Introduction and background
ICT
S
TRATEGYAND
IMPLIMENTATION
FOR
A
HOSPITAL
The Hospital ICT Strategy and implementation has the overall goal of establishing a strong ICT infrastructure to support hospital operations by providing the means to capture, transmit, store and retrieve information in an accurate and timely manner, thereby enhancing the efficiency and effectiveness of the hospital in providing health care in the region. The hospital is situated in Nairobi and has a bed capacity of 1800. Currently most information and records are manual and there is a Central Medical Records store with thousands of files, and x-ray films, which are retrieved manually to facilitate clinic work and patients treatment in the wards. Other areas of support like finance and supplies, Human resources and Maintenance also maintain manual records with a few stand alone computers which require networking. In almost all clinical areas there are a few computers but with no standard software to enable integration of data for decision making in both clinical and administration departments.
The following four Strategic Initiatives have been identified as the key building blocks of the ICT Strategy for the hospital to embrace EMR:
1. Establishment of the Communications Network Infrastructure 2. Acquisition and deployment of a Computer Systems Infrastructure 3. Acquisition and deployment of the Applications Software Infrastructure
4. Capacity Building for staff through the provision General ICT-awareness training.
5. Security system for the software, data and hardware
6. Monitoring and evaluation of the system functionality and the information
1
The Communications Network Infrastructure
Overview
The Communications Network Infrastructure is the underlying foundation for the ICT applications and services which will support critical hospital processes. Installing, upgrading and maintaining ICT infrastructure usually involves a large investment, requires significant resources and typically takes time to implement. Multiple complex dependencies require careful planning when changes are introduced in order to minimize disruption. With the expected heavy reliance the hospital will have on its ICT infrastructure, it will be important to design, install and maintain the infrastructure to ensure it continues to support the hospital’s goals and ensure interoperability of the various hospital activities such as research and information sharing at National and international levels. In order to compete favorably with other healthcare facilities, the hospital must embrace the correct technological, and socio economic environment which support efficiency in data and information management.
Overall Goal: A shared data, voice and video communications infrastructure with appropriately defined service levels, redundancy and security.
Benefits: Reduce overall cost of communications services for the hospital Enhance the effectiveness and efficiency of healthcare and
support services delivery in all departments, through data that can be shared to facilitate decision making, patient care and research activities
Summary of
Requirements: Site Preparation / Civil Works Fixed Cable Installation (Fibre, Copper Cabling)
Enhancement Features Provision (Wireless, Voice, Video, Security)
WAN / Internet Connectivity Capacity building (staff training)
Security features and appliances for the system
Ownership /
Leadership Engineering Services Department ICT Department Budget Ksh. 500,000,000.00
1.1
Site Preparation and Civil Works
1.1.1 Sites Selection / Acquisition
Preliminarily sites have been identified as suitable for selection as data centres / computer rooms:
1. The server room
2. A site for the “disaster-recovery” site
1.1.2 Electrical Works (Conditioned, Uninterruptible Power Supply)
Mains Power Supply (240VAC/50Hz) Power Supply Conditioners and Stabilizers
Uninterruptible Power Supply (UPS) System dimensioned for minimum 1-Hour Autonomy Backup Generator
1.1.3 Heating, Ventilation and Air-Conditioning (HVAC)
The Computer Rooms / Data Centers will be equipment with air-conditioning systems to maintain the computer rooms at optimum environmental conditions. Each site should have at least two systems configured in Main and Standby operation mode
1.1.4 Cabling Pathways
Cabling pathways include: Underground crawlspaces Ceiling cavities
Built-in cable ducts Metallic Trunking
There exists a certain amount of the necessary infrastructure to serve as cabling pathways. Where such infrastructure does not exist, provision should be made for whatever additional infrastructure necessary to support the proposed communications network as designed.
1.1.5 Equipment
The network cabling will terminate in purpose-built equipment cabinets in the Data Centres and selected Network “Consolidation Points”. These cabinets will not only house the network hardware but will also serve as cable termination points.
Equipment Cabinets will be based on the Standard equipment racking system and will include: Rack-mount Units - Floor-standing equipment cabinets
Wall-mount - Floor Standing Equipment Cabinets Wall-mount equipment cabinets
Wherever any equipment cabinets will house active Network Hardware Components, provision MUST be made to equip such cabinets with the necessary electrical power supply connections – appropriately backed up by a correctly dimensioned UPS system – preferably rack-mountable.
