Sunday, June 28, 2009

Software implementation and process engineering for hospitals

SA-H.I.S implementation is about executing a well formulated plan.

  • Analysis of the existing system by people who understand how hospitals function
  • Identifying existing pain points for management
  • Bringing about changes in business processes of the hospital
  • Plugging process loopholes in various hospital departments
  • Suggest methods to reduce stock inventory
  • Improving on patient wait time
  • Bringing about accountability in in-patient billing system
  • Improving patient discharge process
  • Ensuring complete training for staff
  • Custom building of reports for management
  • Building performance matrices for daily monitoring
  • Simulating a disaster recovery

Tuesday, May 12, 2009

Replication for hospital data safety and convenience

As hospital owners and managers, the greatest challenge often is in (a) allocating time to analyse the wealth of information available through management information systems (b) devising easy and affordable means of protecting valuable data from hardware failures and natural disasters.

The SA-H.I.S data replicator is an easy to administer synchronisation tool which enables hospital administrators and owners to seamlessly transfer data to other locations / machines in a safe and secure manner, so that business analysis and planning can be carried out at leisure.

Data replicator is also an ideal solution for small and medium size hospitals, who find it beyond their IT budgets to implement sophisticated server mirroring and other failsafe technologies.

  • Peace of mind with valuable hospital data.
  • Low cost of ownership
  • Management time savings in analysing data offline.
  • Authenticated one or two way transfer of data to laptops
  • Two way data transfer for disaster recovery management
  • Standby server synchronisation for 24 x 7 operations
  • Data dump for third party applications
  • Works with existing hardware and software

Saturday, April 18, 2009

Patient safety and Swiss cheese – How many layers do you have?

Reason's Swiss cheese model has become the dominant paradigm for analyzing medical errors and patient safety incidents. Reason has written extensively about how humans and organizations commit errors and how such incidents can be prevented once their causes are understood. In particular, he has developed what he calls the "Swiss Cheese" model of incident occurrence.

Here is what it looks like applied in one area where vulnerabilities can have dire consequences, the hospital setting:


ARDS is Acute Respiratory Distress Syndrome which can result from a number of preventable circumstances. In the illustration above, each slice of cheese, starting from the right, represents an obstacle or defense to ARDS development in a patient admitted to the hospital. But the holes in the cheese slice represent something different - a latent error or system failure waiting to happen. These could be human error, equipment failure, and so on. Each of these can be handled and prevented by proper training, supervision, maintenance and so on. But when these methods break down, the likelihood of a serious event increases.

To bring the message home, try and develop a model for your operation theater. How many slices of cheese exist to help you prevent an accident, or recover from it? How big are the holes, and how often do you refine your procedures to improve the chances of not being in an accident, or surviving one?

The Operation Theater module of H.I.S can reduce such risks in patient safety. With features like

  • Pre-operative checklist.

  • Pre-define list of instruments and consumables.

  • Equipment and consumable sterilization tracking.

  • Exception handling for emergency surgery cases.

  • Surgery related anesthesia information.

The operation theater module helps you add additional layers of cheese to prevent accidents and ensure patient safety, besides saving you money and increasing process efficiency.

  • Optimal utilization of theater resources.

  • Just in time inventory savings on theater consumables.

  • Surgery scheduling for multiple theaters.

  • Scheduling based on average time for a class of surgery.

  • Measure surgeon's performance.

  • OT performance analysis (Weekly, monthly, yearly).

  • And increased accountability through integrated in patient billing.

So why wait? Increase patient safety and save money at the same time.

Friday, March 20, 2009

Management participation is key to success in any hospital implementation

If one were to list the key ingredients of success in an ERP solution for hospital it would be as follows

# Management participation
It is not about installing a software package. It is about changing bad habits and transforming old ways of doing things. Without the support from top management, the real benefits are never realised and organisation would not have its vision trickle down to the bottom of the pyramid.

# Human resource management
A progressive organisation needs a motivated team - an asset to any organisation that is willing to learn ; change for the better.

# Training
As new people join, knowledge acquisition is often unstructured and incomplete. Hospitals need to adopt the approach of continuous training to help provide better patient experience.

# Implementation skills
Need people who can see eye to eye with the end user operators. Someone who can explain the operations in their language. No jargons, no frills approach recommended.

# Work to a project plan
Avoid last minute surprises. The war is always won before the battle. A detailed plan on a spreadsheet with the nitty gritties would help a long way in on time execution.

# Expertise
The vendor should have the right consulting expertise and business knowledge in guiding the hospital ; the maturity to handle exceptions ; promising 100% delivery.

# Error free software
A tried and tested solution that works error free from day one. Any critical errors in the initial phase would have catastrophic consequences on the morale of the end users.

Sunday, March 1, 2009

Prasanthi hi-tech hospital, Manjeri, kerala - Case study

"We had a customised software with lots of features and developed for our hospital only. But due to various reasons it failed and H.I.S is found to be very efficient in solving these problems, especially stock and sale point. I will give 100% marks for that." - Dr. M.C Joy

The 150 bedded hospital was established in 2004 with over 11 departments.

Problems

* Vendor lacked domain expertise in health care industry
* No skills in implementing best practices
* Endless software customisation created loopholes in the system
* Unstable product / lacked testing methodologies
* Change in key technical personnel
* Vendor closed shop

Key reasons for choosing SA-H.I.S

* Successfully running in all the major hospitals in the region
* Zero downtime reported

The difference

* Excellent implementation guidance
* Introduced best practices in operations
* Systematic end user training
* Brilliant technical support

Benefits

* Control over inventory management
* Easy patient management
* Excellent control over discharge process
* Complete information on stock
* User wise productivity measurement
* Overall cost savings : 30%
* Implemented on time and within budget

Wednesday, February 11, 2009

Hospital technology hype cycle

Does technology really matter ?

