GTZ RSUZA Aceh IT Prelim Findings report

[zainoel abidin preliminary study report]

GTZ Health Aceh

Zainoel Abidin Provincial Hospital

Preliminary Study Report

2 Sept 2006

TABLE OF CONTENT

21INTRODUCTION

21.1Background

21.2About Consulting Services

21.2.1Description of Services

21.2.2Methodology

42FINDINGS

42.1Overview

42.2RSU Zainoel abidin HMIS needs

72.3RSU Dr. Fawziah bireun HMIS needs

92.4UGM PRoposal Evaluation

123RECOMMENDATIONS

123.1Device Strategy and Detailed Framework

153.2Improve on Project Management

153.2.1Step 1: Adopt HMIS Implementation Steps

163.2.2Step 2: Create HMIS Implementation Teams

183.2.3Step 3: Project Plan and Schedule

203.3Technical Recommendations

213.4Working With UGM

233.5Recommendations for RSU Dr Fawziah

274ANNEXES

274.1ANNEX 1: About HMIS

ABBREVIATIONS & ACRONYMS

RSUZA

Rumah Sakit Umum Zainoel Abidin, Banda Aceh

RSUDF

Rumah Sakit Umum Dr Fawziah, Bireun

HMIS

Hospital Management Information System

MOH

Ministry of Health, Indonesia

UGM

University Gajah Mada, Yogyakarta

SOP

Standard Operating Procedure

IT

Information Technology

EMR

Electronic Medical Record

BPR

Business Process Reengineering

UTP

Unshielded Twisted Pair

Rp

Indonesian Rupiah

1 INTRODUCTION

1.1 Background

The Governments of Indonesia, Germany and Australia are jointly assisting the NAD Provincial Government in the refurbishment and rebuilding of Zainoel Abidin General Hospital (RSUZA). Crucial for the hospital management is a reliable Hospital Management Information System (HMIS). Mediconsult has been engaged as an independent consultant to provide technical consulting assistance and to achieve the following objectives:

· Analyze and document the preliminary Hospital Management Information System (HMIS) requirements and operational problems of RSUZA.

· Present a detailed evaluation of the HMIS proposal submitted by University Gajah Mada (UGM), Yogyakart.

Resulting from the above tasks, Mediconsult is to provide a strategic recommendation for the HMIS planning and implementation exercise to ensure the project proceeds in the best direction.

1.2 About Consulting Services

1.2.1 Description of Services

The technical assistance aims to provide the steering committee and the RSUZA management with the following decision influencing information:

· An analysis of the information flow and requirements by each department in RSUZA. Observations will be made to identify operational problems currently faced by RSUZA staffs. This provides the committee with a more accurate picture of actual HMIS needs in RSUZA, thus being better equipped when selecting HMIS solutions and vendors.

· A detailed evaluation of the proposal provided by UGM. The steering committee will be provided with an independent evaluation with cost/benefit analysis. The proposal will be evaluated as a total solution encompassing all components of hardware, software and networking.

1.2.2 Methodology

This technical assistance consulting service required 6 weeks of fact finding to various locations. To achieve the above-mentioned objectives, Mediconsult adopted the following methodology:

· Conduct observations and interviews with main departments of RSUZA to analyse work processes, information flow and operational problems. Each department’s key staffs were asked to describe their day-to-day workflow while the consultants identified problems and issues.

· Visit to the district hospital in Bireun (RS Dr Fawziah) to observe the work processes adopted and HMIS implementation suitability allowing situational analysis and comparison of both provincial and district level hospitals.

· Hold discussion sessions with the team from Gajah Mada University of Yogyakarta (UGM) to evaluate the HMIS proposal to RSUZA. The proposed system’s functions and features were also evaluated along with the hardware and networking design.

A final findings report is compiled and presented to the steering committee and the management of RSUZA.

2 FINDINGS

2.1 Overview

The findings are broken into 3 major sections:

· RSU Zainoel Abidin HMIS needs

· RS Dr. Fawziah Bireun HMIS needs.

