Conclusiones y discusión

Hospital A has a hospital management information system (HMIS). The HMIS was completed and became operational in 1992 through a United Nations Development Programme (UNDP) grant. At that time, the HMIS was the largest and most comprehensive medically oriented system in Egypt. The HMIS is composed of hardware, network, and software; the hardware system consists of roughly 120 PCs. HMIS is composed of several administrative, clinical, and financial applications (El Hattab, 2001). The software has been translated in part into the Arabic language to fit the needs of the hospital. The development and Arabization of HIMS were done by an in-house development team.

Hospital A owns a set of HIS to manage patient information and hospital activities. However, the system was not easy to use and the process was complex for the medical staff to manage the patient information, which consequently affected the HIS adoption in hospital environment as observed by the researcher (Appendix D shows the snapshots of the systems used). These systems are based on decentralized database (El Hattab, 2001).

The HMIS has the following modules (El Hattab, 2001): (1) patient registration, admission, discharge, and transfer system, (2) scheduling system for outpatients and services, (3) surgery module, which is an operating room management system that also handles anaesthesia and non-operating room procedures, (4) laboratory system that covers chemistry, haematology, blood banking, anatomic pathology, and cytology, (5) radiology system that covers conventional ultrasonography and CT scans, as well as nuclear medicine, (6) outpatient and inpatient pharmacy systems, (7) patient billing system, (8) imaging system (picture archiving and communication system or PACS) that covers images, slides, and films in the different departments of the hospital,

including radiology, radiotherapy, pathology, and endoscopy (Peer, Vogl, Peer, & Jaschke, 1999), (9) nursing system, (10) equipment and preventive maintenance system, and (11) other financial and administrative systems, such as payroll, personnel, general ledger, fixed assets, and inventory.

Furthermore, the HMIS was implemented to achieve the following objectives:

1) To improve patient care,

2) To support and improve hospital management, and 3) To support research.

Members of the medical staff, such as physicians, work on the HIS to manage patient information and allow tasks to be accomplished more quickly. However, the use of such system is ignored by numerous physicians and nurses because of the time factor, large number of patients, and poor management of patient information. Appendix E shows some pictures of the situation in the selected hospital.

Currently, the HIMS is used only by the department of the biostatistics and cancer epidemiology (BiOSCED) to collect patient medical records. Some patient information entered by associate employees in this department is incomplete based on data coming from different departments and in different formats. Each department in the hospital has its own type of medical report. The recording of this data is a complex process. Other patient information is recorded in the manual system and saved in the statistics department to manage the patient information. This aspect causes difficulty in managing the data and in utilizing the data for secondary purposes such as research. Figures 4.7 and 4.8 show the sample of the patient file. BiOSCED is responsible for the provision of data for research after the researcher obtained the permission of the hospital manager to conduct research. The BiOSCED provided the required data to the researcher as a hard copy. This procedure is for data protection. The researcher waited in BiOSCED, spent a

long time to read the data, and worked independently. Using the data from the hard copy directly in the research activities by researchers affected data privacy. No system was available to manage the research activities, such as data sharing, which leads to poor collaboration in the research environment among the medical staff. Moreover, using the manual system to manage the healthcare information is difficult, as mentioned by the World Health Organization (2006) (Organization, 2006). Consequently, the medical staff experienced more complications because different systems were used to manage patient information. These systems are based on a decentralized database (does not imply sharing by communication network) and affect the perceived usefulness and intention of the system. The lack of HIS in Hospital A also resulted in poor collaboration among medical staff in such an environment.

Figure 4.7: Biostatistics and Cancer Epidemiology Department: Data Store

Aside from HIS, other manual systems are used to manage various forms of information related to Hospital A, such as pharmacy, payment, and medical staff systems. The observations and interviews with physicians revealed that the physician writes a prescription and the patient bring the prescription to the pharmacy. A pharmacist occasionally retains these pieces of paper or records the information in the pharmacy system without indicating for whom the medicine was prescribed. To pay for the healthcare services, the patient has to go to the accounting department. The payment is also recorded using the manual system.

In sum, almost the entire healthcare system in Hospital A is based on the manual system. This system is used to manage and control patient information, medical staff information, and other activities related to the hospital. The HIS is no longer used by other hospital units. Only BiOSCED used HIS to collect the medical records of patients from all hospital departments. This data is used in statistics issues and only general information is shared. Other data is kept as a hard copy and these copies can be accessed by the researcher using the manual process. HIS is used to manage and control patient information efficiently and safely. However, a number of physicians discontinued its use because it insufficiently managed patient information. The healthcare data analysis and information flow based on the manual system in any hospital are extremely difficult to manage. The manual system causes harm because physicians have inadequate information to make decisions. The lack of computerized systems in the hospital environment also causes poor collaboration among medical staff in such an environment. Moreover, data for the research is unclear and inaccurate, which could affect the healthcare research findings. No available system manages the research activities among researchers, and the direct use of the data by researchers violates privacy laws, as mentioned in Chapter 2.