TODAY it is a challenging job for healthcare providers and healthcare plans to improve the reliability and quality of care as well as reducing cost of treatment. IT system provides solutions to different problems but at the same time problem arises in the form of lack of training and extra learning time curve. In industry such as health care, physicians/doctors are not always well equipped with technology so they must be trained. Healthcare organizations need to understand the benefits of information sharing. It's also important to develop interest among such professionals to increase usage of IT systems. Sometimes technology becomes challenging to use itself.
We have well developed healthcare sectors which include hospitals, basic health units and pharmaceutical etc which are operating well but considering the lack of central and structured data/information about history of patients as well diseases in the healthcare system of Pakistan, it is not possible to have a detailed analysis of emerging diseases in our country. Hence we cannot plan properly to have a complete control over these diseases. Therefore Central case management system will benefit in this area as to have a centrally managed system to store case/history of patients, which can be accessed by authorized person (doctors/hospital staff).
In this study we have proposed to have a central platform (CCMS) to manage case/history of patient's disease and treatment. We discuss different features of CCMS and factors affecting IT systems deployment and we have also conducted a survey to find out views of individual physicians / doctors for the affects that may occur on quality, cost and time of treatment by implementing CCMS.
Firstly we have studied the entire architecture of CCMS then we prepared the questionnaire and gathered appropriate data regarding its implementation feasibility from few hospitals. In the final phase we performed analysis on the gathered data and presented is summary.
Related Work
Here we will discuss our literature review and also try to shed light on previous work that has been done in area of IT solutions in healthcare which are somehow related to our work. After discussing previous work we will distinguish our study from the discussed solutions / studies.
A lot of work has already been done for applying IT solutions in the domain of healthcare [1] [2]. Handling different cases efficiently needs time and personal involvement. Providing an environment to allow a person to perform at his/her best is a challenging task. IT systems utilization can help organization in setting-up such environment. The adoption rates of electronic medical records (EMR) are on the rise [6]. Even though popular opinion holds that the application of health informatics improves patient safety [7,8], improves physician office efficiency [7,8], and mitigates shortages in health human resources [8], such systems can compromise short-term physician office performance, intimidate physicians and their office staff and have been shown, on occasion, to increase medical errors [9,10].
J. R. Hampton et al [3] found that the making of a medical diagnosis depends on three things: the history obtained from the patient, the signs noticed on physical examination, and the results of laboratory investigations. In [3] the evidence is also given that 83% patients were diagnosed only with history taking and they also claimed that a diagnosis could be achieved by history-taking alone in the majority of patients, but books on clinical methods for medical students still devote much more space to eliciting physical signs than to history taking, and the colossal increase in the work load of all service departments shows vividly how dependent we have become on laboratory investigations. It was showed that getting IT technologies to work in concrete health care practices appears to be a politically textured process of organizational change, in which users have to be put at center-stage. Although we hear much more about successes, certain beneï¬ts and the need to implement patient care information systems in health care, the fact is that most applications to date have failed. Large numbers of systems never make it off the drawing table-and if they do, they do not appear to be transportable out of the speciï¬c context in which they were developed. A socio-technical approach and its implication on information systems in healthcare industry were also discussed in [4]. Socio-technical factors can directly influence implementation success of any healthcare system. Implementation outcomes are also affected by systems' graphical user interface design quality, feature functionality, project management procurement and users' previous experience [5]. In this study we are focusing to have a general view of physicians / doctors at quality, cost and time of treatment by using CCMS.
Technical Architecture
There's a shift in demand of IT system all over the world. System must be robust to handle growing requirements and must meet current needs. What modern hospitals want?
Table 1
Modern hospitals Needs
We know that every organization has different set of rules and that's how actually organization works. There are different policies and cultures surrounding an organization. Developing such a system to cater needs of different organization with centric approach is very important. We have analyzed various options and found out that there's a central approach which can solve the problem.
Keeping aside socio-technical factors [11] -- Central Case Management system can meet the needs of different organization with capabilities mentioned in above Table1.
Core Concepts
There are three key users of entire CCMS framework:
Doctors
Patients
Managers
Administrators
Table 2
Users and their tasks
CCMS Process(Context Level)
Figure 1
CCMS Process Flow
System authenticates user and based on his/her role provides set of actions to be considered. User initiates an activity by selecting a process. Creating a case record and mapping record to particular patient for future references. Following is a broad-level set of activities a user can perform based on his/her role:
Create a record/case
Manage Cases/Documents
Map case to a particular patient
Schedule interviews/events
Track finances
Collaborates by sending messages.
Generate reports.
CCMS Features
Case and Participant Indexing Function
Case Event Register Function
Scheduling Function
Calendaring Function
Document Generation and Processing Function
Disposition Function
Execution and Compliance Function
Case Closure Function
General Accounting Function
File, Document, and Property Management Function
Security and Data Integrity Function
Management and Statistical Reports Function
Modules
Central Cases Server Suite
Web-based Portal
Content management
Records management
Document management
Event management (calendaring)
Workflow engine
Mapping different organizations work-flows.
Process design
Integrated messaging
Performance reporting
Technology
Architecture
Web Services (SOAP, WSDL)
Messaging
XML
Web programming
ASP.NET/AJAX/JSON
Feasibility Evaluation Process
Survey Analysis
Below is the summary of the survey conducted and its analysis is presented.
Participants
As CCMS will be beneficial for doctors and hospitals in order to improve their treatment quality and reduce treatment cost and time. So, we tried to focus on doctors, surgeons, medical students, IT consultants and house hold personals in our survey. The survey was conducted from 44 people from different professions as discussed above, from which 90% were male and remaining were females.
Analysis of the survey
As CCMS focus is completely on improvement of treatment quality along with decrease in time and cost: because of the availability of patient's history information. We had conducted a survey that is summarized below:
Table 3
Important questions in survey
Correlation test
As over there we are going to compare quality of treatment with treatment cost and time, so we need to compare the results of these two variables with quality of treatments. A test that is used to do this is called "Correlation Test". Whereas, the scale type is ordinal, so while analyzing data in correlation test, spearman's school of thought will be used.
As our Hypothesis is, "If CCMS is developed then it will improve the quality of treatment and would reduce the overall treatment time and cost"
Following table shows results of the correlation test.
Comparison between Quality of treatment with Treatment cost in CCMS.
Treatment cost and Quality of treatment in CCMS are negatively correlated as shown in the figure.
The significance value is more than 0.05 that shows the hypothesis, that both the variables are independent of each other.
Table 4
Correlation test between Quality and Cost of treatment
Comparison between Quality of treatment and treatment time in CCMS.
Treatment time and Quality of treatment in CCMS are positively correlated as shown in the figure.
The significance value less than 0.05 that negates the hypothesis, that both the variables are independent of each other.
Table 5
Correlation test between Quality and Time of treatment
Conclusion
From the results of correlation test it can be conclude that, with the help of CCMS quality of treatment can be improved with respect to time i.e. time and quality of treatment are positively correlated to each other on the other hand it is also avident from the correlation analysis that Quality of treatment and cost are two independent variables in CCMS they do not relate to each other because in above table the significance value (which is basically a confidence level of SPSS) in between quality treatment and treatment cost is 44.8% which is greater than 5%. Therefore overall hypothesis is rejected. But after watching these results we can rewrite our hypothesis as "If CCMS is implemented it will improve quality of treatment and will reduce treatment time" then it will be defiantly be accepted because the significance value in between treatment quality and treatment time is 0%. So, It would be better choice to implement CCMS because as per the opinions of participants availability of history information supports them in their treatment.