· Survey of hospitals across Indonesia.

· UGM Proposal evaluation.

2.2 RSU Zainoel abidin HMIS needs

Background

Rumah Sakit Umum Zainoel Abidin is the main hospital for the province of Aceh and is located in Banda Aceh. The hospital was badly damaged during the tsunami disaster and has since received much required aid for reconstruction and reestablishment of normal service. The hospital’s status will be changed to the Badan Layanan Umum (BLU) status by 2007 and thus require improvements to the operations especially on the billing and accounting processes. With the BLU status, the hospital will have autonomy of the finances and operates as a commercial entity requiring profits, as it will receive minimal funds from the government.

In line with this objective, the Gajah Mada University of Yogyakarta (UGM) has participated in numerous projects to prepare the hospital for the BLU status. These include cost analysis, benchmarking, financial management and BLU training among other things. UGM, through collaboration of 3 faculties (Medicine, Economics and Computer Science) has also proposed to develop and implement a patient billing and accounting system in RSUZA.

Hospital parameters:

Bed strength: 300

Average outpatient daily: 400-500

Average inpatient daily: 30

Through observations and interviews conducted in RSUZA, the section below highlights some key points:

1. Current IT adoption

There exist a patient registration software provided by Badan Rekonstrusi & Rehabilitasi of Aceh (BRR) and has been implemented since middle of 2006. The system is provided by a commercial IT company named PT Abiyosoft from Bogor, Java Barat. The system is successfully adopted and used. There are currently 5 workstations connecting to 1 PC server. The networking cables installed are only for the 5 workstations and are poorly planned. Cables used are Category 5e UTP and are not concealed. For connections exceeding 100m, repeaters in the form of switches are used to enhance signal strength. The users in the Medical Records department are happy with the system.

There is a inventory computer system supplied by another government agency but is currently not used by the materials management and inventory department as they are still awaiting training and proper implementation.

GTZ has also supported the hospital with 15 workstations currently used in a computer training lab environment. The hospital staffs are gradually being exposed to computer through standard computer appreciation training. The training is provided by an NGO, Yayasan Air Puteh through 4-hour classes daily. Involvement of staff for this training is through rotation. The overall staff’s IT experience is still lacking due to the limited computers for IT training.

UGM currently has contracts running with GTZ to help streamline the operations of RSUZA and also prepare the hospital for the BLU status. Included as part of their proposal is the development and implementation of a Patient billing and Accounting/Finance system. The proposal is still pending currently awaiting GTZ approval.

2. No IT framework or masterplan

RSUZA currently has no clear direction on implementation of IT in its operations. Prior to the tsunami disaster, a complete HMIS system by a commercial company named PT APL based in Yogyakarta was to be installed. Subsequent to the disaster, the project has lost tracked and never continued. However, the management realizes that IT is important to improve the overall operations of the hospital and has expressed commitment to new IT adoption.

3. Standard operating procedures

All departments except the accounting and finance department are operating without a clear standard operating procedures (SOP). UGM has completed several exercises to improvement the operations in RSUZA including the SOP for the Accounting and Finance department. However, the Accounting & Finance SOP has not been successfully adopted by the hospital.

4. Staff exposure to IT

The staff’s overall exposure to computers and the concept of information technology is still relatively low. Many of them does not have experience in using computers for work while some does not know the basic principle in operating computers.

5. IT department

The IT department currently is very weak. The designated IT department head Mr. Junaidi is still awaiting more staffs to join his team. There are currently 5 new staffs that are suppose to join the IT department after the 3 months orientation exercise but they are very junior. With the limited manpower and experience, the IT department will be too overwhelmed with work such as hardware support and thus will be unable to provide vision and framework for the hospital’s IT adoption. Mr. Junaidi himself is better versed with hardware maintenance without sufficient exposure to hospital management information system (HMIS).

