The proper and systematic storage of patient medical record is now compromised by shortage of both primary and secondary storage areas. At present it is very difficult to retrieve old patients notes because the notes are boxed in boxes waiting for proper documentation and transfer to National Archives for secondary storage. There is a likely hood that Archives may not be able to absorb all the 2,000 boxes due to shortage of storage space. The current available filling space has been overwhelmed as more and more patients’ case notes which are churned out in large numbers everyday leading to misfiles thus compromising patient quality care. At present the supply of folders, printer toner and bond paper is very erratic due to monetary challenges resulting in a large number of patients notes not in folders thus cannot be filed. The following breakdown shows the monthly average amount spent on patient administration services.
The only feasible cheaper way of overcoming the above is to adopt the electronic medical record as the solution of the future. Proposal: Integration of Digital Tablet In Hospital Management information system . The base of a patient electronic medical record is already in place in the form of TRiMed system’s clinical module. What needs to be done is to link the module with a digital system. Coincidentally TRYFOUR is rolling out the module next year. The system works very simple: a digital tablets where the clinicians write medical notes in free hand on the digital pad and saved on to the TRiMed system. Basically the idea is to build an Electronic Patient File with seamless integration to ultimately view documents linked to a specific TriMed Patient Record and episode.
The Business plan on Importance Of Patient Safety And Electronic Medical Record In Health Care Institutions
Patient safety remains the priority and is considered the most important challenge for the healthcare institution. With the increasing competitiveness of the market, and the complexity of the functions within the healthcare institution, it is very important to treat every patient as a unique human being who has a right to safe and quality care. Not only from a moral and ethical stance, but from a ...
Note: The above cost relate to a once off expenditure
This is a long term investment with most of the required hardware can serve us for longer time if maintained and handled properly and carefully. In comparison with hard copy system with its inherent costs overtime has proven to be expensive if the above costing is anything to go by. COMPONENTS OF DIGITAL SYSTEM
Digital Handwritten Notes
Digital Signing Pads
Finger print Reader
DIAGRAMATIC PRESENTATION OF MAIN SYSTEM AND DIGITAL GADGETS
Integration of Digital Tablet In Hospital Management Information System Abstract- Experience of HMIS (Hospital Management Information System) implementation over the past decade reveals that even after the computerization of hospitals, the practice to capture the clinical notes is still on paper. HMIS accomplishes the purpose of hospital administration to provide the census, transparency in billing and hospital functioning but the main concern is still unaddressed i.e., how to generate paper less Patient Record so that the patient can also get benefit across the hospitals. Hospitals are having advanced computer systems, computerized automatic health-care equipments and software but the fact remains that the patient clinical notes are continue to be captured on paper. The real reason behind this is that the clinicians do not have enough time to key in this information and moreover they are more comfortable in writing with pen and paper. In such a scenario the real advantage would be if the doctor writes the prescription, progress notes etc with pen and paper and same is automatically captured in EPR (Electronic Patient Record).
This has been made possible with the integration of Digital Tablet with HMIS. Digital Tablet is a stand-alone device with storage capability that digitally captures and stores everything we write or draw with ink on ordinary paper. After integration of digital tablet with HMIS, we can easily view, edit, organize handwritten notes and the same can be saved into the database.
But as the years rolled by, the number of patients has grown and various medical cases arise that the manual method of managing patients’ records, prescriptions and appointment schedule, is no longer practical. In this study, we hope to develop an application that will minimize all paper works and manual records keeping, therefore allowing doctors and staff ease in keeping track of patients, ...
Digital Tablet offers doctors the flexibility to write visit notes, progress notes & draw images in a very user-friendly manner. Keywords: Digital Tablet, EPR, HMIS, Pen Tablet, Take Note
Healthcare is one of the most important aspects of human life. Hospital Management Information System is used in hospitals with the objective of streamlining the treatment flow of a patient, while allowing doctors and other staff to perform to their best ability, in an optimized and efficient manner. The HMIS is modular, thus ensuring sustained benefits through changes in technology, protecting and providing optimal returns from the investment. It is modeled on a unique combination of a ‘patient centric and medical staff centric’ paradigm, beneficial to the recipients and the providers of healthcare. HMIS uses a network of computers (Fig. 1) to gather, process, and retrieve patient care and administrative information for all hospital activities to satisfy the functional requirement of the users. The HMIS incorporates an integrated computerized clinical information system for improved hospital administration and patient health care. It also provides an accurate, electronically stored medical record of the patient. A data warehouse of such records can be utilized for statistical requirements and for research. Some of the advantages of EPR (Electronic Patient Records) over the conventional paper records are: Prompt and reliable information storage, querying and retrieval. Easy access to query data to generate varied records, including classification based on demographic details such as gender, age, and so on. Instant information access for research and library information.
