INTRODUCTION:

A hospital information system is defined as a subsystem of a hospital, which comprises all information processing actions as well as the associated human or technical actors in their respective information processing role.When introducing systems to maximize communication in a hospital, the managing organization shouldconsider two parts: a human part and a machine or technical part. Successful implementation is dependenton how these two parts of a hospital work together to handle change. Here technology is the enabler and not the driver and further, more emphasis should be put on the people working in these newerinformation system forms. An effective approach to setting up information systems is to explicitly identify the objectives of the system and determine the expected results (Gladwin et al. 2003). This will help to give the implementation a certain direction and clear objectives to follow through. So, whether at an organizational or institutional level (a hospital, a university medical school, a health centre) or at a national level (within the health ministry or across the health system), determining the core objectives in terms of both health service provision and information capabilities are important requirements for introducing ICT successfully. Planning and strategizing is an important way to map out possible directions that the information system will be used for on the short and longer term (Gladwin et al. 2003). Processes in healthcare are important and optimal adaptation of Information Systems (IS) to workflow in health care institutions is required. HMIS improvement should focus upon utilizing information as well as data collection and processing. During planning and strategy always make explicit strategies to support the informational management approach and put support strategies in place. In health care, however, the ‘core business process’ consists of highly knowledge-intensive, professional work, typified by a complexity that defies the predictability and standardization required for simple reengineering. Moreover, the professionals ultimately responsible for this process are powerful actors in theorganization. They cannot be simply told to change their work patterns by senior management.Attempting to impose more controls to weed out surprises is a sure route to disaster; unexpectedproblems should be taken as instances to learn from and adapt to rather than as obstacles toovercome (Berg, 2001).

The successful implementation of ICT and health programmes requires complex balancing of the competing views and concerns of the different stakeholders. Some clinicians will view new technology with suspicion, fearing its challenge to their professional autonomy and status. Patients will often seize on the potential benefits (particularly in making care accessible where care would otherwise not be available) but will also hold legitimate concerns about the security and confidentiality of any electronically held patient data. IT specialists may seek to use cutting edge technology where existing tried and tested technology would be more than adequate to deliver real improvements in patient care. Policy makers may require convincing that the initial investment costs in the new technology will bring the benefits promised. All these differing views and concerns need to be addressed at the outset of any intervention involving ICT.

REVIEW OF LITERATURE:

Information is defined by Davis, et.al, (1985), as data processed into a form that is meaningful to the recipient and is of real perceived value in current or prospective decisions. However, the same piece of data could be perceived, interpreted and information derived used differently by two individuals. Stoner, et.al, (1992), define information as what results from thoughtful analysis, manipulation and presentation of data in a meaningful way. However, Long, (1989), suggests that any mention of information system in today's world implies an automated system. Information system is thus a generic reference to a computer based system that provides data processing capabilities and information for the organization, comprises hardware, software, people, procedures and data.

The sustainability of Health Information System depended on the technical features and physical infrastructures. Any lack of technical approach would lead to instability of the information system. Socio-technical aspects played an all important role in information system. Integration of such aspects into the organizational structures would lead to stability (Kimaro and Nhampossab, 2007). They would also enable easy execution of routine activities. Health services mainly include curative and preventive activities. These activities are hampered by scarce resources. The main aim of HIS is to overcome the scarcity and bring about better care. Further, extra attention should be given to users’ needs, evaluation, and feedback generation and future improvements. Information generation and sharing of knowledge within the sustainability strategy framework would also add to the stability of health systems.

Adoption of electronic health records (EHRs) was progressing slowly. A stratified random sample of medical group practices was used in the study. Group practiceswere defined as three or more physicians practicing together with a common billing and medical record system. The main aim of the study was to assess the information technology usage of the medical practitioners. A five point scale had been used to rate the benefits of electronic health records. It was found that electronic health records improved the access to medical record information. Further, they improved the workflow in medical practice and also brought about improved patient care (Gans, Kralewski, Hammons, and Dowd, 2005). The transition from computer-based administrative information systems to fully implemented EHRs has always been more complicated, more difficult, and more expensive. However, EHRs has numerous advantages and it promises to improve practice efficiency, quality, and service. Every action had to be planned, organized, coordinated and controlled in an information management system. Management information system enabled more comprehensive use of information and thereby helped in the decision making process. Information management processes greatly helped in knowledge creation, sharing and use. They also helped to meet the future challenges of effectiveness, increasing needs and demands of patients and decreasing availability of staff resources (Kivinen and Lammintakanen, 2013). There were four sub-categories in the “usage of management information system”. They were system quality, information quality, use and user satisfaction and development. Most of the generated information was used for the human resource management. Automatically generated patient satisfaction and feedback information assisted in evaluating the quality of daily work.