6. Non IT operational problems

There still exist many non-IT problems in the daily operations. Among the observations are:

Medical records: There are insufficient budget allocated for physical medical records folder. Many of the staff are new (due to the disaster) and thus are still not effective in their work resulting in longer patient waiting time.

Laboratory: The laboratory operates with minimal modern equipments. There often are insufficient stocks of essential items such as test tubes, reagents and order forms. The staffs have complained that many of them have not received immunisation.

Pharmacy: In RSUZA, 80% of the patients are under the ASKES (national health insurance for public servants) and the ASKESKIN (national health insurance for the poor) insurance coverage. The ASKES insurance structure requires that all medication to be provided by the ASKES pharmacy. This results in very low revenue for RSUZA’s pharmacy (Rp 3 million /day). The department is small and have limited stocks to cater for the remaining 20% of the patients (pasien umum). Although the medication prices in RSUZA are lower than the outside pharmacies, many patients are unaware of the situation and still purchase their medication in outside pharmacies.

Commercial Accounting practices: Although the SOP has been completed by UGM, the Accounting & Finance department staffs are not trained yet to implement the SOP. The staffs are experts in public hospital environment accounting and financial controls but are not exposed to commercial accounting practice. With the introduction of the BLU status, commercial accounting practices are crucial for transparency and accountability.

The above-mentioned problems of specific departments are considered major, as basic manual operations must first be solved before implementation of a HMIS. The IT system will not be able to solve these operational problems and this will disrupts the direct benefits a HMIS system may bring to the hospital.

RSU Dr. Fawziah bireun HMIS needs

Background

The consultants made a short visit to Hospital Dr. Fawziah (RSUDF) in Bireun for observations on operations and HMIS readiness. RSUDF is located in between the big cities of Banda Aceh and Medan and is one of the major district hospitals in the province of Aceh. The hospital was not affected by the tsunami thus not requiring major reconstruction and rehabilitation efforts. In the aftermath of the tsunami, Dr. Fawziah hospital Bireun served as an emergency centre and provided healthcare services for communities around the district. The referrals from Dr. Fawziah hospital to provincial hospitals (RSU Zainoel Abidin and RSU Adam Malik as the main destinations) average about 5 cases daily, most cases are for psychology treatment.

Hospital parameters:

Bed strength: 107

Average outpatient daily: 160

Average inpatient daily: 20

The hospital also has plans to proceed to the BLU status but has yet to receive approvals from the local authorities. No preparations have been made to date for the BLU status.

Through observations and interviews conducted in RSUZA, the section below highlights some key points:

1. Current IT Adoption

There are currently 3 workstations in the hospital used for ASKES bills processing. As it is the requirement from ASKES to utilize their online system for submission of claims, the staffs has been trained and the system is utilized successfully.

2. HMIS framework and masterplan

The management is forward thinking and realizes the importance of a HMIS to improve the hospital’s operations. However funding has always been a problem. The hospital cannot find sufficient funds and does not have the expertise to select, purchase and implement a HMIS on their own. Due to the lack of exposure to the field of HMIS, the hospital management is unable to have a clear masterplan for HMIS or a framework to work against.

3. Standard Operating Procedure

The hospital has recently created and adopted SOPs for the hospital’s main departments.

The SOP creation and adoption was under the management’s own initiative and this reflects a management team with vision and drive for improvement.

4. Staff IT exposure

The hospital staffs are almost not exposed at all to the usage and benefits of IT. There are about 5 computers scattered around the hospital purchased and used internally for basic operations such as typing letters and this is limited to selected staffs only. Majority of the staffs work manually.

5. IT Department

There is no IT department currently in the hospital. Without the necessary technical people who can convey the benefits of IT and help the management team integrate IT into their future plans, the management team will not be able to envision the plan and framework necessary.

6. Accounting & Finance

A crucial element in the adoption of the BLU status is an efficient Accounting & Finance department capable of commercial level bookkeeping and financial planning. The staffs from this department currently are not exposed to the processes of commercial accounting as they are only experienced with public hospital accounting.

