The e-HIS Effect
Gurgaon-based Artemis Health Institute is one of those rare
greenfield projects in India, which already had IT in its mind before going
operational. Sonal Vij tells you why it was a wise decision to integrate
IT right from the start
are the days of hand-scrawled notes, scribbled prescrip-tions, big diagnostic
charts, patient queues, and lost patient charts. Today, all this information
and critical details are no more than a keyboard click away and one of the finest
examples to display IT efficiency is Gurgaon-based Artemis Health Institute
Realising how IT is fast bringing a makeover of the healthcare industry and
changing the face of traditional doctor-patient relationship, the management
at AHI has always made sure to keep the hospital as paperless as possible. Knowing
that IT is the key to gain optimum operational efficiency, Artemis has implemented
Hospital Information System (HIS) since its inception in July, 2007.
Commander Jose Verghese, COO, AHI, shares, "The new
player always has an advantage of learning from mistakes of the previous players."
Instead of first building a process and then implementing a HIS system, the
hospital built in all the processes with the HIS.
The hospital makes use of eHIS 5.0 version which is provided by IBA Health,
a leading health IT solutions company with a strong international footprint.
The hospital has customised this HIS to suit its needs and make the usage as
simple as possible for the doctors and the medical staff. Emphasis is laid to
use the HIS system for all functions in the hospital.
"Artemis has a one-stop data warehouse of records of patients and treatment
histories that can be consulted by authorised experts, keeping patient confidentiality
uppermost in mind. AHI has integrated almost everything in the hospital, right
from the front office registration to doctor consultation, investigations, the
complete in patient treatment, more so even the laundry is no stranger to it,"
says Commander Verghese. Among the many modules implemented, the main ones are
IP, OP, ER, PCS, clinical information, blood bank, OT, diet, laundry, pharmacy
new player always has an advantage of learning from mistakes of the previous
- Commander Jose Verghese
Artemis Health Institute
of PACS and SAP ensure medical records & financial transactions are
available on real-time basis"
- Vinod Kalra
Every patient is allocated a unique lifetime registration
number free-of-cost along with a registration card. This unique identification
number provides the complete details of the patient's medical history as recorded
in eHIS at any point of time during subsequent visits. Some excellent IT inputs/
facilities comprise the twin display facility at the main registration desk,
wherein when the patient details are being fed into the system, the patient/
relative can see it and correct the details if necessary.
"At every touch point of the patient on his entire movement
from desk-to-desk, the vitals of patients are entered/ checked beforehand and
logged into the HIS. This allows the subsequent touch point to understand the
previous observations/ views/ recommendations to take an appropriate action
when the patient comes to that touch point/desk," explains Manu Deep, IT
Executive. For instance, the vitals entered by the nursing staff at the OPD
station are available to the doctor on his eHIS screen and hence the doctor
can immediately diagnose the patient and move on to the next patient.
This process utilises the waiting time of the patients and
allows doctors to concentrate more on diagnosis. Attendants, nurses and doctors,
also help the HIS monitor each movement of the patient, by continuously feeding
in the required details as well as logging the time of admittance, consultation
and the whole gamut which helps provides intelligence on factors such as average
wait time, consultation time and so on. The HIS is equipped to allow doctors
to access results of all tests, images from radiology and so on of their patients.
The billing is not directly a part of the clinical processes. When a doctor
suggests some tests for the patient, the patient goes and pays at the registration
counter. When he/she pays, their details are fed into the HIS. When they go
to the diagnostic area, their names automatically appear if the test is already
paid for. The diagnostic services will be provided against the account. In case
the patient hasn't paid, the name will not appear.
The hospital has made every effort to ensure automation."The USP of the
HIS implementation is its integration with PACS and SAP seamlessly to ensure
that the entire patient medical records and financial transactions are available
online on real-time basis," says Vinod Kalra, Project Manager, SAP.
The complete hospital workflow, right from patient registration to discharge,
including consultation, prescription, investigations, doctor and nursing notes,
billing, inventory management, etc, is automated.
