Implementation of Information Management System - Case Study Example

? Information Management System of the of the Table of Contents Table of Contents 2 Introduction 3 and Functional Evaluation 3 Information Architecture 5 Strategic Alignment 7 Future State 8 Reference 10 Introduction Research scholars such as Weller (1996) have shown their concern for implementation of information management system (IMS) in healthcare divisions which can save time and cost of patients. The concept of IMS has been popularized in last 15 years due to its effectiveness in decreasing the lead time or bottle neck problems. Other research scholars such as Northcott and Llewellyn (2003) and Appleby and Thomas (2000) have also pointed out that hospitals and healthcare service centers need to implement information management system as benchmarking procedure to increase the efficiency of service delivery and patient management. It is evident from the argument of research scholars that implementation of IMS in hospitals is a pertinent but hotly debated topic. Hence, the researcher has decided to dig deep in this topic by shedding light on existing IMS in hospitals of UK. Description and Functional Evaluation In UK, majority of hospitals are covered under the supervision of National Health Service Estate hence these hospitals show the common tendency while implementing a new IT application. Puig-Junoy (2000) and Tsai and Molinero (2002) have pointed out that in most of the cases, hospitals implement a new system in order to decrease the patient management cost. However, these researchers have suggested that hospitals should implant those systems which can save money and time of patients and deliver service in profitable manner. E-Prescribing has been selected by the researcher as the IMS to study in this paper. Hospitals like Chelsea and Westminster Healthcare NHS Trust has already been implemented the e-Prescribing in order to manage cost of servicing patients (European Commission, 2012). Although e-Prescribing might sound like it’s the electronic version of formal prescription but in real scenario it’s much more than prescribing. E-Prescribing is the modified version of patient management facilities which requires active involvement of stakeholders such as doctors, nurses, patients and many others. Generally hospitals such as Chelsea and Westminster Healthcare NHS use e-Prescribing as packaged software but there examples, where hospitals use customized version of e-Prescribing. Now, the study will try to understand what exactly meant by e-Prescribing. NHS Connecting for Health (NHS CFH) (2009) has defined E-Prescribing as the information management system which is created in order to facilitate and enhance the communication of medicine order or prescription, increasing the options for administration of hospitals to provide medicine to patients in accordance with their prescription, creating decision support and audit support system for the hospital to manage medicines used throughout the treatment of patients. In simple words, objective of e-prescribing is to manage patient information in efficient manner and help the hospital to audit its medicines used per patients. Many of the UK hospitals create the link between e-Prescribing and Enterprise Resource Planning (ERP) in order to help audit section of the hospital to conduct the cost-benefit analysis of its patient service. Implementation of e-Prescribing system is stepwise process which involves the engagement of various clinical stakeholders such as doctors, patient care division in the hospital, Information Management and Technology (IM&T) professionals, senior clinicians, senior managers etc. Specifically, IM&T is responsible for providing technical and infrastructural support to e-Prescribing (NHS CFH, 2009). E-Prescribing cannot be viewed as simple automation of manual task function for prescribing medicines rather than it should be viewed as transformative process. For example, using e-Prescribing empowers doctor and nurses can change the traditional prescribing process and indicate the seriousness of disease for patients and direct ward pharmacist to prioritize patients who need immediate attention. In such context, simple automation of paper based prescription is not able to provide above mentioned interactivity and customization hence it can be assumed that e-Prescribing is basically transformative process which has transformed the traditional concept of viewing prescription of medicine and giving direction about urgency of patient’s health condition as two separate processes. Although E-prescribing can be implemented in hospital wide manner but NHS CFH (2009) has found that it is difficult to implement the IMS facility to divisions such as Accident and Emergency (A&E) departments where extreme level of customization is needed. NHS CFH (2009) has also reported that, it is not possible to implement e-Prescribing system in critical care units or better to say that the system cannot be implanted in overnight manner. Hence such shortcomings of e-Prescribing can be cited as limitation of the system. Hospitals usually implement e-Prescribing in various sections such as inpatient wards, outpatient clinics, discharge prescribing unit, day care centers, oncology divisions, operating theatres and dialysis centers (NHS CFH, 2009). Despite the limitation of E-prescribing, many of the hospitals