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CMS stands for Clinical Management System, including the information integration, inventory control, data processing and tools for medical data exchange. Generally the major user for CMS are physicians, and consist of laboratory information system (LIS), radiology information system (RIS), picture archiving and communication system (PACS).
1In medical fields, the application of new CMS mainly develops in the following stages.
Automated medical record (AMR) is mainly used for the automation in medical data processing from paper into e-format.
Electronic medical record (EMR) ensures a good communication for paperless and image exchange and sets up foundation of medical terminology.
Electronic patient record (EPR) ensures the interoperability & networking for the data exchange between CMS or other parties by using a single and standard format.
Electronic health record (eHR) sustains the medical decision support system. In the medical support system, it conducts data mining skills from getting multiple data from multiple databases to assure the correct medical decision.
Recap above stages, the applications of CMS are useful in medical filed.
Objectives
Due to the following objectives, our team suggests Town Health co Ltd to implement Clinic Management System (CMS).
Increasing business opportunity;
Connecting medical record with Hong Kong Government regulation standard;
Exchanging medical data with Hong Kong Government centralize database.
Company Background
Town Health Co Ltd. (The Group)
Established in 1985, the group has adopted the managed healthcare model to provide high quality and affordable medical services to our corporate clients. THMN has a full range of medical services, including General and Specialists Services, Dental Services, Physiotherapy Services, Laboratories & Imaging Services and other auxiliary medical services.
The Group has well developed and became one of the largest healthcare services providers, with about 30 medical clinics and specialist outpatient clinics, in Hong Kong.
Company network
Figure 1.1 http://www.thmn.com.hk/our_locations.asp
Company Workflow
The Group was operating a standalone medical management system over 10 years. Many problems occur throughout their daily operation. The basic operation workflow is shown as below figures 1.1.
Diagnosis
New Patient
Registration
Consultation
Medical Record
Transfer to Hospital/Other films
Treatment
Figures 1.1
For our daily operation, a new patient is required to fill in a registration form for his / her personal information in paper format. Then the duty doctor consults and examines the patient based on the background and situation at that moment.
The paper medical record and real time observation by the duty doctor will be used as tools to support the diagnosis of the patient. Finally, the staff or nurses will input the finalize treatment formulated and medical record into the existing medical system.
Five Force Analysis For The Group
Suppliers
Industry
Competitions
Buyer
Potential
Entrants
Substitutes
Threat of New Entrants
There are many new entrants in Hong Kong healthcare services industry. It is because of the rapid changing of economical scale, such as new investments from PRC.
Threat substitutes
Since the market demand is changing recently, many different professionals are willing to join together and run their business to provide a 24*7 (24 hours with 7days) services. Besides, they combine their services into a single business firm, such as Chinese medical services, Dental and out patient services. Therefore they can share resources to reduce the operating cost and increase the revenue.
Bargaining power of Suppliers
Most of suppliers ally their product price due to the increasing price of most original materials. For a healthcare group, they are required for lots of inventory, like drugs and medicate equipment. This is a main reason for their high operating cost.
Bargaining power of Buyers
The Government regulation was release as benefit to all Hong Kong elders such as health care voucher, eHealth medical record sharing system, and etc.
Industry Competitors
There are many strong competitors with increasing and steady revenue. Moreover, most professionals quit their job in public sector (Government Hospital) and join the joint venture of healthcare group to start their own business.
SWOT Analysis for The Group
Strength
The group is established for over 25 years, it is a well-known health care services provider with confidence in providing quality services. A wide spread of clinic coverage is convenience to all patients in Hong Kong. The medical management system Helps on keeping patients’ records that ensures the efficiency on daily data processing.
Weakness
Performance of existing medical management system becomes slower due to the increasing size of data. Increasing numbers of patient records reduce the performance of accuracy. Thus, many errors were found in daily operation which influences the efficiency. The system will become a bottleneck of the Group for the business expansion.
Opportunity
Modernize on computer system provided a better management on patient’s data and prevent error to increase efficiency on operation. Also, connectivity to Hospital Authority (HA) and insurance companies’ database can get advantages on increasing revenue and convenience of data exchange for the Group.
Treats
The medical industry competition had a huge impact to the Group due to the decreasing market share and revenue while the running cost for equipment and drugs is increasing.
Research Methodology
Research method
Interview for analyzing the current problems
The aim of the interview is gathering information about the understanding for the current system and its process. Our team conducted the interview to narrow down the problems one by one.
