INSTITUTE OF HEALTH MANAGEMENT RESEARCH

BANGALORE

A REPORT ON

HOSPITAL INFORMATION SYSTEM

AT FORTIS HOSPITAL, NOIDA

SUBMITTED BY- ADITYA KUMAR VARSHNEYA

OF
POST GRADUATE DIPLOMA IN HOSPITAL AND HEALTH MANAGEMENT
PGDHM 2011-13 BATCH

AS A PARTIAL FULFILLMENT OF THE SUMMER TRAINING REQUIREMENT

OF PGDHM PROGRAM

(16TH APRIL- 16TH JUNE, 2012)

IN SUPERVISION OF

Col.H.S.BHAGAT
(GENERAL MANAGER, FORTIS, NOIDA)

ACKNOWLEDGEMENT
The successful completion of any given task requires a lot of hard work and sincere efforts. Hard
work and efforts are only the building blocks of an assignment, but the plinth has to be
inspiration, suggestion, support and guidance.
Experience in a hospital environment is an important part of my course and this I have achieved
from one of the esteemed health care organization, Fortis Hospital, Noida. These two months of
training has added a valuable and knowledgeable exposure in the development of my career and
achievement of my objectives, for which I am highly grateful to the organization
Any attempt at any level cannot be a success without the support and direction of learned people.
A heartfelt gratitude to Dr. Sukhmeet Sandhu (Zonal director,) and Dr. Akash Sud (Medical
Superintendent), at Fortis Hospital, Noida, for giving us the golden opportunity to work with the
Indias leading health care provider. My heartfelt gratitude to Ms. Alfons Madoc ( Head HR) and
Ms. Smita Roy Angrish (HR Manager) for showing keen interest in our training, helping us to
plan our agenda and guide us despite their busy schedule.
I would like to express my immense gratitude to Col.H.S.Bhagat (General manger, operations)
for providing his support and guidance not only for the project in the hospital, but for broadening
my horizon and making me learn various other aspects of hospital functioning, which will
definitely help me a lot in my career. And yes, and for directing my goals and objectives towards
the attitude that derives to achieve and other aspects that one needs to be acquainted with. My
learning here in two months is all because of his help.
I would also like to extend my gratefulness to Mr.Kaptan Sharma (HOD, IT dept.), Mr. Nitin
Khanna (Head, Medical Administration), Mrs. Anju Panwar (HOD, House-keeping), Ms. Neeru
Raina (HOD, PCS) for helping and guiding me throughout the project and helping me learn
various other aspects too.
I am glad to acknowledge Dr. K.S. Srinivasa Rao (Director- IHMR-Bangalore), Dr. Fehmida
Visnegarwala and Maj.Gen.N.K.Manchanda (Mentor) for incorporating right attitude in me
towards learning and for supporting me whenever required.
I genuinely thank my parents, family and friends for their blessings and support. Last but not the
least I am thankful to God, for getting an opportunity to learn from this organization.
2

TABLE OF CONTENTS

CONTENTS
S NO.

TOPIC

Abbreviations

Introduction

SECTION
AHospital
orientation & departmental
study

1.0 History

1.1 The Fortis Logo

1.2 The Mission

1.3 The Vision

10

1.4 Values

10

1.5 Committees
hospital
1.6 Organ gram

10
11
12

PAGE NO.

in

the

1.7 Infrastructure
1.7.1 Departments of
the
Hospital
2.0 Departmental Profile
2.1 OPD
2.2 IPD
2.3 Human Resource
2.4 Marketing Department
2.5 Dietary and Nutrition
2.6 Housekeeping
3

11
12
13
14-15
16-21

13

2.7 CSSD
2.8 TPA
2.9 Store and Purchase
2.10 Engineering and
Maintenance
2.11 Finance
2.12 MRD
2.13 Security
2.14 IT Department
Department study

22-31

14

Executive summary

33

15

Introduction

34

16

HIS- objective

35

17

Functional Coverage

36-37

18

HIS-Fortis

39-42

19

Cloud computing

43-45

20

46-49

24

House Keeping Module

With recommendations
Nursing and Diet Module
With recommendations
IT and Store Module
With recommendations
OPD Module
With recommendations
Other recommendations

25

Fortis HIS-Future

65

26

Data Flow chart

66-69

27

Conclusion

70

28

Reference

71

29

Annexure

72

21
22
23

50-54
55-58
59-63
64

ACRONYMS/ ABBREVIATIONS

HIS-Hospital Information system

CSSD- Central Sterile Services Department
CT- Computerized Topography
CTVS- Cardio Thoracic Vascular Surgery
ECG- Electrocardiogram
ER- Emergency Room
FMS- Facility Management and safety
F&B- Food & Beverages
HAZMAT- Hazardous Material
HR- Human Resource
ICU- Intensive Care Unit
IPD- In-patient Department
IT- Information Technology
MICU- Medical Intensive Care Unit
OPD- Out-patient Department
OT- Operation Theatre
LIS- Laboratory Information System
RIS- Radiological Information system
PACS-Picture Archiving and Communication System
DICOM-Digital Imaging and communication in medicines
RFID- Radio Frequency Identification
CPOE- Computerized physician order entry
EMR- Electronic Medical Record
PHC-Preventive Health Checkup

Introduction
Summer Training is an integral part of the Post Graduation Diploma in Hospital Management
(PGDHM).
The main purpose of this summer training is to get an orientation towards the layout, operations
and workflow of the hospital, in order to understand the processes and systems in the hospital.
5

After completing the first academic year of PGDHM, the students are supposed to undergo a
two months training in a hospital, as a part of the curriculum.
Indeed I have got the golden opportunity to work in Asias leading Healthcare provider, Fortis
Group of Hospitals.
I joined Fortis Hospital, Noida, from 16th April, 2011 for summer internship. The duration for the
summer training is of 2 months i.e.16th April to 16th June.
AIM:
To have an overall orientation / induction of the hospital setting.
Objectives:
1. To get an overview and develop understanding of the hospitals functioning.
2. To gather knowledge about the process flows of major clinical and non clinical
departments in a hospital.
3. To help the management study and address some issues/problems associated with some
specific operational area/department.

Section-A
6

Hospital Orientation
&
Departmental Study

1.0 History:
Fortis Healthcare Limited was established in 1996 by its founder, Late Dr. Parvinder Singh. His
vision of medical care was,
To create a world class integrated Health Care delivery system in India, entailing
the finest medical skills combined with compassionate patient care.
Fortis took its first step towards becoming a world-class provider of integrated healthcare
delivery in India by setting up its first hospital at Mohali, Punjab.
Fortis Hospital, Noida was inaugurated on 7th November 2004, which is a centre of excellence in
Orthopaedics and Neuroscience with additional focus on Cardiac Sciences, Minimally Access
Surgery and Oncology. The hospital has a built over area of 5.53 acres and the allocation of
7

space far above the current Indian norm of 800-900 sq.ft/bed. The total build up areas is 2.20,000
sq. ft with patient centric design by Kaplan Mc Laughlin Diaz (KMD) USA (award winning
designers for FHI & MSH). This allows for flexibility to adapt and accommodate future trends of
patient care.
The Fortis Hospital at Noida, near Delhi, is a centre of excellence in Orthopaedics and
Neuroscience with additional focus on Cardiac Sciences, Minimally Access Surgery and
Oncology. It is a hub where some of the best medical professionals provide quality medical
treatment catering to the special needs of patients and their families. The hospital has been
designed and developed to deliver patient care with maximum ease warmth and effectiveness.
Fortis Hospital Noida has also achieved many first to its name:

1st NABH Accredited Hospital in U.P.

1st NABH Accredited Blood Bank in U.P.
1st NABL Accredited Lab services in U.P.

1.1 The Fortis Logo:

LOGO
A HEALING PASSION
The Fortis Healthcare Limited Logo defines the commitment to patient care. The logo reflects
their endeavour to achieve excellence in healthcare delivery system by bringing together the best
of technology, medical expertise, and patient care. The logo also implies the human values that
govern every facet of our organization.
The 2 nurturing hands along with a red dot on the top depicts- nurturing hands caring for human
life

GREEN is a color of healing and depicts WELLBEING and RED is symbolic of steadfast focus,
dynamic zeal and enthusiasm
1.2 Mission:

To become an Integrated Healthcare delivering organization guided by quality,

excellence,

technology

and

compassionate patient care.

