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    A PROJECT REPORT

    ON

    HOSPITAL MANAGEMENT SYSTEMS

    SUBMITED

    BY

    SAIKIRAN.M

    ROLLNO: 10-37

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    ACKNOWLEDGEMENT

    The satisfaction that accompanies that the successful completion of any task would be

    incomplete without the mention of people whose ceaseless cooperation made it possible.

    Whose constant guidance and encouragement crown all efforts with success.

    We are grateful to Ms. Zeba and Ms. Shaista Akbar for the guidance and suggestions that

    helpful in the preparation of this project.

    I also thank my friends and college faculty who have helped in successful completion of

    the project.

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    TABLE OF CONTENTS

    3

    S no Contents Page nos

    1.

    2.

    3.

    4.

    5.

    6.

    7.

    8.

    9.

    10.

    ABSTRACT

    INTRODCUTION

    HMS BENFITS

    WHY COMPUTERS INHEALTH CARE

    DOCTORSDILEMMAS

    LAN

    STATEMENT OF

    PROBLEMS ANDOBJECTIVES

    METHODOLGY

    OBSERVATION AND

    DISCUSSION

    SUGGESTEDMODULES

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    5-6

    7

    8

    9

    10

    11

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    13-19

    20-37

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    ABSTRACT

    Hospital management System (HMS) is vital to decision making and plays acrucial role in the success of the organization. Computerization of the various

    departments, documentation has resulted in efficient data management and

    information dissemination for the users. Managers, Clinicians and other

    healthcare workers can now access the information without delay or errors.

    Present study reveals, the existing system requires up gradation to meet the

    requirements of the managers and the clinicians. Participants feel HMS assists in

    decision making, and medical audit. Participants felt that the existing HMS

    resulted in longer time for OPD consultation and delay in investigation results.

    Majority of the participants feel that HMS helps in education and research.

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    HOSPITAL MANAGEMENT SYSTEM (HMS)

    A management system in a Hospital would require to very precise and must result into

    cost cutting and efficient management. Which should be accurate in its approach and suit

    all environments including large, medium or small.

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    INTRODUCTION TO HOSPITAL MANAGEMENT

    SYSTEM (HMS)

    Designed to improve the quality and management of clinical care and hospital health

    care management in the areas of clinical process analysis and activity-based costing.

    HMS enables you to develop organization and improve its effectiveness and quality of

    work. Managing the key processes efficiently is critical to the success of the hospital.

    HMS consist process management tool elements: modeling, analysis, and simulation.

    Documentation though an important part of a Hospital, is a non-productive exercise for

    the intellectual human being, whose ability lies in core areas of excellence. Hence a

    systematic approach to the way documents are managed, can transform your Hospital

    resources to its highest utility and advantage.

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    HMS Benefits:

    Enables hospitals and doctors to better serve their patients.

    Improved quality of patient care.

    Increased nursing productivity reducing the time spent by staff filling out

    forms, freeing resources for more critical tasks.

    Better quality of care, procedures and service to Patients.

    Control over the costs incurred by diagnosis-related groups.

    Why computers in health care systems?

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    There is hardly any area today, which has not been influenced by computers, and health

    care systems are no exception. Health sector, in fact is field where computers could make

    maximum social impact. There are human beings today who are half computers and half

    human e.g. patients with Pacemaker, Computerized precision made artificial heart,

    computerized hearing aid, and computerized dialysis machine. The present day hospitals

    are able to understand the complex processes and manage materials, money and

    manpower effectively and efficiently only due to computers.

    We lag behind by decades, as USA even in 1972, 81% of the hospitals had one or morein-house computers. Today it is a norm in USA to allocate 10% of the hospitals budget

    for computerization. I wonder if any hospitals management in India would do so?

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    Doctor's Dilemmas

    Nothing on this earth is more complex than the human body the processors used in the

    most powerful super computers doesnt come close to matching any of the human organs.

    Doctors can understand the human body, but are afraid/hesitant in using computers. This

    hesitancy/phobia/fear/lack of awareness is the main hurdle in the utilization of computers

    in health.

