SUBMITTED BY:-Dr. SHIRIN SAINI(2010-12) BATCH    PG/10/042
ORGANIZATION PROFILE• Sir Ganga Ram Hospital is a 650-bedded multi-speciality state-  of-the-art hospital in India.• It pr...
• Web-based hospital information system was implemented in Sir Gangaram  Hospital in December, 2005.• A hospital informati...
PROJECT OVERVIEW CONTD.• Billing module is one of the most supportive modules for admitting a  patient from the very begin...
Patient comes at the hospital                       Advised by the Doctor to get admitted                PHARMACY         ...
PROJECT OVERVIEW CONTD.• In SGRH, Patient billing and Order communication both are the  prime responsibilities of the Ward...
OBJECTIVE OF THE STUDY• To study the accuracy of decentralized billing in relation to:-       * Glucose Blood Strips      ...
RATIONALE OF THE STUDY• Strict usage and legal issue with Narcotic Drugs.• Digital Thermometer and Hand Rub are the set pr...
METHODOLOGY               •Analytical Study        QUANTITATIVE APPROACH     DATA COLLECTION           &      DATA ANALYSI...
• Simple Random Sampling of Departments was  done for the process of DATA COLLECTION.    Items to study         Department...
Data entered in Microsoft Excel and then ported to SPSS                      for analysis.
DATA ANALYSIS• Done using Microsoft Excel and SPSS.• Paired Sample T-test was applied to the data of Glucose Blood  Strips...
OBSERVATIONS
PAIRED SAMPLES T-TEST        RESULT         FORGLUCOSE BLOOD STRIPS
H0- There is no difference between the number of glucose tests done and number of glucose     blood strips billed.H1- Ther...
OVERALL PERFORMANCE 470 460 450 440 430 420 410                 458 400 390 380                                           ...
DEPARTMENT WISE ANALYSIS250                               GLUCOSE BLOOD STRIPS                                            ...
CROSS-TABULATION ANALYSIS           FOR  DIGITAL THERMOMETER
• Out of the total of 43 patients:-    * 58.13% are issued as well as billed. (True Positive)    * 32.55% are neither issu...
DEPARTMENT-WISE ANALYSIS                         DIGITAL THERMOMETER1412                                                 1...
CROSS-TABULATION ANALYSIS          FOR        HAND RUB
• Out of the total of 43 patients:-         * 62.8% are issued as well as billed for Hand Rub. (True Positive)         * 2...
DEPARTMENT-WISE ANALYSISSWB 4th                            9                       1    2  CB 6th       3                 ...
NARCOTIC DRUGS ANALYSIS                    ICU CUB 1                                           ICU CUB 2120               ...
ICU CUB 3                                                     ICU CUB 4180                                                ...
CONCLUSION• These were the following areas where the management has to look into so as to  minimize the wastage and the as...
• Differences were found, due to reasons like-             * Increased Work Load             * Repeated Bolus dose adminis...
RECOMMENDATIONS• Raise awareness among the nursing staff and the ward executives.• Strict supervision is required over the...
RECOMMENDATIONS CONTD.• The ward store in-charge should handle both the issuing andthe billing status.• Before the patient...
CASE STUDYEFFECTIVENESS OF WEB-BASED   HOSPITAL INFORMATION SYSTEM IN MAINTAINENCE OF         OT STORES(A comparative stud...
INTRODUCTION       COMPUTERIZATION IN SGRH 20 YEARS BACK• FoxPro based Hospital Information System for 20 years, known as ...
CURRENT UPGRADED HIS IN SRGH• A computerized and web-based hospital information system was  implemented in Sir Gangaram Ho...
OPERATION THEATRE MANAGEMENT             MODULE• Facilitates the coordination and efficient management.• Operating Theater...
The present case study focuses on the  maintenance of OT Stores pre and  post implementation of TrakCare.
PRE-IMPLENTATION PROCESS OF OT     STORES MAINTENANCE
STOCK MAINTENANCE THROUGH            TRAKCARE• As TrakCare is web-based HIS, therefore now an Automated Indent is  raised ...
METHODOLOGY• Purely qualitative in nature.• Observations recorded           personal interview• The observations were reco...