To establish Fortis Hospital Noida as a
major corporate hospital in healthcare
delivery system in the region.

1.3 Vision:
Globally Respected Health care organization recognized for Clinical Excellence

and

Distinctive Patient Care.

1.4 Values:
They serve as a guideline for the routine conduct of each Fortisian. The core values of Fortis
Healthcare are:

Patient

Commit to 'best outcomes and experience' for our patients.

Centricity

Treat patients and their caregivers with compassion, care and understanding.
Our patients' needs will come first

Integrity

Be principled, open and honest.

Model and live our 'Values'.
Demonstrate moral courage to speak up and do the right things.

Teamwork

Proactively support each other and operate as one team.

Respect and value people at all levels with different opinions, experiences and
9

backgrounds.
Put organization needs' before department / self-interest.

Ownership

Be responsible and take pride in our actions.

Take initiative and go beyond the call of duty.
Deliver commitment and agreement made.

Innovation

Continuously improve and innovate to exceed expectations.

Adopt a 'can-do' attitude.
Challenge ourselves to do things differently.

1.5 Committees in the Hospital:

1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.

Quality Steering Committee

Hospital Infection Control Committee
Safety Committee
Sentinel Events Committee
Blood Transfusion Committee
Code Blue Committee
Pharmacy and Therapeutic Committee
Medical Audit Committee
Research and Ethics Committee
OT Committee
MRD Committee
Morbidity and Mortality Committee
CME Committee
Purchase Committee
Condemnation Committee
Credentialing and Privileging Committee
Sexual Harassment Committee

10

1.6 Organ gram

11

12

1.7 Infrastructure:
The hospital offers world class infrastructure. It is designed as a green building to allow natural
light into almost all parts of the building especially patient care areas. The architecture allows
conservation of energy. The building is earthquake resistant. CFL lights have been used, thereby
reducing power consumption. The space provided in the various departments is sufficient to
move freely. CCTVs installed all over the building act as digital watchmen and help in security
services. An efficient Hospital Information System is used to store all medical records.
The Hospital is equipped with:

250 bedded hospital with 191 beds currently in use.

8 ICUs with 63 beds: Medical, Surgical, Liver Transplant, Kidney Transplant, Cardiac,

Neuroscience, CTVS and Neonatal ICU.

7 OTs
2 Cath Labs (Neuro Cath Lab and Cardiac Cath Lab)
4 bed -Triage & 6 observation beds -ER
11 bedded Dialysis centre equipped with modern dialysis machines like SLED (sustained

low efficiency dialysis machine) and providing 24 hrs. Coverage.

Diagnostic facility comprising of 1.5 Tesla MRI scanner, 64 slice CT scan, 4 X-Ray

units, 3 Ultrasound units, 1 Mammography machine and 1 Bone dexa scan machine.

All laboratory services of world class standard like histopathology, microbiology,

biochemistry and hematology are present.

Ambulances which transport patients to the hospital emergency.

13

1.7.1 DepartmentsDEPARTMENTS IN THE HOSPITALThe OPD (Outpatient Department) are

Pulmonology
Rheumatology
Obstetrics & Gynecology
Pediatrics
Physiotherapy
Orthopedics
Psychiatry
Ophthalmology
Dental
Dermatology
Diabetes and endocrinology
Internal medicine
Sports medicine
ENT
Emergency medicine
Radiology
Speech therapy
Music therapy
Gastroenterology
Neurology
Neonatology
Infertility
Dialysis

The surgical procedures carried out in the hospital are

General surgery
Cardiac surgery
Laparoscopic GI
Bariatric surgery
Neurosurgery
14

Thoracic surgery
Vascular surgery
Plastic and reconstructive surgery
Liver transplant
Bone-marrow transplant

Other services in the hospital are

Blood bank
Laboratory services
CSSD
Pharmacy
Preventive health check-ups
Patient care service
Day care
Clinical nutrition

International Oncology Centre, NoidaInternational Oncology in strategic collaboration with Fortis Hospital, Noida brings to patients a
state-of-the-art cancer centre equipped with cutting edge technology and offering comprehensive
cancer care under one roof.
Currently, Fortis Noida acts as a hub to the spoke at Fortis Vasant Kunj and Escorts, Faridabad. It
acts as a referral spoke to the Noida centre. The spokes carry out cancer treatment pertaining to
surgeries, chemotherapy, biopsies, tests and scan, except high-end radiation oncology, for which
the patients are referred to the main regional hub at Fortis Noida.
Also, they have strategic collaboration with Albert Einstein College of Medicine (USA) for
advanced physician trainings and for seeking second opinion for complex cases.

Also, Fortis hospital, Noida has a TELEMEDICINE UNIT that carries out CME (continuous
medical education) under the PAN-AFRICA e- network project. It has also allowed their
network to expand its presence by extending quality healthcare treatment to the remote areas of
Northern India as well as overseas.
2.0) DEPARTMENTAL PROFILE2.1 OPD
Functions:
Reception/Information
Appointment
15

Registration-OPD, Diagnosis
Billing-OPD, Diagnostics, Emergency
Report/Document delivery
Customer Feedback

REGISTRATION PROCESS OF OPD

PATIENT ENTERS INTO THE HOSPITAL

PATIENT APPROACHES THE OPD REGISTRATION DESK

PATIENTS FILLS THE REGISTRATION FORM

INFORMATION IS ENTERED IN TO THE HIS OF THE HOSPITAL

THEN, UHID (UNIQUE HOSPITAL IDENTIFACTION) IS GENERATED

BILLS ARE PROCESSED

2.2 IPD
Functions:

Reception/Information
Appointment
Admissions- IPD services(including Daycare)
Report/Document delivery
Customer Feedback
Processing of TPA and corporate patient files

2.3 Human Resource Department:

16

Functions:

Development of HR policies and strategies

Manpower Planning
Recruitment and Selection
Employee Training
Salary Determination
Performance Appraisal
Personnel Data entry and record maintenance
Consultation and Advisory services to management and employees
Grievance Handling

2.4 Marketing Department:

Functions:

Branding and Promotion

Online marketing through website

Corporate link-ups

TPAs

Prepare brochures and pamphlets

2.5 Dietary and Nutrition (Food and Beverages)

Functions:

To ensure that Patient management system (PMS) is done according to F & B service

standards

Outpatient Diet counseling

To educate all inpatients during hospitalization and at the time of discharge for

therapeutic diet requirement

To ensure proper room service to the attendants.
To check the quality of grocery items as per the approved brand list and standard

specifications

Food services to consultants, doctors, and rest of the staff

Food services extended during guest visit, CME, workshop and other important meeting.
2.6 Housekeeping
Functions:

Sanitation and Hygiene

Odour control
Waste disposal
Pests, rodents and animal control
17

Interior decoration
Infection control

2.7 CSSD
The objective of establishing this department is to make reliably sterilized articles available at
the required time and place for any agreed purpose in the hospital as economically as possible.
Functions:

It receives stores, sterilizes and distributes to all departments including the wards, OPD
and other special units.

It processes and sterilizes syringes, rubber goods (catheters, tubing etc.), surgical
instruments, treatment trays and sets, dressing etc.

It ensures economic and effective utilization of equipment resources of the hospital under
controlled supervision.

2.8 TPA
TPA companies are BPO of insurance companies and are responsible for coordinating all aspects
of claims arising due to health insurance policies. These companies are licensed by IRDA.

2.9 Store and Purchase

Stores receives all equipments, instruments and items of raw material, consumables, printing and
stationary, medicines and other essential goods required by the hospital.
Functions:

Procurement of stores through indigenous and foreign resources

Checking of requisition and purchase indents
Negotiating contracts
Issue of purchase order
Follow up of purchase orders for delivery in time
Serving as an information centre on the materials knowledge.

2.10 Engineering and Maintenance

Functions:
18

To maintain electric and water supply

Air conditioning and refrigeration
Intramural transportation

2.11 Finance
Functions:
The functions of the financial departments are interlinked with the functioning of practically all
other departments. The primary and essential functions of this department are:

To maintain financial records

To make payments of bills and expenses on time
To collect accounts due
To monitor the cash flow/ funds
To make payments of wages and salaries
To provide information regarding financial condition to managers and decision makers of
the hospital

2.12 Medical Records Department

Functions:

Proper storage and maintenance of medical records

Maintenance of integrity and confidentiality of medical records
Submission of required data to government
Classify the medical files as per ICD-10
Obtaining missing patient files

2.13 Security
Security services ensure the total safety and security of the internal as well as external customers.
Functions:
To secure the infrastructure and hospital property
Safety of patients
Control of flow of visitors
19

 VIP security
Parking management

2.14) IT Department
Functions:
Maintenance of all the softwares in the hospital.
Modifications of the software are as per the requirements of the department.
It covers the following modules:
IPD Billing
OPD Billing
Administration
House keeping
Ward/Nursing
Diet
Visitors pass
Stores
Purchase
Laboratory Information System
Radiology Information System

DEPARTMENTS STUDIED IN DETAIL:

20

1.

