1. The American University in Cairo
School of Business - Management Center
Postgraduate Healthcare and Hospital
Management Diploma Gradation Project
System Implantation Plan
in Nasser Institute Hospital
Submitted to:
Prof. Mohsen El-Shammaa
Submitted by:
Dr. Mohammed Fathy Sayed Mohammed Zaky
2013

2. ‫الرحيم‬ ‫الرحمن‬ ‫هللا‬ ‫بسم‬

3. Contents
Page
 Introduction 1
 Nasser Institute Hospital 4
 Mission
 Vision
 Hospital divisions
 Organization chart
 Hepatogastroenterology Department 7
 Our mission and vision
 The services provided
 Objectives 13
 Current System 16
 Characters of current system
 Problems 17
 Back draws of current system
 Main problems within system
 Survey 19
 The Survey Results
 Survey analysis & their impacts

4. Contents (cont.)
Page
 Recommended Solutions 37
 Alternative Solutions
 Goals of proposed system
 Implementation Plan 42
 Stage I : Teamwork
 Stage II : Site preparation
 Stage III : Hardware
 Stage IV : New System
 Stage V : RFP creation
 Stage VI : Acceptance & Evaluation
 Stage VII : justification
 Stage VIII : Customization
 Stage IX : Testing
 Stage X : Training
 Implementation in Department 74
 Medical recording 82
 Real-life case
 Workflow
 Reporting procedure
 Conclusion 93

5. Introduction 
INTRODUCTION
As we know the great development in the field of
information technology and the boom that occurred in
last years in this field especially in hospital management
and using automation instead of traditional old methods.
Our project we will go through a brief review on the
steps of implementation plan for a Hospital Information
System (HIS) in Nasser Institute Hospital (NIH); the
largest tertiary referral center for Ministry of Health
(MOH).
We will put a pilot overview for implementation
process steps at all hospital divisions while we choose
the Hepato-gastro-enterology department to be an
applied example for this project to discuss it in details.
At the beginning, we will take a look at the hospital
composition, structure, divisions and organizational
chart. Also we will make a spot on Hepato-gastro-
enterology unit protocol, vision, mission and services
provided.

6. Introduction 
INTRODUCTION (CONT.)
Hospital goals and objectives are discussed
thoroughly identifying its needs and requirements; also
making a spot on the current system and its drawbacks
and problems that make us look for alternative solutions
and leads to our shift to the automated system.
We have done a simplified survey for the hospital
staff to assess several factors include their ability to use
the computer systems, evaluate their opinion for the
current system, detect problems they face and how they
see the way to solve it and their acceptance for our
project idea of applying the hospital information
technology system.

7. Introduction 
INTRODUCTION (CONT.)
The implementation process will including the
request for proposal, vendor`s proposals, and finally our
project is justified to get the management agreement.
Afterwards we start implementation regarding
tasks, responsibility, budget and time frame including site
preparation.Then we start training and test the new
system to evaluate all what we have done prior to go to
real-life work.
Finally we will go through the hospital information
technology system with a real-life case represent a case
came to Nasser Institute Hospital admitted, diagnosed
and managed with the new system. Also, we will see one
of the computerized reports for that case.

8. Nasser Institute Hospital 
NASSER INSTITUTE HOSPITAL
 NIH was opened in July 1987.
 It is resides over on areas of about (130,000 m2
).
 It has a main building and 3 associated buildings.
 The main building has 8 floors with 2 level basements.
 It is containing 885 beds.
 It has over about 40 medical specialties.
Mission
To provide advanced and unique health care for
patients in Egypt and other countries with continuous
improvement via education, training and research.
Vision
To be a center of excellence in providing health
care services, training, and medical research.

9. Nasser Institute Hospital 
Hospital divisions
Surgical specialties:
General surgery.
GIT & liver surgery.
Vascular surgery.
Pediatric surgery.
Obstetrics and gynecology.
Endoscopic surgery.
Plastic surgery.
Orthopedic surgeries.
Microscopic hand surgery.
Arthropathy surgery.
Oncology surgery.
Ophthalmology surgery.
Maxillofacial surgery.
Dental surgery.
ENT surgery.
Neurosurgery.
Urology surgery.
Medical specialties:
Chest medicine.
Nephrology.
Neurology.
Cardiology.
Gastroenterology.
Pediatric medicine.
Neonatology .
Dermatology .
Endocrinology.
Checkup centers:
Cardiac Checkup center
Diabetes Checkup center
General Checkup center
Women Health center
Specialized ICU:
Open Heart ICU.
Cardiac care unit.
Stroke care unit.
Surgical ICU .
General ICU.
Nephrology ICU.
Hepatology ICU .
Pediatric ICU.
Neonatal ICU.
Unique specialties:
Cardiothoracic Surgery center.
BoneMarrow Transplant center.
Maxillofacial Surgery center.
Radiological Intervention units.
Spine Surgery center.
Hand & Upper Extremity unit.
Oncology center.
Kidney Transplantation center.
Hyper baric Oxygen therapy.
Gamma Knife center.
Diagnostic Radiology unit:
X-Ray – US – CT scan – MRI
Laboratory:
Classic and Advanced labs
Training & medical research center
Tele-Medicine and Consultation.
Medical library

10. Nasser Institute Hospital 
Organization chart
In this is the real organization chart of Nasser
Institute Hospital. The chart shows accurate
departmentalization, and work specialty, and shows
good chain of command.

