Technology in modern world is increasingly becoming important and necessary in the lives of many people and organizations. For example, use of technology can be cited to be in great use in key areas like education, entertainment, advertisements, banking, warehousing and health (Prakashan 2008, p. 6). Due to this, it can be deduced that for organizations to succeed in modern world the aspect of automation is vital and necessary. Automation of organizations in itself is considered to play a key role of increasing efficiency in the organization while at the same time ensuring quality services that are delivered within the organization (Prakashan 2008, p. 6). All these activities have become possible due to emergence and development of computer systems that are increasingly becoming important within organization due to their ability to add value to services. Different computer based systems have been developed and currently each of them play an important and integrated management role in an organization.
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Some of the available computer based systems that organizations rely on include Management Information Systems (MIS), Decision Support System (DSS) and Geographical Information Systems (GIS) that are useful in computerizing different activities (Prakashan 2008, p. 6). In this respect of understanding, computer systems in an organization that this research paper aims at study hospital system management in a developing country. Key objectives to realize this include: briefly researching on the history of hospital system management, analysis of existing hospital systems management in a developing country, explaining how a good system should look like and lastly, identifying the ways of managing a hospital system when it has been integrated.
Hospital System Management: History
Computer systems have evolved to become useful in performing functions like collecting, analyzing, storing, retrieving and displaying information appropriately, as it may be required. At the same time, computer systems perform an important function of integrating resource flows, functions of management organizational working of departments together with various technologies implemented by the organization. To this extent computer systems in an organization are becoming a necessity that an organization cannot function effectively in absence of such systems. In the 21st century, especially for organizations, it entails that to insure an excellent performance organizations will need superior systems that have ability to integrate organizations’ activities more effectively.
Hospital systems management has been used interchangeably with hospital management systems where in most books the two words have been used to mean the same thing. Moreover, analyzing information in most books on HSM, a thin line that is almost non-existence characterizes HSM and hospital information systems (HIS). Therefore, research on HSM will largely be intertwined with HIS. Accounting HSM history, one has to remember that the history is largely associated with the emergence and development of management engineering in organizations (Wolper 2011, p. 403). The history of the development of hospital system management can be categorized into four groups: 1950s period; 1960-1970 period; 1980s period; 1990s period and the future (present) period (Wolper 2011, p. 403).
The 1950s period was characterized by growth of management engineering in hospital where was full-time employment of hospital management engineer. Further, this period was characterized by the development of university programs for education and service in management engineering and the subsequent founding of the hospital management system society (HMSS) in 1961 (Wolper 2011, p. 403). As time went by HMSS has started to be a membership society for majority of information system specialists and since then it evolved to become known as health information and management systems society (HIMSS) in the present times (Wolper 2011, p. 403).
The period between 1960s and 1970s was characterized by increased utilization of system resources as management engineering became more integrated in organizations. Utilization of systems was seen to be necessary especially at increasing productivity in healthcare organizations. During this period, management engineering became concerned with improving operations in problem departments and this included enhancing patient admission processes and improving supply systems together with developing efficient employee-scheduling systems (Wolper 2011, p. 403). During the 1980s period hospital management system as a young field continued to grow and expand. This was the period when federal prospective payment system (PPS) was developed (Wolper 2011, p. 403). The objective behind this development was to reduce acute hospitalization that had become a great problem. Systems during this period also concentrated on hospital staffing where was a large creation of systems to maximize reimbursement. During the 1990s period PPS systems continued to be vital but their usefulness was outweighed by great pressures to reduce healthcare costs. As a result, there was the development of an enhanced new reimbursement system that could manage care (Wolper 2011, p. 403). In addition, as the problem of relocation of services within hospitals grew, there was an urgent need to develop information management systems to provide effective resource management. Lastly, during the post-1990s period there were concerted efforts to develop healthcare management systems that could harness healthcare operations particularly delivery systems (Wolper 2011, p. 405).
