Proposing the development of an eye clinic automated-

management information system

Course: Health Management Information system

Faculty: Dr. Ather Akhlaq

Submitted by: Qurat-ul-ain (24152), Sehrish Zehra (23091)

Health and Hospital Management Program, IoBM

Proposing the development of an eye clinic automated-
management information system for Citi Eye Centre

Authors and Affiliations

Qurat-ul-ain working as an ophthalmic medical technologist at Citi Eye Centre (CEC).

Sehrish Zehra working as a chief pharmacist at Fatimiyah hospital.

Abstract:
Objective: To propose a network and useful options which an eye clinic can opt and take their
clinic to next level by integrating clinical, research, administration and medical records. Through
literature make them aware about the advantages and highlights the possible challenges with
solutions which they may face while adopting this system. To make them understand that this will
be a good and beneficial value addition in their clinic.

Method: Four tablets for physician, refraction, diagnostics and operation theatre rooms and two
computers desktop or laptop for administration and registration desk are required. An information
technology (henceforth IT) consultant should be hired who will develop HMIS for eye clinic and
create a network to connect all clinical devices.This Fully Automated Eye Clinic Management
system will comprise of two parts; one is to create an Elegant Responsive Web Application and
the Second is to create a Mobile Application inter-connected with Web Application. This will be
a beginning of the conversion process from a paper filing system to HMIS.

Results: CEC will get rid of all paper work and occasionally they will need them when computer
glitches which will not be very often. Daily backup of new patients will be required but data of old
patients can be transferred from MS Excel to HMIS easily but treatment and notes entry will take
time which they can do gradually so, patient information will be intact. Things will be done more
systematically. Use case diagrams and flow charts will illustrate that how things will work once it
fully get converted into paper-less model.

Conclusion: HMIS will show reduce human assistance in accomplishing clinical tasks. But for
this it is important to make users literate about its usage. After adopting this system, eye clinic will
set an example among its competitors. We will see that overhead expenses will reduce and there
will be no more issues related illegible writing and appointment clashes. Makeable comparison
has been done between paper-work and paper-less work. Network processes in results shows that
different activities will be integrated that will ease clinical work and thus this will give new
direction to a clinic.

Keywords: Health management information system, eye-clinic, web application, information

technology
Introduction:

Advancement in computer technology gives rise to the information system and technology
simultaneously. As the computer technology started its journey from mainframe computers to
personal computers, management information system arose due to the development of spreadsheet
applications including Excel. After that server networks were introduced for sharing of business
information among workers and clients which further transformed by the development of intranets.
For further excellence high speed networks came in the market to connect the different departments
of a company which ultimately improves the efficiency to make business decisions. Now, to
advance further technology get blessed by the introduction of cloud computing which adds a level
of mobility to the systems. This means irrespective of your location you still can access business
information and use business application. Further development of tablet computers, cell-phones,
laptops, high-speed Wi-Fi networks release the workers from office-bound computers to local
networks access. These technologies and improvements brought change in management style and
allow workers and managers to get as much information as they can from anywhere, they can add,
retrieve and send information to each other hence called as management information system.
Management information system (henceforth MIS) is one from the several information systems
that are used in different organizations, enterprises and businesses. Information collected by
managers is structured and can be use easily to run organization tasks smoothly and efficiently.
MIS is comprised of four components these are: (Management Information Systems (MIS), 2017).

1. Information system
2. Database management system
3. Intelligence system
4. Research system

Management information system is basically a system that provides information to management

and the term automated suggests the minimum involvement of human assistance. This system has
the ability to work with people, organizations, technology and relationships among the people and
organizations affecting the company.

In this era of technology everyone is seeking or is trying to seek a real-time management

information system approach in every field and organization. We have seen management
information system (henceforth MIS) most popularly in banks, laboratories and few tertiary care
hospitals. Although this is a today’s need to sustain businesses for future at good position still
many companies and organizations feel insecure and unnecessary to invest at this system.
Companies who wanted to take their organizations to a long term should invest to get a
management information system according to their needs. Today customers and patients wanted
to access everything from home. They are approaching that organization who gives them
everything on one touch.