UGM PRoposal Evaluation

In line with the BLU preparation work, UGM has proposed the development of a HMIS system with the following modules:

1. Patient Billing

2. Accounting & Finance

3. Electronic Medical Records (EMR), includes Order Management

The proposal and system was evaluated by the consultants in University Gajah Mada campus, Yogyakarta and below are the findings:

1. Background

· Development of a HMIS system tailored for RSUZA by the PMPK team (6 programmers).

· The project team (PMPK) will receive technical assistance from representatives of the faculty of Medicine, Science and Economics.

· System is web based and open sourced.

i. Operating system Linux.

ii. Development language PHP.

iii. Database MySQL.

iv. Clients can be under windows or linux environment requiring a web browser for access.

· The proposal is broken down into the following phases:

i. Patient Billing system development (contract commenced).

ii. Patient Billing implementation. (pending)

iii. Accounting & Finance system development. (pending)

iv. Accounting & Finance implementation. (pending)

v. Electronic Medical Records system development. (pending)

vi. Electronic Medical Records implementation. (pending)

· The billing system is deemed complete and ready for laboratory implementation and testing by users

· UGM’s system is to be developed from null and does not yet have previous installation sites. Although one of the major success stories of the UGM team is the Tabanan hospital in Bali, one must recognize that the solution in Tabanan is completely different to that offered for RSUZA. The Tabanan HMIS software was a joint development between a commercial company named PT Aplikasi Perangkat Lunak in Yogyakarta with UGM acting as the consultant. The software was windows based running on Microsoft SQL and developed using Microsoft Visual Basics while the proposed solution to RSUZA is to be newly developed using open source.

2. Table below shows the proposal cost:

Module

Development & Implementation cost

(Rp 000.000)

Maintenance cost

(Rp 000.000)

Patient Billing

250 + 432 = 682

494

Accounting & Finance

831 + 1.449 = 2.280

?

EMR

277 + 611 = 888

?

Total

3.85

?

3. There exist many strong and weak points in the UGM proposal for the RSUZA HMIS system. Among the strong points:

· Project team consist of experts and academics in many fields.

· The system proposed is open sourced thus lowering cost of ownership for future hospitals.

· The team is forward thinking with great visions and ideas.

· The proposed development from null solution will be able to cater for exact requirements from RSUZA.

4. Among the weak points:

· UGM is an academic team, not a commercial IT provider.

Based on the consultant’s observations, the team of solution providers in UGM lacks real world experience and many of the ideas and solutions to the problems in RSUZA are very idealistic and unworkable. For example, the idea of using RSUZA as the development base for an open sourced HMIS system and subsequently providing the software free for other hospitals in the future is not a workable solution. Although open sourced software is free, there still exist installation, implementation, customization and maintenance cost. This notion is further amplified by the proposals submitted by UGM as they provide almost no information on the HMIS software, implementation plan and post-sales maintenance.

· High risk and yet high price

The strategy to build a system from zero comes with high risks to the hospital. RSUZA must invest time and money and risk not seeing the system at the end. The proposed cost of ownership as stated in table above is Rp 3.85 Milyar (Euro 331,000.00) but does not cover cost of hardware, networking and other crucial application software in a HMIS such as Office Automation (e.g. Microsoft Office), Antivirus and Email. As we can see from the hospital survey matrix, this price is very expensive comparatively. Many other HMIS software readily available can be purchased at a lower price. Should RSUZA want to embark on the development from null strategy, time must not be a criteria (average development and implementation time can take up to 2 years) and the price must be cheap as well because the vendor will be using RSUZA as a test bed.

· Undefined maintenance cost and structure

As UGM is not a commercial entity, there exists high risk of failure in future maintenance of the system. Without maintenance, RSUZA will not be able to get software support, troubleshooting and upgrades. Overtime as business processes and RSUZA’s requirements changes, the system cannot be changed and will become destructive to the hospital instead. It is imperative for RSUZA to ensure a solid maintenance plan for a minimum of 5 years with the chosen HMIS vendor. The proposal submitted by UGM does not detail any post-sales maintenance structure or pricing.