EMERGENCY DEPARTMENTThe emergency department in a hospital serves to the need of patients who are in need of
immediate care i.e. accident cases, trauma cases, suicidal cases, medico legal cases etc.
The ER at FHN is 4 bedded along with 6 beds in the Observation room. Also, there is a procedure
room to conduct simple surgical procedure.
ER has separate entry, far away from the general entry and is quite spacious in order to allow free
movement of stretchers/trolleys from the ambulance to the Emergency room.
While bringing in the patient from the ambulance, TRIAGE is done beforehand by the staff nurse

at the ER reception and so patients are placed according to the triage bedsTHE TRIAGE pattern followed here is 1 red bed for category 1 patients i.e. critically ill
3 yellow beds for category 2 patients who need to be admitted
Remaining category 3 patients are kept in observation room
There are 4 ambulances in the ER department, the movement of which depends on the central
emergency call centre at Fortis Escorts, Okhla.
The Fortis group of hospital in Delhi and NCR has a centralized ambulance call centre at Fortis
Escorts, Okhla (105010) where all the calls for requirement of ambulance are received and
depending on the location of the case, the nearby Fortis branch is contacted, a case id is given and
then the ambulance is sent the required location.
A Crash Cart is available in the emergency which provides a one place storage of all emergency
medications required which saves the precious time during treatment.

A Code blue team is designated which consist of 2 teams

a)
b)

ICU Team
Emergency Team
The dial code for individual disaster is 55 and as soon as the information is reached to the code
blue team, the team reaches the required place and take with them the jump kit and the
defibrillator.

21

ACCESSIBILITY WITH OTHER DEPARTMENTSThe ER is located on the ground floor, making it quite accessible to the other departments. The
diagnostic department is right next to the emergency department but the ICU and OTs are at the
second floor and it takes 4-6 minutes to reach there.
Moreover, there is a direct inter- communication system between emergency department and other
services like blood bank, lab, diagnostic, ICU etc. It is all linked thorough HIS and Intercom
service.
The Staff in the emergency department is as:
a)
b)
c)
d)

Nurses
Doctors
CMO
Paramedical Staff

Generally the patient to nurse ratio is 1:1, but team work approach is always followed whenever the
emergency patient arrives.
The emergency department have the following equipments:

Defibrillator
Suction machine
ECG
Cardiac Monitor
Oxymetry
Ventilator
Syringe pump ( for the accuracy of dosage)

2. BLOOD BANK:
The blood bank here at Fortis Hospital, Noida is NABH accredited and is the 1 st NABH
accredited blood bank in U.P.
The 2 main functions of blood bank isa) Blood donation
b) Apheresis
For Blood donation, there are 2 beds and for Apheresis there are 3 beds.
Apart from these basic requirements22

There are 3 storage rooms

1. 6 Deep freezers are there. Temperature maintained is -40,-30 &-80 degree Celsius.
2. 3 Blood bag refrigerators are there. Temperature maintained is 2-6 degree Celsius.
3. 2 Agitators are there. Temperature maintained is 20-24 degree Celsius.
Also, there is an infection marker room for following 6 diseases
a)
b)
c)
d)
e)
f)

HIV 1
HIV 2
HEP B
HEP C
SYPHILIS
MALARIA

Apart from this, there isa)

b)
c)
d)
e)
f)

Quality control room

Refreshment room
Apheresis room
Blood donation room
Screening room to check for vitals
Component preparation room

The Staffing pattern is10 Technicians

1 resident doctor
1 incharge

3. LABORATORY
The Laboratory here at Fortis Hospital is outsourced to SRL Lab and all the routine
investigations are carried out here only. The staff strength is 30-40 with 3 people working during
night.
The samples are received from both OPD & IPD patients and a prescription is not always
required to get a test done unless the history of the patient has to be traced back.
This sample is received in boxes from respective OPD & IPD department and the housekeeping
staff carries the same.
23

Also, for emergency investigations, a red seal is marked on the sample as well as on the
prescription of the patient so as to give it a priority.
Also, all the equipments in the lab are automated i.e. they are linked to computers and so all the
test results are automatically transferred in the computer and a report is generated.
The laboratory has a Laboratory investigation system (LIS). This LIS is connected to the HIS
of the hospital in which all the information like- patients name, IPID or UHID, test to be done
and the reports is stored.
Once the report is generated, it is reviewed by the authorized person and then only it is made
available in the LIS or send to the patient.
Moreover, there is no telephonic communication of reports results, only during urgent or
emergency cases report is spelled out and that too twice to ensure proper communication
Quality check and the calibration of the equipments is carried out twice in a day for quality
assurance.
Also, to maintain employee safety i.e. prevent occupational hazard, when an infected sample or
any chemical bottle breaks in the laboratory, HAZMAT (Hazardous Material) team is called and
immediately the spillage is cleaned up.

List of equipments used in the laboratory are

Biochemical analyzer
Cell counter
Urine routine analyzer
Immuno assay analyzer
Centrifuge
Microscan
Bactec
Tissue processor
Microtone
24

Balance
Glycosylated hemoglobin analyzer ( D 10 )
Sample mixer
Microscopes
Pipettes

4. CSSD
CSSD stands for Central Sterile Supply Department. It is the department that is solely
responsible for sterilization of all the instruments used all over the hospital.
CSSD has 3 zones:
a) Dirty/Receiving Area
b) Clean Area
c) Sterile Area
a) In Dirty Area all used instruments from IPD & OPD are received after they are washed
and. This movement takes place manually, while it is received through a dumb waiter from
the OT.
Here, an ultrasound cleaner is located. This is a fully automatic machine in which the
used instruments are dipped in a solution and are sterilized under 40 degrees Celsius for
10-15 minutes. This machine produces vibrations which sterilize the instruments.
After the above procedure is over, the sterilized instruments are washed under running
water.
After this the instruments are dipped in Preserve solution for 10-15 minutes.
b) In Clean Area, the sterile instruments are kept packed in a double wrapped green colour
cloth
c) In Sterile Area there is 1 autoclave machines that is used to sterilize the used instrument. It
is a double door machine. Through one door the unsterile instrument is loaded and
through the other door the instrument is de-loaded after the procedure is over.

2 temperature are set in this machine according to the instruments to be

sterilized:i. 120 degree Celsius -Under this temperature 20 min is the sterilizing time,
15 min is the dry time and 3 minutes is the pulsing time( Pulsing is an
procedure by which the air present in the machine is moved out and steam
is moved in)
ii. 134 degree Celsius - Under this temperature, 7 minute is the sterilization
time, 3 minute is the pulsing time and 10 minute is the dry time.
25

After the sterilization process is over, the sterilized instruments are packed and Batch Monitoring
Labelling is done through a labelling gun .This labelling consist of:

Expiry Date
Packaging Date
Machine No.
Loading No.
Sterilization Date

5. IPD (INPATIENT DEPARTMENT)

At FHN, there is a separate IPD building which has 5 floors:

IPD 0-Diagnostics.
IPD 1-General wards, single and double room
IPD 3- OBG.
IPD 4- Cardiac unit.
IPD 5- Deluxe, presidential suits.

The hospital has a single central admission and discharge registration no. ( CR No.) for IPD
cases, which is used till the patient discharges from the hospital;
IPD file is generated by the UHID of the patient, and all the patient information like- Case
history, diagnosis along with UHID details are stored.
Apart from keeping the files in the HIS, a hard copy of the same is kept in the MRD (Medical
Record Department)
At each IPD floor, 2 nursing stations are there which helps them monitor the patients effectively.
For IPD patients, there is a separate Pharmacy (IP pharmacy) which is connected with all the IPD
floors through HIS. The data entry operator enters the drugs to be given to the patients under the
supervision of nurse and the list is sent to the IP pharmacy through HIS and accordingly the
drugs are sent to the respective IPD floors.