Often we do get calls from prospective clients who buzz about technology before deciding on software products for the healthcare sector. Typical questions include

  • Is your product built using eclipse or Visual Studio tool
  • Does your product use X or Y rdbms
  • Is your product a web based point of sale application
  • Do you provide unlimited customisation
What matters
  • Contribute to overall return on investment (Ask for value chart)
  • Improve hospital business processes - Process chart for hospitals
  • Enhance patient experience - Reduction in patient wait time
  • Have low cost of ownership (TCO) (thin client for eg; lower operating power)
  • Scalable to support the growth of the hospital
  • Secure enough to hold your valuable data
  • Transparent and ethical on the licencing aspects of the software
  • Constant updates and release upgrades -
  • Be affordable to hospitals in emerging nations - India
  • Zero maintenance cost for software vs cut and paste programming
  • Be self running as hospitals cannot afford dedicated IT departments
  • The software must guarantee return on investment

Energy savings for hospitals

Lighting
• Reduce excessive illumination levels to standard levels using switching, delamping, etc.
• Aggressively control lighting with clock timers, delay timers and/or occupancy sensors.
• Install efficient alternatives to incandescent lighting, mercury vapor lighting, etc. Efficacy (lumens/watt) of various technologies range from best to worst approximately as follows: low pressure sodium, high pressure sodium, metal halide, fluorescent, mercury vapor, incandescent.
• Select ballasts and lamps carefully with high power factor and long-term efficiency in mind.
• Upgrade obsolete fluorescent systems to Compact fluorescents and electronic ballasts
• Consider daylighting, skylights, etc.
• Consider painting the walls a lighter color and using less lighting fixtures or lower wattages.
• Use task lighting and reduce background illumination.
• Re-evaluate exterior lighting strategy, type, and control. Control it aggressively.
• Change exit signs from incandescent to LED.

DG sets
• Optimise loading
• Use waste heat to generate steam/hot water /power an absorption chiller or preheat process or utility feeds.
• Use jacket and head cooling water for process needs
• Clean air filters regularly
• Insulate exhaust pipes to reduce DG set room temperatures
• Use cheaper heavy fuel oil for capacities more than 1MW

Buildings
• Seal exterior cracks/openings/gaps with caulk, gasketing, weatherstripping, etc.
• Consider new thermal doors, thermal windows, roofing insulation, etc.
• Install windbreaks near exterior doors.
• Replace single-pane glass with insulating glass.
• Consider covering some window and skylight areas with insulated wall panels inside the building.
• If visibility is not required but light is required, consider replacing exterior windows with insulated glass block.
• Consider tinted glass, reflective glass, coatings, overhangs, draperies, blinds, and shades for sunlit exterior windows.
• Use landscaping to advantage.
• Add vestibules or revolving doors to primary exterior personnel doors.
• Consider automatic doors, air curtains, strip doors, etc. at high-traffic passages between conditioned and non - conditioned spaces. Use self-closing doors if possible.
• Use intermediate doors in stairways and vertical passages to minimize building stack effect.
• Use dock seals at shipping and receiving doors.
• Bring cleaning personnel in during the working day or as soon after as possible to minimize lighting and HVAC costs.

Water & Wastewater
• Recycle water, particularly for uses with less-critical quality requirements.
• Recycle water, especially if sewer costs are based on water consumption.
• Balance closed systems to minimize flows and reduce pump power requirements.
• Eliminate once-through cooling with water.
• Use the least expensive type of water that will satisfy the requirement.
• Fix water leaks.
• Test for underground water leaks. (It's easy to do over a holiday shutdown.)
• Check water overflow pipes for proper operating level.
• Automate blowdown to minimize it.
• Provide proper tools for wash down -- especially self-closing nozzles.
• Install efficient irrigation.
• Reduce flows at water sampling stations.
• Eliminate continuous overflow at water tanks.
• Promptly repair leaking toilets and faucets.
• Use water restrictors on faucets, showers, etc.
• Use self-closing type faucets in restrooms.
• Use the lowest possible hot water temperature.
• Do not use a central heating system hot water boiler to provide service hot water during the cooling season -- install a smaller, more-efficient system for the cooling season service hot water.
• Consider the installation of a thermal solar system for warm water.
• If water must be heated electrically, consider accumulation in a large insulated storage tank to minimize heating at on-peak electric rates.
• Use multiple, distributed, small water heaters to minimize thermal losses in large piping systems.
• Use freeze protection valves rather than manual bleeding of lines.
• Consider leased and mobile water treatment systems, especially for deionized water.
• Seal sumps to prevent seepage inward from necessitating extra sump pump operation.
• Install pretreatment to reduce TOC and BOD surcharges.
• Verify the water meter readings.
• Verify the sewer flows if the sewer bills are based on them Miscellaneous
• Meter any unmetered utilities. Know what is normal efficient use. Track down causes of deviations.
• Shut down spare, idling, or unneeded equipment.
• Make sure that all of the utilities to redundant areas are turned off
• Install automatic control to efficiently coordinate multiple air compressors, chillers, cooling tower cells, boilers, etc.
• Renegotiate utilities contracts to reflect current loads and variations.
• Consider buying utilities from neighbors, particularly to handle peaks.
• Leased space often has low-bid inefficient equipment. Consider upgrades if your lease will continue for several more years.
• Adjust fluid temperatures within acceptable limits to minimize undesirable heat transfer in long pipelines.
• Minimize use of flow bypasses and minimize bypass flow rates.
• Provide restriction orifices in purges (nitrogen, steam, etc.).
• Eliminate unnecessary flow measurement orifices.
• Consider alternatives to high pressure drops across valves.

Courtesy :
Bureau of Energy Efficiency