· Proposal is a Web based system running on MySQL

Although web based systems has many advantages over client-server applications, systems with high transaction volumes such as a HMIS is usually built using client-server architecture as it is faster. Major global HMIS solution providers such as Cerner, iSoft, IBA and SIEMENS have just begun experimenting with web based HMIS system and has not achieved the success level envisioned. The MySQL database is also not a suitable platform for a volume centric application such as a HMIS.

· Current Progress on Patient Billing software

Although the UGM project management team has reported to GTZ that the patient billing software is complete and ready for laboratory testing and user training, the evaluation shows otherwise. The patient billing system is very basic and will not be able to cater for real life environment in the hospital. More research and development work is required before the system is ready for use.

· Project Structure – PMPK Team

Although there exist technical assistance from the 3 faculties mentioned, the essential system development work is carried out by the PMPK team which consists of 6 relatively young and inexperienced computer programmers. They have very limited exposure to hospital operations and thus are unable to grasp the complexity of an actual patient billing software. Additional point to note is that the PMPK team mainly consist of contract staffs. Contract staffs are not permanent and may present a dilemma for RSUZA in the future due to PMPK staff uncertainties.

3 RECOMMENDATIONS

This section details the recommended strategies to overcome the previously highlighted issues and problems. The recommendations are categorized into four sections:

1. Device strategy and detailed framework

2. Improve on project management

3. Technical recommendations

4. Working with UGM

3.1 Device Strategy and Detailed Framework

The most initial step is for GTZ and RSUZA management to device long-term objectives and subsequently having a detailed step-by-step framework and strategy to achieve the objectives.

Long term Objective: To successfully implement a HMIS system in RSUZA allowing more efficient staffs and work flows resulting in better quality patient care.

To achieve the above-mentioned objective, GTZ and RSUZA must ensure the following:

· RSUZA management commitment

Commitment by RSUZA management and GTZ to drive the implementation initiative. HMIS implementation in hospital is a long and hard process and has very high failure rates thus management perseverance is essential to ensure success.

· HMIS purchase strategy

Although both the “Development from Null” and “Off the shelf” strategies have its pros and cons, it is recommended to purchase the HMIS software off the shelf instead because of the time constraint. The UGM proposal is too highly priced and the structure has too many risks thus making it not feasible. The realistic implementation time of the UGM proposal is about 2 years. GTZ and RSUZA should instead opt for an open tender and invite HMIS vendors to propose a packaged solution (one vendor for entire HMIS consisting of software, hardware, networking and maintenance). It is highly recommended for one single vendor to provide the HMIS solution to avoid inter-blaming when problems arise. However should GTZ and RSUZA opt instead to follow through the UGM development from null strategy, section 4 of the recommendations section (Working with UGM) provides some strategy to minimize risks.

· User Requirement Study, Business Process Reengineering (BPR) & Standard Operating Procedure (SOP)

The first step in the purchase and implementation of a HMIS system is to ensure we know what we require. This is done through the user requirement study. RSUZA need to document all processes of major departments and translate these into HMIS features and functions. With the user requirement study, RSUZA will be able to detail the HMIS software specifications and be more certain when evaluating proposals by vendors.

· Identify Project Plan, Objectives, Schedules and Milestones

The project stakeholders, GTZ and RSUZA management must first identify a project plan and the project schedule. Currently there is no clear schedule and milestones detailed and the project direction is unclear. With specific plans and schedules, the project progress can be measured and strategies realigned when progress is not satisfactory. A detailed project plan and schedule can only be recommended by the consultants upon decision on whether to proceed with UGM or to go with an open tender for an off the shelf solution.

