ABSTRACT

Introduction: Integrated Hospital Welfare Management System (HWMS) is cloud-based and vital to
decision-making and plays a crucial role in the success of the organization. The computerization of
medical records and documentation has resulted in efficient data management and information
dissemination for users. Hospital Welfare Management System addresses the entire major functional
areas of modern multi-specialty hospitals. The package enables improved patient care, patient safety,
efficiency and reduced costs. It provides easy access to critical information, thereby enabling
management to make better decisions on time further this application also provides the service of FOC.

Aims:

The short-term objectives of the online computerized system 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 the analysis
of data to facilitate the decision-making process. Methods: To run the system it requires some Hardware
& Database for IT Department. The technique involves the Patient Registration System, Finance &
Accounts, Human Resource Management System, Laboratory, Out Patient Management System, and
Inpatient Management System.

It can thus be seen that deploying Hospital Welfare Management System (HWMS) can help the medical
profession in improving its quality of service and thus automatically increase 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 upgradeable. 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 hospital
management in improving services, controlling costs, and ensuring optimal utilization of facilities.

1. Introduction

Hospital Welfare Management Systems can be defined as massive, integrated systems that support the
comprehensive information requirements of hospitals, including patient, clinical, ancillary, and financial
management. Hospitals are extremely complex institutions with large departments and units coordinate
care for patients. Hospitals are becoming more reliant on the ability of the Hospital Welfare
Management System (HWMS) to assist in diagnosis, management, and education for better and
improved services and practices.

Hospital Welfare Management System (HWMS) is vital to decision-making and plays a crucial role in the
success of the organization. The computerization of medical records and documentation has resulted in
efficient data management and information dissemination for users. Receptionists, Doctors,
Pharmacists, and other healthcare workers can now access the information without delay or errors. The
present study reveals, the existing system requires upgradation to meet the requirements of the
Receptionist and the Doctors. Participants feel HWMS assists in decision-making and medical audits.
Participants felt that the existing HWMS resulted in a long time for OPD consultation and a delay in
investigation results. The majority of the participants feel that HWMS helps in education and research.

Hospital Welfare Management System addresses the entire major functional areas of modern multi-
specialty hospitals. The package enables improved patient care, patient safety, efficiency, and reduced
costs. The system provides the benefits of streamlining operations, enhanced administration, and
control, improved responses, cost control, and improved profitability.

The System is developed to maintain a secure database of patients and business information. This
system was planned to address the challenges encountered by healthcare centers such as small & large
hospitals and private clinics.

1.1. Importance

The importance of the HWMS is reduced patient waiting time for appointments, billing, and collection of
medicine from the pharmacy and reduced time for diagnostic result preparation by directly capturing
the data from machines. Patient records are available in the hospital and can be referred by any
consultant at any time from any location. Online statistical data is available for middle and top
Management for decision-making. Financial information is available at any given point in time. Human
resource data is available online for taking any decision on the manpower required. In HIS online data is
available on revenue, patient statistics, doctor performance, department performance, and financial
data on the budget for Management decisions. It also helps to improve patient care, cost control, and
data security

1.2. Experiences in Asia

In Southeast Asia the health information technology market continues to grow as healthcare services
are improved and expanded.

• Malaysia–Malaysia’s healthcare system is well developed with easy access to both primary and
secondary care facilities. Health IT is high on the Government’s strategic agenda. Malaysia is the world’s
third most popular destination for medical tourism and the market is expected to grow by 30 percent
per year over the next couple of years.

• Singapore–Singapore has one of the most mature healthcare sectors in Southeast Asia with an
efficient well-developed infrastructure, a highly educated population and local technological expertise. A
10 year IT Master Plan has a US$300 million budget for IT systems. The main goal is to have a nationwide
electronic health record system.

• Thailand–three main health insurance schemes act as the main healthcare purchasers. There are plans
to develop an electronic health information system to link the systems used by these three schemes.
Demand for healthcare services has continued to increase since universal healthcare programme
became free for patient visits to the doctor or the hospital. Thailand’s healthcare system is struggling to
cope.

