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The design and implementation of a management information system for Australian public hospitals.

Existing management information systems (MIS) in hospitals are often inadequate. This has occurred because of a variety of antecedents, including past funding mechanisms, organisational structure and the accepted role of management. A variety of new pressures, including demands for increased accountability, greater resource control and changing relationships between physicians and hospitals are demanding improved MIS to enable the hospital to manage. This paper explores these influences on past and future hospital MIS. It describes the design of a MIS that enables patient care to be costed in clinically meaningful ways. Patient costs may be aggregated to cost specific diagnoses and procedures, Diagnosis Related Groups (DRG), a clinician's case load, a clinical unit or a division. The information can be used for clinical budgeting, flexible budgeting, utilisation review and quality assurance.

Australia↗

An integrated surgical suite management information system.

The operational aspects, application areas, and results achieved from an integrated surgical suite management information system are described. The system, which has been operating within Henry Ford Hospital in Detroit, Michigan, for 4 years, captures comprehensive data for each surgical episode, performs extensive edits on these data to assure data base integrity, and utilizes this data base in multiple applications. These applications include fixed-format reporting for medical staff and management; ad hoc retrieval capabilities to support research, education, and decision making; and linkage to other hospital systems to reduce both data redundancy and paper flow.

Hospital Departments↗

Management information systems--green light for better info.

An EIS gathers financial and non-financial data from a variety of sources, both internal and external to an organisation, and presents them accessibly and understandably. It should facilitate the presentation of data so that it is timely and relevant to senior managers' needs. Generally, there are three categories of EIS: Front-end tools, which enhance the presentation of output from existing systems. For example, they can take the output from a general ledger system and enhance its appearance but do not change the content. Internal consolidation tools, which take data from a number of internal sources (such as the general ledger), store it in a central database, and present it to users. This is often done in report book format to which all EIS style functions may be applied. Integrators of information, which integrate data from internal and external sources. Much of the data is non-financial and a major emphasis is on the users' ability to communicate with each other. The key functions that may be included within an EIS are: Drill down. The facility to explore increasingly detailed levels of data. Trends and variances against pre-set targets, such as financial budgets. Graphics and tabular reporting. Data integrity checking. Analysis of the data, modelling and the production of forecasts using time series analysis techniques. Exception reporting through the use of some form of alert. Incorporation of text into the output.

Diagnosis-Related Groups↗

[The establishment and application of network human sperm bank management information system].

OBJECTIVE: To build network human sperm bank management information system. METHODS: The system was developed with SQL Server 2000 and Power Builders 8.0. RESULTS: The system consisted of 4 modules: file management, physical check-up and laboratory examination management, sperm examination and freezing management, supply and follows-up management. The system worked by long-distance transmission and real time supervision. CONCLUSION: The system possesses the advantages of huge information content, great safety and high confidentiality, as well as the functions of long-distance transmission and real time supervision.

Humans↗

Are the right people managing information systems in your hospital?

Management of information systems in health care has traditionally been left to chance in many institutions. This article explains why use of appropriate staff is imperative because of the high cost of computerization and outlines an example staffing structure.

Administrative Personnel↗

ESMIS--a computer-based emergency medical services management information system. Part 2. Database design.

In this paper, the emergency medical services system of a health care organization are investigated. The result of this investigation is an on-line Emergency Medical Services Management Information System (ESMIS). ESMIS is implemented using the TOTAL database management system. Reports illustrating the system's performance are also provided. Part 1 (this issue) outlined the ESMIS design procedure, while part 2 is concerned with the specifications of the system's outputs.

Computers↗

A computer-assisted management information system for nutrition services.

A computer-assisted management information system was created to facilitate effective management of clinical nutrition services and labor resources in a 330-bed teaching and research hospital. Standards were developed for the quality and quantity of nutrition care, time required to provide nutrition care, and utilization of dietitians' time. Computer software was developed to report the volume of services provided, the need for services, and the utilization of labor hours. Data were evaluated to determine whether services were consistent with standards and to calculate a recommended number of clinical dietitian full-time equivalents for the hospital. Furthermore, the management information system was instrumental in developing a fee-for-service structure, for evenly distributing work loads among dietitians, and for monitoring adherence to standards of care.

Dietetics↗

Implementing a new health management information system in Uganda.