    The awareness amongst health professionals has certainly increased over the past few

    years but still many continue to shy away from computes - some are hesitant, some are

    unsure about their utility and quite a few procure it for a status symbol. Applications in

    health

    Wide applications of computers in health care include hospital management, patient care,

    billing, counseling, appointments, curriculum planning, research, study, communication

    etc. Most of the diagnostic instrument e.g. X-rays, CAT scan, Blood gas analyzers,

    ultrasound, automatic analyzers are based on computers, and have made the monitoring

    of patients and interpretation of diagnostic tests easy. It is not uncommon to see qualified

    professionals being utilized in clerical tasks for maintenance of records etc. at the cost of

    patient care. Computers could help solve some of the problems like:

    1. Relieving physicians from routine documentation and other clerical functions.

    2. Cutting down on the paper work; sparing more time for patient care, reducing

    errors and increasing accuracy in transmission and storage of data.

    3. Establishment of consistent standards and continuous monitoring or transactions

    4. Easy and direct access to various information regarding patient through remotely

    located terminals.

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    Local Area Networking (LAN)

    Has made Hospitals Management System easy, fast, accurate and comfortable. The

    patient's data, x-rays, sonograms, CT Scans and other investigation reports can be

    brought to the terminals in the operations theatres, patients' bed, the consulting room or

    the desk of administrators, just at the press of a button.

    In the hospitals and medical related organization the computers can be utilized through

    LAN for

    a. Communication of Medical Information

    b. Assistance in diagnosis

    c. Assistance in evaluating prognosis

    d. Patients Profile

    e. Administrative Support

    f. Medical research

    g. Legal requirements

    h. Linkage with other specialized computers

    i. Inventory management

    j. Cost control, billing

    k. Maintaining medical records

    l. Patient Counseling

    m. Medical Literature Archival

    n. Image archival and processing

    As 75% of the activity of hospitals is concerned with the processing of information.

    Computers can help improve the efficiency of this information processing that too at low

    cost.

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    Statement of the Problem:

    A study on Computerization of Departments of a tertiary care teaching hospital with

    special reference to the Hospital Management System.

    Objectives:

    1. To study the existing Hospital Management System.

    2. To identify the shortcomings, if any, in the existing Hospital management System.

    3. To suggest the necessary steps to improve the existing Hospital Management System.

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    Methodology:

    The study was conducted in 1050 bedded tertiary care teaching hospital. The Whole

    Departments of the hospital was studied for assessing the Hospital Management System.

    Descriptive research approach as adopted for this study. Descriptive statistics have been

    used to find out the deficiencies, if any, in the existing Hospital Management System.

    The target population consisted of managers, doctors and patients in the hospital. The

    data were collected from a sample of 50, consisting of 5 managerial heads, 5doctors and

    20 patients,10 administrative staff selected by the disproportionate stratified sampling

    technique. The inclusive criteria for selecting the sample, were the managers who

    involved in decision making process, doctors with experience of more than one year, andthe computer literate patients, willing to participate in the study.

    The tool used to collect the data was a structured, closed ended questionnaire. The

    questionnaire was constructed with emphasis on the content, clarity and simple language.

    The scoring has been given according to the nature of the questions.

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    Observation & Discussion:

    It was observed that the complete Hospital management system has been not utilized.

    Having so many resources the hospital people are following the same old technique of

    manual writing of records.

    The staff who are using the computers to do their daily work are not well trained which

    is causing delay in time.

    The storage of the manual records is a big problem the data which is written in them

    cannot be accessed easily.

    The staff is willing to do their work with the use of computers , which will save their

    time and chance of doing mistakes is minimal which is very high in case of manual work.

    The department should be provided with the computers and the essential software

    required to their work and necessary training should be provided.

    The staff who are using the present software Aristotle Medics are well satisfied with the

    package what they are using, because they got habituated to their work and they doesnt

    want any change.

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    THE INFORMATION OR MODULES AVAILABLE IN

    ARISTOTLE MEDICS WHICH IS PRESENTLY USEDIN OHRC INCLUDE

    Administration

    Current Bill amt of admitted patients, amt. recd. and balance amt. HR

    management, Asset management, Ward Management, Public Relation,

    Marketing, Special Tools & Controls.

    Patients :Patient gets immediate attention, A complete history for the proper selection

    of treatment.

    Doctor :

    Patient history, Disease, complaint, medication wise, clinical

    report: includes tabular charts & graphs. Pre entered complaints,

    general & systemic examination, diagnostic & medicine templates.

    In-Patient reading to pay attention to Patients without visiting any

    dept. even from remote locations. Easy preparation of Discharged

    Summary.