Also, there is a direct intercommunication between IPD and outside services like lab, radiology
etc; it is all connected through the HIS.
GENERAL WARD:

There are 7 beds in the general ward and a nursing station is located at the end of the
room.
26

Each bed has a nurse call bell system and there is sufficient space of about 4 feet
between beds for the movement of carts
Attached toilet is available at the extreme right corner of the room.
Nurse to patient is ratio is 1:6

PRIVATE WARDS
No. of beds 1 or 2
When compared to general ward, Private wards have a TV, Telephone, Almirah, Drawer,
and Sofa cum Couch.
Nurse to patient ration is 1:1

6. ICU (INTENSIVE CARE UNIT)

ICU is located at the second floor of the IPD building making it accessible to all the outside
services like lab, diagnostics, OTs etc.
There are 8 Different types of ICUs in the hospital which are as follows:

SURGICAL ICU(4 Beds)

CTVS ICU( 5 Beds)
MEDICAL ICU(16 Beds)
NEUROSCIENCES ICU(14 Beds)
NEONATAL ICU
CCU
LIVER TRANSPLANT ICU
KIDNEY TRANSPLANT ICU

The nursing station is centrally located in the ICU and the nurse to patient ratio in ICU is 1:1.
Also, here at FHN, Barrier nursing is practiced in ICUs so as to minimize the risk of Hospital
Acquired Infection (HAI).
Equipments used in ICUa) Ventilator
b) IABP (Intra Aortic Balloon Pump)
c) Suction
d) ICD (Inter Costal Drainage System)
e) Portable Ultrasound-ray (when needed).
f) DVT (Deep Vein Thrombosis) Pump
27

g) Bi-pap to give oxygen to patient

7. OPERATION THEATRESThe operation theatres are located on the 2 nd floor of the OPD building having a direct
connectivity with ICU (2nd floor of IPD building) so that patient is easily & quickly shifted to and
from the ICU.
At FHN, there are 8 OTs1)
2)
3)
4)
5)
6)

OT 1- Orthopedics & Liver Transplant OT

OT 2 & OT 3- Neurosurgery OT
OT 4- Major & General ( All cleaned & planned cases are dealt)
OT 5 -Cardiac & Transplant
OT 6- Planned, cleaned & emergency cases
OT 7 -MIS( Infected, Minor, Day-care & Emergency cases)
28

7) OT 8 -Minor Surgeries

ZONING- Zoning is basically dividing the OT area according to the hygiene maintained in
different zones. Here we observed 3 different zonesa) DIRTY ZONE i.e. outside corridor, changing rooms.
b) CLEAN ZONE i.e. supply store, scrub area, pre-op room.
c) ASEPTIC ZONE i.e. operation theatre, sterile preparation.
This zoning is very essential in OTs as it helps to prevent infection.
INFECTION CONTROL IN OTsOT being such a sensitive area of a hospital, proper infection control mechanisms need to be
followed in there. So, for the same, after every surgery they mop & clean the OT with 0.4 %
Virex 256 & for Fogging of OT they use 1% Virex
For infected cases they use 2% Virex.
Also, to maintain proper hand hygiene, there are 3 Scrubbing Stations1) Scrubbing Station 1 is in between OT 6 & 7
2) Scrubbing Station 2 is in between OT 4 & 5
3) Scrubbing Station 3 between OT 1 & 2
Fro hand washing and scrubbing, Micro shield & Betadiene Scrub is used.

For sterilization of instruments, CSSD (central sterile supply department) is there where all the
instruments are properly sterilized and send back to the OT.
To make this process more effective, a DUMB WAITER is used.
DUMB WAITER is a lift which directly connects CSSD with the OT.

The used instruments are first cleaned in Instrument Processing Room at OT.
It is then packed in a double wrapped green cloth.
This pack is placed on the dumb waiter in dirty area of OT
It is received in the dumb waiter in dirty area of CSSD
It is sterilized, packed in the CSSD and a biological indicator is placed in the pack.
It is then send from the dumb waiter in sterile area of CSSD
It is received in the dumb waiter in sterile area in OT

29

Moreover, for equipments required during emergency in OT, an Autoclave and Ultrasound
machine is there, wherein the instruments are sterilized and used.
The surgeries are generally conducted from 08:00 AM to 08:00 PM, but in case of emergency,
surgery can be conducted anytime.
Also, the time duration for a patient to be kept in pre-op room is half an hour and is one hour for
post-op room. This is as per the FOS, but it may vary with the severity of the case.

SECTION B
PROJECT REPORT
ON
30

HOSPITAL INFORMATION
MANAGEMENT
SYSTEM

EXECUTIVE SUMMARY:
Hospital industry is an important component of the value chain in Indian Healthcare industry
rendering services and recognized as healthcare delivery segment of the healthcare industry,
which is growing at an annual rate of 14%. The private sector accounts for nearly 80% of the
healthcare market, while public expenditure accounts for 20%.Today, a lot of healthcare
institutions are investing into multispecialty wings of hospitals.
Multispecialty hospitals are very expensive to build and to operate. Administrators and
professionals have to be extremely cost conscious. Effective computerised systems and
procedures need to be implemented to ensure proper utilisation of limited resources toward
quality health care.
Patient care management in Fortis healthcare has fully utilised the power of computers in
Medicare, whereby network of integrated systems maintaining patient database for the hospital
services in the areas of Pathology, Radiology, Medical Research, In-patient Admissions and

31

Billing, Medical Stores & Pharmacy are operational. The implementation of the above modules
has evolved user-friendly computerised systems which are loved and cared by all.
This project tries to cover giving an insight to the Hospital Information system implemented at
the Fortis Hospital Care, Noida which is being fully utilised to provide quality service. The
computerised system has enabled the medicos to serve their customers with a smile and to meet
the corporate objective set by the founder.
I worked in all the departments of the hospital (OPD, IPD, House keeping, and Store) which are
under HIS functional coverage detecting the loop holes and redesigning their module for
increasing the effectiveness and quality of the hospital operations.

INTRODUCTION:
A hospital information system (HIS), variously also called clinical information system (CIS) is
a comprehensive, integrated information system designed to manage the administrative,
financial and clinical aspects of a hospital. This encompasses paper-based information
processing as well as data processing machines.
Computerisation at Fortis Hospital started in a limited way since 2006 when standalone systems
were introduced to take care of routine local area needs the emphasis then was mainly on bookkeeping activities. Today, the Medicare areas are computerised. An integrated information
system has been implemented in the areas of Pathology, Radiology, Medical Research, Medical
Stores & Pharmacy, Inpatient Admissions & Billing. On-line sharing of information has made
extension of the existing system to ICU and wards possible, whereby test results can be made
available on-line enabling prompt remedial action by doctor. Hospital Information System (HIS)
32

and Electronic Patient Record (EPR) instantly provide patient history details and latest test
results to the desktop of the Fortis Healthcare specialist you are consulting, saving valuable time
The most recent breakthrough by Fortis healthcare is centralisation of its IT infrastructure by
cracking a strategic deal with HCL infotech limited. The Hospitals within the Fortis network will
be connected through a centralized IT system installed by HCL which will enable online sharing
of patient records and data. Fortis Operating System (FOS), the common operating system for
all Fortis Hospitals, will be integrated with the IT system enabling faster decision making and
enhanced efficiencies.
Hospital Information System (HIS) and Electronic Patient Record (EPR) instantly provide
patient history details and latest test results to the desktop of the Fortis Healthcare specialist you
are consulting, saving valuable time.

HIS FORTIS Hospital-MISSION

Fortis is a large hospital which devotes considerable emphasis on Patient Care.
The short term objectives of the Hospital Information System in Fortis are to reduce costs
and improve the accuracy and timeliness of patient care, accounting and administration,
record keeping, and management reporting.
The long term goal is to build and maintain a patient database for analysis of data to
facilitate decision making process.
The following are three primary objectives of its advanced healthcare information system:
From the organizational viewpoint:
To provide the necessary support to the individual units, both within the local
environment of the healthcare centre and with respect to the interaction with the other
centers operating over the territory ensuring the overall integration and consistency.
33

From the operating viewpoint. To facilitate the users in the execution of their activities,
by reducing the clerical work and emphasizing the professional aspects of the various
roles. In such a way it is also simplified the introduction of the system in the
organizational context and reduced the needs of training.
From the technological viewpoint. To permit the construction of an overall distributed,
modular and evolutionary framework based on openness criteria and on the adoption of
the most adequate architectural, information and technological solutions emerging on the
international scenario. This approach permits to optimize the costs, by adopting the
hardware and software solutions most adequate to the specific needs, even if developed
by different manufacturers.