As all organizations including hospitals are progressing to approach vast database sets which can
run smartly and doesn’t need many efforts so there is a need to develop a clinical based health
information system as many small setups are running all-around us and they have enormous data
which should be structured and can be used for other purposes as well.

Problem Statement
A set-up we have chosen is using MS excel to record patients information, they are doing a lot of
paper work, do expenditure on folders, OPD files ( patient file and clinical file), letter head papers
and prescription pads . Also they have insufficient space to keep those stuff and records. Making
entry at 05 different places including files, folder and excel sheets. If a patient lost their file and
they wanted from administration to recover the file from their record and tell them doctor’s advice,
for this staff has to search that file and let them know their Rx, this whole thing is time consuming
and sometimes difficult to search in crowded hours. Sometimes staff is unable to find the record
of follow up patients which lead to double entry of existing patients. Poor writing of a consultant
is another problem which unable patient to understand their treatment or suggestion. Patients
wanted expense slip they have done to avail clinic facilities. Appointment and waiting time is
given manually which sometimes lead to clashes with other patients. Today, people are striving
for right information at the right time and at the right place so, is the case of patients, for which we
have to make our systems organized, robust, rapid, feasible and easily accessible at the ends of
physicians, administration and patients and this can only be achieve by exploiting and
understanding automated management information system.

Objectives
• To compare paper-work and paper-less work pros and cons.
• To prove that EMR will ease clinical work and burden of work load through literature.
• To give eye clinic new direction to keep their patient’s record safe efficiently.
• To propose a network and useful options which they can utilize and take their clinic to next level by
integrating clinical, research, administration and medical records.
• To let them understand that HMIS is the future need.

Literature review:

An article on development and acceptance of MIS: an historical overview was published in 1988
which in detail briefs the developing era and processes of these systems. It explains the integration
of medical research, patient care and administration records which ultimately results in
management information system. This article focused on the roots of MISs namely Technicon,
Computer Stored Ambulatory Record (henceforth COSTAR) and Problem Oriented Information
System (henceforth PROMIS). PROMIS was the most influential MIS as it minimizes many
problems at user end. It enables the fast collection of data for epidemiological studies, medical and
business audits. Author explains that benefits and cost-efficiency in using MIS suppresses the
physician resistance and technical support make it user friendly which than ease the work of every
personnel and most importantly will save their time (Kaplan, 1988).

Qualitative, semi-structured interviews from physician and supporting staff were conducted to
study the impact of EMR system on community-based primary care practices. In this research they
have found the factors which prompt the usage of automated management information system in
health care sector. The biggest problem they face while using EMR is the power outages which
consumes time to get settled. Few felt backup insecurity for letting go of the paper record. Other
than that lack of training, unavailability of technical support on time and not having ready access
to help within the practice are the major drawbacks which limits its use. But many practitioners
founds it user friendly after getting used to it. They experienced that it doesn’t only helps in
keeping patients record systematically but it eases the communication with each other. Most
physicians believed that EMR has improved the quality of time and documentation. In short, its
benefits surpassed its disadvantages and those disadvantages can be resolved with time, practice,
training and upgrading software according to the need. The result of this study indicates many
variables will help to ensure a smooth transition from paper to EMR (Karen A. Wager, 2000).
A study is conducted to discover the ways to identify the patient specific clinical information needs
in databases. They have found that log mining is an essential tool to determine the need of clinician
and their requirement. For this purpose they have used Clinical Information System (henceforth
CIS) log mining technique which helps them to follow the pattern of physicians required in making
decisions. Thus they have concluded that this technique will help developers to understand the
need of their users easily and efficiently. So, in this way they can get a quality automated
management information system which fulfills their requirements and minimizes frustration for
the use of such databases (Chen & Cimino, 2003).

