The document discusses strategies for going paperless at Al-Mashfa Hospital in KSA. It discusses ensuring the procurement division has appropriate tools to improve efficiencies and manage costs. It also discusses evaluating crucial points when negotiating contracts for major medical equipment and services, including total cost of ownership, service coverage guarantees, and update/upgrade policies. The document provides an overview of the hospital's purchasing process and policies to integrate purchasing with SAP and set clear procedures. It also discusses some advantages and disadvantages of going paperless in a healthcare setting.

1. Bassem Samir Hamade, Contracting and Purchasing Manager, Al-Mashfa Hospital,
KSA

2.  Going paperless:
Ensuring that the procurement division has
the most appropriate tool and synchronizing
information flow to improve efficiencies,
reduce waste and manage long-term costs
 Ensuring purchasing process integration with
SAP through material management as well as
setting corresponding policies and
procedures
 Evaluating crucial points to consider whilst
negotiating contracts for major/capital
medical equipment and services

3. When people hear the phrase
“going paperless,”
they often assume they’ll no longer be using paper
in daily tasks or even have access to it in their
office. This obviously isn’t true or practical. Going
paperless means using paper wisely and sparingly
and finding effective alternatives.

4. Consider these statistics:
o Organizations spend in labor costs (on average): $20 to file a
document, $120 to find a misfiled document, and $220 to
reproduce a lost document.
o Of all documents, 7.5 percent get lost; 3 percent of the
remainder get misfiled.
o Professionals spend 5–15 percent of their time reading
information, but up to 50 percent looking for it.
o The average cost to process a single invoice manually is $24.
o Of 1,200 organizations surveyed, 40 percent indicated
disaster recovery planning is not a priority.
o Two out of five companies that experience a disaster are out
of business in five years.
Sources: PricewaterhouseCoopers, IOMA, Gartner and Captaris.

5. Advantages:
 To overcome problems and delay when transferring paper medical
records.
 To improve problems with loss or misplacement of physical paper
records and record envelopes.
 To save time spent on handling paper records.
 Information can be shared more easily.
 Email and intranet communication within the practice reduce internal
paper flows, telephone calls and faxes.
 Increase in security and confidentiality because it is easier to control and
audit access to records.
 Opportunity to improve the existing electronic patient records (EPR).
 More efficient and effective consultations (all information is available and
up-to-date(
 Mixing of paper and electronic records causes confusion.
 Patient access to records can be an advantage (more transparency,
equality within the doctor-patient relationship(

6. Disadvantages:
 Data security.
 Document managing and scanning have proved problematic.
 Lack of IT standards for GP staff.
 Problems with data backup (if data are lost or if a system goes down)
 Lack of national protocol.
 Lack of internal protocols within a practice.
 Staff training (time, costs, standards)
 Fear of change and the unknown.
 Health and safety issues regarding more time spent at a
screen/monitor.
 Less effective consultations, as dominated by technology (but patients
do not seem to complain)
 It takes more time for clinicians to read documents such as clinical
letters on screen.

7. Traditional telecommunication companies are heavily involved in
“Paperless” healthcare markets
 Germany’s e-health smartcard project
 Austria’s the NÖMED WAN-project. connecting all public hospitals
there via a Master Patient Index that uses the Austrian E-Card for patient
identification.
 In Spain, installed a regional health network that uses an SAP based
medication module, which enables a large number of primary care
centers to do electronic prescriptions.
 In Saudi Arabia, the new ongoing project for Electronic Medical
Records (EMR) across its health system particularly the integration of
diverse information systems. It effectively linking an EMR to existing
and future systems, at hospital, regional and national levels.
Traditional telecommunication companies will not develop its own next
generation HIS which is important, but it is certainly not indispensable to life.
Their key expertise lies in system integration.