Security and patients’ medical data formed an integral part of the electronic health records management system. Flexibility, modularity and scalability were found to be the important performance factors in electronic health records management systems (Končar and Lončarić, 2003). Unauthorized access of the patients’ medical data from both outside and inside local hospital network should be prevented. Further, demand of legal patients’ ownership of their own medical data should also be taken into consideration in a secured health information management system. IT in health sector could be used for better diagnosis, better training and sharing of knowledge and improving communication about health (Kalpa, 2012).

The scope of public health informatics is immense and it requires the application of knowledge from numerous disciplines, particularly information science, computer science, management, organizational theory, psychology, communications, political science, and law. Policy, standards or guidelines had to be formulated to maintain quality in health information system. Constant flow of funds from the government could result in availability and improvement of current infrastructure, purchasing and installation of latest technology, recruitment of competent staff or train existing health staff. Public-private partnership should be encouraged to expand the utilization of health information technology. Goodhue et al. (1992) have emphatically called for a more nuanced approach to integration. Working out a pragmatically based contingency model, they identify conditions under which they argue that the costs (in terms of loss of flexibility, increase in development costs) may outweigh the benefits of integration. Similarly, and more recently, Singletary (2004) surveys practitioners’ perceptions of downsides to integration including lock-in with vendors, costs and project risks.

RESEARCH METHODOLOGY:

The ESIC case study is based on semi-structured individual and group interviews with patients at ESIC main hospital and related dispensaries in the Tirunelveli sub-region. Follow-up interviews by telephone were conducted with the ESIC patients at reference sites. The sites and interviewees were selected to provide a range of large and smaller sites, more and less enthusiastic patients, more and less urban and more and less affluent areas. In the central ESIC hospital and dispensaries, a number of interviews and discussions with the urban and rural patients, plus interviews with patients in semi-urban areas were held, thus covering most of the Tirunelveli sub-region. Totally 29 patients were interviewed and all the interviews were tape recorded. In this qualitative study, the ESIC patients were selected using convenience sampling. Formal deductive reasoning is used in this qualitative research and this method can represent an important step towards assuring conviction in qualitative research findings. Here the qualitative enquiry takes the form of a case study and this case study is simply an in-depth study of HMIS adoption among ESIC patients. In this qualitative research, deductive process is demonstrated and it is adopted on an informal basis.

RESULTS:

Patients’ Perspective:

Health Management Information System (HMIS) supports the medical professionals in getting higher productivity and better accuracy in their critical tasks. It also allows continuous monitoring of the health status of patients rather than episodic checks during the ambulatory visits. However, the basic integration between different modules of the HMIS in the ESIC hospital is still problematic and incomplete and hence, the hospital tends to keep manual records to avoid diagnostic errors.

Patient 1 says:

“I agree computer usage saves a lot of time; but what about the doctor patient contact time? Here, the physicians spend more time on HMIS than with the patients; efficient use of the HMIS will increase physician productivity but unfortunately, the physicians here spend half their time on data and diagnosis entry; this minimizes direct patient contact and as a patient, that is worrying me a lot”.

Patient 2 opines:

“Apparently the younger doctors are efficiently using the computers and maintain direct eye contact with their patients. Contrastingly, the senior doctors have very good diagnostic skills but they are finding the transition from the old manual method to the new computer software method very difficult.”

Patient 3 states:

“Before we people tend to flock to government hospitals; but now we have the ESIC hospital in Tirunelveli and I can say this is one of the best technologically equipped hospitals in Tamil Nadu and they use the most advanced information systems; the staff over here smartly use the computers and that saves a lot of patient time.”