FUNCTIONAL COVERAGE
A brief outline of the functions covered in various modules is given below.
Admissions/Discharges/Transfers: This module caters to the in-patient admissions and
discharges or transfers from various wards/cabins/ICU, registration of
casualty/observation patients, birth and death records maintenance, on-line and web
based enquiry facility, daily bed availability and monthly Management Information
System (MIS) statistical reports.
Accounts Billing: This module caters to money receipt generation and instant bill
calculation for paying cases. Medicine, Pathology, Radiology, MRC charges are available
on-line for billing.

34

Pathology: This module caters to pathological test request handling and consolidated
result entry. Worksheets are printed by various sections of path lab eliminating data entry
and increasing data accuracy and timeliness.
Medical Stores: This module maintains medicine and other appliances, close
monitoring of inventory with the help of online stock enquiry, issues of medicines driven
by expiry of medicines and maintenance of batch details, analysis of movement,
consumption and indent data available with improved vendor control supported by
VED/ABC analysis and vendor rating facility.
Pharmacy: This module caters to accounting of medicines dispensed to patients from
counters maintained by automatic indenting from sub store. Control of medicine over
dosage and drug to drug interactions are maintained. Statistical analysis available on drug
wise/doctor wise.
Radiology: This module caters to accounting of X-ray films, scheduling of appointments,
and reporting of X-ray requests and result entry. Linked with billing module. Statistical
analysis of graphical data doctor wise/unit wise/type of X-ray film wise utilization versus
wastage etc.

Medical Research: This module caters to request and result entry for special tests
conducted such as T3, T4, TSH, HIV, Hepatitis,FSH etc, linked with Billing module,
statistical analysis of data patient wise/test wise etc.
Communications: In order to extend the reach and range of the existing facilities to the
outside world, Fortis has been linked with Internet, Intranet and E-mail facilities.
Admin module: The module is multidisciplinary and is meant for the administration. It
includes the details of the employees and doctors in specific. The revenue details,
availability timings, contacts etc. and other relevant record of every doctor are mentioned
here. Any person from the top management has the option of looking into the personal
details of any of the staff. However, this module is not open to all of the persons of the
35

organizations .Just the marketing and the top management officials can have a look into
it.

AIM:
To get in-depth knowledge about the hospital information system of Fortis, Noida

SPECIFIC OBJECTIVES:

1. To understand the complete process flow of Hospital Information system pertaining to

different departments in the hospital
36

AND
Accordingly, give suitable recommendations and redesigning their modules to improve
the processes and systems of the hospital.

HOSPITAL INFORMATION SYSTEM

AT FORTIS HOSPITAL,
NOIDA

There are various titles and acronyms which all declare similar approaches to managing the
information flow and storage in hospital routine services, as

Hospital Information System (HIS), or

37

Healthcare Information System, or

Clinical Information System (CIS), or

Patient Data Management System (PDMS)

are comprehensive, integrated information systems designed to manage the medical,

administrative, financial and legal aspects of a hospital and its service processing. Traditional
approaches encompass paper-based information processing as well as resident work position and
mobile data acquisition and presentation. A Hospital Information System encompasses every
aspect from administration to its financial department. It also includes everything from patient
entry and discharge to laboratory tests. Its purpose is to coordinate and/or regulate information
throughout the entire hospital. It helps to keep doctors, nurses, and other hospital personnel
informed and up-to-date. Hospital information systems are implemented through various IT
companies that specialize in health informatics. These systems are implemented in order to do
away with paper based systems. These HIS systems help with keeping patient information in a
computer so it is easily accessible by all of the personnel of the hospital. Also, by implementing
a computer system the hospital is able to recognize trends that the human eye might not be able
to see through paper systems. Databases are filled up so data can be organized. Also there are
less hospital errors because everybody can understand and read a computer. Before when doctors
wrote on paper their hand writing couldn't be understood because it wasn't written properly.
These systems also help with the collaboration between different hospitals in order to reduce
duplicate testing. Time is also saved by looking at previous data instead of having to re-write it
every time the patient goes to a different hospital
Advantages
Easy Access to Patient Data to generate varied records, including classification based on
demographic, gender, age, and so on. It is especially beneficial at ambulatory (out-patient) point,
hence enhancing continuity of care. As well as, Internet-based access improves the ability to
remotely access such data.

It helps as a decision support system for the hospital authorities for developing comprehensive
health care policies.
Efficient and accurate administration of finance, diet of patient, engineering, and distribution of
medical aid. It helps to view a broad picture of hospital growth
Improved monitoring of drug usage, and study of effectiveness. This leads to the reduction of
adverse drug interactions while promoting more appropriate pharmaceutical utilization.
Enhances information integrity, reduces transcription errors, and reduces duplication of
information entries.
38

Components of HIS
HIS can be composed of one or a few software components with specialty-specific extensions as
well as of a large variety of sub-systems in medical specialties, as e.g. Laboratory Information
System (LIS), Radiology Information System (RIS) or Picture archiving and communication
system (PACS)

Laboratory Information System (LIS)

A lab information system ("LIS") is a class of software that receives processes, and stores
information generated by medical laboratory processes. These systems often must interface with
instruments and other information systems such as hospital information systems (HIS). A LIS is a
highly configurable application which is customized to facilitate a wide variety of laboratory
workflow models. Deciding on an LIS vendor is a major undertaking for all labs. Disciplines of
laboratory science supported by LISs include haematology, chemistry, immunology, blood bank
(Donor and Transfusion Management), surgical pathology, anatomical pathology and
microbiology.
Laboratory Information Systems commonly support the following features:

Patient Check In
Order Entry

Specimen Processing

Result(s) Entry

Reporting

Patient Demographics

Physician Demographics

Radiological Information System (RIS)

A radiology information system (RIS) is a computerized database used by radiology
departments to store, manipulate, and distribute patient radiological data and imagery. The system
39

generally consists of patient tracking and scheduling, result reporting and image tracking
capabilities. RIS complements HIS (Hospital Information Systems), and is critical to efficient
workflow to radiology practices

BASIC FEATURES
Radiology information systems commonly support the following features:

Patient Registration and scheduling

Patient List Management

Interface with modality via Work list.

Radiology Department workflow management

Request and document scanning

Result(s) Entry

Reporting and printout

Result(s) Delivery including faxing and e-mailing of clinical reports

Patient Tracking

Interactive Documents

Technical Files Creation

Modality and Material management

A picture archiving and communication system (PACS) is a medical imaging technology

which provides economical storage of, and convenient access to, images from multiple modalities
(source machine types). Electronic images and reports are transmitted digitally via PACS; this
eliminates the need to manually file, retrieve, or transport film jackets. The universal format for
PACS image storage and transfer is DICOM (Digital Imaging and Communications in Medicine).
Non-image data, such as scanned documents, may be incorporated using consumer industry
standard formats like PDF (Portable Document Format), once encapsulated in DICOM. A PACS
consists of four major components: The imaging modalities such as X-ray computed tomography
(CT) and magnetic resonance imaging (MRI), a secured network for the transmission of patient
information, workstations for interpreting and reviewing images, and archives for the storage and
retrieval of images and reports
40

HIS of Fortis, Noida has following Modules:

OPD Billing Module

IPD Billing Module
Store Module
House Keeping Module
Nursing Module
Administration Module
Diet Module
Medical Record
Purchase Module
LIS and RIS

Cloud Computing
Cloud computing refers to the delivery of computing and storage capacity as a service to a
heterogeneous community of end-recipients. End users access cloud based applications through a
web browser or a light weight desktop or mobile app while the business software and data are
stored on servers at a remote location. These services are broadly divided into three categories:
41

Infrastructure-as-a-Service (IaaS), Platform-as-a-Service (PaaS) and Software-as-a-Service

(SaaS). Infrastructure-as-a-Service like Amazon Web Services provides virtual server instance)
to start, stop, access and configure their virtual servers and storage
Platform-as-a-service in the cloud is defined as a set of software and product development tools
hosted on the provider's infrastructure, GoogleApps are examples of PaaS.
In the software-as-a-service cloud model, the vendor supplies the hardware infrastructure, the
software product and interacts with the user through a front-end portal Services can be anything
from Web-based email to inventory control and database processing. Because the service
provider hosts both the application and the data, the end user is free to use the service from
anywhere

42

A cloud can be private or public. A public cloud sells services to anyone on the Internet.
(Currently, Amazon Web Services is the largest public cloud provider.) A private cloud is a
proprietary network or a data centre that supplies hosted services to a limited number of people.
When a service provider uses public cloud resources to create their private cloud, the result is
called a virtual private cloud.