· Prevention of the human resources resistance problem

As highlighted by the hospital survey findings, human resistance to the change in work processes especially involving computers is a very major problem in HMIS implementation. Recognizing this fact, RSUZA should manage and minimize this risk early in the project. Socialization and exposure of RSUZA staff is required before staffs are requested to work using computers, they should be provided with basic computer appreciation training to ensure they are comfortable with computers. As this training is currently ongoing in RSUZA, we recommend that this be continued and intensified with more training sessions.

· Attention be paid to post-purchase maintenance

Oftentimes the mistake made is insufficient attention being paid to post-purchase maintenance. RSUZA should ensure whatever HMIS software or strategy it adopts, post-purchase maintenance should be clearly defined and the budget acceptable.

· Critical HMIS modules

As a first step for RSUZA, the most critical HMIS modules for operations should be concentrated upon before moving on to less critical ones.

Critical modules:

Modules for future implementation:

Improve on Project Management

GTZ and RSUZA should realign the project management approach and reorganize the internal project structure. Sections below provide a 4 step recommendation on improvement.

3.1.1 Step 1: Adopt HMIS Implementation Steps

Adopt the generic HMIS implementation steps. The diagram below provide details on common HMIS implementation steps:

The most initial step is to ensure the internal project organization is established. We need to have project teams and a concrete project plan.

Secondly, a RSUZA requirements analysis must be performed. Before RSUZA purchase a HMIS software, we need to know what RSUZA exactly requires.

Thirdly, the processes internally must be reengineered (BPR). Oftentimes business processes are used because of tradition (passed down by senior staffs). Even when the staffs know there are more efficient and faster ways of working, they are held back by traditional processes which may no longer be suitable. The BPR exercise require staff participation and is a brainstorming session to produce new and more efficient processes and enforce them as new Standard Operation Procedure (SOP).

The next step is for the identified vendor to customize their HMIS software to suit the new SOP. After customization, the system must be thoroughly tested before implementation. In the implementation stage, staffs must be provided with sufficient system usage training. Final stage is the “System Go Live” whereby the old manual processes are replaced with the computerized system.

3.1.2 Step 2: Create HMIS Implementation Teams

HMIS implementation teams are a crucial success factor as it identifies the project stakeholders and each party’s responsibilities. It is recommended that GTZ and RSUZA create the following teams immediately:

The first implementation team is the RSUZA IT department. The department must be setup and enforced immediately consisting of permanent staffs.

Secondly there should be a HMIS project steering committee to provide overall strategic views and plans. This team does not include the vendor, as it must steer the project independently.

Thirdly is the project implementation team. One member of the RSUZA board of directors (BOD) must participate along with other members and the team will serve as the main project driver and solve day-to-day project operational problems. The chosen vendor must be included in this project driving team.

The fourth group consist of the end users. Each module involves selected departments of RSUZA and these groups must be identified and participate during discussions on user requirements study, process reengineering, SOP creation and system testing.

The following diagram shows the recommended organization of all the teams involved:

3.1.3 Step 3: Project Plan and Schedule

The subsequent step is to create a detailed project plan and schedule. This plan and schedule will provide project direction and should be followed rigidly. There should be clearly defined steps along with time frame to complete these steps. The deliverables of each step should also be clearly defined along with the responsible/accountable party. The schedule should be realistic and reflect the identified influencing factors.

Gantt chart below shows an example of a project schedule. The schedule is an example only and does not necessarily reflect the steps for this project.

Example of Project Schedule

3.2 Technical Recommendations

This section provides some specific recommendations on minimizing risk to ensure HMIS implementation success.

· Learn from successful implementation sites

RSUZA management to visit the following hospitals for “study banding” and learn from the implementation experience.

i. RSU Jantung Harapan Kita, Jakarta

ii. RS Pondok Indah, Jakarta

iii. RSU Tabanan, Bali

iv. RSU Dr Kariadi, Semarang

The site visits will provide the RSUZA management first hand commentary on the experiences of these HMIS implementation and key success factors.