Patient 4 comments:

“Maintenance and record keeping of patient information is fabulous. As an ESIC card holder, I just need to carry my card and no longer have to carry the patient related files and test results. Everything is computerized and with these things changing from a paper based approach to a more electronic approach, the patients tend to save a lot of time and energy and this is because, the information system used in this hospital is specifically designed to assist in the management and planning of patient services.”

The infrastructure for the ESIC hospital can be observed as being new and technologically advanced compared to other public hospitals in the Tirunelveli sub-region. Nevertheless, there are some concerns over the network component of the infrastructure that is being provided, namely network access server.

When interviewed, patient 5 says:

“This is a new hospital and the hospital does have flexible and extensible infrastructures that enable internal communication and information sharing; sometimes the staff over here experience server problems and during that time, I have to wait a little longer for my admission.”

Patient 6 has her own concerns and comments:

“Instead of checking the patient files and reports, the doctors can find patient information on the computer software itself; this will reduce long queue in the hospital and it will give the doctors more time to attend to more patients. But because of the frequent server problem, the patient information is not properly displayed on the computers and hence the doctors are forced to use the manual patient records.”

Patient 7 feels:

“The doctors here are doing their best but the management should support the medical professionals in getting higher productivity and better accuracy in their critical tasks; all they have to do is find a solution for the server problem and only then, there will be improvement in the doctor-directed care and nurse-directed care.”

Patient 8 is very optimistic and positive and says:

“With the use of the health information system, the doctors can continuously monitor and precisely administer drugs to the patients by checking their electronic patient records; when this protocol is consistently followed, it can totally improve the health care center and give the organization more sustainability.”

Patient 9 says:

“I usually come here for episodic checks and I feel the service over here is fabulous; the use of computers has definitely improved the patient care and experience.”

An Electronic Health Record (EHR) is an official health record for an individual that is shared among multiple facilities and agencies. Digitized health information systems improve the efficiency and quality of care and ultimately reduce costs.

Patient 10 says with a sigh:

“Only in the main ESIC hospital, computers are used and the dispensaries don’t have this facility; they just maintain manual patient records. What I feel is, these manual patient records should be digitized and shared with the main ESIC hospital and only then the patients can benefit a lot from the health information system at any time.”

Patient 11 states:

“Before a patient is being examined, the doctors can single handedly manage patient registration information, scheduling, insurance status, health history, lab test reports and almost everything; the computers are making our lives easier these days and every time when I come here, I save a lot of time and energy. As a patient, this is what I want this I what I get and I’m very happy about it.”

When interviewed, patient 12 expresses negativity:

“I feel the doctors spend a lot of time staring at the computer screens and this makes me uncomfortable; computers pose a significant distraction to the doctors and if proper computer training is not given to them, they are going to make a lot of diagnostic errors.”

Patient 13 feels:

“During the patient’s visit the doctors can type in their present diagnosis, prescribe medication, order for tests and labs and all this happens in a few minutes time and most importantly, there’s no room for any errors.”

Patient 14 opines:

“After the patient’s visit, the doctors can electronically communicate with the labs and pharmacies, communicate with the insurance payers and even give proper directions on what the patient has to do next; the software ensures that there is continuous monitoring and this is indeed very much helpful to the patients.”

Generally the patients of the ESIC hospital feel that there is a need to have a better design and implementation process for the Health Management Information System (HMIS). The current technical performance of the HMIS is said to be rather poor due to the server problem. In order to make the clinicians happier and more content, there is a considerable need to develop a user- friendly environment.

Patient 15 says:

“I feel the doctors over here struggle to use the system; it’s very important when we are designing the system we must think about the flow and how the doctors will use the system. So, the moment it is not user-friendly, the doctors will just refuse to it.”

Patient 16 comments:

“The computer software used over here is good but not the best; sometimes patient information is not properly loaded into the software and this creates a lot of confusion. What I am trying to say here is that the data should be properly structured and loaded and only then the doctors can make good use of it.”

Patient 17 says in a confident voice:

“If a doctor sees me today and he wants to see what his colleagues wrote four weeks ago, he can see it immediately in the computer; if he wants to enter patient data, all he has to do is just open another application, click modify and enter patient information; so it is a wonderful software and I like it very much.”