CHECKLIST   Time taken for Inventory Management   Downtime   Requirement of Staff   Billing Errors   Billing & Stock ...
OBSERVATIONS    CHECKLIST            FOXPRO BASED HIS                TRAKCARE HISTime for whole process               3-4 ...
Billing Errors       More                      Less Billing and Stock     These were 2 different Hand-to-hand             ...
CONCLUSION• With the implementation of InterSystems TrakCare, Sir  Gangaram Hospital has gained in the following arenas:- ...
REFERENCES•   State of Florida, Department of Health, A.G. Holley State Hospital, Hospital Information System, Function   ...
REFERENCES CONTD.•   A. Winter, B. Brigl, T. Wendt (2003), Modeling Hospital Information Systems (Part 1): The Revised Thr...
Completeness of decentralized billing
Completeness of decentralized billing
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Completeness of decentralized billing

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A hospital information system (HIS), is a comprehensive, integrated information system designed to manage the administrative, financial and clinical aspects of a hospital.
Billing module is one of the most supportive modules for admitting a patient from the very beginning up to its discharge.

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  • State of the art- highest degree of development.Comprehensive- including everything.
  • Integrated-structured
  • Cost-effective-productive in relation to the cost.
  • DT- Chapter8 facility management and safety.HR- chap 5 hosptlinfctncontrlAny wastage is associated with a significant cost. Constant and consistent monitoring of wastage rates and analyzing the factors behind the wastage is an essential part to be played by the management so as to achieve increased efficiency, and bring down the unnecessary wastage and the loss of cost associated with the wastage.
  • A single, unified information environment for all its modules enabling simplified information sharing, faster implementation, easier maintenance, and lower costs 
  • of the theater rooms with skillful use of colors and icons to alert where necessary
  • Completeness of decentralized billing

    1. 1. SUBMITTED BY:-Dr. SHIRIN SAINI(2010-12) BATCH PG/10/042
    2. 2. ORGANIZATION PROFILE• Sir Ganga Ram Hospital is a 650-bedded multi-speciality state- of-the-art hospital in India.• It provides comprehensive Healthcare services, and has acquired the status of a premier medical institution.• It is the only hospital in the private sector that has maintained nearly 100% bed occupancy due to its reputation of providing the highest level of medical services to patients from Delhi and neighboring states.
    3. 3. • Web-based hospital information system was implemented in Sir Gangaram Hospital in December, 2005.• A hospital information system (HIS), is a comprehensive, integrated information system designed to manage the administrative, financial and clinical aspects of a hospital.• According to (Linda Roussel, Russell C. Swansburg and Richard J. Swanburg, 2005), a typical hospital information system consists of six components:- * Admission * Medical records * Nursing * Patient billing * Order entry * Result reporting
    4. 4. PROJECT OVERVIEW CONTD.• Billing module is one of the most supportive modules for admitting a patient from the very beginning up to its discharge.• Importance of Billing Module in HIS * Automatic billing with manual overrides. * IP monitoring. * Generation of final bill with perfect accuracy. * Automatic Billing of every facility or services ordered. * Require less Staff. * Enhance patient care in a cost-effective manner. * Fast, Smart and Accurate bills.
    5. 5. Patient comes at the hospital Advised by the Doctor to get admitted PHARMACY LABORATORY WARD STOREDuring the stay of the patient in the hospital, all his/her orders like- Medicines and all the Labtests are entered in the HIS. The order is placed to the various locations like- Pharmacy Store,Hematology Lab, Bio-chemistry Lab, and so likewise one such location is the Ward Store. * PATIENT BILLING WORKFLOW AND ORDER COMMUNICATION AT SGRH
    6. 6. PROJECT OVERVIEW CONTD.• In SGRH, Patient billing and Order communication both are the prime responsibilities of the Ward Executives, and is decentralized in nature.• Completeness in normal terms means a process from the start till the end is perfectly done according to the set protocols.• My project “Completeness of Decentralized Billing” focuses mainly on the accuracy of the patient billing, that is, the number of usage of a particular consumable should exactly be the same as that of the number of the consumable billed.