A study was conducted in South Africa while implementing the computerized information system
at provincial level. They found the factors that failed this project and describes the methods to
evaluate a system while implementing hospital information system. They found that this project
failed twice as it doesn’t fulfilled the aspirations at user end, lack of handling tricks and training,
developer’s underestimating the health care tasks, reluctance to implement it again due to bad
experience which already immersed their scarce resources, failure of developers to learnt from
previous failed project (Littlejohns et al., 2003)

A study conducted in Pakistan on effective management of patient’s record explained explicitly

the benefits of keeping record by using health information system. According to them this system
records patient’s information accurately, keeps it updated and easily accessible. They also ensures
the hospital administration runs smoothly, keeping storage areas clear and accessible and key
records can be found quickly, saving time and resources. Records also provide evidence of the
hospital’s accountability for its actions and they form a key source of data for medical research,
statistical reports and health information systems. The electronic medical record (henceforth EMR)
is not just one system but may include interfaces with multiple other systems and applications used
by the faculty such as registration, patient scheduling, order entry, clinical documentation,
radiology, laboratory, and other departmental systems(Majeed et al., n.d.).

A study was done in Hawaii USA to extract the experience of Kaiser Permanent’s clinics on
implementing an electronic medical record system (henceforth EMR). In this study they also
compared the views and effectiveness between two software of EMR. They have found that EMR
is a good addition in health care system if its software fulfills their demand timely. Due to the
inability of software, “clinical information system (henceforth CIS)”, to get upgraded with time
some users find EMR as a flawed. They found the factors that prohibit its use are problem with
the software design which reduces doctor’s productivity during implementation only decisive
leaders are able to cross barriers and reduce constraints that comes during implementation. To
resolve these problems KP decided to switch from CIS to EpicCare. But this switching requires
12-14 months of duration to complete their trials and errors, testing and adaptation of new system
in large organization (Scott et al., 2005).

A study on eye clinic setup was done in Nigeria, which shows the increase in success level of EMR
system when used in a small setup. They felt the need of this system when observed natural
disasters and its aftermaths by which hospital’s all paper work get vanished and from nowhere it
get retrieved. They found this system not only reliable but cost-effective in long run. They said
modification of the software by its system integrator according to their need and demand reduces
complexities and hurdles which prompt its usage (Ogundipe, 2011).

An article summarizes the special requirements for EHR system in ophthalmology. As compare to
other fields ophthalmology needs some special features to adopt this system efficiently. Additional
features such as ocular history, visual acuity, intra ocular pressure, mechanism to document
refraction including methods, conditions, testing distance, prism, reading addition, contact lens
parameters, charts for different ocular measurements such as cup to disc ratio, axial length
measurement, intra ocular lens selection, pre-operative medical clearance, post-operative notes
and informed consent forms. The system should have ability to record numerical, non-numerical,
text based and image based data and collect data from Picture archiving and Communication
systems (PACS) as this field is visually intensive or directly using standards of Digital Imaging
and Communication in Medicine (DICOM) (Chiang et al., 2011).

A study was conducted in Western Cape and south Africa regarding importance and
implementation of EMR in low to middle income countries. Khayelitsha hospital situated in South
Africa is selected where dual record system is in place (50% paper and 50% EMR). The finding
illustrates that due to lack of trainings and resources EMR can’t be properly implemented in the
hospital. Study suggested that semi- EMR system can be implemented so, in future hospital can
be shifted to complete EMR (Ohuabunwa et al., 2016).
In this article author reviews the advantages and disadvantages of implemented EMR systems, this
review is done in 2016, Training of staff and physicians and cost of the EMR are the biggest
challenges in implementing EMR. It is concluded in this article that EMR is important part of
modern clinical medicine, that could be used as a source for research purposes and most important
patient safety can be achieved by using EMR (Alpert, 2016).

