final term paper management information systems styled
TRANSCRIPT
University of the Philippines - Visayas Master of Management in Business Management
Management 286 Management Information Systems
John Eric M. Abela, Ma. Luisa B. Alba, and Pia Christie F. Mejia Proposal for the use of an Enterprise Resource Plan for the patient records and accounting processes of the Medical Mission Group (MMG) Hospital and Health Services Cooperative.
Information Systems Strategic Plan For
MEDICAL MISSION GROUP (MMG) HOSPITAL AND HEALTH SERVICES COOPERATIVE
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Project Title : Information Systems Strategic Plan for Medical Mission Group (MMG) Hospital and Health Services Cooperative
Proponents : John Eric M. Abela Ma. Luisa B. Alba
Pia Christie F. Mejia
I. EXECUTIVE SUMMARY
This is a proposal for the introduction and adoption of an Enterprise Resource Plan (ERP)
for the Medical Mission Group (MMG) Hospital and Health Service Cooperative of Roxas
City in order to make its record keeping and accounting operations more efficient and cost
effective, thus allowing the company to provide quality healthcare at a lower cost to its
clients.
Proposed Changes to System Processes:
Electronic Medical Records (EMR)
Electronic Billing and Accounting System
Cloud Sharing and Backup
The initial investment for the proposed ERP is estimated to cost P350,000.00, which shall be
taken from the Special Projects Fund of MMG. If the same should prove insufficient,
available unallocated funds from the Capital Expenditures Fund shall be utilized. Subsequent
operating expenses shall come from the regular fund.
Estimated return on investment is three to five years, to be sources from revenues from
increased client base and cost reduction measures on office supplies and manpower
requirements.
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II. INTRODUCTION
The Medical Mission Group (MMG) Hospital and Health Service Cooperative of Roxas City is
a multispecialty clinic with over twenty five rooms/clinics and over thirty doctors and/or
medical specialists. It was founded as a cooperative by a group of twenty one doctors on 28
October 1997 and is engaged in bringing quality and affordable healthcare services to the
people of Roxas City and the province of Capiz. Its current members include doctors,
nurses, paramedical healthcare workers, and non-medical personnel.
Through the years, MMG has grown in terms of membership, infrastructure, and
operations. At present, it has offices in a two storey building along Washington Street by
the river bank, a stone’s throw away from the City Plaza. Housed in this building are its
laboratories, clinics, and X-ray facilities, including its own pharmacy.
With the many developments that MMG has undergone throughout the years, its day to
day operations have largely been done manually. From patient records to its billing system,
laboratory results, and even pharmacy inventory, all these have been done without the
benefit of computers. There is very minimal information technology involved in its
operations.
And despite its growth in terms of members, facilities, and patients, MMG has failed to
integrate an electronic system in its operations, thus limiting its growth in terms of patient
capability and interconnection with other franchises, among others.
The development of an enterprise resource plan for its operations would allow it to
streamline its business processes, thus allowing it to operate more efficiently, at less cost.
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III. STRENGTHS, WEAKNESSES, OPPORTUNITIES, AND THREATS (SWOT) ANALYSIS
Strengths
Simple system for record keeping and accounting, limited by its use of a manual business process.
Relatively small size
No hospital rooms
Minimal staff and personnel
Dedicated records keeping personnel
Weaknesses
Technophobic doctors and staff
Lack of IT equipment
Lack of an electronic network
Lack of personnel trained in IT
Voluminous existing manual records to be entered electronically
No existing records redundancy strategy
Opportunities
Allows for expansion of database records
Allows for sharing of data with other franchises
Increased efficiency in operations
Cost effective business processes
Financial records transparency
Visible work processes
Offsite access to patient records
Threats
Danger of confidential patient records being stolen
Corruption of data
Rejection of system by end users
Return on investment may not be realized
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IV. CURRENT IT STATUS
At present, MMG has one (1) standalone personal computer running on Microsoft
Windows XP and with basic Microsoft Office Suite installed, being utilized by two (2)
personnel, who use it exclusively for preparing office documents and simple data encoding.
While there is a broadband internet connection with a wifi router for doctors and other
personnel, there is no local area network, wireless or wired, installed which would allow
the sharing of data and other files between computers or for offsite access.
MMG has recently purchased two (2) additional personal computers for use in its
laboratory and the pharmacy, but there are presently no plans to link these with the
existing system.
There are plans of upgrading the system so as to make daily operations easier and faster,
and to have a more efficient way of record keeping, especially the patients’ medical
records. Presently, the trend for almost all healthcare facilities is to go paperless.
