The HIMS is an integrated service of electronic applications needed for any kind of healthcare function. In particular, seven information based innovations in health-care are considered to offer large potential benefits to providers and patients.
These are: electronic communication between patients and providers, electronic prescribing, electronic records with computerized physician order entry, medical data sharing, laboratory management systems, picture archiving and communica-tion systems, and disease management systems (First Consulting Group, 2003).
IT investment in healthcare is regarded as the driving force behind the reduc-tion of continuously soaring costs and the enhancement of service quality, par-ticularly in developing countries (Dey et al., 2007: 48). By better understanding the key IT issues, managers of healthcare institutions can make better decisions about healthcare IT investments and adopt effective technologies for their or-ganizations. Information and communication technologies have the potential to reduce these barriers by eliminating physical distances, enabling the sharing of limited health resources, and making healthcare affordable and widely available to much of the deprived population (Turan & Palvia, 2014: 58).
The healthcare industry is an information-intensive industry with consider-able information requirements. Hospitals have considered various information technologies as possible solutions to provide timely and accurate information in fulfilling managerial needs and improving operational effectiveness and efficiency (Chen & Hsiao, 2012: 811). IT is used to support a wide range of highly specified healthcare tasks and services. But, before implementing IT/IS, hospitals must use a comprehensive assessment method to examine the effectiveness of implementing IT/IS in order to ensure that they make the most efficient investment with their limited resources (Lin et al., 2005: 235). Because, implementing IT in the health sector is very expensive, and each IT investment has potential risks.
A comprehensive HIMS should have the ability to integrate and streamline the healthcare delivery process, improve the quality of care, increase efficiency and reduce the cost of healthcare delivery, and support research (Hillestad et al., 2005: 1105; Jha et al., 2010: 1953). Moreover, these systems have various benefits including decreased wait times for patients, reduced error in prescriptions, a re-duction in the ordering of unnecessary lab tests, better monitoring of chronic illnesses, more flexible monitoring of intensive care unit patients, reduced hospi-talizations resulting from improved disease management, and improved billing
116
(Shekelle et al., 2006). HIMSs enable more immediate and convenient clinician access to patient and medical information, which can reduce the amount of time that is required searching for or collecting medical data. The use of electronic medical records (EMR) reduces duplicate treatments and resources needed for medical transcription and increases the time available for collecting patient his-tory information.
All over the world, healthcare systems are threatened by continuously soaring costs and demand, inconsistent and low-quality care, and poorly coordinated healthcare services (Lluch, 2011: 850). In this respect, IT is regarded as a savior by healthcare providers promising to reduce costs and enhance service quality (Turan & Palvia, 2014: 57). The most frequently used information systems are integrated HIMSs in healthcare institutions. An integrated HIMS can have many different modules but the basic modules are listed in Table 1.
Table 1: List of modules in an integrated Hospital Information Management System
Key Modules in HIMS
Patient Administration User Management and Authorization Module Human Resources Module Preventive Maintenance Module
Pharmacy Module Nursing Module
Blood Bank Module Housekeeping Module
LIS, RIS, HIS Modules Quality Management and Monitoring Module Radiology and Imaging (PACS) File Archiving and Management Module Dieting Module Medical Devices Calibration Module Statistics Module Patient Complaints Module Circulating Capital Distribution Blood Bank Module Performance Module Infection Control Module Financials Module (Billing, purchasing,
insurance processing, materials management, accounting and payroll)
Support Modules (Monitoring, Digital Security, Third party labs device integration, barcode and pharmacy device integration and compatibility) Source: (Ileri, 2016: 5)
Healthcare funding restrictions necessitate healthcare institutions to find more effective ways to utilize resources. Although introducing HIMSs decrease costs and increase efficiency in hospitals, implementing it requires substantial finan-cial funds. Managers face technical barriers to ensure the ease of use of HIS, a user-friendly interface, a satisfactory system speed, the privacy and security of managerial and medical data, interoperability, integration, and a flexible system design. In this respect, we can identify four fundamental categories of barriers of
Ayhan Uludağ & Yusuf Yalçin İleri
Digital Health 117
implementing HIMS. These categories are: organizational barriers, human bar-riers, technical barbar-riers, and financial barriers.