1.2
Fixed Network Installation
The fixed network cabling is described in detail in the draft bill of quantities document. The following is a list of the components:
1.2.1 Backbone (fibre) cabling
1.2.2 Distribution (Copper) Cabling
1.2.3 Network Hardware (Switches, Routers etc)
1.3Enhancements to the Communications Network
1.3.1 Wireless Network Access Points
1.3.2 Voice / Telephony Services (PABX / Paging Systems)
1.3.3 Security Systems (IP-CCTV, Access Control and hardware safety)
1.4Wide Area Network / Internet Connectivity
The establishment of the Wide Area Network (WAN) and internet connectivity will required the installation of a broadband Digital Subscriber Line (DSL) circuit to an Internet Service Provider (ISP).
The Internet connectivity service will support: Electronic Mail (e-Mail)
Outgoing access to the World Wide Web
Virtual Private Network (VPN) services for incoming remote connectivity Components:
1.4.1 Broadband Digital Subscriber Line (DSL) connection
1.4.2 Communications Services:
1.4.2.1
Web Server (on-site or remote hosting)
1.4.2.2
E-Mail server
1.4.2.3
Firewall Appliance
2
The Computer Systems Infrastructure
Overview
The computer systems infrastructure includes the Servers, Workstations, Desktop and Portable Computer, peripheral devices (including printers, scanners, card readers etc).
2.1
Servers
2.1.1 Hardware
2.1.2 Server Operating Systems
2.1.3 Services
The following services will typically be includes as part of the server purchase costs
2.1.3.1
Installation and Commissioning / Configuration Services
2.1.3.2
Client Access Licensing
2.1.3.3
Maintenance and Support
2.2
Shared Storage
2.2.1 Direct Attached Storage
2.2.2 Network Attached Storage
2.2.3 Storage Area Network
2.3Network Clients
2.3.1 Hardware / Operating Systems
2.3.1.1
Personal Computers (PCs)
2.3.1.2
Portable Tablet/Pen PCs
2.3.1.3
Handheld PCs
2.3.1.4
Thin Clients
2.3.1.5
Workstations
2.3.2 General Desktop Applications (Office Automation Software)
The General Desktop Applications are those that are required to support general office automation functions and are typically supplied as part of the Desktop Computer Hardware and Operating System acquisition. One such application is the Microsoft Office suite of software applications. The hospital in it earlier attempt to develop ICT acquired computers which are scattered in various departments with insignificant networking and internet connectivity. Thereis urgent need to revolutionize the system to accommodate new technology and use the correct software for enhanced interface and integrated data and information management.
2.3.3 Specialized Desktop Applications
The specialized Desktop Applications are those that are required to support specific functions within certain business units. These are typical examples:
Application Business Unit Purpose
ArchiCAD Engineering Computer-Aided Design
Adobe PageMaker Public Relations Dept Publications Design Adobe connect Medical Education Distance Learning
2.3.4 Licensing for Client-Server Applications
The client-server applications (including the Server operating systems and the Integrated Hospital Information Management System) will typically be supplied with appropriate Client Access Licenses as provided for by the law. In the event of scarce resources, open source applications can be sort from proven venders.
2.3.5 Maintenance and Support
2.4Peripherals and Accessories
2.4.1 General Purpose Peripheral Devices
2.4.1.1
Printers
2.4.1.2
Scanners
2.4.1.3
Audio Devices (Microphones/headsets/speakers)
2.4.2 Peripheral Devices for Special Applications
2.4.2.1
Barcode Printers and Readers
2.4.2.2
Touch-Screen displays
3
Software Infrastructure
3.1
Operating Systems
Operating systems will be acquired as part of the computer hardware, this may include Server operating system
Backup server operating system Workstations operating system Desk top PC operating system Tablet PC operating system Hand held PC operating system
3.2
Relational Database Management System
The Relational Database Management System (RDBMS) will may include either: Microsoft: SQL Server
IBM Oracle or
Sun Microsystems etc
As part of the Standard Operating Environment (SOE) of the hospital ICT Strategy, one single RDBMS will be selected for use in a shared database environment. All applications described below should be capable of utilizing the single RDBMS selected.
3.3
Integrated Hospital Information Management System (IHIMS)
Overview
The Integrated Hospital Information Management System (IHIMS) will manage all the hospital’s medical and administrative information in order to enable hospital staff - particularly the health professionals - perform their jobs effectively and efficiently.
Designed on a client-server architecture incorporating a network of micro-computers, the IHIMS focuses on the integration of all clinical, financial and administrative functions of the Hospital.