11. Hepatogastroenterology Department 
HEPATOGASTROENTEROLOGY DEPARTMENT
Hepatogastroenterology department in Nasser
institute hospital was opened in March 1999 and it is one
of the outstanding units of the Ministry of Health as it is
considered a reference unit for patients with
gastroenterology and liver diseases from inside
and outside the country.
The department is located in the third floor,
partition (A), containing about 28 beds (10 double bed
rooms and 8 single bed rooms). There is intermediate
hepatic care unit containing 4 beds and also, well
equipped single isolation rooms present to receive the
cases that need isolation. All of the department rooms
are overlooking the gardens of the hospital and
the River Nile.
There is also an affiliated outpatient clinic and
endoscopy unit located in the outpatient department of
the hospital supervised by a group of specialized
professors working 6 days per week.

12. Hepatogastroenterology Department 
OUR VISION AND MISSION
Our vision
A highly qualified reference unit that capable of
providing the standard of care to patients and the best
chance for scientific progress and practical training to
young doctors in the field of Hepatogastroenterology.
Our mission
To offer evidence-based medical service for
patients from Egypt and other countries, to establish the
first specialized Hepatogastroenterology checkup unit, to
raise multidisplinary team and improve facilities
preparing for liver transplant program and to provide a
complete training program for young physicians

13. Hepatogastroenterology Department 
THE SERVICES PROVIDED
The national (when available) and medical
services provided by the department are planned
according the international guidelines (reference
guideline booklet is available in the department) taking
into consideration the safety of the patient and the health
care provider.
 The outpatient clinic:
 Assessment of the attending patients by residents,
specialists and consultants in a stepwise manner
according to the needs
 Offering medical consultations to different specialties
 Offering recommendations for medical tourism
patients before reaching Egypt after reviewing their
medical reports.
 Providing multidisplinary team capable of evidenced
based decision making in some problematic cases
like hepatogastroentestinal tumors and liver surgery.

14. Hepatogastroenterology Department 
THE SERVICES PROVIDED (CONT.)
 Inpatient section.
 Intermediate care unit
 Ordinary ward
 Critical cases which are assessed in the outpatient
clinic or the emergency room will admitted to the
intermediate care unit
 Non critical cases are admitted to the ordinary ward
 Daily clinical and investigational follow up and
modification of the treatment plan are done aiming at
providing the highest level of medical care.
 Continuous observation and follow up of the nursing
care and aiming at raising its level
 Daily follow up of the patient file as it considered the
main source of patient's data.

15. Hepatogastroenterology Department 
THE SERVICES PROVIDED (CONT.)
 Endoscopy unit.
 The endoscopy unit was opened since 1999. It is
considered as a reference unit for patients inside
and outside the country. It is operated by a group of
professional professors.
 The unit isolated in the ground floor of the hospital in
the outpatient department.
 Emergency section.
 Assessment and management of attending cases to
the emergency room such as:
o GIT bleeding
o Hepatic encephalopathy
o Hepato-renal syndrome
o Acute hepatitis
o Spontaneous bacterial peritonitis
o Non-surgical acute abdomen

16. Hepatogastroenterology Department 

17. Objectives 
OBJECTIVES
Our aim is to make complete automation of Nasser
Institute Hospital through detailed Hospital Management
Information System (HMIS) implementation plan.
Goals should be SMART, specific, measurable,
attainable, relevant and time-based.
After the project management team discusses the
hospital goals; they reach the following major objectives:
 Providing novel health-care services
 Developing research skills
 Effective organizing & control of the hospital

18. Objectives 
OBJECTIVES (CONT.)
Providing novel health-care services:
The hospital plan to provide the best quality of
medical service in terms of the best medical outcome
and cover the Essential Public Health Services :
1. Monitor health status to identify & solve health problems.
2. Diagnose & investigate health problems and hazards.
3. Inform, educate, and empower people about health issues.
4. Mobilize community partnerships to identify & solve problems.
5. Develop policies & plans that support community health efforts.
6. Enforce laws & regulations that protect health & ensure safety.
7. Link people to needed personal health services.
8. Ensure a competent public health & personal health workforce.
9. Evaluate effectiveness, accessibility & quality of health services.
10. Research for new solutions to health problems.

19. Objectives 
OBJECTIVES (CONT.)
Developing research skills:
By communicating with the international centers
and research units to share the most recent medical
knowledge.
Effective organizing & control of the hospital:
The hospital aims at making all processes fast and
effective coping with the modern style of management
helping employees raise their skills and abilities and
minimize their work errors leading to efficient and
effective control of hospital resources and expenditure.

20. Current System 
CURRENT SYSTEM
Characters of the current system
- A traditional manual system.
- Based on paper work methods.
- No sufficient types of reports.
- No effective IT department.
- No coordination between hospital units.
- No automatic warning system.
- No Patient IDs recordation.
- Ineffective archiving & storage of patient files.
- Insufficient communication lines with other hospitals.

21. Problems 
PROBLEMS OF THE CURRENT SYSTEM
Back draws of the current system
- Late patients' administration.
- Overcrowds as no appointment schedule on follow up.
- Investigation reports are taking a long time
- Time wasting from request to get the results
- Requested drugs may not available.
- Deficient medical supplies and drugs.
- Staff doesn't know the pharmacy drugs.
- Slow ineffective data processing and collection .
- Many errors & time wasting.
- Inadequate referral system leads to conflicts.
- Poor connection among clinics or departments.
- High frequency in loss of reports & patient files.
- Insufficient financial records with errors & inaccuracy.
- Difficult evaluation & control of employees.
- Incorrect & delayed bells.
- Incomplete documentation of patient medical history.
- Poor data collection and statistical analysis.

