ALL INDIA INSTITUTE OF MEDICAL SCIENCES NEW DELHI

AIIMS

is a centre of excellence in medical sciences created by Jawaharlal Nehru in 1956. This is more of a place for medical education and research in Southeast Asia. It is an autonomous institution through an act of parliament to serve as a nucleus for nurturing excellence in all aspects of Healthcare.

 DR.

B.R.A. Institute Rotary Cancer Hospital started functioning in 1983-84 on 35 beds with infrastructure of 2 floors. Recently it has been converted into a 200 bedded, 7th floor building. Prime Minister of India Sh. Atal Bihari Vajpayee, inaugurated this centre on October 5, 2003.

STUDY OF FUTURE BENEFIT REALIZATION OF IMPLEMENTING PACS IN DR B. R. AMBEDHAKAR INSTITUTE ROTARY CANCER HOSPITAL, AIIMS.

 To

study the existing workflow of the different departments of IRCH. To analyze the role of PACS in making the organization filmless. To calculate the current time of generating the films and reports of the XRay, CT, Mammography and Ultrasound.

 PACS

is medical imaging technology and stands for picture archiving and communication system. PACS provides the ability to electronically (ie, through computer and network technology) :

Access images from (digital) modalities Distribute images to PCs and workstations Read on computer display (diagnostic ) Store (both long and short term) images Transmit (to other areas or off-site)

Rapid access to patient examinations Cases can be viewed at many places simultaneously. Consistently high quality of images No chemical use for processing No lost films An improved work area Decrease in storage and filing costs and space No film costs Easy image comparison Permits image manipulation. Immediate access to radiology reports.

 Cost

of technology maintenance. Learning curve for software. Training of the staff. At times Image retrieval can be slow when demand is high.

sample size of 32 randomly selected patients were undertaken which included all kinds of patients which came for different kinds of tests like CT, Mammography, X Ray, USG. We just follow them and note down all the data which we have required for the study. Time of registration, time of test, time of report etc. We talked to the employees and asked many questions.

study conducted in Klinikum Deggendorf about PACS implementation offers many advantages including increased efficiency and increased income in the hospital after the successful functioning of the new implementation of PACS .

Economic effects 15 % patients were increased. Lower personnel costs Increased commercial competitiveness Working procedure Improved image processing Improved image display Images and data immediately available at any workstation All authorized persons can obtain images of a patient simultaneously Direct transfer of patient data from RIS reduces work and error Permanent storage eliminates losses Reduced radiation exposure with digital imaging

Personnel Fewer personnel in the conventional X-ray type. Fewer personnel in the archiving service. The network administrator appointed for PACS will become increasingly available for other IT tasks. Ecological aspects Reduction in film-based consumables. Reduction in the expensive and environmentally damaging disposal of chemicals and old films.

There is a separate register for IPD ward X-ray, radiography chest and for general patients. A register is also being maintained in the department in which name, age, sex, registration number, body part to be examined; referring ward is being written down. The work load in this department around 30 patients per day and peak hours is 8:30 AM to 1 PM after that mainly reporting of the test is being done. Theres no facility to obtain 3D images. Only 2D images can be seen. Patient is being given hardcopy of x-ray and report. No hard copy is being stored here. Soft copy of patients record is stored for 3 months.

 Fields

written in register - IRCH number, name, age, clinical diagnosis, parts scanned, payment. Patient is being given film and report. Peak hours- 8.30 AM to 1 PM. Afternoon time- mainly reporting is done. Workload- 20 patients, Biopsy- 3 patients.

Patient comes to the department with 1 white slip and 1 pink slip. The white slip is being filled by the doctor and the pink slip is being filled in the department itself. The department has 3 rooms- Sisters/Nurse room where the patient is being prepared, main CT room where the actual CT scan is being carried out and the radiologists area where the images are being viewed in workstations. The report is being prepared within 48 hours and the report goes to the patient file. The report file goes to the concerned doctor and the film is being stored in the file room of AIIMS.

