

1. Registration stickers

When the patient comes to the hospital for the first time, he gets himself registered .at that time

he is given a card with all his demographic details including his name, age, sex, address, phone

number.

He/she is given a unique identification number at the first visit which remains same although the

life of the patient and a new episode number is given for that particular visit.

The sticker is printed at the time of registration with a barcode on it.

2. EPISODE STICKER

Every patient is given an episode number after coming to the hospital. A new episode number is

generated on each visit to the hospital. There are three types of episode numbers:

a. Outpatient episode number

b. Inpatient episode number

c. Emergency episode number

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The outpatient episode number starts with OP, the inpatient episode number starts with IP and

the emergency episode number starts with EM.

Episode sticker for OPD patients denotes patient information like his name, age, sex, date, time

at which the sticker is generated, the name of the doctor whom the patient has come to visit, the

doctor’s department e.g.- general surgery, general medicine, ophthalmology, cardiology etc. and

the GAA number (Unique identification number given to the employees at SGRH) of the

employee or the front office executive who has printed the Sticker .

For IPD patients, the sticker contains all the information which is there on the outpatient sticker.

This also includes the room where the patient is admitted, his ward number etc. in the end the

patient’s registration number is also written.

3. LABORATORY STICKERS

When a private OPD patient goes to CIC or the general OPD patient goes to the labs to get

his/her tests done, he is given a lab episode number. This lab episode number varies with each

visit.And each test is given a lab identification number, which makes it very easy for the samples

to be identified at various departments.

Every sample is given a separate number which makes it impossible for the sample to be scanned

at any other place except its desired place.i.e. - the sample which is supposed to be sent and

scanned at biochemistry lab cannot be scanned at the histology lab. The lab stickers denotes

70

patient’s information about the type of sample e.g.-blood, urine etc., the type of container in

which the sample is contained e.g.-plastic, glass etc., place where the sample was collected, the

place where the sample is supposed to be sent, date and time of collection of sample, patient’s

name, registration number and episode number and a barcode which when scanned at the labs,

displays all the patient’s information.

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72

ADVANTAGES OF HAVING BARCODES AND STICKERS

1) Efficient bar-coding and sticker generation system reduces the chances of sample

mixing.

2) Reduced time consumption at each step.

3) Important patient information is available in condensed form at all times.

4) Reduction in medication errors, increased accuracy.

DISCUSSION

In the developing health sector, there is a great need for automated systems to work in the

direction of improving the quality of health care to the patients.

The barcode and sticker generation system has proved to be a milestone in improving the quality

of healthcare by reducing sample mixing, making patient identification easy and saving time at

each step.

Sir Ganga Ram Hospital had experimented with various other methods of patient identification

and relaying of information across departments in the past,but it is safe to say that barcoding and

sticker generation has simplified and made processes very convenient along with increasing

accuracy since it’s inception.

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PACS (Picture Archiving and Communication System) implementation at

SGRH : Process of vendor selection

INTRODUCTION

Sir Ganga Ram Hospital has a sound HIS system where most of the clinical and back office

activities are being taken care of; but the hospital does not have a Medical Image and archiving

solution and hence images like X-Ray, CT, MRI, etc. are not being stored for further reference.

In view of above there was a requirement of implementing a PACS solution to facilitate not only

the storage of a medical images but also to make them available hospital-wide for reference and

further processing.

Combined with available and emerging web technology, PACS has the ability to deliver timely

and efficient access to images, interpretations, and related data and it breaks down the physical

and time barrier associated with traditional image retrieval, distribution, and display.For the

purpose, IT department was instructed to evaluate the requirement and recommend the suited

PACS solution for SGRH.

PACS

A Picture archiving and communication system(PACS) is a medical imaging technology

which provide economical storage of, and convenient access to, images from multiple modalities

such as X-ray, CT, MRI, etc. on computers, within the hospital as well as in doctors clinics and

homes.For the Indian PACS market, the key drivers are:

• The need for film-less environment leading to film reduction

• Cost savings

• Better workflow through accessibility and availability

• Centralized storage

• The need for Tele-radiology services

• Increase in medical tourism

• Increasing competition among hospitals

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• Increasing awareness and demand for quality healthcare

• Increasing productivity

• Faster transcription

• Reduced rates of repeated imaging.

OBJECTIVES

1) To study the process of vendor selection for PACS at SGRH.

2) To determine the advantages of PACS for clinicians and various department.

METHODOLOGY

The information about PACS and its advantages to various departments is obtained through-

• Interviews

• Observation

People interviewed were- Head IT, Head medical informatics, FUJIFILM’s representatives,

Head of radiology department. And the workflow of the radiology departments was observed.

PROCESS OF VENDOR SELECTION

In the process , department of IT along with department of radiology initiated discussions,

meetings and demonstrations with recognised vendors of the domain and based on the outcomes

prepared a series of RFPs and shared the same with the mentioned vendors for submission of the

technical and commercial specifications/proposal.