Web survey for capture the industry strategy
Due to the rapid change for the market, this survey is aimed to get the most common strategy for our team.
Data Gathering
This process is mainly used for identify the existing operation problems through the interview with the company partners, managements and customers.
Peoples interviewed:
Partners
Project mangers
Customers
The questions for Partners
What is your corporate vision and mission?
What is your corporate development target in long term / short-term?
What is your development strategy in long terms / short terms?
Do you agree the change of Hong Kong market decreasing revenue of your company?
How many resources had been spent on your strategy development projects?
What is / are the existing problem(s) that your company is facing now? And how does your company fix it?
The questions for Project Managers
How do you carry out the CMS?
How long do you planned for your project schedule?
How the CMS fulfill the development of your company that you had mentioned before?
How many resources had been spent on your strategy development projects?
The questions for Customers
What service(s) do you mainly used in Town Health Corp?
Do you comfortable with the current system of Town Health Corp?
3 Do you have any suggestion(s) for Town Health Corp?
Through the interviews, our team recognizes the mission of health care group is providing a comprehensive healthcare service. The short term planning is to develop an effective clinical management system, while the long term objective is to build up an exhaustive service for customers, such as medical decision support analysis.
To achieve the short term and long term objectives mentioned above, we have to improve:
The duties schedule of physician
Communication channels with other insurance companies
The inventory control and allocation
Standardization of e-health medical record
Survey result
All interviewee thought that the eHealth is useful as it answered them many questions and as a platform to communicate with others.
What’s more, over 80% clients having discussion with professional after a year, which is dangerous if they didn’t take annual body check.
Almost 80% clients thought the Clinical management system should be connected into Hong Kong centralize database. Due to the elderly don’t know how to use the high technology (e.g. computers), thus the respondents refuse to use it.
There are only 20% of interviewees think that the Clinical management system cant be effectively the diagnosis processing.
Almost 80% of respondents has been used the clinical management system, especially most of them used the Google one.
The respondents all are educated above the primary school and most of them are in the age group of 30-39.
Values Identified from Interview
Objective
Schedule
Management
Insurance interface
Inventory control
e-medical Record
The duties schedule of physician
Communication channels with other insurance companies
The inventory control and allocation
Standardization of e-health medical record
Problem Definitions
The Group was operating a standalone medical management system over than 10 years. However, there are still many problems occur during daily operation.
Data formatting out of date
The existing medical system was developed in 1989. All clinic offices were allocated a standalone workstation for operating medical system. The medical system database was developed by FoxPro which could not conduct data mapping with other new technology like Microsoft SQL server, MySQL server. Hence each medical system was all recorded year by year until present.
Suffering in medical claim to insurance company
Every time when different insurance companies transfer some patients’ data for inquiry, the staff needs to input the patient data one by one manually in order to get the corresponding data from the database. After all required data have been extracted from the database, the staff needs to enter the corresponding data to different systems that provided by insurance companies. Sometime if the data from insurance companies could not match with the database, the staff needs to notify the insurance company for amendment. After receiving the update data, the staff needs to do the inquiry all over again.
Cannot manage resources on inventory
Existing medical management system can only handle patients’ records. Inventory of the Group is recorded by using a logbook. Using of pen and paper cannot fulfill the services standard nowadays. That is not a flexible and efficiency way to keep track and monitor inventory, especially for a medical group which owned over thirty clinics. Manpower that used on inventory is also become a challenge on management and costs.
Cannot manage customers’ appointment effectively
Many clinics handle their patient appointments by using telephone bookings and marked on the notebook. However, it always has the contrived mistake, for example, marked down the wrong name or contact number. Sometimes the patients need to wait for a long time to check the appointment time or the medicine stuffs.
Furthermore, the doctor may not stay in one single clinic; it is inconvenience for the customers who want to consult the same doctor.
Based on problems above, managements decide to carry out a new Clinical Management System (CMS) to replace the existing one. Our learning area: Electric Medical Record, Interfaces with Insurance Company, Inventory Control and Book appointment with web interfaces.
Successful Stories
2The Hospital Authority (HA) of Hong Kong
3The Hospital Authority (HA) is one of the successful case of implement CMS in Hong Kong. HA set up 15 Chinese medicine outpatient clinics (CM Centres). These 15 CM Centres are served with a fully computerized Chinese Medicine Information System (CMIS). CMIS is developed by HA for managing a large amount of clinical information. The CMIS is aimed to the support for patient administration (example, appointment, registration and payment), clinical modules (example, diagnosis, consultation notes and prescription) and pharmacy management. It can also treat as a platform for data analysis, planning and researches.