This paper reports on research investigating the health management information system (HMIS) implementation process in Uganda, utilizing the diffusion of innovation and dynamic equilibrium organizational change models. Neither perspective guided the HMIS development process. Instead, technological issues, rather than wider organizational issues, dominated the planned change. The need to consider the organizational context when changing information systems arises because the process is more complex than some practitioners have realized, when attempting to understand the causes of information management problems and developing HMIS in low-income countries. In particular, information system developers had not acknowledged that they were promoting an informational approach to management when they promoted a change from a centralized reporting system to a HMIS supporting use of information at the level of collection. Strategies to facilitate this approach were not advocated. Organizational theory can contribute to the diffusion of innovation framework. It has yielded an integration of Rogers's diffusion of innovation framework and Leavitt's concept of organizational forces in equilibrium. The diffusion framework describes the process, but the organizational model has given the context and reason for aspects of the process. The diffusion model does not predict what needs to change within the organization when a particular innovation is introduced, or how much. The addition of the organizational model has helped. These frameworks can facilitate the introduction of future information management innovations and allow practitioners to perceive their introduction as a staged process needing to be managed. Implications for practice are identified.

Diffusion of Innovation↗

Economic analysis of linking operating room scheduling and hospital material management information systems for just-in-time inventory control.

UNLABELLED: Operating room (OR) scheduling information systems can decrease perioperative labor costs. Material management information systems can decrease perioperative inventory costs. We used computer simulation to investigate whether using the OR schedule to trigger purchasing of perioperative supplies is likely to further decrease perioperative inventory costs, as compared with using sophisticated, stand-alone material management inventory control. Although we designed the simulations to favor financially linking the information systems, we found that this strategy would be expected to decrease inventory costs substantively only for items of high price ($1000 each) and volume (>1000 used each year). Because expensive items typically have different models and sizes, each of which is used by a hospital less often than this, for almost all items there will be no benefit to making daily adjustments to the order volume based on booked cases. We conclude that, in a hospital with a sophisticated material management information system, OR managers will probably achieve greater cost reductions from focusing on negotiating less expensive purchase prices for items than on trying to link the OR information system with the hospital's material management information system to achieve just-in-time inventory control. IMPLICATIONS: In a hospital with a sophisticated material management information system, operating room managers will probably achieve greater cost reductions from focusing on negotiating less expensive purchase prices for items than on trying to link the operating room information system with the hospital's material management information system to achieve just-in-time inventory control.

Computer Simulation↗

Management information system ensures maintenance coordination.

The computer-based management information system implemented at Massachusetts General Hospital has proved to be an effective system for ensuring better coordination of maintenance activities in the hospital's maintenance department. The system provides accurate, up-to-date information that managers can use to make decisions concerning allocation of manpower, employee performance, and utilization of resources.

Computers↗

Health Management Information System in Leprosy Control Programme.

Health Management Information System was introduced methodically and enforced with ruthless punctuality in Maharashtra State from April 1981. It has paid excellent dividends so far as the implementation of the National Leprosy Control Programme is concerned. Key indicators have been fixed for new case detection, bacteriological examination, regularity of treatment and screening of old patients for activity status. Monitoring of these activities is done regularly and a feed back is provided. Marks are assigned for each kidney indicator and ranking is done based on the achievement of targets by each district, Municipal Corporation, Health Circle etc., every month. The same procedure is adopted at Primary Health Centre and even lower level. This has introduced a spirit of competition and generated a desire to better one's own performance by identifying and removing deficiencies. Maximum assistance is being derived from the Primary Health Care and use is being made of Multi Purpose Workers, Community Health Volunteers and other anciliary agencies in case finding and case holding programmes. The improvement in performance in respect of all key indicators during 1981-82 has been between 40 and 60 percent over the performance during 1980-81.

Bacteriological Techniques↗

The Philippine management information system for public health programs, vital statistics, mortality and notifiable diseases.

Strengthening the information support for decision making has been identified as an important first step toward improving the efficiency, effectiveness, and equitability of the health care system in the Philippines. A Philippine-German Cooperation is in partnership toward developing a need-responsive and cost-effective Health and Management Information System (HAMIS). Four information baskets are being strengthened specifically to address these needs in a cost-effective way: public health information systems, hospital information systems, information systems on economics and financing, information systems on good health care management. BLACKBOX is the management information system for public health programs, vital statistics, mortality and notifiable diseases of the Philippines. It handles and retrieves all data that is being collected by public health workers routinely all over the Philippines. The eventual aim of BLACKBOX is to encourage the development of an information culture in which health managers actively utilise information for rational planning and decision making for a knowledge based health care delivery.

Cost-Benefit Analysis↗

Implementation and deployment of healthcare management information system.