The submitted responses to RFP were evaluated and based on the same, five vendors were

shortlisted for further evaluation.

Encouraged by the observations made, it was recommended to visit the functional sites of each

shortlisted vendor to evaluate the authenticity of their submitted proposals. The objective was to

75

understand the user feedback related to the respective operations along with the services and

support being offered by the company and to observe the performance related issues, if any, in

live environment.

• Preliminary demonstrations and discussions with various vendors in India to understand

current technological trends – attended by Director Medical, Head of Radiology, Head of

Medical Informatics and Head of IT.

• Request for proposal prepared based in discussions and after studying RFPs of other

institutions. This RFP had all technical and functional specifications.

• The RFP was sent to 9 vendors.

• Proposals received were compared. The proposals were found to be incomparable since

some vendors had included hardware and database licenses in their cost while others had

not.

• A second RFP, solely for commercial purposes, was then floated. This mandated

hardware and all database licenses as within the commercial proposal. Many other factors

were frozen to ensure that commercial quotations were for similar systems.

• An initial evaluation was done based on :

- Functionality provided

- Number of installations and support base in India

• 4 vendors were excluded after the initial evaluation

• A team of 4 experts went for site visits.

Method of evaluation :

• Each hospital was visited for about 4 hours. The hospital team was accompanied by a

member of the PACS provider company.

• A four page questionnaire was used to ask questions from the hospital staff. The

following were met:

1. Head of IT/ PACS administrator

2. Radiologist

3. All meetings were held in confidence, excluding the PACS representative

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• Stress was placed on :

- Professional attitude of the company

- The implementation

- The functionality provided

- The support provided

ADVANTAGES TO THE IMAGING DEPARTMENTS

• Better radiologist reporting accuracy will be possible due to available image comparisons

with previous films and with images obtained from other modalities like X-Ray, CT,

MRI, etc.

• Currently the imaging department machines are able to store their imaging records for a

few days only before the capacity of the machine is filed up. The data is deleted after

that. The only record remains on the printed film which is given to the patient. Once

PACS is available, the imaging data can be stored for the lifetime of the hospital.

• In MLC case, when hospital is asked to provide eh imaging records, the hospital

sometimes has none. With PACS system hospital will be able to print out fresh copies of

the previous image as and when required.

ADVANTAGES TO CLINICIANS

• Clinicians themselves can alter image contrasts, brightness, window levels,

magnification, etc. on the viewing computer, allowing tm to detect finer details which

would otherwise not be visible on a printed X-ray film, improving clinical decision

making.

• It will allow different images of the patient to be viewed side-by-side on the computer

monitor for the purpose of side-by-side comparison, by the clinicians himself.

• Patient’s images like CT scan, MRI, etc. can be seen/accessed by the clinician from

wherever he is, at whatever time. For example if a clinician can give an opinion on the

CT scan of a patient in the casualty while he is in the operation theatre. Alternatively, he

77

can give opinions from home and make rapid decisions and save patient’s lives. This is

especially valuable for neurosurgeons that make decision on more on what they view in

the film than the radiologist’s report.

• The orthopedic department can use its inbuilt computerization (Trauma CAD) for

advanced planning of hip replacements, deformity corrections trauma surgery, limb

lengthening, spinal surgery, etc. This will be far more accurate and produce better results,

than the currently used manual methods. The operative time will be significantly reduced

in such cases. On a given day, with a fixed number of operative hours, a larger number of

patients can be operated. This may increase the revenue of the department and the

hospital.

• Neurosurgeons can use the inbuilt computerized measurement facilities to guide their

stereotactic and robotic systems to that brain lesions can be operated upon with greater

accuracy.

COST SAVINGS

• Patients can be issued with a whole series of x-rays, CT scans, MRIs, etc. on a single CD

without having to print them. This could lead to substantial cost savings.

• In the ICU where most patients get daily X –ray done, rather than print each film

separately and send it to the ICU daily , images can be viewed via the IU doctors on their

monitors without the need to print films daily. At the time of discharge al the ICU x-rays

can be contacted by the packs, and printed on a singer x-ray film and provided to the

patient. This will save the hospital printing costs of many films.

• Manpower requirement to carry films from one location to another will be reduced once

PACS is available.

• As mentioned earlier, more operations will be possible by orthopedics department due to

computerized surgical planning techniques.

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CONCLUSION

There are several reasons why SGRH chose Fujifilm PACS.

Fujifilm India Pvt. Ltd is a large multinational company having very good local and global

backing..Fuji PACS as well as Fuji RIS are highly reputed amongst top PACS/RIS companies in

the world and ranked high by international standards and hence, very good reputation as a

PACS/RIS provider. As per KLAS evaluation, Fuji ranked second place in RIS and third place in

PACS, which is very rare. Fujifilm has been selling PACS in Indian market for 3years now (10+

years globally).

Other hospitals who also have Fujifilm PACS say that it has good functionality, professional

approach, commendable support and services and seamless and quick integration with HIS.