    7. 7. OBJECTIVE OF THE STUDY• To study the accuracy of decentralized billing in relation to:- * Glucose Blood Strips * Newly issued Digital Thermometer * Newly issued Hand Rub * Narcotic Drugs
    8. 8. RATIONALE OF THE STUDY• Strict usage and legal issue with Narcotic Drugs.• Digital Thermometer and Hand Rub are the set protocols under NABH Standards.• All consumables are precious commodity. Any wastage is associated with a significant cost.• Essential feature of management to track the utilization of the Glucose Blood Strips, Digital Thermometer, Hand Rub and Narcotic Drugs.
    9. 9. METHODOLOGY •Analytical Study QUANTITATIVE APPROACH DATA COLLECTION & DATA ANALYSISRESULTS COMPARED, INTEGRATED & INTERPRETED
    10. 10. • Simple Random Sampling of Departments was done for the process of DATA COLLECTION. Items to study Department Glucose Blood Strips 3A Ward Hand Rub 4A Ward Digital Thermometer SSRB-2nd Ward Floor CB-6th Floor SWB-4th Floor Narcotic Drugs Post-Operative ICU PICU ICU CUB 1 ICU CUB 2 ICU CUB 3 ICU CUB 4 3rd & 4th HDU
    11. 11. Data entered in Microsoft Excel and then ported to SPSS for analysis.
    12. 12. DATA ANALYSIS• Done using Microsoft Excel and SPSS.• Paired Sample T-test was applied to the data of Glucose Blood Strips.• Cross-Tabulation analysis was done for Digital Thermometer and Hand Rub.
    13. 13. OBSERVATIONS
    14. 14. PAIRED SAMPLES T-TEST RESULT FORGLUCOSE BLOOD STRIPS
    15. 15. H0- There is no difference between the number of glucose tests done and number of glucose blood strips billed.H1- There is a difference between the two.Level of Significance chosen- α=0.05 (95%)Test Statistic- t=1.812Tabulated value- t α=2.78 (for 4 degrees of freedom and α=0.05)Therefore, as |t|< t α ; we reject the Null Hypothesis and conclude that There is a differencebetween the number of glucose tests done and the number of glucose blood strips billed.
    16. 16. OVERALL PERFORMANCE 470 460 450 440 430 420 410 458 400 390 380 397 370 360 TOTAL TESTS DONE TOTAL BILLED15.37% of the difference between the Glucose Blood Strips used and billed wasobserved; that is the usage was more than the number of Glucose Blood Stripsbilled.
    17. 17. DEPARTMENT WISE ANALYSIS250 GLUCOSE BLOOD STRIPS 39200150 8 TOTAL TESTS DONE 219100 TOTAL BILLED 5 180 109 5 50 4 DIFFERENCES 101 64 59 23 19 43 38 0 3A WARD 3B WARD 4A WARD SSRB 2nd CB 6th SSRB 2nd is the main area of concern with a difference of approximately 22%
    18. 18. CROSS-TABULATION ANALYSIS FOR DIGITAL THERMOMETER
    19. 19. • Out of the total of 43 patients:- * 58.13% are issued as well as billed. (True Positive) * 32.55% are neither issued and neither billed. (True Negative) * 4.65% are issued, but not billed. (False Positive) * 4.65% are not issued, but are billed. (False Negative)
    20. 20. DEPARTMENT-WISE ANALYSIS DIGITAL THERMOMETER1412 1108 NOT ISSUED & NOT BILLED 2 ISSUED BUT NOT BILLED6 1 NOT ISSUED BUT BILLED 1 7 11 4 ISSUED & BILLED4 62 5 3 1 10 3A WARD 4A WARD SSRB 2nd CB 6th SWB 4th
    21. 21. CROSS-TABULATION ANALYSIS FOR HAND RUB
    22. 22. • Out of the total of 43 patients:- * 62.8% are issued as well as billed for Hand Rub. (True Positive) * 2.32% are neither issued and neither billed. (True Negative) * 23.3% are issued, but not billed. (False Positive) * 11.6% are not issued, but are billed. (False Negative)
    23. 23. DEPARTMENT-WISE ANALYSISSWB 4th 9 1 2 CB 6th 3 4 ISSUED & BILLEDSSRB 2nd 7 1 1 NOT ISSUED BUT BILLED ISSUED BUT NOT BILLED NOT ISSUED & NOT BILLED4A WARD 3 3 23A WARD 5 1 1 0 2 4 6 8 10 12 14
    24. 24. NARCOTIC DRUGS ANALYSIS ICU CUB 1 ICU CUB 2120 45100 40 35 40 80 41 30 60 25 111 112 TOTAL BILLED 20 TOTAL BILLED 40 TOTAL IN FILE TOTAL IN FILE 15 16 20 10 16 5 16 16 0 0 INJ.FENTAYL INJ.MORPHINE INJ.FENTAYL INJ.MORPHINE ICU CUB 1 ICU CUB 2
