BUSINESS PROCESS REENGINEERING:

KMC PATIENT REGISTRATION SYSTEM

Prepared for

Prof. Madhavi Latha Nandi

Prepared by Working Group AI2||Section6||MNCN2

T. A. Pai Management Institute - 576104

March 16, 2015

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Letter of Transmittal

16th March 2015

Prof. Madhavi Latha Nandi

Tapmi,Manipal

Subject: Project report for business process reengineering on KMC patient registration

process

Dear Mam,

We have prepared this report based on our project on “Business Process Reengineering on

the KMC patient registration process” as requested is being submitted to you. This report

covers our study of the existing process in place at KMC, identification of the KPI’s,

recommendations and benefits of the changes.

The report has been prepared in accordance with the instructions provided. Kindly accept

our efforts.

Thank You, Yours Sincerely Group AI2

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ACKNOWLEDGEMENT

We express our sincere gratitude to Dr.Sudhakar K, Deputy medical Superintendent, and

KMC for giving us the information for understanding of the process for this project. We are

grateful for giving us his time and guidance without which this project would not be in its

current shape. We thank him for taking out time from his busy schedule and sharing his

thoughts, experiences and ideas with us.

We also express our heartfelt thanks to our ITB faculty Prof. Madhavi Latha Nandi for her

continuous support and guidance throughout the course of the project.

We also thank other doctors at KMC from staff at KMC who helped us in understanding the

process.

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EXECUITVE SUMMARY

The process considered for reengineering is the new patient registration process. Patient registration database is available online. But Registration and payment verification are done at separate counters. A patient spends considerable time in waiting hall without knowing what has to be done. Order of patients visiting the doctor is not shared. The reports of the patients are scanned and stored in database. This leads to a severe capacity crunch. This was the temporary solution to save the warehouse from overflowing.

There are three different functional areas to be considered for this reengineering; they are Registration, Payment and Doctor Allocation. Key performance indicators have been identified to measure the effectiveness of the proposed process. The main bottleneck identified is the waiting time of the patient at two different locations. The proposed reengineered process eliminates the need for waiting at the payment counter.

The basic change that the reengineered process will project is the waiting time being reduced from 37minutes to 10 minutes. A patient visiting the hospital for the first time should register with all the basic details and pay a one-time registration fee. And the payment will be verified before being called up for the consultation with the doctor.

The critical factor that organizes the queue of the patient waiting for consultation is the token system. According to the recommended new process, a token number will be generated for every patient registering at the registration counter. Four processes are combined together in the reengineered process; they are the basic details collection, one-time fee payment, payment verification and token number generation.

As mentioned, a database already exists for maintaining the patient details. But there is no integration of applications. And the reports after consultation are just stored as images. According to the new process, whenever a patient is registering, the details are fed to the central database where all the existing customer details are stored. The central repository will have the basic details of the customer and about his earlier visits to the hospital. So whenever a patient registers, all basic details are collected and the one-time payment is also accepted at the same counter. After the verification a unique id called token number is allocated to the patient. A display board outside the doctor’s cabin will display the token number and the order in which the patient has to go to meet the doctor.

The benefit for this would be the reduction of time spent by a patient in the hospital. Previously the patients were called for consultation in a random order and now the patient will have an idea as when his/her turn will come. Now the board will display the necessary details.

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The ERP system will connect all basic and specialty departments. Therefore if a patient in future visits some other department other than the ones he earlier visited, still the data will be stored through the ERP system. Therefore, the implementation of this ERP will help in reducing paperwork and restrict the manpower required. Changing all the aspects of the process to paperless will be a difficult task because few doctors might still prefer the old traditional prescription way.

LIST OF ABBREVATIONS

KMC: Kasturba Medical College

OPD: Out Patient Department

ERP: Enterprise Resource

ISO: International Organization for Standardization

IPD: In Patient Department

TCS: Tata Consultancy Services

IT: Information Technology

IS: Information System

MBBS: Bachelor of Medicine, bachelor of Surgery

KPI: Key Performance Index

FCFS: First Come First Serve

LED: Light Emitting Diode

ICU: Intensive Care Unit

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Table of Content

Topic Page No

LETTER OF TRANSMITTAL ii

ACKNOWLEDGEMENTS iii

EXECUTIVE SUMMARY iv

LIST OF ABBREVIATIONS V

INTRODUCTION 1

BACKGROUND 1

PROBLEM STATEMENT 1

SCOPE 2

AS-IS PROCESS 2

METHODOLOGY 6

OBJECTIVES 6

KEY PERFORMANCE INDEX(KPI) 6

CHARACTERISTICS OF CURRENT SYSTEM 7

RECOMMENDATATIONS 9

TO-BE PROCESS 9

BENEFITS 13

STRATEGIC POSITIONING 15

REFERENCES 16

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LIST OF ILLUSTRATIONS

Figures

Figure Description Page No.