8. HIMSS
Healthcare Information and Management Systems Society
HIMSS is a cause-based, not-for-profit organization
exclusively focused on providing global leadership for the
optimal use of information technology (IT) and
management systems for the betterment of healthcare.
Saudi hospital first in the Middle East to achieve global
recognition for its healthcare IT. HIMSS Analytics Asia
announced King Faisal Specialist Hospital & Research
Center (KFSH&RC) in Riyadh and Jeddah, Saudi Arabia,
has achieved Stage 6 on the Electronic Medical Record
Adoption Model (EMRAM). And recently in UAE,
Corniche Hospital and University Hospital Sharjah.

10. Definitions:
 Clinical decision support system (CDSS)
 Computerized physician order entry (CPOE)
 Computerized assessment system (CDR system)
 Continuity of Care Document (CCD)
It is a standard intended to specify the encoding, structure,
and semantics of a patient summary clinical document for
exchange
 Closed Loop Medication Application
It is a process to ensure automated validation of medications
and patient identity matching.

11. Going Paperless
It is not just a computer upgrade,
It's a change in the way we
operate.

12. Ensuring purchasing process
integration with SAP through
material management as well
as setting corresponding
policies and procedures

13. HIS
International Conference on Social Science and Humanity
had Described:
"Hospital Information Systems can be defined as massive,
integrated systems that support the comprehensive
information requirements of hospitals, including patient,
clinical, ancillary and financial management." ……."
Hospitals are becoming more reliant on the ability of
hospital information system (HIS) to assist in the diagnosis,
management and education for better and improved
services and practices. In health organization such as
hospitals, implementation of HIS inevitable due to many
mediating and dominating factors such as organization,
people and technology."

14. ERP
ERP is short for enterprise resource planning.
It is business management software that allows an
organization to use a system of integrated
applications to manage the business. ERP software
integrates all facets of an operation, including
product planning, development, manufacturing
processes, sales and marketing.

15. ERP Software Modules
ERP software typically consists of multiple enterprise
software modules that are individually purchased,
based on what best meets the specific needs and
technical capabilities of the organization. Each ERP
module is focused on one area of business processes,
such as product development or marketing. Some of
the more common ERP modules include those for
product planning, material purchasing, inventory
control, distribution, accounting, marketing, finance
and HR.

16. The basic goal for ERP is to provide
one central repository for all
information that is shared by all the
various ERP facets in order to smooth
the flow of data across the
organization.

17. ERP Vendors
 The ERP market for large enterprises (ERP Tier I) is
dominated by three companies: SAP, Oracle and Microsoft.
 For the midmarket (ERP Tier II) vendors include Infor,
QAD, Lawson, Epicor, Sage and IFS.
 For small Business ERP (ERP Tier III), Exact Globe, Syspro,
NetSuite, Visibility, Consona, CDC Software and Activant
Solutions round out the ERP vendors for small businesses.
(Source: EnterpriseAppsToday; ERP Buyer's Guide; Drew Robb)

18. ERP
 One of the benefits; - Integrating between the
different modules in order to facilitate
transforming the information between modules
and saving the efforts & required time for
recording the information again in more than one
module.
 Can be utilized as a requisitioning and
procurement productivity suite that is flexible and
scalable to meet your business needs, giving you
the power to enhance, manage and control any
step of the purchasing process

19.  to interface directly to ERP, users can quickly select vendors and
items, see what's left in real time and, quickly recreate requisitions
for future orders using templates, or quickly assign budget
distribution to designated companies as needed.
 Routing through the approval hierarchy, based on flexible criteria
such as order type, vendor category, approvers can approve,
reject, ask for changes, or request additional information. Email
notifications keep the process moving and increase process
visibility. With some specific modules, approvers can easily
review requisitions on the go.

20.  Approved requisitions can be converted into purchase
orders through the connected ERP. Need to make a change?
The Change Order Module allows users to open a PO, make
necessary changes, and reroute it for updated approval.
 Saved in your transaction history, Requisitions and POs are
easily accessed for quick reference. With the Search Module,
you can search based on multiple criteria such as
Requisition ID, PO, Receipt, Invoice, Voucher Number,
Date, Status, Name, Vendor, Item, and General Ledger (GL
Account # and easily exported to Excel, PDF, etc,. for
reporting.