    25. 25. ICU CUB 3 ICU CUB 4180 450 420 417160 400 153140 152 350 300120 250 200100 99 ICU CUB 3 150 100 INJ.FENTAYL TOTAL BILLED 100 80 ICU CUB 3 TOTAL IN FILE INJ.MORPHINE 50 60 0 4 4 INJ.FENTAYL INJ.MORPHINE 40 20 0 ICU CUB 4 TOTAL BILLED TOTAL IN FILE
    26. 26. CONCLUSION• These were the following areas where the management has to look into so as to minimize the wastage and the associated loss of cost:- * Billing status of Glucose Blood Strips, as the usage is more than the billed, which if not taken care of may lead to wastage and associated loss of cost to the hospital. * In case of Narcotic Drugs, Inj. Fentayl was used more often than Inj. Morphine as Fentayl is a short-acting drug & so more often prescribed by the Doctors.
    27. 27. • Differences were found, due to reasons like- * Increased Work Load * Repeated Bolus dose administration. * Neglected change of location.• Out of all the departments studied ICU CUB 1 and ICU CUB 2 showed noteworthy performance.• 3A WARD also showed a remarkable performance in case of the Digital Thermometer Billing status.
    28. 28. RECOMMENDATIONS• Raise awareness among the nursing staff and the ward executives.• Strict supervision is required over the nursing staff.• Simultaneous entry of data in the file and in the HIS.• In case of digital thermometer & hand rub, the date of issuing the item should be mentioned on the item itself. This was already practiced in Casualty Block 6th floor and so this practice can be implemented in the whole hospital.
    29. 29. RECOMMENDATIONS CONTD.• The ward store in-charge should handle both the issuing andthe billing status.• Before the patient is discharged all his orders should bereviewed again so as to reduce these errors. This can be doneby the nursing head with the help of ward executives.• A regular audit and follow-up should be carried out to helpminimize the wastage.
    30. 30. CASE STUDYEFFECTIVENESS OF WEB-BASED HOSPITAL INFORMATION SYSTEM IN MAINTAINENCE OF OT STORES(A comparative study of pre & post implementation of HIS)
    31. 31. INTRODUCTION COMPUTERIZATION IN SGRH 20 YEARS BACK• FoxPro based Hospital Information System for 20 years, known as HAPIS.• FoxPro is a text-based procedurally-oriented programming language and DBMS.• Originally published by Fox Software and later by Microsoft, for MS-DOS, MS Windows, Apple Macintosh, and UNIX.• Database Management System (DBMS), supports relationships between tables.• Not considered a Relational Database Management System (RDBMS), lacking transactional processing.
    32. 32. CURRENT UPGRADED HIS IN SRGH• A computerized and web-based hospital information system was implemented in Sir Gangaram Hospital in December, 2005.• Sir Ganga Ram chose InterSystems TrakCare™ as its new HIS because of:- * Ease of learning, use, and configuration * Enables simplified information sharing, faster implementation, easier maintenance, and lower costs * A highly reliable technology foundation built on the InterSystems Caché®, a high performance database.
    33. 33. OPERATION THEATRE MANAGEMENT MODULE• Facilitates the coordination and efficient management.• Operating Theater Management functions include: * Registration * Movements * Theater Inquiry * Billing * Theater Booking * Booking Management * Schedule * Schedule Management * Schedule Calendar * Schedule Transfer and Copy * Operating Theater Swap * Variance * Care Provider Activity * Orders * Surgical Preferences * Prosthetics Management * Store Maintenance
    34. 34. The present case study focuses on the maintenance of OT Stores pre and post implementation of TrakCare.
