Read the case given below and answer the questions given at the end.
CASE – 2
CASE STUDY AT MANIPAL HOSPITAL, BANGALORE
Manipal Hospital is situated in Bangalore, known as the Garden city of India, with a population of around six million. The hospital, located on Airport Road, the centre of the eastern part of the city, opened its doors in 1990 for the in and around Bangalore citizens to usher in a new era of sophisticated and specialized medical care in the southern part of the country. The hospital is housed in a magnificent twin towered, centrally air-conditioned, and fourteen-storied building with a bed strength of 450 at each of the towers, totalling 900. The hospital has been set up mainly to benefit the local population.
This hospital is an addition to the Manipal family of health care institutions, which includes four medical and two dental, nursing and pharmacy colleges and ten hospitals with a total of around 5,000 beds. All of this represents four decades of the Manipal family's total experience and expertise in medical education and health services, and it is this track record that ensures the quality of Manipal hospital, Bangalore, known to each and every citizen of Bangalore. This hospital has provided sophisticated medical and surgical facilities. It has gained reputation in Bangalore as a centre for medical excellence and it is all due to the preeminence of the specialists on its medical staff panel, its highly skilled nurses and support staff and sophisticated medical equipment.
A premier, multispecialty unique hospital with multiunits situated at Bangalore, Mangalore, Manipal, Nepal, Sikkim and Goa, it is committed to providing personalized care of the highest order with the widest scope of advanced medical facilities. The hospital offers its medical services on a break-even financial basis, thus bringing high quality healthcare on commercial terms. The individual health insurance plans, company group insurance plans and some subsidized inpatient beds in line with government directives are some of the highlights that bring sophisticated treatment to the middle class family. Besides these, they have standard screen programme at very nominal rates for middle class families and executive screen programmes for the privileged class at a higher rate, covering complete blood count, urine-analysis, stool examination, blood grouping, blood sugar, urea, cholesterol, electrolytes, lipid profile, X-ray chest, ECG, creatinine, triglycerides and finally, consultation with physicians, gynaecologists etc. They work towards a preventive approach, pinpointing all possible risk areas and offering solutions to each and every problem area with the cream of the medical fraternity and state-of-the-art equipment, and thus each of the Manipal hospitals is a cost centre. The central office is at Manipal, from where the medical director and other directors provide corporate guidance to their other hospitals. They decide important matters connected with all their units. At Bangalore, the CEO heads the three hospitals (two situated in the Airport Road, one at each of the towers and the third hospital, known as north side hospital, situated at Malleswaram, the northern part of Bangalore, with 62 beds). One hospital at one of the towers deals with heart operations and is headed by the divisional head, designated as Director, operations. Similarly, in the second tower for three different operations, like Nephrology/Urology, Neurology, Diagnostics, there are three divisional heads who control the operations in their respective areas. The fifth divisional head of Bangalore is at the north side hospital. Each of the divisional heads has different departments under him and each accounts as a separate cost centre. The various departments are personnel, engineering, maintenance, purchase, accounts, matron, finance office, pharmacy, laundry, security, kitchen, housekeeper, etc., and their clients are all at the same level. Each of the officers again has assistants, senior assistants, junior assistants, etc., to look after various sub-functions. Since the inception of Manipal Hospital in 1991, the hospital has computerized the various recurring activities, such as inpatient and outpatient admissions, transfers, discharges, registration, certain corporate activities, payrolls, billing, etc., from the
computers and software packages purchased at that time. They have also developed software of their own at the head office by their software engineers to suit their operations. Though the computerization activities are in full swing at various departments, interconnectivity is lacking and the system is too old to cope with the increased work load. At present, they do not have any connection between computers of different departments and also of different hospitals. As such, the hospital was very serious in modernizing the old computer system at each of the departments and to expand its activities to other departments and to have connectivity to various hospitals, including their hospitals at Nepal and Sikkim, which are far off.
The hospital, considering its future expansions as well as anticipated increased workload, negotiated with some of the reputed consultants in the software field, about six months back and is likely to entrust this task to one of the leading software companies at Bangalore (shortlisted) for the full computerization of the hospital. They are likely to spend a huge amount for computerization activities and the pilot project was likely to commence in April 1999. Manipal Hospital, at present, is having MIS activities, at one nodal centre at each of the hospitals. MIS do not have a separate department, but all MIS activities come under the finance controller.
The pilot project commencing in April '99 included computerization of the following:
(i) Front office (Administration, registration, discharge, transfer, etc.)
(ii) Billing
a. Inpatient
b. Out patient
(iii) Accounts
a. Billing
b. Purchase
c. Stores
d. Payroll
(iv) Corporate activities
(v) CDR
(vi) Medical records, ward management, OT scheduling, doctors' appointments scheduling, engineering and maintenance,
laundry, kitchen, housekeeping, all wards, etc.
(vii) Laboratory (Interfacing)
(viii) Computerized library .........., etc.
(ix) Radiology
Many of the activities, though existing, need to be updated with new systems and wherever systems do not cover departments, these are to be included.
Mr Sairam, who is in charge of all these activities at present, confirms that the entire work will be done in ten phases, as under, within a span of maximum two years.
(i) Take up pilot project at Manipal Hospital (Tower 1 - 450 beds)
(ii) Extend the pilot project to Tower 2 - 450 beds
(iii) Extend the same to north side hospital - 62 beds
(iv) Connect all the three through WAN
(v) Simultaneously with activity 1, work starts at Manipal - 1600 beds
(vi) Simultaneously with activity 2, work starts at Mangalore -1000 beds
(vii) Connect Bangalore, Mangalore, Manipal, across all the hospitals through extended WAN
(viii) Extend similar activities to Nepal
(ix) Extend similar activities to Goa and Sikkim
(x) Connect all hospitals
During this period, care will be taken to include all high-tech systems , such as expert systems (may be useful for hospital research work), executive information systems and DSS for the top management to take decisions on vital matters.
Questions
1. Do you feel that DSS and EIS are required in hospital information system? Give reasons for your answer.
2. Analyse whether an expert system can be effectively used in the hospital's R & D activities.
3. In your opinion, are the computerization plans of Manipal Hospital, a multiunit, multiproduct, multi-location organization,
adequate? Are there any other suggestions you could offer to make this more effective, keeping the budget constant also in
mind?
4. Do you think that client/server technology is part of the business strategy for profit health maintenance organizations (HMOS) and hospitals. Why/why not?