A study was conducted in Malawi to investigate whether the health information system and
medical record system can be integrated efficiently and implemented. A qualitative research is
done in which doctors, nurses and other paramedics and stake holder participated. IT team is facing
multiple challenges in implementing the system. Hybrid Technology can be a better solution in
providing effective, practical and sustainable system inn Malawi hospital, this solution is already
implemented in zomba mental hospital where it is working efficiently. This needs training and
support from management to implement this solution in letter and spirit of the staff (Tough &
Lihoma, 2018).

Methods:

Health management information system is an integrated system which interlinked every

department of an organization and gives instant access to patient’s medical data and medical record
from anywhere for research purposes, administration use, accounts and decision-making. We also
found that it can help to lean the process and make it possible to do paper-less work conveniently.
The growing need for storage space of patient’s files, bills and other documents in a small clinic
give rise to move towards paper-less work to maximize the available space for clinical procedures.
This ultimately will save time and digitalize the system and even make it comfortable for patients
to access their record from anywhere and to get an online appointment. This system can definitely
be cost-effective in long-run. This is a pilot study conducted to assess the successful level of below
proposed methods.

In Citi Eye Centre (henceforth CEC) we must required four tablets for physician, refraction,
diagnostics and operation theatre rooms and two computers desktop or laptop for administration
and registration desk. An information technology (henceforth IT) consultant should be hired on
and developer will develop HMIS for eye clinic and create a network to connect all clinical
devices. He will also train physicians and all personnel in the use of new computer network system,
these all will be the initial steps in order to convert clinical setting from paper filing to paper-less
filing. After that IT consultant will monitor new needs and requirements of physicians and staff
which can emerge with time and can track by using log mining and observation.

This Fully Automated Eye Clinic Management system comprises of two parts; one is to create an
Elegant Responsive Web Application and the Second is to create a Mobile Application inter-
connected with Web Application.

1. Responsive Web Application:

Responsive Web Application consists of a beautiful Website for the Front-end where all the
information (i.e. content, about clinic, Achievements, Awards etc.) about the clinic will be
displayed to all the users who visits clinic’s website. Now on this Web App 3 types of users can
Sign Up, first user is the patient who can Register Him/her self as a patient and then He/she will
be able to book an appointment, secondly, they can also see their previous Appointment record
and medical history as well. Second User is the “Management” who approves the patient
appointment, and deals with all patient processes. Management User is also responsible to manage
employers’ registrations and attendance etc. In short, they can manage and see record history of
patients as well as employers. Third User is the SuperAdmin (CEO) who can see and manage all
the activities and records of all the Patients, Employers and Management.

Record of a Patient & Employer will also be shown with a highly advance graphical representation
which helps them to understand the record history as well.

2. Mobile Application:
In this era of smart phones, mostly people are used to of using mobile applications (android app
or IOS app) to perform their work quickly and easily. So, we are going to provide an eye clinic
mobile application which they can download it from play store or from iTunes. Once they Login
through mobile app they can perform all the tasks and see records same as I mentioned in web
application, but the difference is, in mobile app you don’t have to login to the portal again and
again which makes your work faster and easier.

Results:
CEC will get rid of all paper work and occasionally they will need them when computer glitches
which will not be very often. Daily backup of new patients will be required but data of old patients
can be transferred from MS Excel to HMIS easily but treatment and notes entry will take time
which they can do gradually so, patient information will be intact. Things will be done more
systematically. Below use case diagrams and flow chart diagrams will illustrate that how things
will work once it fully get converted into paper-less model.
Discussion:
Successful journey from paper filing system to an automated health management information

system at the Citi Eye Centre can only be possible when they learn, get trained and use integrated

health management system efficiently. By learning from the mistakes and errors done by the

organizations throughout the world, CEC can wisely invest in this project. As a South Africa study

of LittleJhons et al, explained the failures they experienced in African hospital and drown their

scarce health care budget just by not learning from the mistakes of their own and others. They set

objectives and explicitly gives methods to rule out all the necessity but that was not enough in

practical field.