of UK such as Chelsea and Westminster Hospital NHS Foundation Trust, Western Sussex have achieved success after implanting the e-Prescribing. For example, Chelsea and Westminster Hospital NHS Foundation Trust have reported that, implanting e-prescribing has reduced the error margin by 11% during the prescription in contrast to handwritten prescription and lead time for providing medical facilities to patients also reduced by 7% (Bruce, 2010). Chelsea and Westminster Hospital NHS Foundation Trust has also reported that, e-prescribing system automatically warns prescriber while they propose medicines which can negatively interact with other medicines that are already using by patients and safely dispensing all the information regarding dose and frequency of medicines. (Source: European Commission, 2012) The above diagram is showing that how much amount of discrepancies and errors are removed after the implementation of e-prescribing system in Chelsea and Westminster Hospital. Apart from the statistical result, it can also be stated that the implemented function (e-prescribing system) has worked quite efficiently for hospitals in UK. Information Architecture Upon reading so far of this case study, readers might get interested to know about information architecture of e-prescribing system, well, this section of the study will try to highlight information and system architecture of e-prescribing. When using the packaged software version, hospitals need to install the e-prescribing application in their server computing system by inserting the disk. A ‘set up’ window is created after the insertion of e-prescribing disk. However, hospitals can customize the software by clicking on the customization window of the software. While installing the software, hospitals need to run the e-prescribing in multiple computers of different divisions. Central servers will hold information regarding medicines, patients, frequency of doses etc, while such data can also be checked through laptops of doctors and respective staff or the workstation in the hospital. Although the e-prescribing software can run in both online and offline mode but internet access is needed in order to update the software in periodic manner. E-prescribing system is also needed to be connected with Structured Query Language (SQL) database and the other functional software such as enterprise resource planning (ERP) in order to help doctors to obtain patient numbers, drug information or demographic data in simultaneous manner. Using the integrated system helps the administrator of the hospital to validate the urgency and seriousness of medical condition of patients without wasting much time. E-Prescribing packages can run both in ‘fat client’ or ‘thin client’ interface. However, for ‘thin client’ mode, main software program is loaded in limited number of servers and clients such as commuters, workstations or tablets. Client computers use web browsers to access the program and the aim providing e-prescribing in both ‘fat client’ and ‘thin client’ infrastructure is to help doctors to access and update the software in convenient manner. While working in fat client information infrastructure, clients can download the initial instruction from the server and then do the editing part locally and after completing the task, clients reverse the application to servers. However, the process is lengthy and it is difficult to update the software in clients periodically hence managers of the hospitals prefer to use the thin client infrastructure. Major strength of the e-prescribing is its interactivity, easy to update, easy to access data of medicine and patients in comprehensive manner for doctors and staff of the hospital while slow access to the data through client computer, inability to incorporate non-structured and complex data can be classified as major weakness for e-prescribing system. While interviewing patients of hospitals where e-prescribing has been used by doctors, the researcher has found that most of the patients have got benefitted from the system. Some patients have stated that waiting time for outpatient prescriptions has been reduced 30 minutes to 45 minutes (European Commission, 2012). Outpatients had to wait for almost 2 hours prior to implementation of e-prescribing system whereas the waiting time has been reduced to 1 hour for them after the implementation. Even doctors of Chelsea and Westminster Healthcare have stated they can discharge 40% more patients due to automated prescription procedure. Interesting fact is that, prior to the implementation of e-prescribing system, no discharge prescriptions were written by the medical staff before taking the permission of doctors and such bureaucratic work flow automatically increase the waiting time for patients. After the implementation of e-prescribing system, staff can check the discharge condition from the automated computer system and take the decision in quicker pace so that patients need not to wait for too long. Strategic Alignment Chang, Cheng, and Das (2004) and Chen, Hwang, and Shao (2003) have argued that, hospitals or health organization should not implement any system which cannot help the organization to achieve its strategic objectives. According to these research scholars, implementing a system without having any strategic objective often ends up in wasting money for organizations. However, that is