22. Problems 
PROBLEMS OF THE CURRENT SYSTEM (CONT.)
Main problems with conventional system
 Lack of immediate retrievals:
The information is very difficult to retrieve and to find
particular information like. For example to find out about
the patient’s history, the user has to go through various
registers. This results in inconvenience & time wastage.
 Lack of immediate information storage:
The information generated by various transactions takes
time and efforts to be stored at right place.
 Lack of prompt updating:
Various changes to information like patient details or
immunization details of child are difficult to make as
paper work is involved.
 Error prone manual calculation:
Manual calculations are error prone and take a lot of time
this may result in incorrect information. For example is
calculation of patient’s bill based on various treatments.
 Preparation of accurate and prompt reports:
This becomes a difficult task as information is difficult to
collect from various registers.

23. Survey 
SURVEY
Simplified survey has been working on a random
sample of workers in the Nasser Institute Hospital where
this survey included two parts, the first is about ten
questions to be answered yes or no, while the second
part guarantees the five open ended questions.
 Yes / No Questions:
1 - Do you have a personal computer?
2 - Do you know how to work on the computer?
3 - Have you attended any training IT courses?
4 - Are you satisfied with the current service level in NIH?
5 - Are you satisfied with the traditional work manner?
6 - Do you prefer to work in current system or new one?
7 - Do you think ITS will achieve better performance?
8 - Have you ever worked a hospital IT system?
9 - Are you ready to enroll in IT system qualifying courses?
10 - Are you with or against the application of ITS at NIH?
 Open Questions:
1 - What is the nature of your work within the hospital?
2 - What are the biggest problems you faced in daily work?
3 - What are your suggestions to solve these problems?
4 - What are your experiences in the field of IT?
5 - What are the most important characteristics that
requests be available in the new work system?

24. Survey 
: ‫االسم‬
: ‫الوظيفة‬
: ‫ال‬ ‫أو‬ ‫بنعم‬ ‫األسئلة‬ ‫أجب‬
1-‫آلي‬ ‫حاسب‬ ‫جهاز‬ ‫لديك‬ ‫هل‬‫شخصي‬‫؟‬
2-‫؟‬ ‫اآللي‬ ‫الحاسب‬ ‫على‬ ‫العمل‬ ‫تجيد‬ ‫هل‬
3-‫؟‬ ‫اآللي‬ ‫الحاسب‬ ‫في‬ ‫تدريبة‬ ‫دورات‬ ‫بأي‬ ‫والتحقت‬ ‫لك‬ ‫سبق‬ ‫هل‬
4-‫؟‬ ‫للمستشفى‬ ‫الحالي‬ ‫الخدمة‬ ‫مستوى‬ ‫عن‬ ‫راض‬ ‫أن‬ ‫هل‬
5-‫العمل‬ ‫عن‬ ‫راض‬ ‫أنت‬ ‫هل‬‫؟‬ ‫التقليدية‬ ‫الورقية‬ ‫بالطريقة‬
6-‫هل‬‫؟‬ ‫اآللي‬ ‫الحاسب‬ ‫بنظام‬ ‫ام‬ ‫الحالية‬ ‫بالطريقة‬ ‫العمل‬ ‫تفضل‬
7-‫أن‬ ‫تعتقد‬ ‫هل‬‫؟‬ ‫للمستشفى‬ ‫أفضل‬ ‫أداء‬ ‫سيحقق‬ ‫المعلومات‬ ‫تكنولوجيا‬ ‫نظام‬ ‫تطبيق‬
8-‫بها‬ ‫بمستشفى‬ ‫عملت‬ ‫ان‬ ‫سبق‬ ‫هل‬‫المعلومات‬ ‫تكنولوجيا‬ ‫نظام‬‫؟‬
9-‫ل‬ ‫تأهيلية‬ ‫بدورات‬ ‫لاللتحاق‬ ‫استعداد‬ ‫على‬ ‫انت‬ ‫هل‬‫نظا‬‫المعلومات‬ ‫تكنولوجيا‬ ‫م‬‫؟‬
11-‫؟‬ ‫بالمستشفى‬ ‫المعلومات‬ ‫تكنولوجيا‬ ‫نظام‬ ‫تطبيق‬ ‫ضد‬ ‫أو‬ ‫مع‬ ‫أنت‬ ‫هل‬

25. Survey 
: ‫باختصار‬ ‫األسئلة‬ ‫أجب‬
1-‫ماهي‬‫؟‬ ‫المستشفى‬ ‫داخل‬ ‫عملك‬ ‫طبيعة‬
...............................................................................................
...............................................................................................
...............................................................................................
2-‫؟‬ ‫اليومي‬ ‫عملك‬ ‫في‬ ‫منها‬ ‫تعاني‬ ‫التي‬ ‫والعقبات‬ ‫المشاكل‬ ‫أكبر‬ ‫ماهي‬
...............................................................................................
...............................................................................................
...............................................................................................
3-‫؟‬ ‫المشكالت‬ ‫هذه‬ ‫لحل‬ ‫اقتراحاتك‬ ‫ماهي‬
...............................................................................................
...............................................................................................
...............................................................................................
4-‫المعلومات‬ ‫تكنولوجيا‬ ‫مجال‬ ‫في‬ ‫خبراتك‬ ‫ماهي‬‫؟‬
...............................................................................................
...............................................................................................
...............................................................................................
5-‫ماهي‬‫؟‬ ‫الجديد‬ ‫العمل‬ ‫نظام‬ ‫في‬ ‫توافرها‬ ‫تطلب‬ ‫التي‬ ‫الخصائص‬ ‫اهم‬
…………………………………………………………………………………………
…………………………………………………………………………………………
…………………………………………………………………………………………
…………………………………………………………………………………………

26. Survey 

27. Survey 
Doctors
28%
Nurses
18%
Technichans
12%
Officers
38%
Others
4%
The Survey Results
50 hospital staff people underwent
this survey distributed as follows:
 14 Doctors
 9 Nurses
 6 Technicians
 19 Officers
 2 Others

