Hospital Management Information Systems in Health ... - DergiPark

Journal of Current Researches on Health Sector (J o C R e H e S)

Year: 2017 Volume: 7

www.stracademy.com/jocheres ISSN: 2547-9636

Issue: 1

Hospital Management Information Systems in Health Sector and Development in Turkey Demokaan DEMİREL1 Keywords Health Sector, Information System, Hospital Information Management System, Institutional Efficiency, Turkey.

Article History Received 1 June, 2016 Accepted 10 June, 2016

Abstract

Information systems play an important role in the production, sharing, storage and transmission of information in various fields. Hospital information management systems used in the health sector actively meet the needs of physicians, administrators, and patients in institutional processes. Hospital information management systems ensure that data are collected in a correct, complete and interdependent manner. Hospital information management systems started to be used in the 1960s. These systems can be classified as integrated and modular systems. Integrated information systems are divided into hospital general information system, clinical information systems, management information system, and a database management system. In another classification, hospital management information systems are seen to include resource utilization and programming, financial management, materials and facility management and staff management systems. Hospital management information systems have purposes such as providing patient satisfaction, strengthening internal communication networks, reducing costs, and reliably storing data in a digital environment. The development of hospital information management systems in Turkey is based on the Health Information Systems Project, which was supported by the World Bank in 1990 and conducted by the Ministry of Health. The use of hospital information systems in health institutions has become increasingly widespread with the studies conducted under the leadership and coordination of the Ministry of Health after 2000 years. The purpose of this study is to evaluate the development and functions of the hospital information management systems in the health sector by acting from the Turkish case. The study first examined the development and types of hospital information management systems. The purposes of the usage and benefits of these systems have been referred to the study. In the second part of the study, the development and components of hospital management information systems in Turkey are evaluated.

1. Introduction The conditions that enable global competition in the information society are the development of communication technologies and the importance of the administrative information flows and the inter-institutional communication networks. Therefore, more emphasis is placed on information systems in the Corresponding Author. Asist. Prof. Dr., Ömer Halisdemir University, Faculty of Economy and Administrative Sciences, Public Administration Department, [email protected] 1

competitive presentation of public services. Information systems are one of the means by which public institutions can save economic indicators, such as time and cost. Since the 1960s, the use of information systems in the health sector has become widespread. Health care is a priority in ensuring the social well-being and protecting the public interest. Especially in the presentation of preventive and curative health services, it is seen those information systems to provide greater convenience to patients and physicians through an electronic database. The role and importance of information systems in the health sector have increased in an intra-institutional correspondence, the supply of materials, and in-house and interinstitutional information transfers to health care staff. Information systems clearly show the results of institutional performance of healthcare institutions in the sector as well as disease statistics. It is possible to make various determinations of the data provided by the information systems about the success rate of the institutional service delivery. Hospital management information systems provide an institutional framework consisting of different information about the medical, financial and managerial functions of a particular hospital. The first applications of these systems are limited to, the recording of patient information and the billing of health services offered. Today, new modules have been added to patient management information systems such as appointment over the internet, follow-up patients, and request analysis and display results. Thus, it has become possible for doctors to transmit their requests directly to the laboratories via automation systems and to monitor the results online. In this respect, the main problem of the study is to define the role of hospital management information systems within the functional context. The purpose of the study is to evaluate the development in Turkey qualitatively by setting out the importance and advantages of the hospital management information systems in the health sector. In the first part of the study, the development and types of hospital management information systems are discussed. It is revealed how the system has followed a developmental line from the 1960s to the present day. In addition, sub-systems covered by hospital management information systems are addressed. In the second part, the purpose of hospital management information systems in health institutions is explained. The benefits provided by the management information systems in the health sector are explained. The last part of the study examines the studies on the use and development of hospital management information systems in Turkey. It is depicted how the Health Information Systems Project, initiated by the Ministry of Health initiatives in the 1990s, has been developed with the works of 2000 and later. The basic components of hospital management information systems used in Turkey are also mentioned. 2. Development and Types of Hospital Information Management Systems Information systems include all the expert workforce, computer networks, system models and system information required to perform various functions such as collection, processing, storage, access and distribution of information. It is possible to see information systems as systems that aim to provide accurate, up-to-date information where and when they are needed (Bengshir, 1996: 14). The performance of information management systems is closely linked to the current 38

