Hospital information systems

Part 1 of a series on enterprise information systems

This is the start of a series of blogs looking at various ways enterprise information systems are used

Hospital systems are not an area I thought much about – until I had the chance to experience them when my son was admitted to a private hospital in Johannesburg for an operation.

To start, the process of admission took a long time with multiple forms to sign and authorise, and foolishly I thought the process after that would be straight-forward. When we got to the ward, however, there was even more paperwork to complete, some of it involving duplication of other paperwork, and this took even longer than the admission process did.

I am aware that hospital information systems are a major drive by some advocates of improving information management and flow in hospitals. But I am married to a doctor and when I have asked her why there is so much paper in hospitals, her response is that doctors need the information in that way. What is provided on paper has evolved over time so that the information doctors and nurses need is in a way that is easy and quick to understand and interpret.

The other aspect of the medical world that is now apparent to me is how expensive a relatively minor operation has become. Fortunately my medical insurance covered the operation but they provided reports on the various costs, and I was amazed at the expense.

If new information systems are to be introduced into hospitals, they cannot be a factor that increases costs further, or give doctors and hospitals a reason to charge more. Eli Goldratt argues in the Theory of Constraints, and in his seminal book, The Goal, that a business benefit is only real if it does at least one of three things:

  1. increases throughput (the rate at which revenue is generated);
  2. reduces inventory;
  3. reduces operating expenses.

In a hospital, Item 1 is constrained by regulation and medical practice. Item 2 is one area for improvement considering the cost of medical material these days, but it would be Item 3 that new systems would have to be focused on.

Where in the hospital process chain can operating expenses be reduced? One area might be administration-related costs – all that paper pushing. So could hospital information systems reduce operating expenses by focusing on information delivery, its content and context? If information on a form was captured once, then other forms could be generated from that information.

It did occur to me that all the paper forms that I saw had to cost the hospital something, and storing it must have a cost. However, I could not personally justify a new system that, say, used tablet computers (like the Apple iPad) to record and display information if that cost was more than the paper processing and storage cost.

The same applies to enterprise systems in other businesses: what are the real business benefits of a new system. I will be getting to that issue in a later article.

For benefits that are less easy to quantify – such as improving risk or governance, information visibility, or alignment of operations and strategy – the difficulty is to collectively decide and agree on the assumptions that make up these benefits.

What is your experience of assessing business value of an enterprise system? Specifically for hospitals, I would be very interested to learn how new systems have performed in terms of the Goldratt measures.

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