28. Survey 
34
27
12
22
17
19
26
9
14
23
16
23
38
28
33
31
24
41
36
27
0
5
10
15
20
25
30
35
40
45
50
Q 1 Q 2 Q 3 Q 4 Q 5 Q 6 Q 7 Q 8 Q 9 Q 10
YES NO
The Survey Results
Q YES NO
1 68% 32%
2 54% 46%
3 24% 76%
4 44% 56%
5 34% 66%
6 38% 62%
7 52% 48%
8 18% 82%
9 28% 72%
10 46% 54%

29. Survey 
0
5
10
15
YES NO
0
2
4
6
8
10
12
14
YES NO
YES
68%
NO
32%
Q1 Q2
YES
NO

30. Survey 
0
5
10
15
YES NO
YES
44%NO
56%
Q4
0
5
10
15
YES NO
Q3
YES
NO

31. Survey 
0
2
4
6
8
10
12
YES NO
0
2
4
6
8
10
12
YES NO
YES
34%
NO
66%
Q5
YES
38%
NO
62%
Q6

32. Survey 
0
2
4
6
8
10
12
YES NO
0
5
10
15
20
YES NO
YES
52%
NO
48%
Q7
YES
18%
NO
82%
Q8

33. Survey 
0
5
10
15
20
YES NO
0
2
4
6
8
10
12
YES NO
YES
28%
NO
72%
Q9
YES
46%
NO
54%
Q10

34. Survey 
0
5
10
15
20
25
30
35
40
45
50
YESNOYESNOYESNOYESNOYESNOYESNOYESNOYESNOYESNOYESNO
Q1Q2Q3Q4Q5Q6Q7Q8Q9Q10
Others
Officers
Technichans
Nurses
Doctors

35. Recommended Solutions 
Survey analysis and their impacts
When we try to analyze the results of the survey
which we did in the hospital staff, we found that there are
positive and negative points. It is very important to
address and manage the negatives before and during
the implementation of our project to ensure that
implementation will be applicable and successful and
also to reduce the obstacles and difficulties that may be
face us during the process.
The survey analysis tells us that the poor general
economic situation has led to our underdevelopment
status with comparing to the world in the field of
information technology. Although that more than 68% of
the participants in the survey have personal computers,
only 54% of them are fluent users and less percentage
that have computer skills in the form of using software
applications such as office and network browsing.

36. Recommended Solutions 
Survey analysis and their impacts (cont.)
In fact negligence of this aspect in education and
employment is the main problem and this was evident in
the outcome of the third question where it was found that
less than a quarter of the survey participants have
enrolled in training courses in this field and the result is
our electronic illiteracy.
Also, the results of the survey show dissatisfaction
about half of the participants for the service provided at
the hospital and the reason for this result is the
traditional work methods which became now a path from
the past in the world. About 66% of the participants
answer negative when they were asked about their
satisfaction with the current traditional work method while
more than 60% of the participants prefer to use a new
technology in their work. Also, more than half of the
participants see that information technology will lead to
get a best performance in the hospital.

37. Recommended Solutions 
Survey analysis and their impacts (cont.)
This may be a good indicator of general awareness
that there is a problem in the hospital current system and
realize that it needs to be solved through using of
information technology system.
Another aspect of the survey shows that the field of
information technology in the management of hospitals in
Egypt is very limited and that as we mentioned before is
because the limited funding and idea negligence. It was
appeared obviously in our survey in the results of
questions number (8) and (9) as only nine out of fifty
have previously worked in hospitals with information
system and only fourteen out of fifty have enrolled in
information technology training courses.

38. Recommended Solutions 
Survey analysis and their impacts (cont.)
The question number ten in the survey explained
that the hospital staff had broken up into two teams, one
supporter of the idea of the project and the other is
against it. This will lead us to start the implementation of
the project by using and training the accepting team
hand by hand with trying to understand the reasons for
the objection of others and avoid it.
Open questions in an attempt to get closely
acquainted with the most important problems facing the
working groups and staff at the hospital and the ways to
solve them, also included questions asked about workers
knowledge about information technology and whether
they have any previous experience in use it. The was
Most important question was for properties that working
groups like to met in the new system that will be
implement in the hospital.

39. Recommended Solutions 
Survey analysis and their impacts (cont.)
The participates whom answering the survey were
more than ten doctors, three pharmacists and a dentist.
Also it answered by three high Nurses, four nurses and
two assistant nurses. The participated group of
technicians was three radiological technicians and three
laboratory technicians. Also, a group of employees
participated from different hospital departments and
sections were reaches about nineteen officer.
Doctors' problems were summarized in the
difficulty of communication between hospital
departments, attendance system and data loss, while
nurses and technicians saw that's personal shortage,
excessive paperwork, and work overload were the main
problems. Officers said that their first problem is in
keeping and retrieval data.

40. Recommended Solutions 
Survey analysis and their impacts (cont.)
The variety of proposals to resolve and are mostly
in the application of some successful methods of other
hospital systems, and the virtue of a number of doctors
and employees automated system to resolve the crisis.
The majority of the officer personnel in the hospital had a
good idea about the information technology system and
showed presence of some past experiences in it, while
experiences in such field for medical personnel and
technical were limited.
The main characteristics demanded by the
participants in the survey focused on ease of use,
adequate training and the quality of services.
Pharmacists focused on the importance of use of such
system especially in the field of drug store and medical
instruments. Also, doctors worried about patient
information security and privacy while officers stressed
on the importance of regular maintenance of the system.