1.3. Pakistan Prospect

The system is well-developed in developed countries but almost absent in developing countries like
Pakistan. Some of the private hospitals and welfare system in Pakistan has taken initiative but could not
operate properly.

2. Aims

In a large hospital, which devotes considerable emphasis on patient care? The short time objectives of
the computerized system are to reduce costs and improve the accuracy and timeliness of patient care,
accounting, administration, record keeping, and management reporting. The long-term goal is to build
and maintain a patient database for the analysis of data to facilitate the decision-making process.

This vision to maintain complete paperless and filmless patient records, where patients will not carry
any papers anytime to come to the hospital was a major challenge for us.

3. Methods

Run HWMS requires some hardware, software, and a database for the IT department like two node
cluster SERVER with a storage device, application SERVER, backup SERVER, server rack, switch RAC, KVM
switch, Line UPS, voltage stabilizer, database(RDMS) with RAC, network cable, network switch, RJ-45
connector, laptop, computer, lager printer, DOT matrix printer, technical Instrument.

3.1. Technique

The technique involves some systems like Patient Registration, Patient Appointment, Patient Billing,
Finance & Accounts, Pharmacy Management, Medical Store, Procurement Management, Assets
Management, Human Resource Management, Payroll Management, Laboratory Management, Patient
Appointment Management, Out Patient Management, Inpatient Management, Nursing Care
Management, Accident & Emergency Management. OPD Management, Infection Control Management,
Social Welfare Management, Engineering Management, Intensive Care Information, Mortuary
Information, Forensic Medicine Information, Security & Access Control Management Systems.

3.2. Process Description

When a patient comes to any health center for medical service, the procedures for providing the patient
with the desired service(s) are covered in this module which are described below:

There are two types of patients visits a hospital and healthcare center. One type of patients are
registered ones, and another type of patients are those who do not get registered (T_ID) with any
center. The process description is provided according to the visits (1st visit and subsequent visits of
registered patients, and visit of T_ID patients) to a healthcare center. The visits of patients are described
below:

1. First Visit of a Registered Patient

2. Subsequent Visits of a Registered Patient

3. Visit of a T_ID Patient Detailed process description of the above three categories are given below:

3.2.1. First Visit of a Registered Patient

Processes involved in maintaining and providing service to a new patient visiting for the first time to a
hospital or health center who gets registered with the center are as illustrated below:

The patient at first comes to the reception for registration and hospital information. For the patient
willing to be registered, his/her primary information will be put into the system and the system
generates a registration number known as CRN (Computer Registration Number) for the patient. This
CRN will be used throughout the whole system as the reference ID for that particular patient. The
receptionist will consider about the patient whether he/ she is a corporate client (preset categories of
patients who get special facilities) or not. These and some other categories of patients may have free
registration facility. In these cases, such patients will go directly to the Nurse Station, ignoring the step
3.1.2 & 3.1.3 (The whole process may be carried out at the Nurse Station in case of increased workload
at the reception).

From the reception the patient is sent to the Cash Counter to pay the registration fee or FOC Services.

The person in duty at the Cash Counter will receive registration fee from patient and he/she may come
to the reception again in case of needy patient the counter register the patient for FOC service in that
case the inventory will be managed accordingly..

If the patient wants to avail Social Welfare facility, he/she then is sent to the Social Welfare Department.
From Social Welfare Department the patient will come to the Nurse Station.

Figure 1. Patient Registration flow for first visit for OPD.

At the Nurse Station, the patient details his/her complaints the person in duty at the Nurse Station and
arranges appointment with the General Physician or with a Specialist and then enters information
including Chief Complaints, Past Illness, Family History, Personal History, Anthropometry, General
Examination, etc. if necessary.

At the Nurse Station, the patient will again be informed about the Social Welfare facility available for the
registered patients.

The patient visits the General Physician and gets his/her advice and treatment. The Physician may advise
the patient to see a Specialist for his/her complaints. In this case the patient comes back to the Nurse
Station The person in duty at the Nurse Station arranges appointment with the Specialist and the patient
follows the process 3.1.6.2.

The patient visits a Specialist and gets his/her advice and treatment.