· Define clear strategy on current system by Abiyosoft

The system is currently used in the patient registration and medical record reporting department in RSUZA. There should be a clear strategy on how to proceed with this system after taking into consideration all influencing factors.

· Immediate User requirement study and tender document preparation

The user requirement study and site analysis should be conducted immediately and translated into HMIS specifications. If GTZ and RSUZA adopts the tendering strategy, these HMIS specifications must be included into the tender document to ensure bidders know what to propose against. On the other hand if UGM is developing the system, then these user requirements can be used as the required functions and features in the future system.

· Commercial Accounting & Finance training

A crucial element in the successful adoption of the BLU status for RSUZA is the accounting and finance system. It is highly recommended that the hospital accounting and finance staff be trained on commercial accounting standards and practices. The processes and knowledge must first be in place before IT can help further improve efficiency.

· Computer appreciation to continue

The computer appreciation training running currently should be continued and intensified to ensure all RSUZA staffs are comfortable using the computers.

· Avoid misconception that open source is free

Oftentimes there are misconceptions that open source software is free. The truth is that open source may lower cost of software but is definitely not free as all projects will have cost for customization, implementation, project management, training and support/maintenance.

Working With UGM

If GTZ and RSUZA wish to continue pursuing the HMIS implementation project with UGM, the following section provides recommendation on moving forward. The objectives of these steps are to minimize the risks involved when working with UGM.

· Detailed Proposal

The UGM proposal currently provides almost no information. It is recommended that UGM resubmit a more detailed proposal encompassing the following to GTZ/RSUZA:

i. Detailed functions and features write-up.

ii. Implementation plan and time frame.

iii. To include crucial components such as operating systems, email system, office automation (e.g. Microsoft Office), hardware/networking. This is to ensure GTZ and RSUZA have the complete HMIS price.

iv. The price should also be indicated clearly for each component. The Bill of quantity and deliverables for each payment must be specified. Maintenance cost per year for each component and the payment terms must also be proposed.

v. Maintenance plan and structure.

· UGM to be the single vendor

One of the key failure points is to have multiple vendors in a HMIS implementation. With a different vendor handling different components (e.g. Split by hardware, software and networks), there exists a high possibility of inter-blaming between vendors when problem arises. To avoid this situation, it is highly recommended that UGM to be the single provider for the HMIS project. UGM can sub-contract the components out if they do not have the expertise or manpower but should ultimately be the consortium leader and be held accountable.

· More expertise to the PMPK team

The PMPK team who develops the system currently requires more expertise. The team members lack exposure to hospital environment and thus is recommended that more experienced staff be included into the development team. The new manpower should have clear understanding of hospital processes and experience in developing similar systems for equal sized hospitals.

· Clearly defined deliverables

The proposed solution currently is still very ambiguous and does not provide details on exact deliverables. GTZ and RSUZA should ensure all deliverables are clearly identified.

· Better inter-faculty communication

Although there are participation of many experts from the 3 faculties (Medicine, Economics and Computer Science), communication between the faculties to the PMPK software development team is still lacking. Transfer of knowledge from the faculty representatives to the PMPK team must be enhanced to ensure the system development team is well versed with hospital operations and problems.

· Software warranty (post implementation)

There should be a minimum of 1-year warranty for the system. This clause must be included in the contract and UGM must be responsible for fixing any system bugs and problems for the entire warranty period.

Recommendations for RSU Dr Fawziah

RSUDF should be further assessed for suitability of implementing HMIS. The surface assessment shows that the conditions are perfect for the adoption of a HMIS system;

· Management is supportive and wants a HMIS system.

· SOP already in place

· Small environment for easier control

· Lower investment required

A more detailed assessment should be performed in the hospital to further evaluate the environment’s readiness for HMIS implementation. Should the assessment bring positive results, a detailed user requirement study should be performed and with this, translated into a tender document to invite HMIS vendors’ proposal through an open tender.