41. Recommended Solutions 
RECOMMENDED SOLUTIONS
Alternative Solutions
1. Improved Manual System:-
One of the alternative solutions is the improvement
of the manual system. Anything, which can be done by
using automated methods, can be done manually. But
the question arises how to perform thing manually in a
sound manner. Following are some suggestions, which
can be useful in the manual system. A more sophisticate
register maintenance for various Patient Information,
Doctor diary, Immunization Details and a good system
for writing bill amount employees and stock availed for
the customers can be maintained at central place.
Adequate staff may be maintained so that updating are
made at the very moment at the same time. Proper
person for proper work should be made responsible so
that a better efficiency could be achieved. This needs a
lot of work force.

42. Recommended Solutions 
RECOMMENDED SOLUTIONS (CONT.)
2. Online System:-
This system (HMS) provides online storage/
updating and retrieval facility. This system promises very
less or no paper work and also provides help to Doctor
and operational staff. In this system everything is stored
electronically so very less amount of paper work is
required and information can be retrieved very easily
without searching here and there into registers. This
system is been discussed here.

43. Recommended Solutions 
RECOMMENDED SOLUTIONS (CONT.)
Goals of proposed system
1. Planned approach towards working : - The
working in the organization will be well planned
and organized. The data will be stored properly in
data stores, which will help in retrieval of
information as well as its storage.
2. Accuracy : -The level of accuracy in the proposed
system will be higher. All operation would be done
correctly and it ensures that whatever information
is coming from the center is accurate.
3. Reliability : - The reliability of the proposed
system will be high due to the above stated
reasons. The reason for the increased reliability of
the system is that now there would be proper
storage of information.

44. Recommended Solutions 
RECOMMENDED SOLUTIONS (CONT.)
4. No Redundancy : - In the proposed system
utmost care would be that no information is
repeated anywhere, in storage or otherwise. This
would assure economic use of storage space and
consistency in the data stored.
5. Immediate retrieval of information : - The main
objective of system is to provide for a quick and
efficient retrieval of information. Any type of it
would be available whenever the user requires.
6. Immediate storage of information : - In manual
system there are many problems to store the
largest amount of information.
7. Easy to Operate : - The system should be easy to
operate and should be such that it can be
developed within short time & fit in the limited
budget of user.

45. Implementation Plan 
IMPLEMENTATION PLAN
System implementation will be done in 10 stages :
Stage I : Teamwork
Stage II : Site preparation
Stage III : Hardware
Stage IV : New System
Stage V : RFP creation
Stage VI : Acceptance & Evaluation
Stage VII : justification
Stage VIII : Customization
Stage IX : Testing
Stage X : Training

46. Implementation Plan 
Stage I : Teamwork
Our teamwork structure consists of :
 General manager plays the role of the coach
 TQM manager as the project manager
 Financial manager is in charge of budget
 HR manager is responsible for training
 Medical manager is responsible for medical support

47. Implementation Plan 
Stage II : Site preparation
Data Center creation:
Preparation of the center in which the system
servers and network router will be located, as well
as any additional changes that might be introduced
to accommodate the automated system.
The data center site is selected to be in
isolated building. It will be divided to three sectors,
one for each stage. Each sector will be accomplish
within 4 months duration including testing the
additional changes done to insure that everything is
working properly and ready.

48. Implementation Plan 
Specific considerations:
 The floor and ceiling will be coated with
heat & sound proof walls.
 Ventilation is modified to provide a high
cooling effect.
 A heat detection point is placed to alarm
the management.
 The servers are linked to the alternative
generators of the hospital.

49. Implementation Plan 
Stage III : Purchase and Hardware
 Fully integrated system.
 3 servers.
 1500 PCs.
 150 scanners.
 300 printers.
 Communication lines.
 Intranet.
 Decision Support System (DSS).
 Executive Information System (EIS).
 Expert System.
 Analytical System.
 Virtual Private Network (VPN).

50. Implementation Plan 
Functionality of required system :
 High technical fully integrated system to support
electronic flow of information.
 All modules have to exchange information
whenever needed & produce one single report.
 All supplementary applications such as DSS, EIS
& ES should be a part of the proposed solution.
 All medical healthcare equipment has to be
integrated with the new system.
 The new system has to be fully integrated with
the old manual system available on site.
 One single report should represent the entire
movement of the patient for the moment he is
admitted until discharged.

51. Implementation Plan 
Stage IV : New system
General specifications :
- It should be workflow-based.
- It should be real time and on-line integrated MIS.
- It should be scalable, flexible, modular & fully integral.
- It should be designed full features ease of use.
- It should be have a multilingual capability.
- It should be able to chat messages between users.
- It should be allow implantation in a phased manner.
- It should be able to give formal reports.
- It should be able to store and print reports.
- It should be using uniform codes by all health units.
- It should be allowing pricing service.
- It should be a Medical Record oriented system.
- It should be compatible with internationally standards.
- It should be ensure data security and reliability.
- It should be have controls to minimize user errors
- It should be capable to concluding back up action.
- It should be conducting actions upon authorization level

52. Implementation Plan 
The system modules :
1. Medical modules
2. Para-Medical modules
3. Non-Medical modules
Medical modules
- Master patient index system
- Electronic medical record system
- Inpatient management system
- Outpatient management system
- Intensive care management system
- Checkup information system

53. Implementation Plan 
Para-medical modules
- Specialized centers management system
- Pharmaceutical services management system
- Medical supplies management system
- Nursing management system
- Laboratory information system
- Radiology information system
- Clinical research module
- Medical library module
Non-medical modules
- Biomedical engineering system
- Medical logistic system
- Management support system
- Administration module
- Cashiering module
- Accounting module

54. Implementation Plan 
Types of reports:
 Admission form
 Referral letter
 Discharge summary
 Death declaration form
 Vital signs report.
 Blood transfusion form.
 Fluid intake and output balance.
 Patient medical data reports.
 Out-patient clinic reports.
 Lab. reports.
 Radiology reports.
 Inpatients follow up reports.
 Emergency room statistical reports.
 Referral reports.
 Infection control reports.
 Pharmacy contents reports.
 Financial status reports.
 Patient discharge reports.
 Patient accounting reports.
 Wages and salary analysis reports.
 Employee leaves reports.
 Purchase orders report.
 Medical statistical reports.