Main challenge that will come across will be difficulties in documenting ocular findings as
ophthalmologists usually prefer to draw a condition of eye or represent graphically but this can be
overcome if software is provided with drawing and annotation options. In a study it has been seen
that documentation of ocular findings is much easier on paper than on software which consumes
extra time for documentation with little or no increase in volume and major changes has been seen
in the nature of ophthalmic documentation but improvement in the design and usability will
improve the efficiency of this system in an ophthalmic set-up (Chiang et al., 2013). So, this whole
new system in an organization needs continuous efforts and practices as it will only benefits in
long run. After developing or tailoring software according to ophthalmic clinical needs, it gives
most structured textual documentations and interpretations (Sanders et al., 2013).

UK, USA, Nigeria, Africa and many other countries are not only using this system but also trying

to improve it further to get more benefits from it. Literature shows that we can improve our systems

once it get started by log mining and taking time to time feedback from its users. Keeping record

on HMIS will benefits in any uncertainties like Tsunami, earthquakes, building collapse or any

unwanted event in which patient and health care centers loss their data.
It has been evident from the studies that when processes are made according to the system usage

and needs then HMIS works and supports well and probability to fail decreases. Effective usage

gradually eliminates paper work and users enjoy it due to its comfort and many roles. Its ease of

use encourages many ophthalmologists in USA to adopt this system although the adoption rate is

low compared to other specialties. But it is increasing as its users are highly satisfied and

recommending it to their fellow ophthalmologists (Chiang et al., 2008). In a comparative study

between users and non-users of EMR system in a large academic multi-specialty physician group

showed that there is an increase in patients volume who uses EMR system while patients volume

stable in non-users. They showed that physicians who have experience of 6 months or more in

using EHR system increases their productivity (Cheriff et al., 2010).

In a systematic review on the “impact of health information technology on quality, efficiency and

costs of medical care” identify three major benefits on quality which achieved by every

organization they observed using HMIS which are increased adherence to guideline based care,

enhanced surveillance and monitoring and decreased medication errors (Chaudhry et al., 2006).

Beside achieving these benefits CEC can gain more if starts using HMIS as after that they don’t

have to increase their storage rooms; they do not have to worrisome in searching for a specific file

manually, patients do not need to carry files, there will be no more clashes in appointments, all

records of every patients will be at finger tips which will be accessible from anywhere. It will be

run more systematically and able to keep record of every activity. This path doesn’t only improve

quality but gives financial benefits as well by reducing the overhead costs of papers, letter heads,

prescription pads and folders. Expenditures will be less after adopting this system. It has been

proved in a cost-benefit study that adoption of EMR system in health care organization results in

a positive financial return (Wang et al., 2003). The only obstacle which will come across would
be resistance of physicians to learn and use HMIS effectively for their daily activities. Secondly

they want to see immediate results which will not be possible as this system will benefits in long

run.

Another benefit is that patient can also access his/her file and can show any other physician

elsewhere even they can share it electronically so the new doctor do not need to ask everything

which has been done and ask before. All the information needed will be fully available. So, there

will be no problem for patient if their physician get retired, stopped practicing, shifted or even died

because they can retrieve their case by themselves and can seek other doctor. In this way clinic

will attract more patients due to its leap in value.

Conclusion:
The main study will be feasible without any amendments in its processes. HMIS will show reduce

human assistance in accomplishing clinical tasks. But for this it is important to make users literate

about its usage. After adopting this system, eye clinic will set an example among its competitors.

We will see that overhead expenses will reduce and there will be no more issues related illegible

writing and appointment clashes. Makeable comparison has been done between paper-work and

paper-less work. Network processes in results shows that different activities will be integrated that

will ease clinical work and thus this will give new direction to a clinic.

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