    Nurses :Nurse chart acts as worksheet for all activities & take inputs to maintain the

    clinical records.

    Accounts :

    Automatic generation of indoor patients bill which includes establishment,

    nursing, consultant, service, pathological etc. charges, complete

    accountancy up to balance sheet, Investigation Book, Requisition Book,

    OPD Register.

    Other staff :

    Reception: Admitted patient list with referred by information, Patient

    Registration / Bed Allocation / Pathology / Radiology / O. T. Records /

    Pharmacy stores.

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    WHAT IS BEING ACTUALLY USED BY OHRC

    ADMINISTRATION: Current Bill amt of admitted patients, amt. recd. and balance

    amt, Discharge process.

    Accounts :

    Automatic generation of indoor patients bill which includes establishment,

    nursing, consultant, service, pathological etc. charges, complete

    accountancy up to balance sheet, Investigation Book, Requisition Book,

    OPD Register.

    Other staff :

    Reception: Admitted patient list with referred by information, Patient

    Registration / Bed Allocation / Pathology / Radiology / O. T. Records /

    Pharmacy stores.

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    Table 1Due you think that their is need ofcomputerization of departments .

    Out of total sample size of 50. 37 respondents feel that there is need of computerization

    of departments in hospital for the better and efficient usage of the available resources.

    16

    No of

    respondents (n=50)

    Yes No Total

    Doctors 4 1 5

    Managers 5 - 5

    Administrativestaff

    13 7 20

    Patients 15 5 20

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    Table 2 Opinion about the existing Hospital

    Management System

    Category

    (n=50)

    Response

    Good Moderate Poor Total

    Managers 4(80%) 1(20%) 5

    Doctors 3(60%) 2(40%) 5

    Patients 15(75%) 5(25%) 20

    Administrative staff 8(80%) 2(20%) 10

    Total no of

    respondents(%)30(60%) 20(40%) 50

    0

    5

    10

    15

    20

    2530

    35

    40

    45

    50

    Good poor

    Managers

    Doctors

    Patients

    Clerkcial staff

    Total no ofrespondents

    This hospital has a good Hospital Management System which is not properly/ completely

    in use. The study reveals that the department is providing information to the health

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    authorities regularly. The overall opinion of the managers, doctors and patients about the

    existing Hospital Information System in the hospital is satisfactory (60%) and 40% feel

    that the system is poor. (Table-2)

    Table 3 Disadvantages of the existing Hospital

    Management System HMS

    Disadvantages of existing

    Hospital Information System

    responses regarding the existing system

    StronglyAgree

    Agree Disagree Stronglydisagree

    Non-Existence of ward

    Computers is affecting

    patient care

    37(74%) 13 (26%)

    OPD consultations take

    longer time 35 (70%) 10 (20%) 5 (10%)

    System break down 10 (20%) 15 (30%) 25(50%)

    The majority of the Respondents (85%) feel that the nonexistence of ward computers is a

    hindrances in providing the expected patient care. They also feel that the existing

    Hospital Management System does not help either in making the OPD consultations

    quicker or in generating quick laboratory reports.

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    Modules of Hospital Management System (SUGGESTED

    FOR OHRC)

    Patient Registration

    Appointment Scheduling

    Admission Discharge Transfer

    Bed Management

    Wards Management Module

    Patient Relations

    Doctors Workbench

    Nursing Workbench

    Operation Theater

    Electronic Medical Record

    Clinic Specialties

    Laboratory Information System

    Radiology Information System

    Pharmacy

    Central Sterilized Supply Department

    Blood Bank

    Housekeeping/Laundry

    Equipment Maintenance System (EMS)

    Healthcare Packages

    Patient Billing

    Insurance and Contracts Management

    Hospital Administration

    Roster Management

    HRMS

    Financial Accounting

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    Goals of proposed system

    1. Planned approach towards working: - The working in the organization will be well

    planned and organized. The data will be stored properly in data stores, which will help

    in retrieval of information as well as its storage.

    2. Accuracy: - The level of accuracy in the will be higher. All operation would be done

    correctly and it ensures that whatever information incoming from the center is accurate.

    3. Reliability: - The reliability will be high due to the above stated reasons. The reason for

    the increased reliability of the system is that now there would be proper storage of

    information.

    4. No Redundancy: - the utmost care would be that no information is repeated anywhere, in

    storage or otherwise. This would assure economic use of storage space and consistency

    in the data stored.