55. Implementation Plan 
Some reports forms used in hospital
Refeeral Sheet Treatment Request Form

56. Implementation Plan 
Some reports forms used in hospital
Patient Admission Sheet

57. Implementation Plan 
Some reports forms used in hospital
Nutrition Request Informed Consent

58. Implementation Plan 
Some reports forms used in hospital
Medical Recommendation Report Blood Transfusion Form

59. Implementation Plan 
Stage V : RFP creation
One single report should represent the entire
movement of the patient for the moment he is
admitted until discharged.
RFP is consists of :
1. Introduction
2. Objectives
3. Enterprise profile
4. Current operational system
5. Problems of the current system
6. Required new system
7. Functionality of required system
8. General terms and conditions
See
before

60. Implementation Plan 
 General terms and conditions:
 Delivery:
Detailed delivery plan including
hardware units and software applications.
 Installation:
Complete installation plan for all
required components whether internal or
external.
 Warranty:
Present the standard warranty period
with the annual cost of every extra
warranty period.
 Maintenance:
Submit a draft of comprehensive
maintenance contact which should
include : full guaranty – renewal contract
– periodic inspection – annual follow up –
training for hospital medical engineers.
 Training:
Specify training programs that will be
offered covering theoretical overview
sessions and practical hands-on courses.

61. Implementation Plan 
 Terms of payment:
- 20%  down payment upon the signature of contract.
- 30%  2nd payment after the delivery composition & testing the system.
- 30%  3rd payment upon sign off the system.
- 20%  last payment will postponed one year after complete the operation.

62. Implementation Plan 
Stage VI : Acceptance and Evaluation
Acceptance Criteria Wt.
100%
Easiness
It can be used easily by all medical
teams
13 %
Training
Full training course for all medical teams
including cross-training methods
12%
Flexibility
Can communicate with other hospitals
systems wither local or abroad
11%
Cost
Minimal cost can met our needs
accepted.
10%
Modularity
Must be able for farther improvement
with other modules later on.
10%
Compatibility
It can used with the present medical unit
& equipment, PCs, printers & scanners.
9%
Speed
Should be have very high speed to help
getting reports within minute
8%
Maintenance
Comprehensive maintenance by renewal
contract, periodic inspection & follow up.
7%
Features
Important to be a high technical fully
automated one.
6%
Customization
Each department have to get has all
required items to get full report data
5%
Integration
It is mandatory to be integrated with old
hospital isolated systems
5%
Documentation
Briefly detailed booklets should be
provided with software
4%
Results
d if get scoreYou will be accepte
more that 70% in evaluation criteria

63. Implementation Plan 
At this stage vendors offer their proposals and
the project management team evaluate these
proposals according to the acceptance criteria
mentioned in the request for proposal.
Evaluation
Criteria
Wt.
%
A B C
Rate Score Rate Score Rate Score
Easiness 13 % 2 5.2 3 7.8 5 13
Training 12% 5 12 3 7.2 1 2.4
Flexibility 11% 5 11 2 4.4 2 4.4
Cost 10% 2 4 4 8 5 10
Modularity 10% 1 2 4 8 2 4
Compatibility 9% 1 1.8 3 5.4 2 3.6
Speed 8% 2 3.2 3 4.8 5 8
Maintenance 7% 4 5.6 3 4.2 4 5.6
Features 6% 3 3.6 2 2.4 5 6
Customization 5% 2 2 4 4 5 5
Integration 5% 1 1 2 2 4 4
Documentation 4% 4 3.2 4 3.2 4 4
Results 100% 54.6% 61.4% 70.0%
As we see, three vendors offered their proposals
and are evaluated and the project management
team choose vendor C as he has the best offer.
Vendor C values his proposal by 3,000,000 US$
including site preparation, complete installation and
implementation of the new system.

64. Implementation Plan 
Stage VII : Justification
Management agreement:
A management agreement must be obtained by
top management and project team to be committed to
the new system and must take full responsibility for the
success of the implementation, also must share the
responsibility for failure.
It is obtained through formal meetings to discuss
the project from different aspects and take in to
consideration top management ideas and opinions. Also
a report is written clarifying and justifying the project.
A survey was done at the hospital to know to what
extent they are satisfied with the current hospital
situation and according to the previous results we
suggest that we have to shift our hospital to become fully
automated with a budget of 3,000,000 $ to start our
project. The system is likely to be installed & signed off
by the end of 2015.

65. Implementation Plan 
Justification elements:
The project has to be justified regarding time
scale, costs & benefits.
Time scale:
 The project will last for 3 years as follows:
 The project will start on 1st Jan 2013.
 The project will end on 31th December 2015.
 This period divided into for 3 stages as follows:
 The 1st stage will include medical modules.
 The 2nd stage will include para-medical modules.
 The 3rd stage will include non-medical modules.
 Each stage consists of 3 steps as follows:
 The 1st step will last 4 months for site preparation.
 The 2nd step will last 4 months for implementation.
 The 3rd step will last 4 months for training & testing.