An Electronic Medical Record (EMR) contains the standard medical and clinical data
gathered from a patient by the health care provider. The EMR represents a medical record
within a single medical facility such as a clinic or a hospital. Electronic records are more
beneficial than paper records because it allows providers to track data over time, identify
patients due for preventive visits and screenings, monitor how patients measure up to
certain parameters, such as vaccination and blood pressure readings, and improve overall
quality of care in a practice. With a good EMR software program, it can even incorporate
laboratory results done and medications prescribed, as well the billing statements for a
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particular visit, which make for a more efficient patient records and patient data
management. Strict security measures for EMRs should be implemented, as confidential
and privileged information is involved.
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V. ISSP VISION, MISSION, AND OBJECTIVES
Vision
- To provide efficient and cost effective healthcare services to the people of the Province of Capiz.
Mission
- To effectively and efficiently use information technology as a tool in bringing down costs and streamline operations.
Objective
- To create an Enterprise Resource Plan Solution to make the operations of MMG more efficient and cost effective.
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VI. RECOMMENDATIONS
Recommendation #1: Secure the full support of the Senior Staff and Management
a. Rationale
Enterprise Resource Planning is a costly, time-consuming, and risky project. Without
the full support of upper management and the major stakeholders, i.e. doctors,
senior staff, and senior nurses, the project would most likely fail. Thus, meetings
and consultations among stakeholders must first be held to gather and address the
concerns of everyone involved and to ensure their commitment to the project.
b. Current Status and Discussion
MMG does not have an existing ERP, relying instead on manual records written on
paper and stored physically. There is a single computer whose purpose is to help
facilitate in record keeping of doctors’ appointments and correspondences, record
keeping of pharmacy stocks and sales, and printing of laboratory requests and
results; all using simple spreadsheet software (Excel) and document creation/editing
(Word). However, there is no database used, no existing network among computers
and/or workstations, no standard programs and standard business/hospital data
forms, and no robust security measures. Thus, although some of the data is encoded
electronically, there is no way of using said data for automated queries and reports.
The present method is still to print out the data from the individual
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computers/workstations and re-encode them for whatever purpose they are
needed, such as accounting auditing.
All major stakeholders who will be affected and will benefit most from the success of
the project agree that there is a need for an ERP. A budget of 5% from the over-all
cooperative hospital yearly budget has been earmarked for ERP. With such a
restriction on the budget costs, the primary goals of the ERP project are on a
modular system that would bring the most “bang-for-the-buck” with the focus on
improving patient care.
c. Steps
Set up meetings and consultations and write down actual observations within a two-
month period to get a clear picture of the needs of the day-to-day operations of the
clinic. This would enable us to define and focus on which ERP module to implement
first.
Identify the hardware and software requirements that are needed. Canvass and
secure the information needed for the suppliers of the said requirements.
Allot personnel and a budget to accomplish these preliminary steps.
d. Required Involvement
Assign at least one staff member who has the technical inclination for the tasks
involved, one senior doctor with the same inclination and secure the services of a
consultant well versed in hospital ERP.
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Recommendation #2: Create the core group who will be in charge of the ERP project.
a. Rationale
Having a small but dedicated group will make the implementation of the project
easier to handle. There would be less people to train, allowing the ERP provider to
better focus on the transfer of skills necessary for the use of the ERP. This core group
would then be the ones to train the other personnel in using the ERP.
b. Current Status and Discussion
At present, there are two (2) personnel trained in using basic Microsoft Office
programs like Microsoft Excel and Microsoft Word, however, they have no
background in database design or entries in Microsoft Access or SQL. These two,
along with a doctor and a senior staff member, will form the core group for the
project.
c. Steps
A crash course in database design and use would be necessary to familiarize the core
group with the ERP software and its modules. This will take a minimum of seven days
to complete, depending on the level of education already attained by the core group.
Once the core group has acquired a basic knowledge of the database system and the
logic behind it, an in-depth training on the system lasting between fifteen to twenty
days would be necessary to complete the training of the core group.
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d. Required Involvement
The core group shall be composed of two (2) staff members, a supervisor, and a
medical doctor. This group shall form the nucleus around which the entire ERP
project shall be initiated.
Recommendation #3: Identify, define, and limit the scope of the ERP project especially the assessment level of software customization needed, so that project costs and project duration will be manageable and doable.
a. Rationale
The project of MMG does not require a total ERP package, instead focusing on record
keeping, billing, and accounting. Keeping the level of change as minimal as possible,
yet achieving the optimum results would keep costs down in terms of money and
personnel downtime.
b. Current Status and Discussion
MMG has almost no electronic system for its operations, but it intends to streamline
its record keeping, billing, and accounting systems for easier access and
interconnectivity.
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c. Steps
The ERP system to be installed will consist of two (2) modules, an EMR module for
patient records and an accounting module to handle its accounting and billing
operations.
These two systems will be interconnected and capable of being linked and cross
referenced for easier use.