    5. Immediate retrieval of information: - The main objective is to provide for a quick and

    efficient retrieval of information. Any type of information would be available whenever

    the user requires.

    6. Easy to Operate: - The system should be easy to operate and should be such that it can be

    developed within a short period of time and fit in the limited budget of the user.

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    Hospital Management System - Registration

    The Registration module is an integrated patient management system, which captures

    complete and relevant patient information. The system automates the patient

    administration functions to have better and efficient patient care process.

    Patient Registration Details

    Inpatient and Outpatient Registration

    Medical Alerts Details

    Appointment Scheduling (Patient / Doctor wise)

    Doctor's Schedule Summary

    Doctors Daily Schedule List

    Patient Visit History

    Medical Record Movements

    Appointments for Radiology tests and Operation Theatre

    Patient Visit Slip

    Sponsorship Details

    It provides for enquiries about the patient, the patient's location, admission, and

    appointment scheduling and discharge details. Furthermore, this system even takes care

    of package deals for a patient for a fixed cost. Medical Record keeps an abstract of

    clinical data about patients. It allows easy retrieval of medical records on patients.

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    Hospital Management System - Electronic Medical Record

    The EMR Module is a fully integrated knowledge repository that caters to Medical and

    clinical records of patients in the hospital. The system supports medical professionals of

    various departments of the hospital with relevant information like medical examinations,

    diagnoses, treatment histories, test results and so on. The module provides access to

    critical and complete patient data that leads to high quality cost effective and efficient

    patient care. The EMR should have the following features

    Patient Search with Various Search Strings

    Patient Demographic Viewing

    Previous Visit Details

    Medical History of the Patient

    Billing Details of Patient

    In addition the user should be able view investigation requests, prescriptions, reports

    and other clinical details. The system should provide separate access rights for each part

    of the EMR. The patient medical file can be securely retrieved from this module and sent

    across LAN and WAN and also can be E-mailed

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    Hospital Management System - Billing

    The Patient Billing module should handle all types of billing for long-term care. This

    module facilitates cashier and billing operations for different categories of patients like

    Outpatient, Inpatient and Referral. It provides automatic posting of charges related to

    different services like bed charges, lab tests conducted, medicines issued, consultant's fee,

    food, beverage and telephone charges etc. This module provides for credit partly billing

    and can be seamlessly integrated with the Financial Accounting Module. The billing

    module is extensively flexible by which each of your billing plans can be configured to

    automatically accept or deny. The system is tuned to capture room and bed charges along

    with ancillary charges based on the sponsorship category. The Billing Screens is used for

    In-patient and Outpatient Billing and Invoicing. Further more the charges for various

    services rendered can be recorded through service module and this can be used for billing

    purposes.

    Payment Modes / Details

    Sponsorship Conditions Details

    Patient Billing Details

    Package Installment

    Approval from Sponsor

    Company Sponsorship Details

    Package Registration

    Sponsor Verification

    Retroactive Processing

    User-defined Billing cycles

    Automatic Room and Board chargesRecurring Ancillary charge capability

    Auto-generated Codes and Billing Criteria

    Provision for Pre-billing

    Extensive third-party Billing

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    Hospital Management System - Financial Accounting

    The Financial Accounting Module should deals with Cash/Bank, Receipt/Payments,

    Journal Voucher and General Ledger etc. Books like Cashbook, Bankbook and Ledger

    book can be generated. This module should generate reports like Trail Balance, Balance

    Sheet and Profit and Loss statement. The Financial Accounting Screens should describe

    about the Account Payable, Account Receivable and General Ledger. Also describe the

    activities related to IP, OP, Bank related activities and provision to clearing the Supplier

    Invoice and keep track of the Account Receivable and Revenue related activities. The

    services that are covered by the sponsor companies, Insurance Agencies, Family

    Accounts, Individual Accounts, sponsorship details of the patient, Health Card Insurance

    are should be recorded in the system.

    Hospital Management System - Fixed Assets

    The Fixed Assets Module should deals with all the activities that are related to the Fixed

    Assets Part of Financial Accounting.

    This describes activities that are related to:

    Identifying an item as a Fixed Asset

    Allocating depreciation

    Managing its movement Maintenance

    Revaluation and Disposal etc.