66. Implementation Plan 
System costs:
Hardware
Equipment 200000 $
Supplies 150000 $
Software
Operating system 200000 $
Application software 300000 $
Installation
Stationary 50000 $
Training 25000 $
Maintenance 75000 $
Total cost per stage 1000000 $
System benefits:
Quantifiable Unquantifiable
The predicted direct increase in
hospital profits approximately
20% by the end of coming 3 yrs.
The predicted decrease in waste
is approximately by 5% annually
Better hospital performance
Better hospital reputation.
Better hospital services.
Better working conditions

67. Implementation Plan 
Stage VIII : Customization
The implementation process in each stage will
be divided into 4 levels, everyone will lasts only one
month, to be all ended within the determined period
for implantation step (4 months).

68. Implementation Plan 
 The Medical modules stage :
Starts at May 2013 and ends in Aug 2013
level 1:
 Master patient index system
Responsible team: TQM and Medical managers.
level 2:
 Electronic medical record system
Responsible team: TQM and Medical managers.
level 3:
 Outpatient management system
 Checkup information system
Responsible team: Checkup center & Outpatient managers
level 4:
 Inpatient management system
 Intensive care management system
Responsible team: ICU and In-patient managers.

69. Implementation Plan 
 The Para-medical modules stage:
Starts at May 2014 and ends in Aug 2014
level 1:
 Specialized centers management system
 Nursing management system
Responsible team: Specialized centers & Nursing managers
level 2:
 Pharmaceutical services management system
 Medical supplies management system
Responsible team: Pharmacy & Medical supplies managers
level 3:
 Laboratory information system
 Radiology information system
Responsible team: Lab and Radio managers.
level 4:
 Clinical research module
 Medical library module
Responsible team: Medical manager.

70. Implementation Plan 
 The Non-medical modules stage:
Starts at May 2015 and ends in Aug 2015
level 1:
 Management support system
Responsible team: General manager.
level 2:
 Administration module
Responsible team: Administration managers.
level 3:
 Cashiering module
 Accounting module
Responsible team: Finance managers.
level 4:
 Biomedical engineering system
 Medical logistic system
Responsible team: Engineers & Public relation managers.

71. Implementation Plan 
Stage IX : Testing
The system testing is an endless process
starting before the system software installation &
extends after the go-live date. It is involved in each
stage within the determined period for training &
testing step (4 months).
System testing stages:
 Testing the system on development.
 Testing the system upon installation.
 Testing the functionality within each module.
 Testing the integration between modules.
 Testing the system interaction with external systems.
 Testing and follow-up after going-live.

72. Implementation Plan 
Testing the system on development:
o Performed at the vending company by the
system developers
o To confirm that orders and requirements
of the hospital
o Are all uploaded on the system with the
desired specifications.
Testing the system upon installation:
o Performed at the hospital by the IT
specialists
o To confirm that tests conducted and
documented by the system
o Developers give the same results when IT
specialists perform them.
Testing functionality within each module:
o Performed by the department managers.
o To ensure that everyone's module is up to
par & meet standards.

73. Implementation Plan 
Testing the integration between modules:
o This stage represents a demo version of
the real system.
o It tests the integration between all
modules as if you work in real life.
Testing interaction with external systems:
o The new system is tested regarding
interaction with external systems
o Hospital suppliers systems like
pharmaceutical companies ,
o Insurance providers, banks, catering
agents and other hospitals.
Testing & follow-up after going-live:
o This is an important ongoing process after
launching new system.
o To ensure that new system is working
effectively & meet standards.

74. Implementation Plan 
Stage X : Training
The training process in each stage will be
divided into 3 levels, everyone will lasts only one
month, to be all ended within the determined period
for training and testing step (4 months).
level 1: “ one month ”
Aimed group: IT specialists
Trainers : system developers.
During implementation process to ensure that it
meet the standards.
level 2: “ one month ”
Aimed group: tactical managers.
Trainers : IT specialists.
Involved in testing process to provide ideas and
support.
level 3: “ two months ”
Aimed group: Every staff member.
Trainers : IT specialists.
How to use their module which relevant to his
function.

75. Implementation Plan 
Training go through 3 phases:
Phase 1: general overview of the new system.
Phase 2: specific procedures & activities of each module
Phase 3: controls, errors and recovery procedures.
By the end of the training process:
 Each user receives his copy of the user manual
specific for his module.
 It is a continuous process doesn’t stop but checked
periodically.
 Members' performance is evaluated and corrected
continuously.

76. Implementation in Department 
IMPLEMENTATION IN DEPARTMENT
The Hepatogastroenterology department
implementation will be done as a part of the major
implementation process. We will explain the specific
consecrations that are belonging to it.
Stage I : Teamwork
 General project teamwork:
Plays the major roles that mentioned above including
coaching, budget, training, supporting and controlling
 Hepatogastroenterology department teamwork:
 Leader is for coordination.
By: Head of Hepatogastroenterology department.
 Training supervisor is for training.
By: A Specialist with IT previous experience.
 Medical supervisor is for medical support.
By: A Specialist with best medical experience.

77. Implementation in Department 
Stage II : Site preparation
The system servers and network router will be
located in an isolated building as mentioned. We
choose three rooms to be the location of the IT
equipment and tools in the Hepatogastroenterology
department as shown in the figure.