22. SAP
SAP
MM Module
Purchasing
Component
Procurement
Process Create PR
Inbound to HIS
If STD
Create PO
Source ListSave PORelease it
If New
RFQ
RFQ Process
Inventory
Management
Material
Requirements
Planning
Component Component
Finance
Module
HR
Module
Etc.

26. PURCHASING DEPARTMENT
Policies and Procedures
Number: PD 01-004-0
Title: Purchase Process
Original Date: August 1, 2012
Effective Date: August 1, 2012
1. Policy Statement
All acquisition facilitated by the Purchasing Department should follow the Purchase Process.
2. Purpose
2.1 Establish a standardized flow in making purchase requests throughout the hospital.
2.2 Serve as a guide to all personnel with regards to the purchase process.
2.3 Protect the interest of Al Mashfa Hospital by assuring that purchase requests are of good faith
and beneficial to the cause of the hospital.

27. 3. Responsibility
In accordance to this policy, it is the responsibility of the;
3.1 Purchasing Manager to ensure that all departments are well informed with the process
implemented by the Purchasing Department.
3.2 Department Heads to ensure the necessity of item requested; and to inform the Purchasing
Department on the nature and urgency of each request.
3.3 Appointed personnel of each department that all purchase requests follow the approved
process in Submitting requests.
3.4 Purchasing staff to ensure that all requests go through the standard flow and assure that these
are processed in a timely manner.

28. 4. Definition
4.1 Purchase Requests are written communication substance to the Purchasing Department
describing item not available in the storeroom and the requested for purchase.
4.2 A Vendor/Supplier is an individual or company that provides supplies, equipment or services to
the hospital.
4.3 A Request for Information (RFI) is a method of collating information from different supplies
prior to formally sourcing products or services. It is normally used where there are many
potential suppliers and not enough information is known about them.
4.4 A Request for Proposal (RFP) is a formal method of receiving detailed and comparable proposals
from different supplies for a defined products or service. It is a comprehensive document that
should provide all the required information needed to make an informed purchasing decision.
4.5 A Request for Quotation (RFQ) is a competitive bid document used when inviting vendors to
submit a bid on project or products. An RFQ is suitable for sourcing products that are
standardized or products in repetitive quantities. A technical specification must be provided as
well as commercial requirements.
4.6 Cooperative Purchasing refers to the exchange of price information, vendor list, and other
purchasing information between institutions so that maximum value can be obtained.
5. Equipment
5.1 Purchase Request From
5.2 Request for Information (RFI)/ Proposal (RFP)/ Quotation (RFQ)

29. 6. Procedure
The following process ensures that all purchases are beneficial to the institution. Process is
depicted in a diagram. (Refer to PD 02- 001-0)
6.1 The Store Keeping submit requests for regularly consumed supplies only.
6.2 Purchase Requests for new items must be made by concerned units/ department and may be
Accompanied by products/ item descriptions.
6.3 All requests must have been signed by the respective department heads.
6.4 Requested items classified as Prohibited Item are not accepted. There include;
6.4.1 Personal items such as pencils and other personal care items.
6.4.2 Luxurious items; wherein more expensive new products have no proven advantage or
Benefits over the current and more economical products in the hospital supplies.
6.5 Single Transactions which include items needed in few amounts or used infrequently and
Costs SR 2000 are bought directly by Purchase Agents, upon approval from the Purchasing
Manager.
6.5.1 Purchase Agent scout and present the best price to the Purchasing Manager.
6.5.2 Funds are requested directly from the Finance Department.
6.5.3 Relevant expenses may be reimbursed as Petty Cash, as per Finance Department Policy.
6.5.4 Official receipt Department.