The EMR module will contain all the relevant patient data such as name, age, gender,
address, contact numbers, including his medical data such as family history, vital
signs taken during previous visits, and notes from his physician. After research on
existing EMR applications in the market, it was decided that Doctor @t Work mobile
app for Android shall be used. This application has garnered glowing reviews from
other medical practitioners and is free. It also has a desktop application synchronized
with the mobile app which can be used for primary storage in the server. Additional
security and backup by sharing data in a dedicated Dropbox cloud storage facility
shall also be utilized. This app shall be installed on the tablet PCs in the clinics, to be
used by the doctors during checkups and consultations while the desktop module
shall be installed at the laboratory, pharmacy, and records keeping PCs where
pertinent data shall be entered before and after checkups and consultations to avoid
work duplication.
The accounting module will contain all the records of tests and consultations done
on the patient, including all medicines prescribed and if the same were purchased
from the pharmacy. This module will then be linked to the server and accessed by
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the cashier for billing purposes. The Quickbooks application has modules for
accounting, billing, and record keeping, all of which can be customized to fit the
needs of MMG. There is a facility for the import of external data in the application,
which shall be used to connect it with the Doctor @t Work desktop module, so as to
facilitate the automatic sharing of data between the two applications.
d. Required Involvement
Initial roll out will require the involvement of four (4) key personnel, namely the
accounting clerk, the records clerk, the cashier, and a doctor with a background or at
least an interest in Information Technology.
These will deliver the inputs needed for the ERP provider to customize the modules
for MMG operations.
Recommendation #4: Use open source ERP solutions customized for MMG operations.
a. Rationale
The bulk of the income of MMG is reinvested in the purchase or update of medical
equipment and facilities, leaving a small slice for Information Technology
infrastructure development.
The use of open source accounting and inventory software like Quickbooks,
customized for the needs of the company, is a cheap alternative to purchasing
expensive modules from a qualified ERP vendor or securing the services of a
software provider.
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Also, having the data onsite and not in the databanks of a third party makes the data
more secure and less prone to leaks. However, to allow offsite access to pertinent
data, sharing via Dropbox shall be utilized.
b. Current Status and Discussion
At present, MMG does not have a standard ERP system in place, relying instead of
manual encoding of patient history and other data on paper, stored in filing cabinets
and other storage facilities.
Billing and purchases from the pharmacy are also done manually, requiring the entry
of data in paper ledgers and books. When a patient leaves a clinic or the pharmacy,
the doctor or the pharmacist gives the patient a handwritten note to be given to the
cashier, who will then enter the details in the cash register and collect the payment
from the patient.
c. Steps
Identify the data needed for patient records and prepare the appropriate fields in
the database for these entries. Create special attributes for the fields for blood
pressure, electrocardiograph data, and other unique data.
Determine how and when doctors enter data in the patient records, paying attention
to the manner in which data is entered to enable the end users, the doctors, to enter
data with ease.
Study the billing and accounting processes, determine how best to eliminate paper
and enable sharing across the system.
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Prepare a time and motion study among the major departments (laboratory,
pharmacy, and clinics), determining the steps involved in entering data from
laboratory results and doctors entries and prescriptions. Provide a flowchart of
systems operations and determine the optimum path to be taken. Prepare a
checklist of laboratory tests to be taken prior to the checkup and consultation with a
doctor to eliminate delays in the processing of patients.
d. Required Involvement
This phase in the ERP process requires the involvement of four (4) key personnel, the
accounting clerk, the records clerk, the cashier, and a doctor with a background or at
least an interest in Information Technology.
Recommendation #5: Data security and backup and electricity backup in case of some sort of disaster.
a. Rationale
The confidentiality and integrity of patient records is of paramount importance to
MMG, not only because of the legal ramifications in the event of unauthorized
disclosure but also in terms of the effect on the company should the trust and
confidence of its patients in MMG be lost.
b. Current Status and Discussion
Patient records are handwritten on custom printed forms and then kept in
alphabetical order in filing cabinets and other storage areas. This is an inefficient and
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insecure way of storing data, not allowing for instantaneous sharing of information
for those who need it.
c. Steps
Identify the inherent threats in the software and decide whether the system shall be
limited within the local area network or available to users online.
Even standalone systems have their vulnerabilities but threats are limited to those
who have direct actual access to connected computers. However, this will limit the
capabilities of system users and of sharing across other branches of the franchise.
If the decision is to make the data available online, cloud storage facilities like
Dropbox or Google Drive should be considered because these are cheap or even free
cloud storage. Having data available online would expand the capabilities of MMG by
giving users access even when not physically in the facility, by allowing remote
consultations of patients. However, this also exposes the data to exploits from
hackers and crackers.