43

Cloud computing of Fortis, Noida

Fortis, Noida has Private cloud computing network
Infrastructure as a Service - A robust data centre providing virtualized hardware and connectivity
for all Fortis locations with full disaster recovery and backup infrastructure
Platform as a Service - for Fortis IT and Fortis software vendors to develop, maintain, deploy
and deliver software applications for various Fortis functions.
Software as a Service - As part of the cloud, Fortis has centralized its Hospital Information
System: Trakcare from Inter Systems and created a central analytics and MIS platform.

HOUSEKEEPING MODULE OF HIS

Introduction

44

Housekeeping refers to the general cleaning of hospitals and clinics, including the floors, walls,
and certain types of equipment, tables and other surfaces. The purpose of general housekeeping
is to:
reduce the number of microorganisms that may come in contact with patients, visitors, staff
and the community
provide a clean and pleasant atmosphere for patients and staff.
Existing House Keeping Module:
Housekeeping module of Fortis hospital mainly deals with the bed status of the ward in which
firstly the beds from which patient ready to move are shown and then the information through
phone is being delivered to the floor supervisor about the room that has to be cleaned which is
also shown in the HIS housekeeping module then when the room is cleaned the information is
being passed by the supervisor to the housekeeping desk that room has been cleaned and the
person attending the call mark in the HIS that the room has been cleaned and vacant and ready to
be occupied by other patient.
Since according to my perspective the house keeping module is very short and limited other
work like laundry management is not dealt in this HIS module and staff at the department has to
do extra work along with the assigned task and there is shortage of the staff also.
Recommendation
On the basis of existing module.
Bed status to be filled by the nurse when the patient is about to move.Information of bed to be
cleaned should be displayed on the screen which is to be installed in the house keeping
department. The beds which are to be cleaned should be displayed on the screen just like status
which is shown on the railway station showing train status.
Then, through phone message is to be send to the concerned floor supervisor regarding the
cleaning of the room and then the supervisor should tell to the nursing station to mark it vacant in
the system. Housekeeping module should be a part of ward module. There is no need of
housekeeping module it should be a part of ward module according to the existing module
because it needs extra employee to be there to attend and to see the status and it is also causing
delay in the work as person who is attending has to do his assign work also.
Secondly, The status of the beds other then the floor wards like (micu, ccu) which is being shown
on the housekeeping module should not be shown as it is to made vacant by the nurse

who is on HIS desk as it cause an extra work and extra overload on the employee and more over
these beds are not under the authorization of housekeeping department.
My Recommendations on New module
45

Other then the facility and options provided by the exiting HIS housekeeping module. The
housekeeping module should be designed to forecast the total number of housekeepers needed
each day in the future based on current guests in-house and expected arrivals/departures. For
example the forecast report may indicate that a total of 124 rooms will be dirty tomorrow for a
total cleaning time of 101 hours. The next day there are 214 dirty rooms for a total cleaning time
of 194 hours. This information can be used to plan the work schedules of housekeepers to make
sure there are not too few, or too many, housekeepers each day
The housekeeping module can automatically create a cleaning schedule each day for each
housekeeper based on the number of dirty rooms, estimated clean time per room, and number
of housekeepers.
The third major element of the housekeeping module is historical reporting. It is possible to
measure the performance of each housekeeper by tracking the estimated clean time and actual
clean time, as well as variance. We can also track each time a room was cleaned and by whom.
For example, if a guest checks in to a dirty room, you can determine which housekeeper
erroneously marked the room as clean.
Other then the housekeeping module there should be laundry management module which is to
merged with and called as housekeeping and laundry management module.
A modified housekeeping module:

Laundry management module:

46

Cash voucher and bills

47

Stock ledger

The other technique which can be used to increase the efficiency and effectiveness of the
HIS is implementation of the RFID(Radio frequency identification) technique to track
the location the assets and to improve the quality of the hospital services
Radio Frequency Identification (RFID) is a method for remotely storing and retrieving
data using devices called RFID tags or transponders.

Nursing Module
48

Nursing module has been installed into IPD department. There are 5 floors in the IPD department
and 2nd floor consist of all ICUs (NICU, MICU, CTVS, SICU, LTICU etc). Each floor except 2 nd
floor consists of two nursing station where nursing module of HIS has been installed. Nursing
Module includes nursing wards administration, patient data monitoring, nurse planner,
appointment Scheduler, patients search, documentation, patient data folders. Majorly, the work of
the nursing module is to enter the IP patient indent and investigation report into the HIS. Other
options include return indent, indent received options, and diet scheduler and surgery procedure,
and discharge tracker are also entered into it.
The process flow is:

Nurse enters the patient indents which are being prescribed by the doctor into the doctor
sheet of the patient file
Nurse enters the prescription into the register present on the nursing station

Indents are entered in the system by the data entry operator into the HIS and this
information is then send to the IP or MC (medical consumable) Store

Then the indents are being supplied to the nursing station.

Nurse receive the indents and again the data entry operator mark as Received into the
HIS.

Investigation orders are also entered into HIS with same procedure and discharge
intimation are also given with the ward module.

Nursing module also include Diet Scheduler module in it where diet of the patients are
being entered

49

NURSING MODULE IS BEING CONNECTED TO THE FOLLOWING:

Recommendations on the Nursing Module:

Since Nursing module is very big and needs lots of work and attention. Nurse as we know are
very important part of the hospital. Acc. To me module should be divided into two parts:
Ist part contain the use of Tablet PCs by the nurse and medical professionals which can be
connected to HIS of the hospital. Tablet PCs should be connected with each bed (one tab to one
bed or two bed) Patient history and other details can be easily shown in the pc and it should be
PACS and DICOM enabled to see the images of ultrasound, x-ray etc.Tablet pc will help in
entering correct prescription which should be entered by doctor only to reduce medication error
and patient activity sheet can be prepared. Nursing and doctor notes can also be written in the
tablet PCs. Since paper work takes lots of time and chances of error are more

50

ELECTRO
NIC
MEDICAL
RECORD
DEPT

Tablet pcs will be connected to ward module which can be cut short and contains only diet
module and discharge intimation process also we can view information about the patient through
patient IPID. Tablet PCs will function as doctor will enter the prescription rite from the patient
bed which will directly go through HIS to store department and radiological department. Tablet
PCs will contain all the patient history which will be entered into it along with DICOM enabled
images viewer it will help in reducing chances of error and time. On the spot report can be
generated and send to the IPD billing department for billing procedures.
More info of Tablet PCs
The tablet PC is an ultimate solution for nurses and medical professionals to perform daily
documentation and reference works. It offers quick wireless access to medical and drug
reference, patient records and allows instant connectivity with the main database of the hospital.
This tablet PC has been designed to save time and boost accuracy by eliminating paper records
and has the potential to become a complete hospital solution to save countless deaths each year
caused by various medical errors.
The portability and use of medical software of the tablet will replace the nurses clipboard and
increase her functionality. It will feature a touch screen interface where the user can interact with
various applications and also can be docked on the table for more familiar use. Throughout the
51

hospital there will be several docking base where the nurse can dock the Tablet Pc to recharge
the battery and input data easily.

Tablet PCs allow health care professionals of all levels to be more efficient and accurate
in their day-to-day activities by enhancing their ability to perform a variety of tasks, both
at their desks or on the go.
Examples of activities that can be improved include:
Collection and Integration of Patient Data
Patient Record Retrieval, Review and Collaboration,
Meetings
House calls and patient bedside visits
Wireless interaction among staff and physicians
These activities all involve basic tasks, which are made easier by the Tablet PC.
Some examples are:
Completing electronic forms or writing prescriptions
Taking progress notes in handwriting that can be converted to printed text
Adding handwritten notes to charts and images
Integrating several reports, such as tests and treatment plans, into one document
Sharing data via a secure wireless LAN
The key features behind these benefits are:
The versatility of the Tablet PC, which allows data entry from a keyboard, a
Digital pen or dictation
The Tablet digital pen for navigation and writing
A health care worker using a Tablet PC can enter data directly into an electronic form via
an Electronic Health Record (EHR). This not only saves the time previously required to
fill out a paper form and then re-enter the data into a computer, but also eliminates the
human error inherent in this process.
When conducting examinations, patient reviews, treatments, or rounds, the Tablet PC
can provide immediate access to information. Additionally, the capability to write
directly on the durable tempered glass screen permits capturing useful information, such
as progress notes, diagrams or images in an electronic format, and then annotating them,
ensuring that no information is lost. When completed, a full report can be generated on
the spot.
The Tablet PC assists with document creation, editing and collaboration. The capability to
write directly on the screen allows health professionals to share a broad range of
Information regardless of whether it is in the form of notes, sketches, or document
Annotations.