 Workload

is comparatively less in this department, about 5-6 patients per day. No preparation is required for mammography. Patients are given the reports only, films are not being given to patients. Films are stored in record room. one copy of report is stored in the hospital.

patients ratio per day

Mammography 6%

CT 30%

X-Ray 32%

USG 32%

Chart Title
80 70 60 50 40 30 20 10 0 X-Ray CT USG Mammography

On manual sytem

On computerized system

 Most

of patient did not responded because of their illness, so they ignored us. Work load is heavy so lack of cooperation form the staff. Patient were sitting in groups, so it creates biasness from the patient side. Time constraint.

 Per

day approximately 30 patient for xray, 30 for Ultrasound, 27 for CT and 5 for mammography. e.g.:- on an average x-Ray takes 6.75 minutes means 6.75*30= 202.5 minutes = 3.38 hrs, after implementation of the PACS it will be reduced by 25%. Reports can be electronically transferred to Patients and Doctors also. No. of patient can be increased up to 100%.

 Computerized

system should be implemented which will increase the efficiency and accuracy of the department. Hospital Information System (HIS) should be implemented so that patients records are maintained in a systematic manner.

 In

case of CT scan, patient should be given the report as well as the film so that he can refer to it in the future. Reports should be delivered to the patients on time. In case of any delay, the patient should be informed in advance.

 Training

of staffs annually or semi-annually should be encouraged. More and more skilled technical staff should be recruited in order to work on software Proper performance appraisal of the employees should be done. Knowledge of computers should be made mandatory in selecting employees in order to work easily when in future PACS is implemented.

 Online

monitoring of the patient work flow can be done for the each and every step of the process, so that it is moves faster.

 Objective

is to know the opinion of different staff members of the registration department about the computerized registration system and the queue management systems. This study would let us know the real insight of the implementation of IT in this department and will help us give new ideas and also suggestions for the improvement of the present system.

IT has enormous potential to propel the healthcare system to a higher quality. IT helps makes the system more efficient and adaptive for the patients as well as for the staff in the hospital. Since no IT system is perfect in this world, this study would help us identify different problems faced by the staff members of the registration department at AIIMS. This study is based on the staff perception about the Centralized registration information system. Computerized Registration Process started in 2007 and the QMS started in Feb 2011. Token- Fill ID slips wait- registration card- OPD

 Questionnaire

Based study Staff of the registration department were interviewed. Total number of questions : 20 Sample Size :37 Study includes all the staff members.

 There were

28 male and 9 female.

Femal e, 24.3 0

Male, 75.70

Type of staff 32.4 32.4

19 16.2

Security Guards Token Distributers

Supervisors

Registration counter

Registration
Mannual System Computerized System 5%

95%

0 70 60 50 40 30 20 10 0 Needed Not needed Percentage of staff

printing Problem
70 60 50 40 30 20 10 0 yes no printing Problem

Chart Title
10 9 8 7 6 5 4 3 2 1 0 R1 R3 R5 R7 R9 R11R13R15R17R19R21R23R25R27R29R31R33R35R37 Rating out of 10 MEAN (7.8)

 Staff

was happy after the implementation of IT in this department. The feedbacks were reliable as all the staff members were computer literate. It is quiet easy to operate the token machine.

 Proper

interaction with the staff was not possible because of the limitation of time Since the study was conducted in only this hospital so the recommendations cannot be used for other hospitals Qualitative data could not be analized.

proper training to all the staff should be imparted. Limits of patients for the particular department should be computerized. Limits should be displayed on the LCD screens.

COMPUTER AWARENESS AMONG HOSPITAL STAFF AT Dr.B.R Ambedkar IRCH,AIIMS

The present study aimed to explore the computer awareness among hospital staff and after the results make recommendations and suggestions to improve.

structured questionnaire was used to gather data . There were 21 questions included in the questionnaire. Our survey was constructed to elicit information in six primary domains relevant to identifying training needs of staffs. These are1) basic computer operation and concepts; 2) word processing skills; 3) internet /web skills; 4) multimedia skills; 5) email skills; 6) access to a computer.