The patient comes from the Physician / Consultant to the Cash Counter to pay Physician or Consultant’s
charges. Registered patients are entitled for full or partial payment. They can leave some payments due.
From the Cash Counter a prescription will be printed for the patient.

If medicine(s) are prescribed for the patient, and if the patient wants to get the medicines from drug
store or pharmacy, the process for taking and/or buying medicine(s) and/or other items will be covered
by the Pharmacy module.

If the patient is advised for any investigation by the Physician or the Specialist, the patient comes to the
Nurse Station. The person at the Nurse Station may suggest the patient for some available discounts in
some investigation(s) and the patient goes to the reception.

From here on, the process of Diagnostic Investigation Management (DIM) module starts.

3.2.2. Subsequent Visits of a Registered Patient

When a registered patient comes to that hospital or Health care center any time after registration,
his/her visit is considered to be the 2 nd visit. The procedure to manage such registered patients is
illustrated below:
A registered patient at first may come to the reception, or may directly go to the Nurse Station. At the
reception the patient is reminded about the Social Welfare facility. If the patient wants to go for Social
Welfare, he/she is sent to the Social Welfare department. Else the patient is sent to the Nurse Station.
Figure 2. Patient’s second visit flow for OPD.

At the Nurse Station arranges appointment with General Physician or with a Specialist. After
appointment is scheduled, the patient details his/her complaints and the person in duty at the Nurse
Station enters these information including information like Chief Complaints, Past Illness, Family History,
Personal History, Anthropometry, General Examination, etc.
Here the patient is reminded about the availability of the Social Welfare facility and asked if he/she
wants to avail the same. If the patient wants to avail Social Welfare facility, he/she then is sent to the
Social Welfare Department.

The patient visits a Consultant/Specialist and gets his/her advice and treatment. The Consultant may
view/ edit/update the patient’s progress sheet information like Chief Complaints, Treatment History,
Anthropometry, and General Examination information entered at the Nurse Station. Information like
Systemic Examination, Past Investigation, Provisional Diagnosis, Provisional Treatment, Present
Investigation (investigation finding(s) of the immediate past (OPD) visit of the patient, depending on
which the Physician may confirm the diagnosis), Confirmed Diagnosis, Confirmatory Treatment, etc. will
be entered into the system by the Consultant. (The Specialist may take the printout of the prescription
for the patient. Otherwise, it will be done at the Cash Counter).

The patient visits the General Physician and gets his/her advice and treatment. The Physician may view/
edit/update the information of the patient’s progress sheet Chief Complaints, Treatment History,
Anthropometry, and General Examination information entered at the Nurse Station. Information like
Systemic Examination, Past Investigation, Provisional Diagnosis, Provisional Treatment, Present
Investigation (investigation finding(s) of the immediate past (OPD) visit of the patient, depending on
which the Physician may confirm the diagnosis), Confirmed Diagnosis, Confirmatory Treatment, etc. will
be entered into the system by the Physician. (The Physician may take the printout of the prescription for
the patient. Otherwise, it will be done at the Cash Counter).

The Physician may refer the patient to a Specialist doctor for his/her complaints. In this case, the patient
comes back to the Nurse Station The person on duty at the Nurse Station arranges an appointment with
the Specialist and the patient follows the process.

The patient comes from the Physician/Consultant to the Cash Counter to pay the Physician or
Consultant’s charges. Registered patients are entitled to full or partial payment. They can leave some
payments due.

From the Cash Counter, a prescription will be printed for the patient.

If medicine(s) are prescribed for the patient and if the patient wants to get the medicines from a drug
store or pharmacy, the process for taking and/or buying medicine(s) and/or other items will be covered
by the Pharmacy module.

If the patient is advised for any investigation by the physician or the Specialist, the patient comes to the
Nurse Station. The person at the Nurse Station may suggest the patient some available discounts (in
case of corporate patients, and/or discounts assigned for area/ locality, etc.) patient can avail FOC
services on demand in some investigation(s) and the patient goes to the reception. From here on, the
process of the Diagnostic Investigation Management (DIM) module starts.