Patient safety in terms of correct medication, correct dose, allergies to various
drugs, etc is taken care of by HIS. AHI has added cathlab, endoscopy, gamma-camera,
PET-CT, and all radiology modalities in PACS making the images available
online in digital format. Also, complete patient monitoring system is available
online from any corner of the hospital for the doctors to have a look at patient's
"Implementation of HIS along with integration of PACS is to create a paperless
environment in which medical and nursing staff can work online in a more cost-effective
and accurate manner. The aim of this implementation is to enhance patient safety
with generation of instant alerts and reducing medication errors," says
Verghese. This system has eliminated the need for large medical record charts
as everything has been posted online with due care for data security. However,
it is practically impossible to think of a completely 'paperless' hospital in
Reasons Verghese, "You cannot go totally paperless due to some legal constraints.
Digital signatures are not yet legalised in India. So, if we are taking consent
from the patient for any procedure, it has to be on hard copy and it has to
be stored alongside the medical record. All other patient records are available
Doctors as well as other medical staff can easily follow-up a patient's medical
history. The doctors can access the results of all tests, images from radiology
and other patient details using their ID. Images of radiology, endoscopy, and
echocardiography can also be accessed by doctors anytime within few clicks.
At any point in time, real-time data is available from the ICU, bedside monitors
in the hospital.
The head surgeon can also view a real-time video of a surgical procedure being
performed by his team from his personal chamber. "The HIS server uses 760
mb per day and the PACS server about four GB daily. The facility also has three
terabytes of storage area network," informs Deep.
Each ICU bed has a bedside laptop. The nurses and doctor's access and update
patient vitals and details on the HIS. When the doctors go for patient visits,
the doctor directly enters the details into the HIS.
One of the unique technologies is pneumatic chutes in the hospital connecting
the wards to the laboratory and pharmacy. "The test samples are collected
and bar-coded from the patient bedside and sent via the chute to the lab where
the tests are done. The pharmacy too sends medication required for patients
to the wards via the pneumatic chute, thus reducing the need for movement and
saving on time," explains Deep.
Apart from HIS and PACS implementation, AHI has implemented SAP for its material
and finance management operations to track the vendor and customer financial
transactions. SAP is also being used to manage the inventory of the medical
and non-medical items to ensure that the right medicine is available at the
right time. This is being achieved by implementation of Material Requirement
Plan (MRP) that runs within SAP.
The initial stages were difficult. The hospital had a team of eight people from
iSOFT who were at the hospital for four months including technical persons
developing the interface, a team from Philips, who were the primary suppliers
for modalities, a team of biomedical engineers, and various departmental users.
While interfacing there were problems though, not major ones.
The biggest challenge to any HIS system is resistance from the user. "However,
the Artemis management was very clear with its vision to use EMR. Its message
was very clear to all the doctors, the nurses, the technicians, front office,
inventory and store employees," says Verghese. Dealing with doctors and
nurses was a challenge. "There were nurses who had never touched a computer
in their life and we had to plan their training accordingly," says Deep.
Even the doctors were initially reluctant, but now they enter the data themselves.
"Initially when we started implementing, we did not have data, being a
greenfield project. Each department was asked to collect and feed their own
data into the system. This was done in a specific format provided by iSOFT.
After the data was collected, it needed to be validated, checked and then entered.
Laboratory and radiology departments entered all the data, so it worked well,"
says Deep. Other modules' data was entered by data entry operators, which took
quite some time to correct.
The biggest challenge for any hospital using HIS is to impart training to the
end-users. There were differences in opinion of the users. However, today nearly
all the doctors are happily using the HIS with complete EMR available online
at the click of a button.
Having already automised to such a large extent, AHI is planning to implement
the portals for making online registrations, lab/investigation reservations,
payment gateway and online information availability to the patients about his/
her complete health history in the hospital. "This is a priority for us
and will be done by end of this year," assures Verghese.
Another plan is to integrate the TPAs online (as soon as TPAs are ready) with
the HIS system so that the insurance approvals happen at minimum possible time
and thereby minimise patient woes of waiting for the approvals before final
The IT budget for the hospital project was Rs 6.5 crore, which was effectively
used in equipping the hospital with TFT monitors and small desktop machines.
Thus, there is no bulky equipment anywhere.
The hospital is truly reaping the benefits of the good IT system and making
it reach the end user!