Demirel, D. (2017). Hospital Management Information Systems in Health Sector and Development in Turkey

features of the software, hardware, and data. Data collected, stored and analyzed in information management systems are evaluated according to criteria such as certainty, up-to-datedness, reliability, and being unnecessary. As much as possible in the planning of information systems in public administration, the requirements of vertical and horizontal hierarchical levels in the public organizations should be estimated. Information management systems in the public sector are used to monitor the environment and to take into account the interaction of external factors with each other and with public authorities (Bozeman and Bretschneider, 1986: 481-483). The Hospital Information Management System is a system that hospitals collect and process all necessary information is processed and collected through computers about health care services and management. This information can be transferred between the units via the automation system in the electronic environment. It plays integrating role different information that emerges in terms of medical, financial and management functions of the hospital (Akkoç, 2009: 33). The hospital information management system is an institutional resource planning system that has been privatized and increased in quality according to the needs of the health sector (Özoğul, Karsak, Tolga, 2009: 2093). Hospital information management systems keep a lot of data because hospitals have so many functions. In this type of system, there is a wide variety of information available from the workforce used by the patient to what the staff can make or do in order to follow the functioning of the hospital and facilitate administrative tasks (Saka, 2003: 64-67). The system provides feedbacks on patient care processes for hospitals. It reminds us of the necessary tasks to perform and allows us to develop a diagnosis and treatment protocol that can be applied to a special patient (Yılmaz and Aloğlu, 2002: 335). First-generation hospital information management systems were first developed in the 1960s and ended in the 1970s. In 1972, the first hospital information management system was used the El Camino Hospital in California. This system only provided request inputs and result reporting services. It did not provide emergency and outpatient services. In this process, computers have changed from single-tasking hosts to multi- tasking, user-friendly computers. Besides, along with other factors such as economic developments and increased data manipulation have led to the development of hospital information management systems. Information management systems developed during this period include some patient care topics and basically the automation of patient medical records. The second generation hospital management information systems emerged in the mid1970s and ended in the late 1970s. In this period, hospitals are focused on the use of financial systems and financial problems. The main purpose of the system is to transfer information from the end user to financial systems. During this period, interest in patient care has increased. By bringing together information from different clinics, integrated patient care information files have been transferred to computers (Ball, 2003: 89; Dağlı, 2011: 9-10). Third generation hospital information management systems began in the late 1970s. This phase was under the influence of the introduced database technology at the beginning of the 1980's and focused on problems such as patient care planning, laboratory, and pharmacy issues. Fourth generation practices began at Journal of Current Researches on Health Sector, 2017, 7 (1), 37-50.