Components of a hospital information system consist includes the following:
3.3.1 Core (medical/clinical) modules
3.3.1.1
Registration / Help Desk
3.3.1.2
Out-patient Management
3.3.1.3
In-patient Management
3.3.1.4
Clinical/Medical Information Module
3.3.1.5
Laboratory Module
3.3.1.6
Nursing Module
3.3.1.7
Pharmacy Module
3.3.1.8
Radiology / Diagnostic Imaging Module - with Integrated
Picture Archiving Communication System (PACS)
3.3.1.9
Operation Theatre Management
3.3.2 Clinical Support Modules
3.3.2.1
Physiotherapy
3.3.2.2
Nutrition
3.3.2.3
Occupational therapy
3.3.3 Financial and Administrative:
3.3.3.3
Human Resources Management
3.3.3.4
Management Information Systems Module
Whereas a hospital information system can be quite complex, recent and continuing advancement in computer technology and the development of information exchange standards makes the task of administering and integrating such systems a little more easier.
3.4
Additional Applications
3.4.1 Document Management System
3.4.2 Property Maintenance and Management System
3.4.3 Performance Management System
4
Capacity Building for ICT
Overview
No information system can be considered a success without the complete participation of its owners and users. Thus human and social factors must therefore be considered in the design and implementation of such a system. This is usually addressed by providing adequate training and education about the system. The top management and staff must embrace change and identify change champions to fast track the process of computerisation and migration from the comfort zones to ICT.
Once the Integrated Hospital Information Management System (IHIMS) is fully implemented, personnel at different levels within the various departments will interact with the IHIMS in a way that requires varying levels of computer knowledge and skills as follows:
Level 1: Basic Computer Operations – Equivalent to the International Computer
Driving License (ICDL) Certification. Such knowledge will be required for simple routine operations such as data entry and querying. All users of computer equipment must at least have this basic level of computer knowledge.
Level 2: Office Automation User Training – to a level equivalent to the Microsoft
Office Certification Level. Such skills will be necessary for personnel required to produce typed reports (word processing), conduct basic data entry operations (using spreadsheets and database applications) etc. Secretaries and Clerical officer for instance
Level 3: Application-Specific Training for the various component modules of the
IHIMS. Junior-level, middle-level and senior-level technical / operational personnel within the various department should get hands-on training on the operations of the modules relating to their departments or functional areas.
Level 4: Technical Training on IHIMS – this level of knowledge transfer will be
required in order to enable the hospital to develop an in-house ability to operate, maintain, and customise/upgrade the software. This is the kind of advanced training that would be offered to personnel of the ICT department (or the Medical Records section of the Clinical Services Department)
Level 5: Management Level Training: Conducted in the form of Seminars and workshops, the training of “Champions” is designed to give a management level appreciation / overview of the hospital systems automation. Specifically, the senior management will be introduced to the kind of Management Information and Decision Support systems that can be derived from the Hospital Automation Systems.
The goal of the Capacity-Building strategic objective is to continue to provide ALL staff at the hospital with a requisite knowledge of ICT systems and services in order to fully participate in
Requirements
The following are some of the key activities that need to be undertaken in order to achieve this objective
1. Training needs analysis for all staff who will use the system for 2. Design and/or Selection of the appropriate Training programmes 3. Delivery of Training Programmes
4. Continuous Monitoring and Evaluation
5. Ethical principles, privacy, confidentiality and security features
Benefits
The provision of an ICT-related education and training programmes will make it easier and simpler for staff at all levels to apply ICT in their day-to-day interactions within the various units in the hospital – thereby enhancing the overall effectiveness in providing healthcare. The interoperability and interfaces of appliances will ensure data collection transmission and sharing to fast track patient care and administrative functions in the hospital, besides relating with others at national and international levels.
Leadership / Ownership
Human Resources Department: Maintenance of HR Development Records Departmental / Section / Unit Heads
ICT Department for Maintenance and system monitoring
Timelines
This is a Continuous Process over a five-year development and implementation period with yearly budget provision and/or request for government / donor support to finance the project
CONCLUSION
In conclusion, the ICT strategy for the hospital has taken into consideration the importance of evidence in public health decision making process which is only achievable in an EMR environment as the world is a global village and nobody/ institution can afford to continue lagging behind with no modern ICT architecture that supports connectivity to the rest of the world. Information is key to all decisions and must be shared in a secure manner for the benefit of all stakeholders. The ICT will support public health information for the hospital and the country, Efficient Electronic Medical records and personal records for treatment history etc. The system will therefore, lead to better investigations, awareness creation, efficient management, rapid response and interventions, monitoring and evaluation and finally continuous education.