The Integrative Medicine Information and Research Manager of HA, Tat Tse said, the system can reduce errors and enhance risk management, for example, the emergence of drug incidents, we can trace the patient and arrange examination as soon as possible.
4Union Hospital in Hong Kong
Another successful case for CMS implement is Union Hospital and Union Hospital Polyclinic. Union Hospital was established in the year 1994 while Union Hospital Polyclinic (Tsuen Wan) went into service in January 2007.
Hospital and polyclinic have an advanced Customer Management System to provide comprehensive patient data and flexible registration service. It is convenience for the clinic and the hospital to access the patient information and medicine history. It is also expediency for the patient to choose the venue for having the follow-up care thought out the network of Union Hospital.
Proposed Solutions
With the reference to the above successful cases in Hong Kong, the main purpose for the CMS is easy to deliver medical data. It is a centralized system to control and share the resources, like medical information, to related departments, like Pharmacy, Laboratory and front-end clinics department. Besides, CMS can be synchronized all the medical data to both public and private hospitals and other CMS.
A brand new CMS become an important milestone in the IS strategy development.
Inventory control
To improve the inventory control, the implement of inventory control system is required. It can increase the flexibility and efficiency. The new system will include inventory monitoring, stock transfer, out of stock alert and reporting, and other function like expiry date reminder and search. These functions are the daily tasks which are operating manually every day. The implement of new system can help to reallocate manpower to other tasks.
Schedule management
The system will renew the data periodically. Old records of patients will be found easily. Clinic staff can handle the patient’s records and the appointments by using an easier way.
Insurance interfaces
The system can get requests from different insurance companies and reply those insurance companies automatically.
A summary report will generate for checking every day. This can save the manpower of processing insurance companies’ request and prevent missing or wrong information exchange.
E-medical standard
Since all the new medical data should be matched with international standard, developers change all the new medical data into [5] HL7 format. HL7, an international standard medical system, can exchange data with other systems, which will be the main trend for future development. This action may cost lots of resources in transferring to the new CMS, it is still certainly required for the long term strategy of health care industry.
Physical Architecture
This section describes the physical architecture of the System.
The below diagram shows the physical architecture of the System.
The CMS is constructed in 3-tiers web based architecture, which includes web server, application server and database server.
Web Server
The Web Server will be the primary entry point for all users to access the system. All user activity will be limited within the Web Server.
Application Server
The Application Server will serve the validation process and the using of the stored data in the Database Server. Users will access these functions through the user interface located at the Web Server.
Database Server
The Database Server will be the central repository of all data. These data will be using for validation purpose.
Software requirements
Internet Explorer 5.5 above
Java web starter 6.0 above
MySQL 10.0.1 above
Tomcat web server 6.0 above
Hardware requirements
IBM X3250 M2, Xeon E3110 3.0GHz/ 1333MHz (DC 65w 6MB L2 cache), 8GB 667MHz SDRAM, 160GB Hot-Swap SATA HDD
Tape Drive [Prod Servers]
IBM Tape Backup Drive
Juniper Netscreen-5GT
CableCat5 and Cat6
KVM 1U 15″ LCD Monitor w/ 8-port PS/s
Solution Budget
The solution estimated project costs are shown as below:
Items
Estimated Costs (HK$)
1. Project team staff/development costs#
500,000
2. Project office set up and running costs – including rent, telecom costs, mail/courier, etc.
100,000
3. IT costs – including PC, software, printer, fax, LAN set up, etc.
100,000
Grand Total
700,000
Workflow of new CMS
E-Medical record standard formats (Health level 7) apply in CMS
First of all the medical record (HL7) run across multiple module of CMS, the example shown the workflow of e-medical Record useful in multiple modules of CMS. HL7 is mainly use for data exchange in different multiple module. Such as a single medical record it can be data exchange to doctors in clinical departments then transfer information to other lab departments then the lab result can be generate the medical decision support lab test. Finally the doctor can be made the medical decision and prepared the consultation result. The medical can be claim to insurance company directly for patients.
Workflow of appointment in CMS
The client calls to book the time with the right doctor.
The clinical nurses mark down the information of the client and find out the clinic data from the database.
The nurse call to remind the client and confirm the booking.
When the client comes, then the appointment is done.
Phone in to clinic
Mark down the client information
Call back and remind the clients
Appointment done!