52

2nd part consist of ward module which will deal with diet module, bills, reports
generation, bed management, patient transfer process and other process which is present
on existing ward module except the one which has been covered in use of tablet PCs to
make the work easier, effective and maintaining the inflow of the patients.

Summary
No need of file to maintain
No loss of documents
No medication error
Can be effective in discharge Process of the patients
Mistakes can be avoided through access to complete medical histories and by
inputting information directly into electronic forms that have built-in logic to flag
errors as they are entered
Can save more than moneyit can save lives and ensure that patients receive the
best care available.
Speed up the work of emergency response teams
Tablet PCs could help insurance companies and health care providers by:
Responding to and closing claims more quickly
Producing more accurate claim reports
Submitting more accurate coding for correct billing
Reducing insurance fraud

53

IT and Store Module

Health information technology
IT allows health care providers to collect, store, retrieve, and transfer information electronically
by providing new ways for providers and their patients to readily access and use health
information. Information technology (IT) has the potential to improve the quality, safety, and
efficiency of health care.
Similar terms can be used to define different products, and the exact functions of a system will
depend on the specifics of its implementation in a given setting. Both the terms and the functions
also change over time. For example, computerized provider order entry (CPOE), which can
minimize handwriting or other communication errors by having physicians or other providers
enter orders into a computer system, can apply only to prescription drugs, or may also include
additional physician orders, such as x-rays or other images, consultations, and transfers. For
electronic health records (EHRs, also known as electronic medical records, automated medical
records, and computer-based patient records, among other names)
The following technologies and terms are often included in information technology in health
care:
Electronic
(EHR):

health

record

Computerized provider order

entry (CPOE): CPOE in its basic
form is typically a medication
ordering and fulfillment system.
More advanced CPOE will also
include lab orders, radiology
studies, procedures, discharges,
transfers, and referrals.

EHRs were originally envisioned

as an electronic file cabinet for
patient data from various sources
(eventually integrating text, voice,
images, handwritten notes, etc.).
Now they are generally viewed as
part of an automated order-entry
and
patient-tracking
system
providing real-time access to
patient data, as well as a
continuous longitudinal record of
their care.

Clinical decision support

system (CDSS): CDSS provides
physicians and nurses with realtime diagnostic and treatment
recommendations.
The term
covers a variety of technologies
ranging from simple alerts and
54

prescription
drug
interaction
warnings to full clinical pathways
and protocols. CDSS may be used
as part of CPOE and EHR.

Bar coding: Bar coding in a

health care environment is similar
to bar-code scanning in other
environments: An optical scanner
is used to electronically capture
information encoded on a product.
Initially, it will be used for
medication
(for
example,
matching drugs to patients by
using bar codes on both the
medications and patients arm
bracelets), but other applications
may be pursued, such as medical
devices, lab, and radiology.

Picture
archiving
and
communications system (PACS):
This technology captures and
integrates
diagnostic
and
radiological images from various
devices
(e.g., x-ray, MRI,
computed tomography scan),
stores them, and disseminates
them to a medical record, a
clinical data repository, or other
points of care.

Radio frequency identification (RFID): This technology tracks patients

throughout the hospital, and links lab and medication tracking Wireless
communications system. It is neither mature nor widely available, but may
be an alternative to bar coding
Automated dispensing machines (ADMs): This technology distributes
medication doses.
Electronic materials management (EMM): Health care organizations use
EMM to track and manage inventory of medical supplies, pharmaceuticals,
and other materials. This technology is similar to enterprise resource
planning systems used outside of health care
Interoperability: This concept refers to electronic communication among
organizations so that the data in one IT system can be incorporated into
another. Discussions of interoperability focus on development of standards
for content and messaging, among other areas, and development of adequate
security and privacy safeguards.

Barriers to adoption
Investment in IT is costly
The costs of implementation and ongoing maintenance vary by the
size of the hospital, as well as by the functions to be installed
Resistance to change by doctors, nurses and other staff
Not all staff is tech savvy, so they prefer paper work
55

56

STORE MODULE:
Store module consists of all pharmacy and inventory management process. Store module
covers IP Pharmacy, Medical Consumables store, General Store, OT Pharmacy, OP
Pharmacy.
Process flow in IP Pharmacy

Order is being given through HIS in the form of

Indents to IP store by the Data entry operator (nursing Station)

Person in the IP store checks the Indents Depending upon

The type of indents (New, Stat, Normal)

Medicines are recorded, quantity is checked and the medicines are

Dispatched to the respective stations
IP store mainly delivers the drugs to the IPD patients only. Other features of the IP
store module consist of Purchase requisition to be given to the purchase department
for new drugs to be bought which is dependent on ROQ(re order level quantity) and
QOH (quantity in hand) which is shown in the HIS.
Return Indents are kept which are being received by the nurse and data is entered in
the HIS and it is thoroughly checked whether it infectious or not or it is broken or not
if any of such problem is found out then indents are not taken back.
Once the Purchase return has been entered it cannot be corrected. The only
way
is to reject the IP returns in the HIS.
FIFO (First in First out) method is followed in dispatching of the medicines to
reduce expiry date errors.

Medical consumables Store

57

The Function of MC Store Module is as same as IP store but it is different in the form
of delivery of Indents. IP pharmacy basically deals with the drugs and MC sore deals
with the medical consumables like bandages, syringes, adhesive, solution, cotton etc.
MC Store is attached with the General store also.
OP pharmacy
The function of HIS in OP is different from the other stores. Here, drugs are directly
dispatched to the patients on the basis of Doctor Prescription. OP store mainly deals
with the OPD patients. Here, the Prescription is given by the patients to the chemist.
The chemist prepares the bills and dispenses the drugs to the patients directly on the
Basis of Doctor Prescription.
OT pharmacy
It is as same as IP store module.
Recommendations:
The IP, MC, OT pharmacy should be connected to PC tab not with the ward module
as discussed in the nursing Module so that Indents should be directly entered by the
doctor on e-prescribing method through CPOE(Computerized Physician order entry)
through PC tablet. So that the chances of medication error can be reduced, saving on
time
E-prescribing, which will allow electronic prescriptions filled by physicians to flow
to both the pharmacy and the Prescription Pricing Authority that manages payments.
CPOE should be implemented for OP pharmacy for less paper work and efficiency
and to reduce medication errors
Advantages of CPOE:
reducing medication errors, including adverse drug events
decreasing dosage errors
prescribing certain medicines more precisely
Improve the quality of healthcare
RFID technology or bar coding technology should be implemented
(more emphasis on RFID technology) to reduce ambulatory and
inpatient medication error and the number of adverse drug events.
RFID technology tracking the assets as medicines are one of the
important assets in the hospital and it can be combined with the
existing HIS of the hospital.

OPD MODULE

58

The Outpatient Department of Fortis, Noida has a separate building for outpatients with
ground floor and First floor having all the important services like TMT, Echo, ECG, Surgical
OPD, Paediatric cardiology, Consultation, Executive Health Check (EHC), Comprehensive
Cardiac Check (CCC), and Pharmacy. It has a lab facility in lower Basement along with a
sample collection room on the ground floor.
The patients collect their report from the report desk in the ground floor of OPD building.
The preventive health check up is done on the ground floor with x-ray and Ultrasound in the
IPD building opposite to the OPD building.
PROCESS OF OPD BILLING
PATIENT ENTERS INTO THE HOSPITAL

PATIENT APPROACHES THE OPD REGISTRATION DESK

PATIENTS FILLS THE REGISTRATION FORM

INFORMATION IS ENTERED IN TO THE HIS OF THE HOSPITAL

THEN, UHID (UNIQUE HOSPITAL IDENTIFACTION) IS GENERATED

BILLS ARE PROCESSED AND NEW INVESTIGATION ORDER OR

DOCTOR VISIT ARE ENTERED INTO HIS

THEN, HARD COPY

OF THE BILL IS TAKEN WHICH IS GIVEN TO

THE PATIENT FOR FURTHER PROCEEDING

The Standard Support services provided in the OPD are:-

59

a) ECG Room
b) Dressing Room
c) Plaster Room

This process of Registration takes 2-3 min.