Invest in an uninterruptible power supply to allow the data to be saved in case of a
power outage. A standby generator is a big investment and might not be cost
effective in the long run. The additional cost in acquiring expensive equipment will
delay the expected ROI.
d. Required Involvement
This requires the involvement of the members of the Board of Directors of MMG
because it will entail decision making at the highest level and will require significant
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costs to the company. It will also entail the involvement of the President for the
implementation of the system and the Treasurer and the disbursement of funds
necessary for the project.
Recommendation #6: Intensive technical support for the first six months of implementation
a. Rationale
Every new system has bugs in the initial phase, no system is perfect at the get go.
Technical support during the first six months will assure the company that these bugs
or flaws in the system can be fixed or remedied by the software provider before the
full implementation of the system is done.
b. Current Status and Discussion
The personnel of MMG has already mastered the filing system being used, even
though slow and cumbersome, it is a system familiar to all.
c. Steps
Ensure that the contract with the software and hardware provider(s) includes a
provision for technical support and training for key personnel for at least six (6)
months from date of implementation. Ensure also that there is a provision for
warranties.
An option for a discount on future purchases should also be requested.
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d. Required Involvement
This will entail the involvement of the legal counsel of MMG for the perusal of the
service contract and the President for the signing of the agreement.
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VII. IT FUNDING STRATEGIES
MMG has an existing capital expenditure plan integrated in its annual budget for special
projects determined by the Board of Directors. Under its charter, the company allocates
10% of its unallocated earnings from the previous year to the development of new business
processes to streamline its operations.
The funding for this project shall be taken from the budget for capital expenditures and
special projects amounting to PESOS THREE HUNDRED FIFTY THOUSAND (P350,000.00)
ONLY. The budget shall cover the following expenditures:
HARDWARE Server P40,000.00 Workstation 1 (Laboratory)* P25,000.00 Workstation 2 (Pharmacy)* P25,000.00 Workstation 3 (Records) P25,000.00 Tablet PCs (10) P120,000.00 Wifi Router P5,000.00 UPS (4) P10,000.00 External Backup Drive P7,000.00 Portable Scanner P5,000.00 Laser Printer with Scanner P14,000.00 Biometrics Scanner P3,000.00 Inkjet Printers (3) P9,000.00 SOFTWARE Microsoft Exchange Server 2012 Bundled Microsoft Windows 7 OS Bundled Dropbox Cloud Storage $750.00 per year Doctor @at work app for Android free Quickbooks free OTHER EXPENSES Labor and Professional Fees P50,000.00 * already purchased
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VIII. IMPLEMENTATION PLAN
This Information System strategy will be implemented as follows:
a. Advocacy
The existing corporate culture of resistance to change and fear of information
technology must be overcome by the commitment to the systems change by senior
management.
The advantages of an ERP and the need for the company to embrace new technology
must be made known and emphasized. Employee and staff feedback from meetings and
dialogues must be incorporated in the system and in training programs.
b. Infrastructure Building, Resource Acquisition, and Management
The existing infrastructure of the company can not handle the ERP system, thus
requiring the acquisition of new equipment consisting of a server mainframe to store all
the pertinent data, connected via wired local area network to the computer systems of
the cashier, pharmacy, and records keeper. The system shall also require the acquisition
and customization of tablet computers which shall contain the application needed for
doctors to enter data, which shall be connected wirelessly to the main server.
The main server shall be connected to a cloud storage facility, requiring the use of a high
speed internet connection from one of the major ISPs.
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The company shall also require the hiring of a dedicated information technology
specialist to install, repair, and maintain the system, to be trained by the software and
hardware provider.
c. Systems Development and Maintenance
Systems development for the first six (6) months of the system shall be done by the
software and hardware supplier, taking into account feedback from the end users of the
system. The system shall be debugged and refined over the service warranty period,
with emphasis on its ease of use by the end users and access to the data by those who
need it during the truncated life cycle of the system.
During this time, an IT specialist shall be trained in the system, who shall then take over
the maintenance of the system after the end of the service warranty period.
d. Risk Management
Risks to the system such as security breaches and loss of data should be analyzed and
the appropriate preventive measures taken. Anti virus programs, firewalls, data
encryption, and layered access should be installed and implemented to prevent data
loss.
An uninterruptible power supply (UPS) should be standard for PCs while a backup
generator, although not essential, might prove useful in case of disasters where power
outages become common.
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e. Monitoring and Evaluation
During the first six (6) months after the implementation of the system, the software and
hardware provider, with the assistance of the IT specialist, shall monitor the system for
ease of use and security, making adjustments in the GUI as and when needed, or
altering the database for easier access to the database with the minimum use of
electronic resources. Continuous and intensive evaluation by end users should be
conducted in order to allow the software provider to customize the system to suit the
needs of the company.
At the end of the service warranty, periodic evaluation should be made by the software
provider to determine the changing needs of the company and to prepare for the
installation of a new updated system.