Accordingly, it had been suggested that during this period efforts were to be directed to creating and implementing healthcare systems that had ability to achieve pricing strategies, effective information systems and efficiency in facility design, all created to achieve aggressive disease management (Wolper 2011, p. 405). Therefore, it can be concluded that modern-day management engineering should focus on increasing the effectiveness of information systems through application of system design analysis techniques to replace manual systems (Wolper 2011, p. 405).
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Hospital Systems Management in Developing Countries
Hospitals have been described to be complex organizations that normally manage large quantities of information (Bhagat, Wang, Khasawneh, and Sribari n.d, p. 1). As a result, to set up hospital management information system, there is a need for in-depth analysis of the information system of the hospital and all the interacting elements that are responsible for gathering, processing and supplying information that is vital for the activities of the hospital (Degoulet and Fieschi 1997, p. 92). Hospital management information systems (HMIS) are “designed to integrate data collection, processing, reporting, and use for the improvement of patient health services, effectiveness and efficiency through better management of patient data at all levels of implementation” (Archangel 2007, p. 3).
Further, many HMIS constitute two subsystems, including, a patient management information system and hospital management information system (Archangel 2007, p. 3). In most cases, these two systems function interdependently, where they incorporate all the patient data and hospital data using information-processing tools.
Functional and working information and health information systems have been found to be important for the development and strengthening of health systems in developing countries, especially in the realization of MDGs (Igira et al. n.d, p. 1). As this may appear to be a necessity, the real situation on the ground shows that HIS development in developing countries still faces numerous problems especially those that emanate from organizational complexity (Igira et al. n.d, p. 1). This usually occurs due to fragmentation and uncoordinated organizational structures, coupled with unrealistic ambitions that usually scuttles success of maintaining effective HIS.
Nigeria is one of the developing countries located in sub-Saharan African continent where health has become a key issue of concern. Evidences have been cited at the spirited effort of Nigeria to enhance its national health information systems with partner agencies pledging to support. Some problems have been cited on the Nigeria’s healthcare system and they include defectiveness of the registration system of births and deaths (Ebonyi State University and World Health Organization N.d, p. 3). In addition, there is availability of scanty information usually collected in a few limited surveys and research studies making the provision of health services a big problem. Being one of the developing countries that faces rampant problems with healthcare systems, Nigeria has been found to manifest the following inadequacies: weak organizational support of data collection systems, lack of standardization and coherence, especially with regard to improvement of health information systems (Ebonyi State University and World Health Organization n.d, p. 4).
Other identified problems include untimely collection of data, inadequate use of information and evidence for decision-making and harboring high ambitions with regard to computerization of health information systems that sometimes the country finds unable to maintain (Ebonyi State University and World Health Organization n.d, p. 4). According to the country’s government and the health sector at large, there is a need for availability of accurate, timely and useful health information that can be effectively used to make informed decisions concerning health of people (Ebonyi State University and World Health Organization n.d, p. 3). As a result of this need, government in Nigeria continues to support efficient generation and availability of health data and information that can be used as a public good by public, private and NGO’s organizations. This concern led to the establishment of the National Health Management Information System (NHMIS) by all state governments in the country as a management tool for making informed decisions at various levels (Ebonyi State University and World Health Organization n.d, p. 3).
World Health Organization (WHO) has stated that better health systems can be developed when timely and reliable information and evidence are used for decision and policymaking (Ebonyi State University and World Health Organization n.d, p. 3). In Nigeria there have been continuous efforts to promote the use of health information systems. Such systems are seen to have tremendous impact especially on improving efficiency, cost-effectiveness, quality and safety of medical care delivery in the country. As a result, WHO has described and defined a functional health information system as one that “ensures the production, analysis, dissemination and use of reliable and timely health information by decision-makers at different levels of the health system, both on regular basis and in emergencies” (Ebonyi State University and World Health Organization n.d, p. 3). Progress has been made in the country with regard to creating effective hospital management information systems, although it has been found that the country’s health sector still faces certain obstacles. Majority among these obstacles include lack of access to the information that is important to make decisions on the need to provide healthcare within the available budget. Nevertheless, Nigeria’s healthcare system continues to grow with regard to HIS development and implementation. Key areas where progress has been witnessed include: increasing availability of information and communication technologies and increasing number of health information support programmes (Ebonyi State University and World Health Organization n.d, p. 3).