    35. 35. PRE-IMPLENTATION PROCESS OF OT STORES MAINTENANCE
    36. 36. STOCK MAINTENANCE THROUGH TRAKCARE• As TrakCare is web-based HIS, therefore now an Automated Indent is raised through the OT Store.• In TrakCare there are 5 major steps for the raising the Indent:- * Stock Transfer Request * Stock Transfer * Stock Transfer Acknowledgement * Stock Transfer Inquiry * Stock Inquiry * Stock Location Inquiry
    37. 37. METHODOLOGY• Purely qualitative in nature.• Observations recorded personal interview• The observations were recorded according to the checklist created.
    38. 38. CHECKLIST Time taken for Inventory Management Downtime Requirement of Staff Billing Errors Billing & Stock Upadating Procedure Availability of Data Study of trends
    39. 39. OBSERVATIONS CHECKLIST FOXPRO BASED HIS TRAKCARE HISTime for whole process 3-4 hours Hand-to-hand stock is of Inventory updated. Management Very frequently happened No history of downtime due to Index Corruption has occurred since Downtime and it used to took implemented. 30minutes-2hours to solve the problem.Requirement of Staff Less More
    40. 40. Billing Errors More Less Billing and Stock These were 2 different Hand-to-hand both Updating exercises in Foxpro billing and stock is Based HIS. updated. They both go side by side.Availability of Data Data Back-ups were Data since December taken to undertake any 2005 is available without kind of study. any Back-up. Study of Trends Cannot be identified in Can be indentified. this.
    41. 41. CONCLUSION• With the implementation of InterSystems TrakCare, Sir Gangaram Hospital has gained in the following arenas:- * Better management control * Standardization of operations and functioning * Decrease in cost * Reduce errors and corresponding litigations * Better quality of service * Development of a good brand image * Higher growth prospects
    42. 42. REFERENCES• State of Florida, Department of Health, A.G. Holley State Hospital, Hospital Information System, Function Specifications Document• Hamid Reza Kaghazch, Hospital Information System Modelling• John D. Wiedemer, Billing system for computer software• Mohanty Rajesh*, Rana Sarosh D**, Kolay Saroj K***, Hospital Information System in Medicare – An Experience at Tata Main Hospital, Jamshedpur• Haux Reinhold, Winter Alfred, Brigl Birgit (2004). Strategic Information Management in Hospitals: An Introduction to Hospital Information Systems.• Roussel Linda, Swansburg Russell C, Swanburg Richard J (2005). Management and Leadership for Nurse Administrators. Contributor Russell C. Swansburg, Richard J Swansburg. Jones & Bartlett Publisher.• F Labrèche, T Kosatsky, R Przybysz, Childhood asthma surveillance using administrative data: Consistency between medical billing and hospital discharge diagnoses• Ashwani .K. Ramani et.al, Hospital information system: PULSE [implementing IT in health-care]
    43. 43. REFERENCES CONTD.• A. Winter, B. Brigl, T. Wendt (2003), Modeling Hospital Information Systems (Part 1): The Revised Three- layer Graph-based Meta Model 3LGM2• Sue M. Malone, Billing Error Reduction Project: A Hospital Payment Monitoring Program Special Study• MedicaPlus- Patient Billing Overview• Quintegra HMIS• Nurse Training Manual at SGRH• OT Store Billing Manual at SGRH• Stock Processes Manual at SGRHWebsite Links:-• www.Wikipedia.org• http://www.binaryspectrum.com/Outsource/healthcare_solutions_billing.html• http://www.intersystems.com/trakcare/index.html• http://www.iienet2.org/uploadedFiles/SHSNew/Tools_and_Resources/Sampling%20Plan%20for%20Billing %20Accuracy%20Paper.pdf• http://ipac.kacst.edu.sa/eDoc/2006/156398_1.pdf• http://en.wikipedia.org/wiki/FoxPro_2

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