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    Hospital Management System - Payroll

    The Payroll & Personnel module should deal with Pay (and deduction) calculation,

    printing of salary slip, salary certificates, and PF statements, Gratuity Statement and

    provides a monthly analysis.

    The maintenance of employee bio-data, Attendance / Overtime details.

    It also reports on absenteeism, leave encasements etc. The Personnel & Payroll

    department is responsible Employee Related Activities like appointing the staff,

    maintaining the employee database, Fixing allowances and deductions, Leave

    entitlements, Leave sanctions, Loan, Termination Process, Maintenance of Hospital

    documents, Insurance details, Tenancy Contracts and Vehicle Registration.

    Hospital Management System - Outpatient Management

    The Outpatient module should serve as an entry point to schedule an appointment with

    the Hospital Resident Doctor or Consultant Doctor for Medical Consultations and

    diagnosis. This module should support doctors to take better and timely consultation

    decisions by providing instant access to comprehensive patient information. Patient visits

    are divided into New, Follow-up and Review. The module also handles requests and

    results of laboratory tests and other examinations. External Doctors visit to in patients can

    be defined as "Call on". Some patients may avail only the hospital facilities like Lab,

    Radiology, Nuclear Medicine, and Physiotherapy and so on.

    Medical Alerts Details

    Consultation Duty Roster

    Diagnosis Details

    Triage Parameters

    Patients Appointments

    Daily / Weekly Schedule Summary

    Appointment Scheduling / Rescheduling Facility

    Outpatient Medical Observation Details

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    Hospital Management System - Inpatient Management

    The inpatient module should be designed to take care of all the activities and functions

    pertaining to Inpatient Management. This module automates the day-to-day

    administrative actives and provides instant access to other modules, which leads to a

    better patient care. It should provide comprehensive data pertaining to Admission of

    Patients & Ward Management. Availability of beds, Estimation, Agreement preparation,

    Collection of advance, planned admission, Emergency admission and so on. The

    Inpatient module should also deals with Ward Management Shifting from one ward to the

    other, Bed availability, Surgery, Administration of drugs, nursing notes, charge slip and

    so on.

    Admission Cost Estimation

    Admission Approval

    Admission Request

    Doctor Transfer Details

    Nursing Notes

    IP Medical Observation

    Pending Drug Request

    Surgery Scheduling Details

    Discharge Notification Summary

    Expected Date and Time of Discharge

    The module tracks every visit made by the patient and caters to follow-up visits of

    patients, along with multiple appointments.

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    Hospital Management System - Pharmacy

    Pharmacy module should deal with the automation of general workflow and

    administration management process of a pharmacy. The pharmacy module should equip

    with bar coding facility, which makes the delivery of medical items to the patient more

    efficient.

    Enquiry

    Quotation

    Purchase order

    Online approval,

    Pharmacy drug configuration

    Pharmacy stores configuration

    Drug issue to patients and billing

    Unit dosage facility

    Supplier information

    Maintenance of drug inventory

    Automatic reorder level setting

    Purchase Requisitions

    Purchase Order

    Online request for stock from various sub-stores

    Online stock transfer

    Maintenance of stock at different sub-stores

    Return of items nearing expiry

    Destruction of expired itemsPhysical stock verification and adjustment

    Goods receipt

    Stock Transfer (inter store stock transfer)

    Stock Adjustment

    Stock in Hand reports

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    Hospital Management System - General Store & Inventory

    General Stores and Inventory module should deal with Purchase of Items, Issue of Items,

    Maintenance of Stock, Automatic Reorder level Setting, Online request for stock from

    various sub-stores, Online stock transfer, maintenance of stock at different sub-stores,

    Physical stock verification and adjustment, Return of items to supplier etc.

    Stock management

    Stock control

    Stock Purchase through Enquiry generation

    Sub stores issues and receipt of stocks

    External hospital stock issues and receipt

    Option to include and track gift or donation of stock

    Stock requisitions from sub-stores and corresponding management

    Quotations and Purchase Requisitions

    Purchase order generation and processing- LPO, Emergency Purchase order, Principal

    and Blanket PO

    Advance payment requisitions to Finance

    Goods Receipt Note and Purchase returnsAutomatic stock updates on receipt of goods

    Stock returns and destruction tracking

    Invoice verification

    Supplier management and supplier payment bucket facility available

    Supplier invoice management

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    Hospital Management System - Laboratory

    The Laboratory module should automate the investigation request and the process

    involved in delivering the results to the concerned department/doctor of the hospital.