In the following article we present development of the Management Information System, an implementation of our own Data Warehouse, build on top of the existing Healthcare Information System. We discuss requirements and phases of development of the system, we present the structure of the system, the experiences with end users and obstacles that we met, as well as possible improvements end extensions of the system. The system is designed as a framework that works with workload measurement sub-systems, which are defined as multidimensional arrays, and are observed through different units of time. Each of the axis has several hierarchical structures build on top of it. Setting up the system is a difficult task, because it requires a good knowledge of organisational structure of a particular hospital. We used an incremental approach in defining the organisational structure. On top of the framework we build a user customisable graphical user interface, which enables different types of end users to efficiently use the system.

Data Collection↗

Medicaid program; Medicaid Management Information System; system requirements--HCFA. Final rule.

In this notice, we are informing State Medicaid agencies of three new system requirements for Medicaid Management Information Systems. These systems will be required to accept: (a) and use exclusively a uniform diagnostic coding system (the International Classification of Disease, 9th Revision, Clinical Modification (ICD-9-CM)), wherever diagnostic coding is used; (b) And use exclusively a common claim form for inpatient and outpatient hospital billing (HCFA-1450); and (c) A uniform electronic billing format for institutional billing. The purpose of these requirements is to improve the efficiency and effectiveness of the Medicaid program; the second and third requirements will reduce the paperwork burden by implementing a single claim form and a single electronic billing format for providers to bill multiple third party payers.

Centers for Medicare and Medicaid Services, U.S.↗

Evaluation of existing district health management information systems a case study of the district health systems in Kenya.

INTRODUCTION: This paper discusses some of the issues and challenges of implementing appropriate and coordinated District Health Management Information System (DHMIS) in environments dependent on external support especially when insufficient attention has been given to the sustainability of systems. It also discusses fundamental issues which affect the usability of DHMIS to support District Health System (DHS), including meeting user needs and user education in the use of information for management; and the need for integration of data from all health-providing and related organizations in the district. METHODS: This descriptive cross-sectional study was carried out in three DHSs in Kenya. Data was collected through use of questionnaires, focus group discussions and review of relevant literature, reports and operational manuals of the studied DHMISs. RESULTS: Key personnel at the DHS level were not involved in the development and implementation of the established systems. The DHMISs were fragmented to the extent that their information products were bypassing the very levels they were created to serve. None of the DHMISs was computerized. Key resources for DHMIS operation were inadequate. The adequacy of personnel was 47%, working space 40%, storage space 34%, stationery 20%, 73% of DHMIS staff were not trained, management support was 13%. Information produced was 30% accurate, 19% complete, 26% timely, 72% relevant; the level of confidentiality and use of information at the point of collection stood at 32% and 22% respectively and information security at 48%. Basic DHMIS equipment for information processing was not available. This inhibited effective and efficient provision of information services. CONCLUSIONS: An effective DHMIS is essential for DHS planning, implementation, monitoring and evaluation activities. Without accurate, timely, relevant and complete information the existing information systems are not capable of facilitating the DHS managers in their day-today operational management. The existing DHMISs were found not supportive of the DHS managers' strategic and operational management functions. Consequently DHMISs were found to be plagued by numerous designs, operational, resources and managerial problems. There is an urgent need to explore the possibilities of computerizing the existing manual systems to take advantage of the potential uses of microcomputers for DHMIS operations within the DHS. Information system designers must also address issues of cooperative partnership in information activities, systems compatibility and sustainability.

Data Collection↗

The management information system and change processes in health systems.

This report describes a management information system (MIS) designed by PAHO's Health Systems and Services Division in collaboration with technical experts from a number of different countries. This MIS, a methodology currently used at the institutional or national level in more than 21 countries of the Americas, is a strategic and practical instrument that is easy to apply, interpret, and use, and whose purpose is to facilitate fundamental changes in health management. Based on the management concept that inputs, processes, and outputs are quantifiable, the MIS places special emphasis on health system productivity, an essential condition for achieving health coverage that is both adequate and equitable.

Community Mental Health Services↗

A management information system model for process-oriented health care.

OBJECTIVE: To develop a conceptual model of a management information system for process-oriented health care organizations. METHODS: Qualitative data was collected from two case studies in process-oriented health care settings. The first study addressed the information requirements of health care managers and the second study focused on organizational activities and clinical practice. From these data, preliminary models were iteratively developed, interpreted, and further revised. SETTING: A county hospital in southern Sweden with 30 clinics and 3,200 employees. RESULTS: A conceptual model of a management information system for process-oriented health care organizations was developed in two parts: one part that describes the organizational interface of the model and the other part that describes the architecture of the model. CONCLUSION: A conceptual model has been developed for local-level integration of management information systems and organizational procedures in process-oriented health care organizations

Delivery of Health Care↗