Figure 1.1: Current Process diagram (Illustration) 5

Figure 2: Flow Chart of the As-Is Process 6

Figure 3: Business process reengineering cycle 8

Figure 4: To-Be process (Illustration) 11

Figure 5: Sample LED display board (Illustration) 13

Figure 6: Flow Chart of the To-Be Process 14

Figure 7 : Components of the ERP recommended for KMC 16

Figure 8: Strategic positioning on Mc Farlan’s Grid 17

BUSINESS PROCESS REENGINEERING:

KMC PATIENT REGISTRATION SYSTEM

INTRODUCTION

Background

KMC was established in the year 1953 by Shri T.M.A. Pai in the town of Manipal. Ever since

the establishment of the hospital there was a need felt to have a clinical facility to double as

a teaching hospital. This was done successfully when the Medical Relief Society joined

hands with the Manipal group to establish the Kasturba Hospital in May 1961, with 150 beds.

Today KMC has almost 8000 beds in total at its various centres across Karnataka. The

hospital at Manipal still remains the hub for major departments in healthcare. The KMC is the

largest private hospital in India and has 10 basic specialty departments, 10 super specialty

departments and various special centres including advanced research centres. The hospital

is committed to international quality standards and a certified ISO: 9001:2000.

The mission of KMC is to be the most preferred and comprehensive hospital through clinical

excellence, patient’s centricity and ethical practices to meet the health care needs of the

community.

While studying a large organization like KMC our focus was the "Patient Centricity".

Improvement in the patient care has become very important and one of the key objectives of

the healthcare providers is patient satisfaction. KMC sees a footfall of more than 1 million

patients in both the inpatient and outpatient departments every year. But when we look at

the revenue streams we find that the IPD (In patient department) generate around 80% of

the total revenues and the remaining 20% from the OPD (Outpatient department) and basic

consultations. This skewed contribution of revenue contribution of OPD towards the total

revenue is found to be one of the major reason that the processes in the OPD are mostly

manual and comprises of various redundant processes as the management is not keen on

investing a lot of budget on the OPD wing of the hospital. The patients often have to face

multiple queues, long hours of waiting and are cluelessness while waiting for their turn.

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The quality of the patient care at any hospital is measured by the quality of infrastructure,

quality of training, competence of the personnel and adoption of the system that is 'patient

oriented'. For the amount of patients that KMC witnesses every day and the revenue that is

generated by the OPD and basic consultation patients the administration does not see an

investment in a major IT system as essential and beneficial. KMC has already been

approached by IT giants like TCS who have implemented the IT solutions at other major

hospital chains like Apollo healthcare enterprise Ltd.

As of now IT systems are being tested in the Department of Dermatology as a pilot run. The

department has a system digitized which means that the prescriptions and patient files are

kept online. A major reason cited for such systems not being implemented so far is that the

doctors are used to writing prescriptions on papers and are not comfortable with the idea of

doing the same task on a computer screens.

Scope

The scope of our study was the basic consultation of the Outpatient department. This

comprises of the patient who are not admitted but come to hospital for basic consultation for

which the prescription is provided by the concerned doctors and patients are sent back.

AS-IS PROCESS

Study of the Existing process

The hospital is strategically situated in the town of Manipal. Thousands of cases from the

entire state of Karnataka and other neighboring states are referred to the hospital by various

medical practitioners in and around the state.

For the patients who are coming to the hospital for the first time the following steps are

followed:

Help Desk: The hospital has set up a help desk to advice patients and their families

to the concerned desks for registration. This helpdesk also helps in assisting the

visitors, attendants and patients with their queries regarding various procedures,

processes, layout and other concerns. For a patient enquiring about OPD and

consultations the help desk person directs him/her to the Registration Counter.

Registration Counter: There are four registration counters at KMC. The counters

usually have a long queue of patients waiting to get their patients registered. There

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are attendants provided who help the patients with filling the form. This form

comprises of the details of the patient name, age, address, phone number and

ailments. Once the form is filled they are asked to go to the ground floor to make the

payment in the payment counter.

Payment counter: The payment counter is a single kiosk on the ground floor of the

hospital where the all the patients queue up to make their payment. This queue is

usually very long because of the processes carried out at the counter. As the patient

reaches the start of the queue they submit their registration form and details are fed

into the system. This data also serves as the patient data. A unique patient ID is

generated for the patient. The authority on the other side of the counter verifies the

payment and creates a file. Once the payment is made the patient is directed to the

concerned floor and room number.