Workflow of inventory system
1. Medicine, equipment or office supplies delivered to warehouse, information and amount of each product will be updated into the inventory system
2. Staff in clinics will place order for different items in the inventory system, delivery will be arranged. For some critical items like life-saving medicines, order will be automatically placed once the amount dropped to preset minimum quantity
3. Items delivered to each clinic from warehouse
Workflow of Medical Claim Enquiry From Insurance Company
Insurance company send medical claim request to CMS, CMS will retrieve data automatically from database and return diagnosis result back to that insurance company.
Implementation Schedule
The following is the paramilitary schedule of the proposed plan:
Date
Major Milestone
Month 1
Launch of the CMS Project
Proposal Assessment
Month 2-4
Project Initiation
User Requirement Collection
Mouth 5-6
System Design and Analysis
Procurement and Installation of Hardware and Software
Interface with external systems
Mouth 7-8
Program Development
Mouth 9-11
User Acceptance Test
Documentation
Training
Mouth 9-11
User Feedback Collection
User Feedback Analysis
System Design Revision
Mouth 9-12
Program Modification
User Acceptance Test
Documentation
Training
Phase 2 Live Run
Conclusion
Durng the study topcis,all of us exploer our eye on Hong Kong Helthcare business operations.Due to the market change from previous, Hong Kong became stanadardation with international.The government of HKSAR become the leader role on electric health care stanard and regulations. Hence the team regonzine the implementation of cinical management system just the begin electric health care stages.
All the industry stakeholders become more international standardization in future!
Project Self-Assessment
The study of CMS and its functions team completed the target because we can learn Healthcare knowledge during the project.
The project management works are fine and the team conducts many discussion points during preparation. Finally I inspirit our teamwork steps until project closure.
Tommy Wong @ Middlesex University 2011
During this project, I got the chance to explore and learn about the medical industry, and the relationship between information technology and medical and how they benefit each other. In my own findings using information technology in medical industry especially the outpatient services, is still in a preliminary stage, which mean more I.T. elements can be used to enhance the perform, more efficiency and profit can be archived.
Simon Wong @ Middlesex University 2011
During this project, our division of labor is very balance. Everyone tried the best and put many efforts on it.
I in charged the parts of findings, included the survey result, interview result and others. However, some difficulties encountered in investigations, for example, many respondents were not sure what is eHealth, or send the mail to people have not reply.
I think our team spirit is good. But I should do the project more actively.
What’s more, after my self-Assessment, I think my work is fair effective and efficient, due to the fair English grammar, I might need the others group mates help to proofread.
At the same time, I think my time management can be better, because of my delay, the schedule of work might postpone. I hope I will do it better next time.
Eric Pang @ Middlesex University 2011
Medical topic is a totally new topic to me, but to deal with different industries and departments is one of characteristic for Information Technology. Though this project, my skill for handling an unfamiliar topic is improved, which is equipped me to be an Information Technology professional.
In this group project, I responsible for research on medical field business model. I found that even in a field of professionalism, the competition between companies still very great. Therefor price war is not a best way for them to increase the revenue. Before this project, I truly believed that price war is always a way to help companies to develop their business, but now I understand that with the information system support and re-engine the process flow, the company still can increase their productivity and achieve the target of increasing revenue.
After this project, doing the analysis on the company background and market background become more and more import to me when designing solutions. This is the first time for me to handle an unfamiliar topic, medical & health care industry. I had spent a lot of time to search information and catch up the schedule of my teammates. By having thIs experience, I am sure that I can do better for next time.
Ben Wong @ Middlesex University 2011
Appendix 1 – Interview Questions with Answer
Dr Joseph Lee, Partner of Corporate Development
Town health Co Ltd
1 Feb 2011
Dear Dr Lee,
We are a group of year 3 undergraduate students of Middlesex University, School of Engineering and Information Sciences.
As part of our final year studies, we have been asked to contact and interview a strategic manager on a topic related to the use of Information Technology and Information Systems within the organization.
The focus of our approach is to look at the strategic reasons why a particular configuration of IT/IS functionality was adopted assuming that competitive advantage was the prime focus of the implementers.
The topic we have selected is Clinical Management System implementation for the chain health care group. We approach you because we believe that our topic represents an important strategic use of IT/IS within your organization.
We are requesting a short interview with an appropriate strategic manager within your organization. We should only take a short amount of time at your convenience. However, we do have a deadline of early December for this part of our work. If you are available to help, please reply me by email to [email protected]
Thank you for your consideration of our request.