EPR is combination of Patient Demographic Detail, Complaints, History, Progress Notes, Treatment, Investigation, Operation Detail, and Discharge Report etc. For capturing the data we have various entry points like Demographic details are capture at the point of registration, Investigation result details from investigation module, Treatment detail can be entered from Pharmacy module. Complaints, Progress notes, Image Examinations needs to be done by doctor and clinical staff only. However, the clinicians are more comfortable with pen & paper while examining/treating the patient. Under normal circumstances most of the information will not be keyed into the system. This information can also be captured with the help of data entry operators but the chances of erroneous data entry are more and at the same time we require extra manpower. Working with only paper based records at many times can result in loss of crucial patient information, and thus no possibility of aggregation of the captured clinical information for decision making at higher levels. The Digital Tablet with its versatile form supports pen navigation and the capability to write directly on the screen and convert to printed text. This offers today’s health care workers the ability to revolutionize the ways they work by making it easy to capture, and use information wherever the job takes them. According to the usability of digital tablet we have different integration techniques to integrate the digital tablet in HMIS: Integration of Digital Tablet with Image Editor
Pg. 1 Introduction In the last thirty years digital image processing has grown from a scientific research field to a technical area that has many scientific and commercial applications. Many of these applications are due to the enormous improvements in computer technologies. Electronic image processing is now readily available on most typical desktop computers as opposed to the past when only a ...
The main objective of HMIS is to maintain the paper less EPR. In EPR we have two major types of data, codified and descriptive. Codified data are treatment detail, diagnosis, allergies, investigations, operation detail etc. All codified information is mandatory at their entry points and without entering these information HMIS cannot allow concerned user to go further. The descriptive information like progress notes, visit notes, OPD visit summary information is maintained by doctors. In few departments clinician also draw the images to show the findings. The entry point of descriptive information is OPD and IPD. In OPD Amarjeet Singh Cheema, Prakhar Misra, Md. Riazuddin Ansari 166. doctor writes all information on the Patient OPD card and in IPD, case sheet is maintained. As per the present scenario this information can be capture in following ways: Doctor keyed detail in Outpatients and Inpatients.
Nurse, Junior doctor enter the clinical information into system Data entry operator enter the information
Before I began my collegiate career, my parents or other authoritative figures basically gave me everything that was crucial to my upbringing. Life seemed simple because all the information I needed in order to advance was spoon fed to me. My parents were always there to guide me through life and correct me whenever I made mistakes. In school, teachers and mentors would instill in me study skills ...
In all cases we have to rework. If nurse or data entry operator enters the descriptive data then the chances of errors are more. We also check the possibility of standardization of progress notes and OPD information through macro facility. Macro facility is used to maintain the predefined descriptive statements of progress notes and OPD summary department unit wise. But again it is difficult to make a huge repository of every progress notes, and it also requires searching. To overcome these issues, solution is to allow doctor to work with pen and paper and at the same time information become the part of EPR. Presently in various other HMIS digital tablet is used as image editor only. In HMIS we try maximum usage of digital tablet. We found following areas in which we can take benefit of digital tablet. 2.1 Capturing OPD Visit Summary
Using Digital Tablet clinician can enter OPD Card detail directly into an electronic form and this becomes the part of EPR. 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. 2.2 Progress Notes
In case of patient treatment it is required to maintain the progress notes of patient by clinician. Progress notes are descriptive entry in which clinician mentions the condition and treatment progress of patient. Digital tablet is very useful in writing the progress notes where the actual handwritten text can be entered directly in the system without keying in the text. This information can be entered into the system in online and offline mode. In online mode digital tablet is connected with HMIS application and the written notes become the part of EPR. In offline mode like patient bedside, written notes will save into digital tablet storage in sequential manner, which can be later ported into the system. 2.3 Patient Bedside visits
Nursing teams and clinician are normally reluctant to bring their Note book PCs to home visits or to patient bedside meetings for capturing the progress notes because the computers are bulky, they require a table to use, and the screen can act as a barrier between the caregiver and the patient. Digital Tablet solves these problems by being: Lightweight
Comfortable and natural to use while placing on their lap Flat, similar to a pad of paper or a clip board 2.4 Image Editor Doctor is more comfortable with pen and paper for image examination. With the help of digital tablet, doctor can easily edit and add comment to images. The images drawn with the help of digital tablet will be directly captured by HMIS image editor. Integration of Digital Tablet In Hospital Management Information System 3. About Digital Tablet
The Process and Difference of Digital Imaging and Their Effects The traditional photographic process that has defined image reproduction for over 150 years involves a long drawn out series of chemical reactions beginning with the capture of light on silver film and ending with the fixing of the image onto paper or a transparency through the development processing. The final image is analog, which ...