Out of the 25 employees interviewed, 8 of them were doctors, 12 of them were radiological technicians and 5 were administrative staffs. 80% of the doctors use computers either in their workplace or in their homes. They also have sound knowledge of MSOffice, internet and know basic computer terminologies. 50% of the technician use computers and , about 30% of them know computer terminologies, MS-office and internet. About 40% of the administrative staffs were aware of computer applications, internet and have used computers at their workplace

For Doctors- Internet awareness

120

100

80

60 100 40 80 88 87 62 20 60

No (%) Yes(%)

0 Use power point Read email Reply to email message Use word Use Excel Own computer

For technician- Computer awareness

90 83 80

70 60 60 50 50 40 40 35 27 50

65 60

40

30

20

10

0 Computer skills Familiar with computers Use computer Use Excel Own computer Yes(% )

 Computerisation

of the department should be

be done. Computer training classes should encouraged in the department.

A

computer friendly workplace would help in better computer awareness among the employees. records should be made computerised.

Registration, billing, patients

Medical faculty certainly needs some kind of formal introduction and education to the new information technology for learning purposes. Provision of structured computer and information technology training for medical staff would equip them with the skills they need to practice up to date and evidence based medicine in future, which are essential to improving the quality of medical care. Computer awareness of staffs will increase the quality of human resource of a hospital.

Computerization of existing process in Institute of Rotary Cancer Hospital (IRCH), AIIMS

To study the need of computerization in IRCH and also to give recommendations to make the processes as well as workflows fully automated in the future.

questionnaire was used to gather data which contained both open ended and close ended questions. Both type of questions were included in order to gain both qualitative as well as quantitative. knowledge about the computerization process.

 Out

of the 25 employees interviewed, 8 of them were doctors, 12 of them were radiological technicians and 5 were administrative staffs. 80% of the processes were manual.

Around

Computers

were used only in viewing images during the tests like X-Ray, CT Scan, USG and not for maintaining patients records.

Level of computerization

20

50

High
30

Moderate Low

No of computer trained staffs

85%
0.9 0.8 0.7 0.6 0.5 0.4 0.3 0.2 0.1 0

70%

40%

No of computer trained staffs

 The

processes should be computerized for improved efficiency. Most of the administrative staffs were not computer trained. Training should be made available. Patients records and databases should be maintained.

Computerization department leads to improvements, by giving hospitals the ability to manage information more efficiently. When a facility installs software, they are looking for something that gives them better control over the chaos in their department.

Objective of this study is to know the opinion of the different kinds of patients/ attendants who are coming to AIIMS for their treatment to the different departments about the queue management system. This study would let us know whether the objective of computerization in the registration department successfully met the satisfaction level and whether there is any further need for improvement.

Patient Satisfaction in any process of the hospital is important so as to: Improve the quality of different processes feedback to professionals and managers acceptability of processes To know the performance of the system

Generally it is seen that:

Responding alone (without help), more positive Taking help from others often more negative Immediate responders , more positive

 Patients

from different OPDs were interviewed. It was a questionnaire based study consisting of around 20 questions. 30 Patients were randomly selected. And the responses were noted down. Identity was kept confidential.

1 0 100 80 60 40 0 0 Male/Female Satisfied/Not tokens satisfied availble on internet tokens Coustomer availble via care required call centre

 Sample

size is less. Biasness from the patient side, as they were sitting in the groups. It only includes the OPD patients who go through from RAJKUMARI AMRIT KAUR OPD, AIIMS.

 QMS

system was successful and most of the patients feel it has improved the over all system. Waiting area is quiet comfortable.

 Token

should be given online. It should also be given thorugh call centre fascility also. LCD screens should be increased for the display of tokens as well as limits of patients. There should be a customer care officer who will guide all the patients.