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the beginning of the 1980s. An important feature of this period is that it integrates with third party systems, including financial and other departmental systems. Providing all the needs of a single firm is the basic feature of this phase. Hospitals have adopted the best practice or a software procurement strategy available in the market for private clinics. In 1990, investments in hospital information management systems projects increased, along with the cheapness of computers. Information systems have been used more extensively as the proportion of computer ownership of health care providers has increased. In 1991, the Institute of Medicine published the report "Computer-Based Patient Records: Essential Technologies in Health Care". This report concerns the problems caused by paperbased records and encouraged the use of electronic patient records. In addition, the report pointed out the importance of the doctors in the system and stated that the focal point of the system should be patient (Dağlı, 2011: 9-10; Ball, 2003: 8389). After the 2000s, patient safety, reduction of medical errors and an increase in health care quality became the priority in the system. Broadband internet access, smaller and more portable devices, wireless technologies and radio-frequency identification tools have been used as important technological tools in the healthcare industry (Dağlı, 2011: 10). Today, electronic health record systems are among the most basic applications of the health sector. A patient index is registered at the base of the hospital management information system. All transactions are done using this index. The patient index consists of the patient's name and surname, date of birth, gender, address, second name, marital status, mother and father's name, allergic reaction information and name and phone information for emergency situations (Murphy, 1996: 586). Once the patient enters the system with patient acceptance, he is transferred to the relevant compartment and comes out of the system as a discharge after the treatment period. These systems process different patient information in hospital management. It conducts out-of-hospital communication on issues such as procurement and finance. It functions as medical departments and services in patient care (Reichertz, 2006: 286-289). Hospital information management systems can be classified as integrated and modular systems. All information system functions are carried out together with the integrated information systems. Integrated information systems are divided into hospital general information system, clinical information systems, management information system, and a database management system. The hospital general information system sets up online information systems for the entire hospital. The clinical information systems allow medical interpretation and processing of medical data in the context of diagnosis and treatment. The management information system is the processing and storage of the data needed to help management units on decision making, planning, and auditing functions. The database management system carries out storage of a large number of related data in a general format. The modular systems, on the other hand, involve different operating and application forms within and among other units. This type of structure reduces the initial investment cost by piecemeal institution's procedures (Davis, 1994).

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Hospital management information systems are seen to include resource usage and programming, financial management, material and facility management and personnel management systems in some reference sources. Effective resource allocation is achieved through resource usage and programming system and the system offers convenience to the patients. This system is very useful when hospital admission and operation day are determined. Thanks to the system, more economical use of staff and services, patient transfer between services and staff support are provided (Harwood, 2003: 24). The objectives of a financial management program are listed as follows (Dieter, 1987: 71-72): 

To carry out daily accounting transactions

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To provide the necessary numerical data in order to minimize the expenses in the investment decisions

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Developing efficient and functional financial sub-systems

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To provide management information for evaluation and control of transactions

In the material and management system, computers are one of the main means of providing information to management, helping hospitals to manage facilities and materials more efficiently. For example; this includes the procurement, inventory control, food management, food list preparation, facility maintenance, energy management, programming and supervision of projects (Austin and Boxerman, 2013: 12). In addition, there is a need for a good personnel management information system in hospitals in order to benefit from labor force planning and productivity analysis. The functions of the hospital personnel management information system can be summarized as follows (Austin and Boxerman, 2013: 198; Degoulet and Freschi, 1997: 91, Haux et al., 2004: 30-33): 

Keeping and recording the files of hospital staff constantly

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Getting information and correction of information processes from files when necessary, provision of task control

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To draw out the study analysis reports of each cost center of the hospital, to produce reports to analyze personnel problems

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To produce information on cost distribution of labor costs, quality control, and personnel productivity

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Providing enhanced information support on the effects of diseases, drugs, diagnostics and treatments

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Knowing the special talents and document situations of the staff

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Getting information about patient treatment quality, performance, and costs

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Using Purposes and Benefits of Patient Management Information Systems

The purposes of use of hospital management information systems are (Akbolat, 2013: 115; Winter, 2001: 99-109): Journal of Current Researches on Health Sector, 2017, 7 (1), 37-50.

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All information about the patient's CV and the illness is recorded instantly on the computer and can be accessed when requested.

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Loss of time is avoided for the establishment of a modern archiving system. The diagnosis of the disease is fast and reliable.

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All hospital management information is followed by the computer system and this information is easily accessible.

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Increase in incomes through billing and official document preparation processes are performed in a reliable manner

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All trading and material distribution operations in hospitals are carried out through computers.

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Medical research is supported and high-quality communication is provided by exchanging information between different hospitals.

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Protective and curative health services can be managed.

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Establish an effective financial transaction sub-system.

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Time is saved. The output of labor and medical devices is at the highest level.

The main benefits of hospital information management systems are as follows (Özyurt, 2009, www.saglikbilisimdernegi.org; Hatcher, 1998: 124-127; Özoğul, Karsak, Tolga, 2009: 2093):

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Reducing the red tape by arranging all forms used in the hospital through the system.