Yours truly,
Tommy Wong
Attn: Dr Joseph Lee, Partner of Corporate development, Town Health Co.
Interview Questions
1. What is your corporate vision and mission?
Our group mission is grouping up all the clinic services to provide a comprehensive healthcare place to the public.
2. What is your corporate development target in long term / short-term?
Long -term:
Our corporate development target will be emphasized on the “elderly mansion”. We can provide the periodically body check as elderly easy to have the elderly ill. We would like cooperating with them by contractual in the future 5 years. What’s more, they will enjoy the discount by joining our group elderly program. We hoped that we can have over 30 “elderly mansion” join us.
Short -term:
Another our consideration is the doctors who wanted save the rent. They can use the place that share with other doctors, thus they still have their own clinic room but share the rent and human resources. It is because we want to keep increasing our shops (about 10 /year) in different area in HK to enhance our brand image.
3. What is your development strategy in long terms/ short terms?
Increase the shops of Town Health is the one of the promotion plan. It increases the brand warranty and customer trusting. When the demand increases, the supply should be increased too.
In long term, Town Health has to use personal selling to explain the services to the “elderly mansion”. Therefore we will recruit more sales to demonstrate our job to the elderly to increase our professional image and increase the corporate opportunities.
4. Do you agree the change of Hong Kong market decreasing revenue of your company?
No. It was totally opposite with your question. As the citizens in HK becomes older and older, their requirement of the elderly instruments and healthcare in growth rapidly. In fact the target market in our industry is growing, the revenue of our company is in an enhancement.
5. How many resources had been spent on your strategy development projects?
A lot! Human resources and Material resources which includes the instruments, medicines, equipments. I think it will over 100 millions.
6. What is / are your existing problem(s) that your company is facing now? And how does your company fix it?
We have to find the Corp target carefully as many of them are not the legal one, whatever the “mansion” or doctor. We want to enlarge our clinic healthcare by a good quality. We would like asking the existing customers’ opinions and their past experience. Sometimes we need to find the good doctors by the positive word-of mouth.
Thanks for your time and attention.
Mr Jackson Tam, Project Manager
Town health Co Ltd
1 Feb 2011
Dear Jackson,
We are a group of year 3 undergraduate students of Middlesex University, School of Engineering and Information Sciences.
As part of our final year studies, we have been asked to contact and interview a strategic manager on a topic related to the use of Information Technology and Information Systems within the organization.
The focus of our approach is to look at the strategic reasons why a particular configuration of IT/IS functionality was adopted assuming that competitive advantage was the prime focus of the implementers.
The topic we have selected is Clinical Management System implementation for the chain health care group. We approach you because we believe that our topic represents an important strategic use of IT/IS within your organization.
We are requesting a short interview with an appropriate strategic manager within your organization. We should only take a short amount of time at your convenience. However, we do have a deadline of early December for this part of our work. If you are available to help, please reply me by email to [email protected]
Thank you for your consideration of our request.
Yours truly,
Tommy Wong
Attn: Jackson Tam, Project Manager, town health Corp.
1. How do you carry out the CMS?
I would set up a project team. Most of the members come from functional team. I also recruit external consultant to be the project adviser.
2. How long do you planned for your project schedule?
2 years
3. How the CMS fulfill the development of your company that you had mentioned before?
The functions of CMS commit, electronic medical format as connecting with international standard, the platform connecting with insurance company modules and also control inventory and physicians schedule management.
4.How many resources had been spent on your strategy development projects?
Over 2 Millions. All are spent on in-house team development works.
Thanks for your time and attention.
Ms Eva Ma, Deputy Business Development officer.
AIA HK Co Ltd
1 Feb 2011
Dear Eva,
We are a group of year 3 undergraduate students of Middlesex University, School of Engineering and Information Sciences.
As part of our final year studies, we have been asked to contact and interview a strategic manager on a topic related to the use of Information Technology and Information Systems within the organization.
The focus of our approach is to look at the strategic reasons why a particular configuration of IT/IS functionality was adopted assuming that competitive advantage was the prime focus of the implementers.
The topic we have selected is Clinical Management System implementation for the chain health care group. We approach you because we believe that our topic represents an important strategic use of IT/IS within your organization.
We are requesting a short interview with an appropriate strategic manager within your organization. We should only take a short amount of time at your convenience. However, we do have a deadline of early December for this part of our work. If you are available to help, please reply me by email to [email protected]
Thank you for your