The OPD is located in the OPD building(right side to the IPD front

desk)
Co-ordinaters are there who help the patients regarding their queries
Proper signages are there in the OPD department for easy flow of the

patients
A large waiting area is there near the OPD registration counter, and

outside all the departments, adequate no. of chairs are placed.

Appointment is either on Telephone or by personally coming and
getting the appointment fixed.

Functional Organizational Structure (OPD)

Head patient Care Services

OPD Supervisor

PHC Supervisor

Assistant Supervisor

PHC Co-ordinator

Front Office Assistant

PHC Activities:

60

 Customers appointed are scheduled for the desired PHC package & the appointment
date & time is informed as per the process of booking.
PHC customers are informed about the precautions they need to take fasting (12 hrs)
medication etc and other information related to packages.
For scheduled appointments, all concerned department (lab, radiology, NIC) are
informed about the no. of appointments.
Customers arrive at OPD/PHC reception as per their appointment.
Clients are registered and billed
As required customers are escorted to various departments like lab, radiology, NIC
All investigation reports are compiled and appointment for final consultation with
doctor is fixed.

Problems in PHC
The biggest problem which faced by the PHC department is the waiting time in XRay and ultrasound. Patients becomes irritated as it takes long time for them for the
test to be done

61

Interpretation:
The above pie chart shows different time consumed at different places starting from the
billing till the updation of final reports.
The value of Turnaround Time is 4.5 hours according to Fortis Operating Systems Indicator
for the package. As we can see that more time is consumed for processing and final updation
of reports just after the patient gives the second sample after breakfast, so the time should be
maintained in order to achieve the benchmark of 4.5 hours.
Recommendations:
1. Regarding the waiting time in ultrasound, it can be reduced by redirecting some
patients to the other test which has to be done with fasting. Since, ultrasound and Xray has limited machines which increase the waiting time of the patients. In the
meantime they can be directed to take other test this will help in reducing the irritation
of the patients and as well as improving the TAT as the patients doesnt have to wait
for test for a longer time.
2. Use of PACS and DICOM in the hospital will help in reducing the time as we have
seen in the above diagram as most of the time is taken in processing of the final
reports and consultation. PACS and DICOM will enable the doctor to view the reports
directly into the computer which will result in fast consultation and processing of the
reports will be reduced as the data of the patients will be directly linked to HIS so,
there will be minimum or no use of films used in X RAY and ultrasound and they can
be directly obtained from the patient UHID.
3. If patient want to see the report or want to take the report it can be printed at one
station or it can be directly viewed by the patient on the website through the UHID
with password given by hospital as happens in the lab report.
4. With this implementation it will help in reducing the cost incurred in the films
produced and processing of that films and reports thereby reducing the waiting time.
5. Connecting the LIS and RIS with the HIS through PACs and DICOM viewer will also
help in improving the threat of lost of files or reports.
62

6. Medical check-ups for the staff should be scheduled in the afternoon when the patient
load is considerably less.
7. The last and the foremost thing for improving the waiting time is implementation of
the RFID technique for patient tracking
Active RFID-RTLS patient tracking and transport applications are being used to improve
patient flow in hospital.
These patient tracking systems can provide data which have significant effect on improving
patient tracking, patient flow and provide valuable insight into patient flow improvements
that can impact patient care. For example, patient tracking and patient flow applications can:

Measure patients waiting longer than 15 minutes for triage

Detail the percentage of patients waiting longer than 15 minutes

Determine lab turnaround times to hold them accountable.

63

Other Recommendations:
Medical record department should be made electronic ( Implementation of the
electronic medical record) which will help to

Improve quality and convenience of patient care

Increase patient participation in their care

Improve accuracy of diagnoses and health outcomes

Improve care coordination

Increase practice efficiencies and cost savings

Implementations of RFID will help in improving the effectiveness and in providing quality
care to the patients.
RFID will help in
Patient Identification
Many health professionals are concerned about the growing number of patients who are
misidentified before, during or after medical treatment. Indeed, patient identification error
may lead to improper dosage of medication to patient, as well as having invasive procedure
done. Other related patient identification errors could lead to inaccurate lab work and results
reported for the wrong person, having effects such as misdiagnoses and serious Medication
errors In order to cut these clinical errors, to improve patient care and security and also to
improve administration and productivity, RFID-based patient identification and tracking
systems should be implemented
Blood Tracking
RFID system should be there to track the blood going from the blood bank
Anti-Counterfeiting
Drug counterfeiting is an increasing problem: counterfeit drugs reduce patient safety,
as they can contain dangerous substances. RFID technology should be used in tracking the
drugs and labeling of the drugs so that the product codes can be retrieve and product
authenticity can be checked

64

FORTIS Hospital Information SystemThe Future

Fortis has become the First Healthcare Company in India to
Undertake Complete Outsourcing for IT Applications and
Infrastructure Management. This deal will pave way for Enhanced
Efficiencies and Patient Care

HCL Info systems Ltd, Indias premier information Integration Company and Fortis
Healthcare Ltd, on September 2009, announced a strategic IT outsourcing deal. The deal is
part of a five year agreement under which HCL will undertake complete outsourcing of IT
systems and processes of Fortis Healthcare Ltd.
Fortis, Noida will be operating on Trak care a complete Hospital Information System (HIS)
solution. This is a totally web-based system connected to centralized server. Different
modules like BILLING which is used in OPD and IPD for patient billing, PHARMACY
which is used for dispatching medicines and medical consumables to outpatient and
inpatients, INDENTING module is used by nurses for indenting medicines to the patients.
DISCHARGE SUMMARY modules used for making discharge summary of patients, which
is integrated with their LMS server for lab reporting. The Pathology Lab for all inpatient and
outpatient lab reports uses LMS. The finance module is based in Prodigious, which is
completely integrated with Trak modules for all MIS and other reporting purposes.
This tie up will create newer benchmarks in the quality of healthcare delivery and patient
care and take it to the next level. IT forms the back bone for hospital operations and
improved patient care. The system integration with high end IT infrastructure would result in
enhanced performance and superior patient care.

65

Data Flow Diagrams

The following diagrams are showing the total process flow in the hospital
right from the beginning when patients enters into the hospital till he
discharges pays the bill and go out of the hospital.

Level 0

66

Level 1

67

Level 2

68

Level 3

69

Conclusion:
It can thus be seen that deploying IT can help the medical profession in improving its quality
of service and thus automatically increasing the preparedness and defensiveness. Of course, it
is of vital importance that the software must have the right type of modularity and openness
so that it is manageable, maintainable and upgradable. The hardware should also be reliable,
available and have the necessary performance capacity. Certainly, computers with their
intrinsic power can play a major role in a hospital. Computers can act as a communication
link between departments and allows the common database to be shared by them. They can
perform the complex task of matching, tabulating, calculating, retrieving, printing and
securing the data as required. Well designed, integrated computer system can be a great tool
in the hands of the hospital management in improving services, controlling cost, and ensuring
optimal utilisation of facilities.

70

Bibliography
1.
2.

www.wikipedia.com
http://www.hp.com/sbso/busproducts_notebooks.html

3.

www.rfidjournal.com/article/articleview/319/1/1/.

4.

IIE Solutions. Florida Airport Gets First RFID

System. July 2002

5.

www.hospitalinformationsystem.com

6.
7.

8.

www.wikinvest.com/concept/Cloud_Computing
www.cdac.in
http://www.scribd.com

71

ANNEXURE A

S.No.

Department

Date of visit

time spent

People met

LABORATORY

3 MAY 2012

30 MINUTES

Mr. Kumar( Lab

Manager)

CSSD

7 MAY 2012

25 MINUTES

Mr. Raj
Kumar(HOD)

EMERGENCY

10 MAY 2012

45 MINUTES

Dr. O.P
Choudhary( ER
Head)

ICU

18 MAY

20 MINUTES

Blood Bank

23 MAY

20 MINUTES

Dr. Seema
( HOD)

OT

29 MAY

1 HOUR

Sister Anitha

72