In addition, progress has been witnessed in the increased availability of free resources in the internet, emergence and growth of international community that has interest in the improvement of health information access and lastly increased political interest in access to healthcare information (Ebonyi State University and World Health Organization n.d, p. 3).
Analysis of Existing Hospital Systems Management- BK-Ehospital System
Health needs can be regarded to be similar in majority of developing countries although not on wholesale. As a result, HIS development and application in one country may be borrowed and transferred to another country depending on the similarity of the countries’ health problems and needs. Therefore, Nigeria’s healthcare can borrow HIS developed in Vietnam known as the BK-eHospital system (Nguyen, Vu and Webster 2011, p. 6). BK-eHospital system is a web-based EMR system that has largely been implemented in Vietnam where the system makes it possible to access medical records by hospital medical staff and patients online (Nguyen, Vu and Webster 2011, p. 6). In this way, the healthcare system is made to be more efficient than the manual one. The system is developed using ASP.Net, VB.Net, and C++ languages and it manages information using the SQL Server 2000 (Nguyen, Vu and Webster 2011, p. 7). By implementing this system in Vietnam, it has been found to be robust in its performance, the time used to acquire data and transfer rate is quick and also the information storage, printing and reporting statistics modules of the software work efficiently (Nguyen, Vu and Webster 2011, p. 7).
Analysis of this system shows that it has become one of the best healthcare information systems to the people of Vietnam. Moreover, adoption of this system results in minimization of errors that may be due to manual entry of patient to medical data. The system functions through automated data acquisition of medical information from medical equipment such as laboratory devices, ultrasound, DR, CT, MRI machines and others as it has been evidenced in Vietnam’s hospitals (Nguyen, Vu and Webster 2011, p. 7). At the same time the system provides opportunity for patients to access their medical information through the internet, where also it has the capacity to provide information about patients’ medical tests in a timely manner and the treatment recommended by doctors for quick recovery (Nguyen, Vu and Webster 2011, p.8). The system has been found to have ability of serving a population of about 1000 people or less and given its relatively low cost. The system can be implemented in a number of hospitals in any given developing country. Analyzing Nigeria’s healthcare systems, it becomes clear that there is a lack of developed standards that can be used to share and manage patient health records among different hospitals. As a result, the above-proposed system once established and well managed in Nigeria has the ability to establish standards of managing, storing and sharing medical records between numerous healthcare providers in the country.
At the moment it has been explored that with the development of cell phone technology BK-eHospital system can be developed to enable patients’ access to their medical records through their cell phones in the future. By just having a password to log-in, patients will be able to review the status of their health and consult medical staff for advice appropriately (Nguyen, Vu and Webster 2011, p. 10). At the same time the system is likely to be improved with a possibility of providing additional key features. These features include automatic acquisition of medical data, such as video data from endoscopy, 3D and 4D image data, waveforms of electrocardiograms, electromyograms, electroencephalograms and other related signals and store them in the system database appropriately (Nguyen, Vu and Webster 2011, p. 10).
The Basal Structure of a Hospital System
With the development of information technology today it has been identified that numerous HIS exist on the market. But even with miscellaneous available HIS it has been found out that not all of them possess the requirements of a good HIS. Hospital may require to provide adequate integration, especially with larger health-care networks (Degoulet and Fieschi 1997, p. 91). Research done on the appropriateness of HIS indicates that for a functional HIS to be created hospitals need to consider and integrate multiple related factors, such as the diversity of the tasks to be performed, the key players to be involved, the nature and needs of the existing organization and the technical possibilities that the organization has (Degoulet and Fieschi 1997, p. 91). Before designing and installing an effective HIS it has been suggested that hospital management needs the following key points. First, all efforts need to be done for acquiring knowledge and understanding the underlying information system of the hospital. Second, there should be a detailed analysis of the sociology of the key structure that the hospital has, whereby this may entail good communication internally. Lastly, there should be availability of a well-adapted hardware and software strategy coupled with a good estimation of the resources required for deployment and maintenance (Degoulet and Fieschi 1997, p. 91).