not the case for Chelsea and Westminster Healthcare or other organizations in UK which have implemented the e-prescribing system. There are sufficient examples available which state that, Chelsea and Westminster Healthcare has implemented e-prescribing system as part of integrated strategic framework in order to fulfill three objectives, 1- reduce the waiting time for patient, 2- decrease the inventory cost for medicines by reducing stock holding for low-demand medicines and 3- increase the quality of patient service in comprehensive manner. For example, linking e-prescribing system with ERP system has helped the hospital to optimize the stock level for medicines by monitoring the system alert for frequently and less frequently prescribed medicines by doctors. The following diagram will show that prior implanting e-prescribing system, inventories of the hospital shown the tendency to increase while the same tendency has reversed after the implementation. (Source: European Commission, 2012) It is evident from the above diagram that Chelsea and Westminster hospital has not only reduced the medicine inventory level for both inpatients and outpatients but also inventory holding cost. Prior implementing e-prescribing system, value of the non-performing inventories for Chelsea and Westminster Healthcare has reached to the value of ?2,400,000 while this amount of spoilage of resources has been reduced to ?1,400,000 after the implementation of the system (European Commission, 2012). These evidences are substantiating the claim that implanting e-prescribing system is a strategic decision for most of the hospitals in UK with an expectation that the system might help them to achieve competitive advantage over other competitors. Future State Grosskopf, Margaritis and Valdmanis (2004) have stated that hospitals in UK need to be more systematic and process driven when it comes to handling patient care and medicine inventory management. The same argument can be used while recommending extension of e-prescribing system. For example, as it has been already mentioned that e-prescribing system faces problem while processing complex data regarding accident & emergency division, critical care units hence it can be recommended that the upgraded system must process complex and huge amount of data in simultaneous manner. The interface of the extended version of e-prescribing system might work in the following manner. (Source: Boussabaine & Kirkham, 2006) According to the above model, some of the powerful client systems such as workstations, computers and laptops should be placed in the frontline of emergency divisions and these clients will be controlled through a centralized server while client systems with low processing speed will be placed in the intermediate division of the network. These clients with low processing speeds will handle the e-prescribing of other medical section of the hospital. Two way arrangement client-server networks will not only increase the efficiency of e-prescribing system of that Chelsea and Westminster hospital but also help the hospital to fulfill its strategic objective of delivering medical service to critical care and emergency division in efficient manner (European Commission, 2012). Reference Appleby, J., & Thomas, A. (2000). Measuring performance in the HNS: What really matters? BMJ, 320, 1464-6. Boussabaine, A . H., & Kirkham, R. J. (2006). Whole life cycle performance measurement re-engineering for the UK National Health Service estate. Facilities, 24(9/10), 324-342. Bruce, S. (2010). London trust sees e-prescribing gains. Retrieved from http://www.ehi.co.uk/news/ehi/6479/london-trust-sees-e-prescribing-gains. Chang, H., Cheng, M., & Das, S. (2004). Hospital ownership and operating efficiency: Evidence from Taiwan. European Journal of Operational Research, 159, 513-27. Chen, A., Hwang, Y., & Shao, B. (2003). Measurement and sources of overall implications in hospital services: Evidences and implications in hospital services. European Journal of Operational Research, 161(2), 447-68. European Commission. (2012). E-pharmacy at chelsea and westminister hospital, uk. Retrieved from http://ec.europa.eu/enterprise/archives/e-business-watch/studies/case_studies/documents/Case%20Studies%202006/CS_SR10_Hospital_2-ChelseaAndWestminster.pdf. Grosskopf, S., Margaritis, D., & Valdmanis, V. (2004). Competitive effects on teaching Hospitals. European Journal of Operational Research, 154, 515-25. NHS Connecting for Health. (2009). Electronic prescribing in hospitals Challenges and lessons learned. Retrieved from http://www2.lse.ac.uk/LSEHealthAndSocialCare/pdf/information%20systems/eprescribing_report.pdf. Northcott, D., & Llewellyn, S. (2003). The ladder of success in healthcare: The UK national reference costing index. Management Accounting Research, 14, 51-66. Puig-Junoy, J. (2000). Partitioning input cost efficiency into its allocative and technical components: An empirical DEA application to hospitals. Socia-Economic Planning Sciences Journal, 34, 199-218. Tsai, P., & Molinero, C. (2002). A variable returns to scale data envelopment analysis model for the joint determination of efficiencies with an example of the uk health service. European Journal of Operational Research, 141, 21-38. Weller, D. L. (1996). Benchmarking: A paradigm for change to quality education. 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