Visit of a T_ID Patient

Processes involved in maintaining and providing service to a new patient visiting for the first time to
hospital center who is not registered with the center are illustrated below:

The patient at first comes to the reception. The Receptionist enters the primary information of the
patient into the system and the system generates a temporary ID number known as T_ID (Temporary ID)
for the patient. This T_ID will be used throughout the whole system as the reference ID for that
particular patient. The patient is then sent to the Nurse Station At the Nurse Station, the patient details
his/her complaints and the person in duty at the Nurse Station decide whether the patient should visit a
General Physician or a Specialist and informs the patient about the consultancy charges. If the patient
agrees to go for consultancy, he/she is sent to the Cash Counter to pay the consultancy charges.

The patient pays the consultancy charges at the Cash Counter, receives a payment slip and comes back
to the Nurse Station. The person in duty at the Nurse Station arranges an appointment with the General
Physician or Specialist and enters the patient’s data including information like Chief Complaints, Past
Illness, Family History, Personal History, Anthropometry, General Examination, etc.

The patient comes to the Physician and receives his/her advice and treatment. The Physician may view/
edit/update the patient’s progress sheet information like Chief Complaints, Treatment History,
Anthropometry, and General Examination information entered at the Nurse Station. Information like
Systemic Examination, Past Investigation, Provisional Diagnosis, Provisional Treatment, Present
Investigation (investigation finding(s) of the immediate past (OPD) visit of the patient, depending on
which the physician may confirm the diagnosis), Confirmed Diagnosis, Confirmatory Treatment, etc. will
be entered into the system by the Physician. (The Physician may take the printout of the prescription for
the patient. Otherwise, it will be done at the Cash Counter).If the physician advises the patient to see a
Specialist at any center, then he/she is sent to the Nurse Station.

The person in duty at the Nurse station arranges appointment with the Specialist and sends the patient
to the

flow for OPD.

Cash Counter to pay the consultancy charges of that specialist. The T_ID patient has to pay 100% of the
consultancy charges of the Specialist before going to consult with the Specialist. The Consultant may
view/edit/update the patient’s progress sheet information like Chief Complaints, Treatment History,
Anthropometry, General Examination information entered at the Nurse Station. Information like
Systemic Examination, Past Investigation (investigation finding(s) of the immediate past (OPD) visit of
the patient, depending on which the physician may confirm the diagnosis), Provisional Diagnosis,
Provisional Treatment, Present Investigation, Confirmed Diagnosis, Confirmatory Treatment, etc. will be
entered into the system by the Consultant.

If medicine(s) are prescribed for the patient and if the patient wants to get the medicines drug store or
pharmacy, the process for taking and/or buying medicine(s) and/or other items will be covered by the
Pharmacy module.

If the patient is advised for any investigation by the Physician or the Specialist, the patient comes to the
Nurse Station. The person in duty at the Nurse Station may suggest the patient for some available
discounts (in case of corporate patients, and/or discounts assigned for area/locality, etc.) for some
investigation(s) and the patient goes to the reception.

From here on, the process of Diagnostic Investigation Management (DIM) module starts.
4.2. Challenges of HWMS

The main challenges to the implementation of HMWS in rural hospitals are lack of computer equipment
with high-speed internet facilities, lack of computer skill manpower, and cost of computers. Therefore
from the findings, the current ICT technologies in place within the rural areas in developing countries are
still unreliable, inaccessible, and not sustainable.

• Some peoples sometimes resist computerization.

• Shortage of skilled technical people in HWMS in Pakistan

• In a hospital most of the top label management is doctors, so they can understand the importance of
IT in the hospital.

• Designing the system to be followed in all the departments in computerized environment

• Designing the software for all the specialty doctors for e-prescriptions and e-medical records from the
day one of the starting of the hospital

• Making live from the day of starting the hospital

• Complete electronic patient record

• Fully integrated front office and back office operations

• Also paperless environment for materials, pharmacy, finance and HR

4.3. Increase Indoor Patients

5. Conclusion

It can thus be seen that deploying IT can help the medical profession in improving its quality of service
and thus automatically increasing 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 upgradeable. 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 allow 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 hospital management in improving services, controlling costs, and ensuring optimal
utilization of facilities.