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Statistical results can be obtained according to different criteria.

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Unnecessary usage and leakage are prevented by input, output, control and follow-up of all kinds of materials in the hospital.

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During operation, the relevant images are saved and the reporting system is recorded in the digital environment.

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All information is stored in an electronic environment via digital archiving.

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The personnel's performances are constantly followed by recording the movements of hospital staff.

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The acceleration of the health services presentation ensures continuity of patient treatment and patient satisfaction.

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Support is provided for personnel management, logistics operations, and case costs. Better strategic decisions are made by increasing the efficiency of the supply chain of the health care organization.


3. Use of Hospital Management Information Systems in Turkey Initiatives to establish hospital management information systems in Turkey began in 1990 with the passing of the Ministry of Health and the World Bank's Health Information Systems Project. The development of the health information system is in the main objectives of the 1st Health Project launched in 1991, the development of the management information systems and the primary health care information systems are the main objectives of the 2nd Health Project covering the years 19952001 (Özsarı, 1998: 15). In this way, the Health Information Systems Project started in 1992 with the planning phase. At this stage, problems related to the quality and information validity of the hospitals were evaluated. Since 1995, hospitals' interest in hospital management information systems has increased and hospitals have begun to take advantage of information systems more. In 1996, the data processing department of the under-secretariat of the Ministry of Health was established. In the same year, Hospital Information Systems Technical Specification Evaluation Commission was established under the data processing department. However, no standardization has been achieved in practice. For this purpose, the Ministry of Health prepared a report entitled "Purchasing Principles of Hospital Information Systems" and distributed it to all hospitals. In 1999, the Ministry of Health tried to create application software within the data processing department and selected Ankara Education and Research Hospital as a pilot hospital. However, at the end of 2003, this project was stopped. It has been decided that the hospitals should obtain their information management system needs from private sector companies with their own sources of revolving funds. In the same year, "Turkey Health Information System Action Plan" was created by Turkey Health Information System Action Plan Working Group. In 2004, the ministry completed work on basic care services in the field of health care. In 2005, SSK, BAĞ-KUR and the pension fund and the contracted hospitals were merged under the roof of the Social Security Institution and this institution checked the payment process of the patients registered via Medula (General Health Insurance) system. In addition, the Social Security Institution requires that each hospital information system is integrated with Medula over the Internet. In 2005, the rate of having hospitals' information systems reached 90%, and 100% in 2006 (T.C. Sağlık Bakanlığı, www.sagliknet.saglik.gov.tr/giris.htm, 02.05.2017). In 2007, the Ministry updated the Principles on the Purchase of Hospital Information Systems and put the Health-Net project into effect. The data obtained from the hospital information systems are shared with the Health-Net platform over the internet. The health information about the patients is also stored in Health-Net (Dağlı, 2011: 9-14). In addition, the Ministry of Health established health data warehouses starting from 2014 and planned to use the information applications on the Health Special Network (SB.Net). In 2015, the ministry has passed web-based architecture in hospital information management systems and family medical information systems. The basic components of Hospital Management Information Systems used in Turkey are (Reyhanoğlu, 1998: 416-419):

Journal of Current Researches on Health Sector, 2017, 7 (1), 37-50.

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Patient Registration-Acceptance: The personal information about the patient applying to the hospital is recorded in the related polyclinic. The patient's provision is taken.

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Patient Inpatient-Discharge Procedures: Patient admission procedures are followed by expendable supplies of patients in the hospital and drug use. After the diagnosis and treatment of the patient, discharge operations are carried out.

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Patient Follow-up: It keeps records of procedures performed on the patient's examination, given medications, applied examination, and treatment.

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Referral of the Patient: If the patient cannot be treated in the hospital where the patient is referred to, the patient is transferred to another hospital.

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Central Hospitalization: It gives a hospital admission appointment to the patients to be admitted to the hospital.

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Emergency Service: It makes a patient record to the hospital emergency department. It forms the consultation records of the patient. It records the treatment applied to the patient.

