Overview and Architecture of Hospital Registration System – Pilot

Testing and Lessons Learned

By: Dr Mean Reatanak Sambath

M&E and Health Informatics Program Leader

Email: msambath@urc-chs.com

6-7 December 2012

Patient Management and Registration System (PMRS)

• PMRS designed as a component of the larger hospital improvement program

• Other components:

– Formal Triage Protocols

– Patient Flow

– Emergency Room Strengthening

– Improved Patient Charting (paper-based)

– Strengthened Record-keeping

Social Health Protection

• HEF eligibility, registration and billing currently managed by HEFOs with URC as HEFI

• Uses a FoxPro database system that is getting overloaded

• PMRS is designed to replace FoxPro system, and integrate hospital and HEF registration

PMRS Patient Flow

PMRS Patient Flow

PMRS Patient Flow

PMRS Patient Flow

Benefits of PMRS

• Hospital has better control of patients and payments, can produce reports on demand

• Patients like registration process, ID card, speed • Cashier Office much more efficient • Clinicians can access and retrieve patient dossiers (paper-

based) • Pilot to replace OPD register shows that data can be

entered much more quickly, reduces transcription errors • Helps in the production of aggregated reports/statistics and

HO2 reports

PMRS Background

• Initial idea discussed in a workshop in Dec 2009 (DPHI, PHD and URC)

• The idea took action and discussed with SRP hospital director in April 2010

• System requirement and process were discussed and moving forward.

• PMRS started on 16 November 2011

PMRS Meetings and Workshops

• First discussion in 2009

• A workshop for Siem Reap hospital staff in Dec 2011

• A scale up plan workshop with 17 hospital directors in May 2012

• A partner meeting with DPHI/MoH on 31 May 2012

• Weekly Friday meeting DPHI/URC at MoH

Design Principles

• Well-established open source software

• Expected to remain license free

• Scalability and flexibility

• Modular design, expectation that modules will be produced by other groups

• Uses common shared information (population, administrative boundaries, facility and village names, ID Poor, etc.)

PMRS Infrastructure

Internet Connection

Network Connection and a server

Workstations at data-entry points

Patient Dossier Storeroom w/shelving

Materials:

Patient Cards with preprinted barcode ID

Webcam

Patient Folders

Labels

Invoice Papers

Patient Papers

User interfaces

• Simple interface

• Role based User interfaces – Clerks

– Cashier

– HEF operator

– CBHI operator

– Providers

– Managers

– System Administrator

PMRS-Patient Information System

• Population data including Pre-ID

• Coverage data-health facility and administrative

• National patient ID, photo and/or fingerprint scan

• Patient demographic

• Patient clinical information and codes (= register data)

• Payment information-user fee, HEF, CBHI etc.

PMRS Pilots

Hospitals

• Provincial Siem Reap Hospital (0.9 – no HEF)

• Mean Chey referral Hospital (1.0 – only HEF)

• Phnom Penh Municipal Hospital (1.0 – only HEF)

Outside Queue

Before Triage After Triage

Stage 1 Triage

Registration

OPD Consultation

Payment (Cashier)

Pharmacy

Patient File Storage

Registration by clerks

HEF Pre and Post ID info

HEF Home Screen

HEF Report Sample

Cashier

Receipts

Data Privacy

Siem Reap Hospital Registration Results

2719

3267

5688

6472

6919 6839

7698 7402

8397 8536

6855 6863

5930

1675

4024

3112

2408 2244

1949 2063 2098 2437

2262 1982 1879

1683

0

1000

2000

3000

4000

5000

6000

7000

8000

9000

Nov-11 Dec-11 Jan-12 Feb-12 Mar-12 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12

Hospital Utilization as visits New Registered as Individual Hospital Patients

HO2 generated by PMRS

• First use in Siem Reap hospital, Mean Chey and PP Municipal hospitals

• Next will implement in Sampov Meas PH and other hospitals

• Replace stand alone FoxPro database in HEF ODs

PMRS Road Map-Role Out

Lessons Learned

• One way entry and registration system

• Use individual patient identifier with national ID (pre design with barcode)

• Introduce and improve triage system at hospital level

• Improve health information system at data collection, processing and reporting

• Improve data use and coding system through computerize system

Lessons Learned

• Integrated patient database that able to produce multiple reports and data use different users

• Connect and share data among hospitals and HMIS

• Improve clinical and case management for clinical management and planning

Interoperability and Standard

PMRS, HMIS and CRVS use standard data and system:

• Standard code for health facilities

• Standard code for administration

• Standard population data

• Share data or have interoperability system among different databases.

• Standard disease codes

Shared Population Data

HMIS Integrated System

Thanks for Your Attention