Therefore, insuring the above requirements, how should an efficient and effective HIS look like? HIS implemented in a hospital should be able to improve the quality of health care within the implementing organization. In this way, the system should be able to help solving health care issues within the organization. Moreover, the system should have the ability to act as a decision-making tool because management of the hospital relies on the system to solve rising health issues in the organization. At the same time the developed HIS need to have the potential and capability of controlling costs in the organization (Degoulet and Fieschi 1997, p. 90). HIS developed again need to reflect the needs and aspirations of the organization. In this way a good HIS need to be developed within the budget constraints of the organization putting in considerations such factors as size, economic aspect of operating the system and maintaining it along with the personnel training cost of the system. More aspects that will ensure the hospital information system and structure are efficient to include demonstrating ability of operation with regard to recognizing social and cultural aspects of the organization. Other aspects include the system having the capacity to foster and encourage human capacity development smoothly, encourage participation and awareness on how it functions and contributes to organization growth and demonstrates its sustainability (Archangel 2007, p. 4). In summary, a good HIS structure needs to be developed within the premise of budget resources, capacity of the organization to manage the system, ability of the system to foster precise decision-making in the organization and the ability of the system to promote continuous learning in the organization.
Ways to Keep up or Manage Hospital System When it has been Integrated
Integrating HIA is the first step in ensuring that organization is able to realize its goals. When organization has created and implemented HIS it needs to be managed effectively to ensure that the set goals of the organization are realized. Managing an integrated HIS requires material and human resources. Material resources will need finances, computer systems and related back-up materials. Human resources will entail training and group of experts to run and operate the systems (Mahady, McCullagh, Grainger, and Kinsella 2002, p. 3). In all these endeavors a key to success in managing HIS will be the cooperation and support of the organization top management team. Since the systems operate in an entire organization, right attitude of the management team is required to ensure that the system operations, functions and goals are realized without any conflict. Entailing the right organization culture on the HIS will also be vital in managing the systems (Mahady et al. 2002, p. 3). For example, the organization’s employees will need training, education and awareness of the programs to enable them to accept the HIS more positively. Right culture has been found to be a key to the success of adoption and implementation of information systems in many organizations (Mahady et al. 2002, p. 3).
Evaluation of HIS needs to be carried out regularly to insure that all goals are being fulfilled while new goals are set with the updating of the systems. Evaluation is vital for encouraging the organization to identify the key areas or aspects of HIS to be improved, changed or modified. Another way of managing HIS will result in continuous researching on the most updated forms of HIS, especially with regard to changing needs of the organization (Perezgonzalez 2005, p. 24). With a help of continuous researching the organization will be able to learn about the latest technologies and how well such technologies can be integrated in the organization. On overall, HIS management will be successful when there is coordination, interdependence and cooperation of all elements that concern the implementation of HIS in the organization. In addition, learning, adaptation and continuous improvement will be vital in managing successful HIS in the organization.
Hospital management system in the 21st century is necessary. Hospitals are discovering that for effectiveness and efficiency there is a need to adopt cost-effective HIS that are able to meet organization’s needs. In this research paper it has been discovered that although developing countries continue to make progress in adoption and implementation of HIS, there are still some obstacles in a full realization of HIS goals. The obstacles largely emanate from organizational, economic and socio-cultural aspects. Despite this, it has been found out that HIS are likely to succeed when all elements in an organization function in cooperation and interdependency. In summary, the research paper has identified the need for hospitals in developing countries to develop HIS that are largely customized to the needs and capability of hospitals in the country.
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