A digital tablet is a computer input device that allows one to hand-draw images and graphics, similar to the way one draws images with a pencil and paper. These tablets may also be used to capture data or handwritten signatures. A digital tablet consists of a flat surface upon which the user may “draw” an image using an attached stylus, a pen-like drawing apparatus. The image generally does not appear on the tablet itself but, rather, is displayed on the computer monitor. Some tablets however, function as a secondary computer screen that you can interact directly using the stylus. Some tablet has feature to store the all-writable data in sequential order in tablet, which can be later transferred into the system. Some tablets are intended as a general replacement for a mouse as the primary pointing and navigation device for desktop computers. According to capabilities of digital tablets we are working on two types of Digital Tablets: Take Note (Fig. 2) digitally captures and stores everything one writes and draws on a paper, and is not required to be connected to a PC while being used. The captured files can be downloaded onto a PC or a laptop using the USB-2 interface. Once transferred to desktop or laptop, the files can be modified, colored, converted to text or edited like any other data object and it can be saved as a book-file or an individual file. It also works in synchronous mode i.e. what you write, it appears on the screen and at the same time it can be converted to text 3.2 Pen Tablet
Pen Tablet (Fig 3) offers user the flexibility to write, draw, design, interact with the Graphical User Interface and perform other input-related tasks in a very user-friendly manner. Also comes with a 3 button cordless mouse with scroll button . 4. Digital Tablet Integration in HMIS
Digital Image Analysis of Yellowstone National Park Introduction Remote sensing refers to the tell-observational surveying and mapping of physical, urban and environmental features. Remote Sensing is also a composite of many other subjects such as aerial photography, radar surveying, thermal surveying, weather forecasting and photogrammetry. It has now become quite common practice to use remotely ...
According to the usage of Digital Tablet in HMIS we have three different techniques to integrate digital tablet. 4.1 Digital Tablet as Images Editor Image Editor is a web based utility developed using applets to draw and upload the images. Image editor has all capability of image editing tool and designed in such a way to support digital tablet plug & play feature. The images drawn with the help of digital tablet will be directly captured in image editor and become the part of EPR. Fig. 4 describes the work flow of Digital Tablet as Image Editor.
Fig4: Digital Tablet Work Flow
4.2 Digital Tablet as Progress Notes
Writing on pad with pen is more natural for the doctor than keying in to the system. For this feature, we integrated the ‘My Script Builder’ SDK. ‘My Script’ is natural handwriting recognition software, which captures handwritten data. ‘My Script Builder’ is the Software Development Kit (SDK) for fast and easy integration of ‘My Script’ handwriting recognition capabilities into standard system solutions with pen-based user interfaces. The handwritten text will be captured using the digital pen and pad, converted to text using the handwriting recognition tool and then passed to the relevant process. Fig. 5 describes the work flow of Digital Tablet:
Fig.5: Digital Tablet Work Flow
Basic flow of digital tablet implementation in HMIS Application (Fig.6): User writes on Take note device
My Script takes the hand written text from Take note and convert it to the text HMIS Application takes the converted text from the My Script and processes the text.
Fig.6: SDK Integration with HMIS Application View
4.3 Digital Tablet in OPD Card
In OPD all treatment and visit detail is captured on the OPD Card. To capture these details in HMIS we used ArioForm utility with digital Tablet. ArioForm is a third party application, which is available with Take Note. In this technique the OPD card is template is generated in ArioForm, this template is mapped with Database Table. When the clinician write anything on this OPD Card using digital tablet, these detail are automatically captured in ArioForm template . After click on convert button these information will be saved into database. In this case doctor just need to press the convert Button, all information motioned in the card will be saved into HMIS database. As shown below in Fig 7, the written data is converted in database.
Fig.7: ArioForm Template
Fig. 8 describes the work flow of Digital Tablet.
Fig.8: Implementation using ArioForm
Digital Tablet allows clinician to be more efficient and accurate in their day-to-day activities by enhancing their ability to perform variety of tasks, both at their desks, or on the go. Collection and Integration of Patient OPD Data
House calls and patient bedside visits
Write/draw/sketch on normal paper with pen
Use it anywhere to capture your notes/drawings
Online Writing Function. You can write on paper and see the same simultaneously on computer screen. 6. Conclusions
With digital tablet, information capture in HMIS saves time and provides a thorough and efficient way to manage patient information.