    Laboratory module starts with receiving the online request from doctors and also allows

    laboratory personnel to generate requests. The Laboratory module should support to

    perform various tests under the following disciplines: Biochemistry, Cytology,

    Hematology, Microbiology, Serology, Neurology and Radiology. Tests are grouped

    under various sections and sample type (specimen). Based on the request the user can

    input the sample and generate the sample number. Results can be entered based on the

    sample type either to one test or multiple tests. If the test result requires approval, the

    supervisor has to approve the result and it is made available to concerned doctors.

    Sample Result Entry

    Test Report Entry

    Specimen Association Details

    Antibiotic Details

    Result Range for Test

    Investigation Request

    Bulk Sample Request

    Sample Details

    Samples Received from External Laboratory

    Samples Dispatch to External Reference LaboratoryInvestigation and Treatment History

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    Hospital Management System - Radiology

    Radiology module should cater to services such as X-ray, Scanning, Ultra sound etc.

    Scheduling of Radiology resources is possible. The system should store all the result

    details of various tests and makes a Report based on the Test Results.

    These Tests are carried out both for Inpatient and Outpatient. The system should store all

    the details (like patient number, Test Report like X-Ray, Scanning details) and for each

    scan the system generates a unique number for the image.

    Investigations can be done only after the billing is done. This rule is exempted when the

    case is declared as Urgent.

    Hospital Management System - Physiotherapy

    This module should facilitate tracking the services given to patients depending on the

    consultant's recommendations.

    Physiotherapy sessions are carried out both for Inpatient and Outpatient. Appointment

    has to be fixed by the patient for these sessions.

    All the Appointments to the Physiotherapy will be through the consultant. There will be

    no direct appointment.

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    Hospital Management System - Dental

    Dental module should cater to the services rendered by the dentists. Treatment and

    follow-up treatments are tracked using this module. Progress readings can be recorded

    through this module.

    Hospital Management System - Service

    The service module should deal with all the services available in the hospital and the

    charges for these services are stored through this module. There are various services that

    are available in the hospital can be seen.

    SERVICE MASTER: This master gives the details about package details, Group detail

    ROOM TYPE MASTER: This gives the details about Room Type (Ex: Private, Semi-

    private, Deluxe, ICU, Suite etc) and their charges.

    CONSULTATION CHARGE MASTER: This gives the details about Doctor and the

    charges (like new visit, Follow-up, Review and Call-on).

    REVENUE TYPE MASTER: This gives the predetermine charges for various service

    given by hospital (Like Ambulance, Anesthetists Fee, Baby Cot etc).

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    Hospital Management System - Help desk

    The Help Desk Module should automate the day-to-day functions of the Front office

    management of a hospital. This module helps in assisting patient with accurate

    information and supports in handling patient related enquiries efficiently.

    Patient related enquiries

    Bed Allotment

    Admission Details

    Demographic Details

    Payment Details and

    Discharge Details.

    Doctor related enquiries

    Availability Details

    OP Clinic Details

    Appointment Schedules

    Operation Schedules and

    Charge Details

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    REFERENCES

    Conclusion

    THE PRESENT SCENARIO IN INDIA IS THAT MOST OF THE HOSPITALS ARE

    PARTIALLY COMPUTERIZED. THIS SYSTEM EXISTS IN SOME HEALTH CARE

    FACILITIES, WHERE ENTRIES ARE MADE BY DIFFERENT HEALTH CARE

    PROVIDERS, SUCH AS PHYSICIANS, NURSES AND THERAPISTS, INTO THE

    COMPUTER IN DIFFERENT NODES IN A LOCAL AREA NETWORK. THE

    SURVEY CONDUCTED IN THE HOSPITAL REVEALS THE IMPORTANCE OF

    INFORMATION NETWORKING BETWEEN THE DEPARTMENTS. MAJORITY OF

    THE BENEFICIARIES OF HOSPITAL MANAGEMENT SYSTEM, ARE AWARE

    ABOUT THE ADVANTAGES OF COMPUTERISATION IN THE HMS IN

    PROVIDING BETTER HEALTH CARE. ALL OF THEM AGREE THAT ONLY IN

    AN EFFICIENT SYSTEM THE INFORMATION CAN BE READILY AVAILABLE.