The estimated budget for RSUDF is about USD 95,000.00. This is a rough estimation only and is for complete HMIS software. Budget breakdown:

Computer Allocation:

Networking:

4 ANNEXES

4.1 ANNEX 1: About HMIS

A Hospital Management Information System (HMIS) is becoming more and more crucial to the hospital’s operating environment as it simplifies work processes while capturing important information electronically allowing easy generation of reports and information to support decision making.

Typically, a complete HMIS will include the following modules:

Critical

· Patient Management – Outpatient and Inpatient registrations (to capture demographics), patient transfers, bed management, census reporting, patient lookup (current and historical).

· Medical Record tracking – Medical record creation, folder tracking.

· Order Management – Orders for pharmacy/laboratory/radiology are entered from the wards/clinics. Orders are queued and processed in respective locations while capturing fulfilment of orders and results through the system. Consumables are also captured.

· Pharmacy – Fulfilment of pharmacy orders, medication production, costing, inventory management, reporting.

· Materials Management – Overall inventory system managing all assets of the hospital. Purchase requisition, ordering, receiving, stock management.

· Patient Billing – Processing of patient bills, cashiering, insurance patient processing.

· Accounting and Finance – Accounting and finance management.

· Executive Information System – Hospital management (board of directors) reporting. Immediate graphic display and reports of key performance indexes.

Non-Critical

· Clinical Information system –System based clinical data, medical records. No more usage of paper medical records.

· Picture Archiving and Communication System (PACS) – Computerized radiology department whereby all images are electronic without usage of films. Direct image capture through modalities sent to online storage. Images are tagged to patient data in HMIS and high-resolution images are retrieved for diagnostic or review. Typically installations are expensive in the range of USD 1-2 million.

· Laboratory Information System – Automated laboratory system where all equipments are connected to the HMIS. Orders processed are sent automatically from equipment to the online HMIS storage, which tags to the patient’s data.

· Critical Care Information System – Bedside monitoring fully integrated to the HMIS.

· Human Resources Management System (HRMS) – Employee database, payroll calculation, resources scheduling.

· Laundry and CSSD – laundry and equipment tracking, processing.

· Dietary – Food production, cost calculation, stock management.

· Maintenance – Asset and maintenance tracking.

· Operating Room management – room / procedure scheduling, inventory, operation notes, connected to anaesthetics management.

There are many vendors in the market both local and abroad offering either all or selected modules mentioned above.

The diagram below illustrates the hospital processes and corresponding HMIS modules:

Hardware

Servers & UPS

Patient Management

Printers

Total (USD)

Materials Management

Medical Record

Network points (Category-6 UTP)

Workstations + UPS

Estimated Price (USD)

Patient Billing

Order Management

Executive Information System

Laundry

Human Resources

CSSD

Maintenance

Electronic Medical Record

Kelvin Hui

GTZ Health Service Management System ACEH

Gedung Administrasi Lama Lantai II, Rumah Sakit Umum Dr. Zainoel Abidin�Jl. Tgk. Daud Beureueh No. 108 Banda Aceh 23126 ACEH-Indonesia�PO BOX 672 Banda Aceh 23001

�HYPERLINK "http://www.gtz.de"�www.gtz.de�

HMIS Project Manager & Technical Advisor

GTZ Health Service Management System ACEH

Gedung Administrasi Lama Lantai II, Rumah Sakit Umum Dr. Zainoel Abidin�Jl. Tgk. Daud Beureueh No. 108 Banda Aceh 23126 ACEH-Indonesia�PO BOX 672 Banda Aceh 23001

�HYPERLINK "http://www.gtz.de"�www.gtz.de�

5000 + 400

19,000.00

5000

600

95.500

QTY

1

27

(incld. 2 spares)

25

(incld. 3 spares)

22

Switches

4

1000

UPS 500 VA for computers

27

4,100.00

Network

Software (HIS)

1

60,000

UPS 500 VA for switches

4

Accounting & Finance

Pharmacy

400

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