Patient 18 hints:

“I feel X-Rays should also be able to be opened up through the computer software, because at the moment this feature is not available in the health information system; if they can add this feature to the software, it will turn into a complete super-high-tech software.”

Patient 19 says:

“The data is just there sitting in the computers and the healthcare professionals can’t use it; automation is there but they can’t utilize it and that’s the sad part.this is mainly because of the server problem.”

The ‘electronic health record’ (EHR) is increasingly being used to deliver health information to the point of care. EHRs consist of components that enable health care providers to access a patient’s health information regardless of geographical location. Other components refer patients to various providers and enable providers to access clinical decision support and electronic prescribing, physician order entry, and integrated communication with laboratories, imaging centres, colleagues and patients. Further, health care data in an electronic form improves the safety and quality of care provided and reduces the clinician’s time spent on administrative tasks.

Patient 20 gives a smile and says:

“Earlier I had to carry all the manual reports and test results; now I just have to carry my ESIC card. My own view is that the health information system used in this hospital has definitely made my life easier.”

Patient 21 comments:

“Sometimes I have to wait a little longer for my admission and that irritates me; when I ask them, they simply say they have server problem; over here I see brand new computers but they still face server problem.this does not make any sense.”

Patient 22 says:

“Everything over here is computerized but if you are talking about performance, then definitely they are not at the peak of their performance may be this is because of the obsolescence of the system or hardware; every time I say to them that I have taken the test but they simply say it is not loaded in the computer and that annoys me; obviously it is their mistake and what can I do for that?”

Patient 23 states:

“The doctors are in a hurry and they want to see the patient records immediately but unfortunately the computer hangs; it just hangs on and off quite frequently; it is very slow especially when it hangs; I feel the manual records are far more reliable than this.”

When interviewed, Patient 24 says:

“I feel there has to be a better networking design for the health information system used in this hospital; firstly they should focus on the server problem and only then they can get the desired results; as a patient, I don’t see any standardized protocol and everything over here is utterly disorganized.change can be a good thing indeed.”

Gaining the acceptance of HMIS by physicians, nurses and other health care professionals is often problematic. A primary reason cited is a general lack of trust in HMIS with respect to the critical issue of data quality, since possible errors may cause serious problems to patient health. A further barrier to effective understanding and use is the poor computer literacy of some health care personnel. Also, HMIS can be perceived as a distraction, which impedes the physician’s focus on the patient.

Patient 25 states:

“t’s always nice to venture into something different and I feel this development is going to do a lot of good to us in the future days; in the good old days we had to carry the medical records with us, sometimes we would lose our patient records and at that time, it was very difficult to trace them because the hospital did not have enough time and man power and that would cause a lot of inconvenience to both the patients and doctors but now the whole idea of heath information system is something very interesting and challenging.”

Patient 26 opines:

“Earlier the admission process would take a longer time but now things have changed; it does help in terms of data, waiting for admission, doctors, patient service.actually things are getting better these days.”

Patient 27 says with a tinge of suspicion:

“Most of the time the doctors and the staff over here can’t access the computers and this is because of the server breakdown and during that time they switch to the alternative manual registering method.the system should deliver what it actually promised; when they can’t access it on time, that’s really frustrating and waste of time; the objective is to have a total health information system but it’s not happening over here and that’s a serious problem indeed.”

Patient 28 feels:

“Earlier, with the manual registers the information and data gathering was poor but now things have changed and the electronic records are accurate and accessible at any time; I feel that’s the main aim of the project and that has been achieved but there is always room for improvement.”

Patient 29 says:

“With health information system, retrieval of lost data should be like a breeze, isn’t it? By right, all the patient information is put in the system, isn’t it? The worst part is that they lost all my test results and they can’t retrieve it.According to me, this is the greatest failure of health technology.”

It may be that the health care is missing out on the potential benefits of the health information system through these perceived data quality issues but there is a building body of evidence that suggests capturing and providing health care data in an electronic form improves the safety and quality of care provided. Further, it also reduces the clinician’s time spent on administrative tasks. All this can be achieved through changing the ‘systems of care’ rather than merely computerizing the existing workflow.