If healthcare professionals believe in the usefulness of hospital information systems, they will try to learn and integrate the system into their daily work.
According to studies (Chau and Hu, 2001; Karsh & Holden, 2007; Venkatesh &
Davis, 2000; Zhang et al., 2010), perceived usefulness is affected by perceived ease of use, compatibility, skills, self-efficacy, prior experience, and training. When us-ers perceive that the system’s usefulness is satisfactorily high, they become more positive toward the system and are more willing to use it. Then, they believe that using such an information system enhances work performance and they adopt a positive attitude toward the system (Holden & Karsh, 2010; Yu et al., 2009).
Surely, top management is responsible for each and every activity (e.g. develop-ment of organizational structure, technological infrastructure, and giving various decisions) at all the levels of the organizations. Besides maintaining a high-quality of care; making good decisions dealing with the pressure of cost control is one of the basic problems of healthcare managers. Preferring one strategy instead of another is a difficult task for healthcare managers to overcome (Aktas et al., 2007: 143). Researchers claim that organizational characteristics intensely affect the success of IT implementation and organizations with higher IT experience have a higher possibility of undertaking complex assessments (Tsao et al., 2004;
Thong, 1999; Galliers & Sutherland, 1991).
For a friendly and understandable HIMS interface design, composing such systems that are less complicated and more convenient for the daily use of stand-ard users is critical (Khalifa, 2013: 340). Meeting this design challenge is the most important factor that will influence future success (Walsh, 2004: 1184–1187).
Because of the ease of access and data transfer, electronic documents raise tremen-dous privacy and security risks. Sensitive personal information of patients, such as contingency diseases, drug abuse, or psychological problems may be accessed from personal health records, so, healthcare organizations should provide security against threats and violations of patient data (Turan & Palvia, 2014: 57). Using electronic systems may lead to information loss or corruption confidentiality of health information. So, access control, data encryption, or managing printing and deletion privileges should be used in hospitals to enforce patient privacy, confi-dentiality, and security of medical and managerial data security. HIMS should satisfy the needs of different departments by performing requirement analysis (Khalifa, 2013: 340) such as program modifications or additions such as add-ing alerts, reminders, patient-safety reports, changes specific to the requestadd-ing department, the rearrangement of the user-interface layout, improving response
118
times, increasing the speed of data searches and exporting, device interfacing, and the application of standard medical codes. Meeting these needs could facilitate clinical and administrative activities specific to the unique workflow and data management of that department (Yoo et al., 2013: 389–395).
The implementation of hospital information systems requires high operation and maintenance costs and the shortage of financial resources to invest in EMRs (Khalifa, 2013: 339) which causes trouble for healthcare institutions. The effec-tive utilization of limited resources is a vital problem for healthcare managers (DeAngelis et al., 2003: 102–113). The cost of changing old paper systems to paper-less electronic systems, insufficient healthcare financing to cover the costs of im-plementing HIS, and the costs of training (Amatayakul, 2010: 104–106) may lead to financial defects in the budgets. In this respect, financial issues should also be considered carefully when implementing large and complex information systems.
Finally, implementing HIMSs bring several advantages for healthcare institu-tions. Major benefits of HIMSs include the following:
– Much easier and faster patient admission discharges and transfer functions.
– Improved billing, contract management, and accounts receivables.
– Detailed information of the consumption of any material and service.
– Better material management and pharmacy system.
– Advanced management reporting and statistics.
– Efficient work lists, processing, and reporting of any services.
– Self-quality control.
– Barcode generation, barcode printing, and reading systems.
– Working with standards like HL7 and DICOM.
– Reorder quantity and minimum and maximum levels for each store.
– Inquiries and quotations for drugs, consumables, assets, and general items.
– Electronic scheduling and online patient registration using mobile devices.
– Electronic comparison of quotations and preferred vendor for each item.
– Electronic purchase request orders creation and approval process.
– Expired stock and quarantine systems.
– Automated drugs and consumable issues and returns to patients.
– Multiple electronic views to see the patient medical record.
– Graphical representation of the lab results and vitals.