78. Implementation in Department 
Stage III : Purchase and Hardware
In addition to the basic general requirements we need
to have the following in in the Hepatogastroenterology
department:
 Eight Personal Computers:
 Four for the Hepatic ICU
 One for the endoscopy room
 One for the officer of outpatient clinic
 One for the officer of inpatient department
 One for the officer of endoscopy unit
 Three scanners:
 One for the officer of outpatient clinic
 One for the officer of inpatient department
 One for the officer of endoscopy unit
 Three printers:
 One for the officer of outpatient clinic
 One for the officer of inpatient department
 One for the officer of endoscopy unit

79. Implementation in Department 
Stage IV : New system
In addition to the previous modules we need a
specific software and reports as:
The system modules :
 Hepatic ICU software.
 Endoscopy unit software.
 Hepatogastroenterology clinic software.
Types of reports:
 Upper GI endoscopy report.
 Colonoscopy report.
 ERCP report.
 Stages from V to VIII are same as major process.
Stage V : RFP creation
Stage VI : Acceptance and Evaluation
Stage VII : Justification
Stage VIII : Customization
Stage IX : Testing

80. Implementation in Department 
Stage X : Training
As we explain before the training process in will
be divided into three levels, level (3) will aim to train
every staff member. Our department is consisting of:
Doctors:
- 5 consultants
- 10 specialists
- 20 residents
Nurses:
- 10 high nurses
- 10 nurses
- 5 assistant nurses
Officers:
- 5 secretaries
Training two main phases:
Phase 1:
General overview of the new system.
For: all stuff members
Phase 2:
Specific procedures & activities of each module
For: certain chosen stuff members

81. Medical Recording 
MEDICAL RECORDING
Real-life case came to Nasser Institute Hospital and managed with the new system
Medical
record
information
Inpatient encounter
Responsible
party
Scheduling
Reason for admission: active GI bleeding
Number of available hepatic ICU beds: 2
Office staff.
Scheduling staff.

82. Medical Recording 
Identificationsheet
Preadmission
Demographic data:
Patient’s name: Nour ahmed
Age: 55
ID Number: xxxxxxx
Address: Naser city.
Insurance eligibility: eligible.
Predicted length of stay:
physician's decision.
Authorizations: Egyptian MOH
Admin staff.
Authorization
Registration
Verify information: by ID
Bed assignment: ICU, bed no. 4.
Identification bracelet: issued.

83. Medical Recording 
Problemlist(diagnosis)
Generaldata
History
Chronic Back pain
on large doses of aspirin
Heavy smoker for 15 years
Diabetic for 10 years
Medical staff.
Assessment
Examination
Severe GI bleeding
= hematemesis and melena
Patient vitally stable
No chronic liver diseases.
Consult
Provisional diagnosis
bleeding peptic ulcer

84. Medical Recording 
Problemlist(management)
Investigation
Laboratory
CBC, Blood group.
PT,PTT & INR
LFTs & KFTs
Glucose level.
Radiology
Plain X-ray.
Pelvi-abdominal
ultrasound
Medical staff.
Treatment Management
Egret upper endoscopy
Antibleeding measures
Stop aspirin and NSAIDs
Followup
Care
Vital signs / 2 hours.
Regular investigations.
Insure drugs intake.
Discharge
3 days after controlling of the bleeding.

85. Medical Recording 
Medicalrecodingandresults
D.
Chronic drug induced peptic ulcer Consultant
Lab
CBC = Anemia
Blood group = O+
PT,PTT & INR = 1.7
LFTs = normal
KFTs = normal
GL level = elevated
Lab. Technician
Rad
Plain X-ray. = free
Pelvi-abdominal ultrasound = fatty liver
Radiologist
Procedures
Diagnostic & therapeutic Endoscopy =
Chronic active bleeding prepyloric
peptic ulcer injected by ethanolamine
EndoscopistMedications
Controloc 40 mg vial every 8 h
Sandostatine amp sc every 8 h
Rocephine 2 gm vial for 10 days
2 units of packed RBCS & FFP daily
Physicians
Followup
Vital signs / 2 hours.
Enema / 12 h.
Regular investigations.
Nurses

86. Medical Recording 
Dischargeinstructions
andsummary
Discharge
Stop aspirin & NSAIDs intake
Re endoscopy after one month
Strict follow of medications.
Nour Ahmed, 55 years old, presented
with a GI bleeding due to PU. He was
admitted to hepatic ICU & was
subjected to full medical assessment &
subjected to complete management &
had endoscopic intervention & a follow
up schedule.
Medical records

87. Medical Recording 
Workflow of real-life case in Nasser Institute Hospital
1- Emergency workflow :
2- Blood transfusion workflow :
3- Lab investigations workflow :

88. Medical Recording 
4- Imaging workflow :
5- GI endoscopy workflow :
6- Medications workflow :
7- Discharge workflow :

89. Medical Recording 
The workflow represents system integration:
Administration where the data of the patient is recorded.
Out-patient clinics for patient case assessment and examination.
In-patient departments to make any interventions or admission.
Lab. & Radio. if it requested according to patient needs.
Pharmacy as patient will get his medications.
Finance where patient will pay and get report.
This process done automatically through the new system using
data to make the patient`s electronic file which is sent
electronically to the different parts in second

90. Medical Recording 
Reporting procedure at Endoscopy unit in Nasser Institute Hospital
Procedure : Shape a single final endoscopic report
contains the all patient required medical information.
Work flow
Secretary
Assessment
Nurse
Consultant
doctor
Resident
doctor
urseN

91. Medical Recording 
Secretary
by writing patient basic data andRegistration
medical report data and print it.
Assessment nurse
by video recording & takingDocumentation
he endoscopic procedure.pictures of t
Consultant doctor
by operating the endoscopic procedureDiagnosis
and select medical report data.
Resident doctor
by observing procedure steps, reportSupervision
writing & choose report pictures.
Nurse
eport data andby reviews rConformation
delivers it to the patient.

92. Medical Recording 

93. Conclusion 
CONCLUSION
Automation of Nasser Institute Hospital is a multi-stage
process requiring accurate planning and on-time performance.
The hospital automation will add much to the effectiveness and
efficiency of the hospital management.
Information Technology is of great importance in modern
management of hospitals and is totally advisable to any hospital to
be fully automated. It is important to remember that complete
automation of the hospital is not the end of the road, as the future
carries more advances and promises for the science of Health-
care Management Information System (HMIS).

94. Thank You 