Waiting Hall: There are waiting rooms for patients on several floors. The layout of the

waiting room is a large hall which has seats arranged for the patients waiting for

different consulting doctors in the OPD department. This waiting hall is connected to

4-5 consultancy chambers were the resident doctors sit. Inside the waiting room an

intern from the medical college comes and checks the patient’s temperature, B.P.,

palpation and discusses the health problems faced. The intern also asks several

questions to understand the problem of the patient better. The interns are generally

doctors who are graduates pursuing their MBBS from the KMCH and are qualified to

handle various patient aliments. The patients are supposed to wait in the hall until

their name is called out for consultation by the nurses assigned to each doctor.

In the meantime these nurses are assigned the task of going to the reception from

time to time to collect the patient reports and details. Sometimes the employees from

the reception staff take the patient files from the reception to the doctor’s cabin. As

the patients leave after consultation the name from the next file is called out for

consultation. Often there is a haphazard handling of serial order of the patients

arriving and there are complaints from the patients that the management does not

handle the serial order of waiting correctly.

Consultation with doctor: Once a patient’s name is called out the intern and the

doctor enter the consultation cabin. The interns and doctor discuss the case and

provide the prescription to the patient. The consultation time depends on the type

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and intensity of the ailment. After this the patient carries the prescription and one

copy is saved in the patients file.

Figure 1: Current Process diagram (Illustration)

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Flow Diagram of As-Is Process Figure 2: Flow Chart of the As-Is Process

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METHODOLOGY

Objectives

The objectives of the project are as following:

A. Identify the bottlenecks in the patient registration system

B. Identify the KPI's to measure the effectiveness of the solutions

C. Make recommendations on streamlining the patient registration process

Key Performance Index (KPI)

We have identified the key KPI’s (Key Performance Index) through which we can identify the

bottlenecks and gaps to recommend a suitable solution. The KPI’s are used to evaluate the

success of any process or an organization. For identifying these KPI’s it is important to

identify the goals of the organization. We need to ensure the mission of KMC which focuses

on three parameters clinical excellence, patient centricity and ethical practices are met while

suggesting recommendation. Since our suggestions are focused on the patient welfare we

picked our KPI’s accordingly. The KPI’s are as below. We have calculated the values by

observing patients coming to the desk.

Registration time

Payment time

Customer relation

Number of patient treated per doctor per shift

Revenue for hospital

Better shift planning

As per the flow diagram depicted the registration time is an average 5 minutes.

1. Payment Time: The payment time is 15min as there is only one single queue on the

single counter.

2. Customer Relation: This parameter measures the way a business communicates to

its customers. It measures the customer goodwill and retention of the customer. In

our discussion the patients and their attendants are the customers.

3. Number of patient treated per doctor per shift: We have included this parameter

because KMC is considered an epitome for providing quality healthcare to the needy

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and the poor. By including this we can see what impact the recommendation can

have towards the hospitals aim.

Our study was focused on the analysis and designing the new workflow for the business

processes. The process of business reengineering has been described in the diagram

below:

Figure 3: Business process reengineering cycle

Characteristics of current system

1. Patient registration database is online and hence the detail of the patients are fed

into the system at the registration desk

2. Registration and payment verification are done in separate counters. The total

time spent on these counters combined is 22 minutes average.

3. A patient spends considerable amount of time in the waiting hall after registration.

Though the interns come and discuss the ailments the patients have to wait until

their names are called out. Usually the name is called haphazardly and queue is

not followed.

4. While waiting for their names to be called out in the waiting hall, the order of

patients is not shared. This leads to confusion, impatience and restlessness

amongst the waiting crowd.

Identify process

Review, update, Analyze

As-Is

Design To-be

Test and implement

To-be

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5. Often the personnel responsible for collecting the file from the reception and

sending them to the doctors’ nurses get delayed and the serial order in which the

patients were registered is mixed up.

6. Currently the hospital has deployed a pilot run of an IT system in the Department

of Dermatology. The system saves the patient files and reports in digital form.

The data is fed in this system by scanning the files and further there are parsers

and OMR devices to read the files and save the data in the database

7. Storage capacity crunch: During our discussion with the Dr.Sudhakar he shared

that the system is facing major crunch of space in storing the patient files

hardcopy and the other data related to the consultations, inpatients, surgeries

and related data.

8. The hospital comprises of 10 basic specialty departments, 10 super specialty

departments, and Special centres which include Burns Centre, Infertility Centre,

Neonatal ICU and the Centre for Nuclear Medicine and Several advanced

centres. Apart from this there are several other departments like the pathology

labs and therapies. Often a patient might get referred to several of these

departments during the course of his/her treatment. This leads to enormous data

generated from the various prescriptions, procedures like surgeries, lab tests and

consultations. Most importantly a doctor or intern who wants to study their cases

finds it tedious to refer to the files.