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Human Resources: It is the systems where the information about the personnel can be followed and made accrual processing. It consists of four modules in the form of record, leaves, staff movements, and promotionsaccrual. In the system, permissions for users on the screen and transaction basis are defined. Thus, users can only perform the operations they are authorized to do with the system.

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Voluntary Work: It keeps records of examinations and surgeries done by doctors, working days of staff, gross wages earned.

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Health Board: It keeps a record of the permission and medication reports given to the patient and transfers this information to the e-health system.

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General accounting: It maintains general accounting and fixed asset system records in accordance with the SSK curriculum.

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Purchasing/Material: It defines the necessary materials for the hospital and codes them. It provides storage of materials in warehouses and shelves. It keeps track of the entrance and exit movements by following the hospital stock status of the material.

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Appointment System via Phone: It enables the appointment process to be carried out 365 days/24 hours without an operator. It reports, patient flow information such as the daily number of patients calling, the number of appointments, and the number of patients examined each day.

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Laboratory: It manages the auto-analyzer devices used in hospital laboratories. It coordinates the desired tests to be performed for the patients in the appropriate hospital and auto-analysis device. After Demirel, D. (2017). Hospital Management Information Systems in Health Sector and Development in Turkey

receiving the results from the system and confirming to the laboratory supervisor, the report is presented to the patient. 

Pharmacy: It keeps stocks of drugs and expendable supplies and provides the necessary statistics. It performs the material orders, invoices, and discharge of hospitalized patients. It follows the prescribed process of the outpatient clinic.

A study conducted by the Ministry of Health has identified some standards related to hospital management information systems used by health institutions in Turkey. These are listed as follows (T.C. Sağlık Bakanlığı, 2005: 13): 

Unique Descriptive Standards: These relate to the patient, the health care facility and the equipment and other materials used in the health institutions. It includes patients or healthy persons, all types of health care providers, related organizations, used devices and inventory, consumables, drugs, blood and blood products.

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Model, Content and Building Standards for Electronic Patient Records: They are the standards that deal with the modelling, contents, and structure of public hospitals. It is necessary to follow a regular chain of rules so that hospital information systems can continue to operate in a coordinated and successful manner. These standards are one of the most important rings of the regular rules chain.

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Message/Data Communication Standards: It includes storing and reliable storage of data between the administrative and financial units (diagnosis and treatment data, blood transfusion, e- prescribing, electronic provision and billing, laboratory, imaging data) and communication with those who request data.

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Standards related to the Display of Clinical Data: It includes disease diagnosis, health care services, dentistry, and grouping of patients according to their diagnosis, all surgical procedures, medical wastes, pharmacology, medical consumables, and medicines.

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Privacy/Personality and Safety Standards: It covers standards related to patient confidentiality and patient safety. Personal data belonging to all patients who apply to the hospital are recorded and stored according to the privacy principle. This personal data is made ready for use when necessary.

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Standards related to Health Information Management and Quality Indicators: It covers all communication tools in health services as well as quality standards and indicators of statistical data in laboratories. Reporting of these data and getting ready for use are included in a certain program. These standards are appropriately presented for the use of health institutions and organizations.

4. Conclusion Information systems are one of the structural changes that public institutions have adopted in recent times. One of the basic requirements of the information society is transparent and fast public administration. It is thought that such an Journal of Current Researches on Health Sector, 2017, 7 (1), 37-50.