DISCUSSION:

End users define HMIS benefits according to their work requirements; they want the system to improve the quality and safety of patient care, so they tend to look at HMIS as a tool that can satisfy their own work demands. In order to achieve any of the identified benefits suggested by the system users, the perceived barriers need to be overcome first. When examining the barriers, it is useful to consider the responses using a bottom-up approach, since it is the end users who are the heaviest users of the HMIS. End users utilize the HMIS as a tool to complete their daily work so it needs to be available and reliable at all times. In their responses, the end users emphasized that the main barrier to the effective adoption of HMIS is lack of awareness of how it can work and how it can support them in their job. From an examination of the results of this study, it is clear that ESIC’s HMIS, which has been designed for the primary health care setting, is designed for management needs rather than clinical and service requirements. This research has demonstrated that the design process should be amended to facilitate the development of a practical conceptual framework in order to improve the adoption of HMIS in ESIC hospitals and dispensaries. The framework should be designed by health information system experts, health care professionals (medical and paramedical), IT staff and senior policy makers. The overall objective of the framework would be to allocate appropriate resources, such as money and staff, and to improve the adoption of ESIC’s HMIS. Moreover, the results in this study related individual patient characteristics to the socio-technical variables in the TAM and TAM2 models.

CONCLUSION:

The ESIC patients were mostly satisfied with the daily procedures and the reminder component of the health management information system used in the ESIC hospital and dispensaries in Tirunelveli sub-region. The health application received better ratings for daily routine use than for overall impression and ability to get specific information. Most of the ESIC patients feel that the HMIS has negatively impacted communication between doctors and patients and a sizable majority say it hasn’t improved communication between doctors and other healthcare professionals in ESIC hospital. The patients are highly satisfied with the inpatient HMIS system. However, inferior health information processing systems in the ESIC hospital caused disruptions in productivity and workflow and thereby, they negatively influenced patient satisfaction. The health management information system used in the ESIC hospital is only partially successful so the ESIC management should take necessary steps to sort out the technical issues. Health system users should be educated about changes to the system and ways to manage such changes. In addition, it is also desirable that ESIC doctors and healthcare professionals are involved in HMIS software development from the very beginning.

REFERENCES:

1. Adindu, A. (1995). Quality in PHC Management Information Systems. Nigerian Journal of Health Planning and Management , 8-17.

2. Devine, K., and O’Clock, P. (2014). An Analysis of the Benefits of Technology Implementation in the Healthcare Industry. Journal of Health Care Finance , 2-10.

3. Faiz, G. A., and Ahmad, F. (2015). The Effect of Entrepreneurial Orientation on the Organizational Performance: A Study on Banks in Libya. The journal of social sciences research , 25-31.

4. Gans, D., Kralewski, J., Hammons, T., and Dowd, B. (2005). Medical Groups’ Adoption of Electronic Health Records and Information Systems. Health Affairs , 1323-1333.

5. Kalpa, S. (2012). Health IT in Indian Healthcare System: A New Initiative. Research Journal of Recent Sciences , 83-86.

6. Kimaro, H. C., and Nhampossab, J. L. (December 2007). The challenges of sustainability of health information systems in developing countries: comparative case studies of Mozambique and Tanzania. Journal of Health Informatics in Developing Countries , 1-10.

7. Kivinen, T., and Lammintakanen, J. (2013). The success of a management information system in health care - A case study from Finland. International Journal of Medical Informatics , 90-97.

8. Končar, M., and Lončarić, S. (2003). Concept for integrated electronic health records management system. Informatica medica slovenica , 1-14.

9. Pettiford, C. (2011). Letter to the Editor: Personally-controlled electronic health records have potential to improve reporting on quality and safety in Australia. Health Information Management Journal , 4-5.

10. Roca, J. C., and Gagne, M. (2008). Understanding e-learning continuance intention in the workplace: A self-determination theory perspective. Computers in Human Behavior , 1585–1604.

Received on 24.10.2017 Modified on 28.11.2017

Res. J. Humanities and Social Sciences. 2018; 9(1): 49-55.

DOI: 10.5958/2321-5828.2018.00009.8