30. 6. Procedure (continued)
6.6 Items worth more than SR 2000 and considered non-urgently needed may have to go
through a bidding process to identify the most suitable supplier/vendor.
6.6.1 RFI/RFP/RFQ are sent to qualified companies listed in the supplies database.
6.6.2 Bidding determines the most suitable Vendor/Supplier.
6.6.3 Products are tested for trial use, or sent for evaluation prior to awarding a contract to a
Supplier.
6.7 Items bought in large quantities and used regularly are usually included in Blanket Orders.
6.8 Purchasing Orders are prepared are must be approved by the Purchasing and Finance
Department before being sent to Vendor/Supplier.
6.9 The Finance department is notified upon delivery of products. It is only then that the
transactions can be entered in the Accounts Payable List.
6.10 The Purchasing Department may participate in Cooperative Purchasing Agreements with
other healthcare institutions or organizations to gain better prices and choices, in the
provision that, participate does not affect the quality and service requirements maintained
by the hospital.
6.11 Inter- institutional purchasing arrangements can be implemented if it is in the best interest
of AL Mashfa.

31. 7. Documentation
* Refer to the following policies for more information;
7.1 Policy on Product Evaluation and Standardization
7.2 Policy on Selection of a Qualified Vendor
7.3 Policy on Preparing Purchase Orders
8. References

32. Evaluating crucial points to
consider whilst negotiating
contracts for major/capital medical
equipment
and services

33.  Total Cost of ownership (TCO)
 Service Coverage uptime Guarantee
 Update/Upgrade Policy

34. Total Cost of ownership (TCO):
The core principles of the concept of utility and efficiency.
is a method to describe all costs of a certain infracstructure.
TCO, when incorporated in any financial benefit analysis,
provides a cost basis for determining the total economic
value of an investment. Examples include: return on
investment, internal rate of return, economic value added,
return on information technology, and rapid economic
justification.
TCO tries to quantify the financial impact of deploying an
information technology product over its life cycle . These
technologies include software and hardware, and training.

35. Technology deployment as part of TCO includes the
following :
 Computer hardware and programs
 Network hardware and software
 Server hardware and software
 Workstation hardware and software
 Installation and integration of hardware and software
 Purchasing research
 Warranties and licenses
 License tracking - compliance
 Migration expenses
 Risks: susceptibility to vulnerabilities, availability of
upgrades, patches and future licensing policies, etc.

36. Technology deployment as part of TCO includes the following :
 Operation expenses
 Infrastructure (floor space)
 Electricity (for related equipment, cooling, backup power)
 Testing costs
 Downtime, outage and failure expenses
 Diminished performance (i.e. users having to wait, diminished
money-making ability)
 Security (including breaches, loss of reputation, recovery and
prevention)
 Backup and recovery process
 Technology training
 Audit (internal and external)
 Insurance
 Information technology personnel
 Corporate management time

37. Technology deployment as part of TCO includes
the following :
 Long term expenses
 Replacement
 Future upgrade or scalability expenses
 Decommissioning

38. Service Coverage uptime Guarantee
All major systems Included to a contract shall be
subject to service coverage uptime Guarantee of 95%
to 98% depending on the system. Let's take some
equipment at Al-Mashfa hospital as an example:
 97% for Diagnostic Imaging, Ultrasound and BMD
 98% for Anesthesia and Ventilator systems
 95% for all other clinical systems and devices

39. Update/Upgrade Policy
The update/upgrade policy for Major equipment
should be mentioned clearly either under a
separate clause or within the warranty clause.
Needless to mention, major equipment shall be
warranted for 5 years from earlier of final
commissioning date or first patient.

40. Update/Upgrade Policy
Updates shall be provided free of charge of the
lifetime of the capital equipment.
Contracts must be made to ensure the receipt of
the major equipment with the latest upgrade
version regardless of the version mentioned in the
PO at that time.

41. Thank you