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administrative structure will be effective in service provision. Healthcare is one of the areas where the public sector allocates the most resources. First of all the states must ensure the health of the family and society in general, taking into account the public interest. For this, it is important to harmonize preventive and therapeutic health practices to current developments in information and communication technologies in order to ensure the productivity of the healthcare industry. Hospital information management systems are systems that collect data from different sources, taking on functions of gathering information in hospitals and transmitting information to administrative units. Such a system consists of software, hardware, and the necessary communication infrastructure and is established both on paper and computer. It permits the efficient exchange of data with doctors and other hospital personnel with colleagues in and out of their own institutions. Hospital information management systems have made progress since the 1960s. These systems, which focused on reducing costs in the 1970s, aimed at bringing together various elements in a holistic way in the 1980s. According to this; all detailed information about patients is kept in a system. In this way, physicians can make accurate diagnoses by reaching the information about the patients instantly. This situation offers an advantage in terms of cost and time by avoiding unnecessary medical tests to be applied to the patient. The use of electronic patient records became widespread in the 1990s. After the 2000s, it was aimed to increase the quality of patient care in the health sector through technological applications. Hospital Management Information Systems are classified as integrated and modular. Another classification incorporates staff management systems into hospital information systems with resource utilization and programming, financial management, materials and facility management. Hospital management information systems have greatly reduced red tape practices in public hospitals today. It avoided unnecessary use of resources. The storage of all information in the electronic archive environment has improved the quality of the health care service and increased patient satisfaction. Hospital management information systems in Turkey have developed since the 1990s. In 1996, with the establishment of the Data Processing Department affiliated to the undersecretariat of the Ministry of Health, the studies in this area gained momentum. In 1999, the Ministry of Health began work on creating application software. However, at the end of 2003, this project was ceased and applications based on free competition and market orientation became widespread in the health sector. It has been decided that the hospitals should purchase information systems from private sector firms with own budget possibilities. In 2005, the Social Security Institution began to monitor patient records electronically via the Medula (General Health Insurance) system. In 2007, the Health-Net Project of the Ministry of Health was improved and the data obtained from various hospital information systems were shared with the Health-Net platform. Today, hospital management information systems are used in institutional processes such as patient registration, patient follow-up, hospitalization, patient referral and discharge operations, health board reports, human resources, voluntary work, buying and 46


material procurement, general accounting records. Laboratory analysis results can be entered into information systems. Thanks to these systems, citizens can receive hospital appointments by phone or over the internet. Hospital management information systems have a history of about 30 years in Turkey. The Ministry of Health establishes standards for the use of hospital management information systems in accordance with the developments in the world and it has become compulsory for health institutions to participate effectively in the system. Suggestions for a successful hospital management information system are: Hospital information management systems should be able to meet the needs of patients, healthcare staff, managers and system designers. Stakeholders involved in the health care system should be able to access 24 hours a day, regardless of occupational and geographical boundaries. The system administrators should clearly define administrative objectives. The records of primary and secondary health care services should be standardized. Processes related to the supply and use of information technology should be simplified. The requirements for information systems should be determined at the institutional level. Hospital management information systems should be coordinated and controlled by the Ministry of Health at the national level. Political interventions should be avoided in the process of institutional decision making. Health care users should be encouraged to participate and contribute to the information management system. The health personnel should also assume an active role in the planning process and inform to the hospital management of any deficiencies that may arise as a result of the system being used. References Akkoç, Latif (2009). Hastane Bilgi Yönetim Sisteminin Isparta'da Bulunan Sağlık Kuruluşları Üzerindeki Etkililiğinin Araştırılması. Yayınlanmamış Yüksek Lisans Tezi, Isparta: Süleyman Demirel Üniversitesi Sosyal Bilimler Enstitüsü. Akbolat, Mahmut (2013). "Hastane Bilgi Sistemleri", Sağlık Kurumlarında Bilgi Sistemleri. edt. Ali Yılmaz. Eskişehir: Anadolu Üniversitesi Yayını, 108-136. Austin, Charles, Boxerman, Stuart (2013). Information Systems for Healthcare Management, Eighth Edition. Chicago. Illinois. USA: Health Administration Press. Ball, J. Marion (2003). "Hospital Information Systems: Perspectives on Problems and Prospects". International Journal of Medical Informatics. 69: 83-89. Bengshir, Türksel Kaya (1996). Bilgi Teknolojileri ve Örgütsel Değişim. Ankara: TODAİE Yayınları. Bozeman, Barry and Stuart Brestschneider (1986). "Public Management Information Systems: Theory and Prescription". Public Administration Review 46: 475-487.


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