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RECOMMENDATIONS:

To-Be Process

After closely studying the patient registration and the related processes related to patient

management during the course of the project we have identified few changes and our

recommendations for the process.

Our business process in the project is the patient registration between arriving at the hospital

and reaching a doctors cabin for consultation. Most importantly we have recommended KMC

to install an IS system that connects the various departments and facilities like the

registration, billing, labs, ancillary services provider an all the departments. Going in the

chronological order the proposed changes are as following: Figure 4: To-Be process (Illustration)

1. We propose to increase the registration counter from the existing 4 desks to 5 desks.

This would mean merging the registration counter and adding the facility of payment

at the registration counter.

Benefit: Cut down the time spent in standing in the queue for the payment

(Reduction in registration time).

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2. Another addition at the registration desk level is that the patients will be provided with

a token that contains a token number. Since the proposed system would have IS

system the token number will be stored as identifier for patients visit on the particular

date. The token number combined with the date and time will be the primary key for

the data stored.

Benefit: A patient’s queue order is set and saved on FCFS basis (First Come First

Serve Basis)

3. As the patient is allocated his/her doctor at the one-stop registration desk the token

number is reflected at the IS system portal installed at the doctor’s end. Our next

recommendation based on this idea is installation of an LED screen outside every

resident doctor’s cabin. Figure below illustrates on the next page.

Figure 5: Sample LED display board (Illustration)

This screen will be placed outside every doctor’s room.

First field displays the Room number and the floor. Next is the doctor’s name which

can be updated by the system on the LED display which is installed outside the

doctor’s cabin. The most dynamic part of the data displayed on the board is the

patient information which is the Serial number, token number and the patient name.

The Serial number is an automated list whereas the token number and patient

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numbers are fetched from the patient database as the data is updated at the

registration desk. The first name in the list indicates the patient name in green which

signals that the patient is inside the doctor’s cabin. As the board indicates the data in

the serial the interns can identify the subsequent patients in the line by calling out the

token number and perform the pre-examination tests.

4. As the patient’s turn comes the doctor starts his examination, he opens the patient’s

data file thus looking for the patient data and turning the name displayed outside as

green. As the patients move in cycles the data displayed on the LED screen keeps

Figure 6: Flow Chart of the To-Be Process

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updating. As the patients leaves the doctors cabin the doctor provides them a copy of

the prescription and keeps a copy with him/her which would be later scanned and

added to the patient’s record by the attending nurse.

Benefits: Most important intangible benefit is the patient satisfaction and clarity

about their progress in the attending queue. Other benefits are:

The interns can attend to the patients in a systematic way

The noise level inside and chaos can be controlled at considerable level

Reduction of the task of the attending nurses of collecting the files from the

reception. Reduction in wastage of movement

Lastly is the recommendation for installation of one of the widely acclaimed ERP system.

ERP System

The hospital comprises of 10 basic specialty departments, 10 super specialty departments,

and Special centers: Burns Centre, Infertility Centre, Neonatal ICU and the Centre for

Nuclear Medicine and Several advanced centers. Apart from this there are several other

departments like the pathology labs and therapies. Often a patient might get referred to

several of these departments during the course of his/her treatment. This leads to enormous

data generated from the various prescriptions, procedures like surgeries, lab tests and

consultations. Most importantly a doctor or intern who wants to study the cases fined it

tedious to refer to the files. Author Joe Valacich in his book Information Systems today

describes the ERP system as an application that integrates the business activities beyond

departmental boundaries. An ERP system helps integrate the various data sources and

processes of an organization into unified system. The diagram below depicts the various

modules that can be part of the KMC ERP.

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Figure 7: Components of the ERP recommended for KMC

The ERP systems enables an organization to maintain the data from several departments

the data can be accessed from across the organization. There are several IT services

provider who can modify the ERP for specific usage for KMC.

Benefits

The benefits of the proposed changes for the business reengineering are summarized as

following:

Reduced registration time

Reduced paperwork between Registration & Payment counter

Reduced manual intervention

Less manpower required

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Increased customer satisfaction

MAPPING OF THE PROPSED CHANGES ON Mc Farlan’s Grid

The proposed recommendations can be placed on the Mc Farlan’s grid as following

Figure 8: Strategic positioning on Mc Farlan’s Grid

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REFERENCES

1. Mission and vision retrieved from http://manipal.edu/kmc-manipal/hospital/vision-

mission.html.

2. Facilities retrieved from http://manipal.edu/kmc-manipal/hospital/facilities.html

3. Enterprise Resource planning from Joe Valacich, Christoph Schneider-Information

Systems Today, 5th Edition -Prentice Hall (2011)1.pdf

4. Business process Reengineering retrieved from

http://en.wikipedia.org/wiki/Business_process_reengineering