Better care via better capacity management

Accountability is regarded as an important principle of information security. This means that all actions carried out on the system need to be traceable back to the user outlining the time, date and actions performed. This is required to ensure the user is accountable and responsible for their actions or omissions (REF Fundamental Security Concepts). The Galway Clinic policy states ‘Access to Meditech and information is recorded throughout the clinic. Reports on data and module access over a period of time can be requested by any Head of Department. Those reports can be produced on a user or department level’. Although this highlights that an audit trial can be generated on Meditech, there is no ongoing surveillance in place and is therefore reliant on people reporting data privacy and confidentiality breaches.

Staff also need to be aware of the policies and procedures they need to adhere to in order to keep the information accessed secure. Some of the policies and procedures in place in the Galway Clinic relating to security are:

Contractor confidentiality agreement
Electronic medical record access
IT Server Room Access
Network and Domain security
Anti-Viral Protection
User setup for Domain access
Backup Procedure
Acceptable use of Galway Clinic computers and systems
Backup Data Retention
Disaster Recovery Policy
User Access Request Form
Visitor confidentiality agreement

In relation to accessing the Meditech system, both clinical and non-clinical people require some level of access to view and handle personal health information about individuals. There is no refresher sessions currently. Staff are kept up to date informally by their managers in their individual departments. All staff can attend the orientation session again if required, but it’s not mandatory. The IG manager is also responsible for ensuring all legislation is adhered to, as well as local and national policies. Staff need to be updated with any changes/amendments to governance policies. All relevant legislation and policies is followed but not limited to the following list:

Awaiting the Health Information and Patient Safety Bill (Referred to committee for prelegislative scrutiny (PLS)).
Data Protection Acts 1988 and 2003, and subsequent regulations
Data Protection (Access Modification) (Health) Regulations 1989
Freedom of Information Acts 1997 and 2003, and subsequent regulations
The Health (Provision of Information) Act 1997

Details of the System

Hamad Medical Corporation is one of the prestigious health care organisations of Qatar and has been talking attempts on integrating and improving the health care technologies that have been employed by them. Hamad Medical Corporation has made several technological integrations in its operational processes; however, there still exists certain area that requires improvement or addition to make the services flawless and more efficient. The organisation has integrated several modern amenities and technologies so as to enhance the patient experience. The organisations of health care sectors are integrating various advanced technologies for efficient care management as well as database management, so as to ensure that the care that is provided to the patients fulfils all their health care demands. Hamad Medical Corporation, which is one of the premier not-for-profit health care organisations operating in Qatar, offers premium and state-of-the-art treatment and diagnosis services, which were earlier managed only in the overseas institutions. The staff members from all the discipline have been contributing to the procedure of developing improvements, fundamentally on the principle of capturing the collective creativities, especially with respect to the critical business issues, thereby translating the ideas into actions. The management of Hamad Medical Corporation have been focusing on improving the capacity management system of the organisation so as to improve the bed capacity for the patients, within the hospitals.

The fundamental objectives of Hamad Medical Corporation were to increase the availability of beds, ensure that patients get discharged on time and eliminate the necessity for the newly delivered mothers to wait in the labour suite to acquire a bed. ]

With the inclination of Qatar government towards establishing e-health ecosystem, aimed to be achieved through integration of systems, the need for flow of information among the medical and healthcare unit have become essential nowadays. One of the most important and sought-after aspects for any healthcare organisation is the capacity of the institution. The first implementation of electronic patient medical records in the world was demonstrated by Hamad Medical Corporation with the Healthcare information and Management Systems Society (HIMSS) establishing the integrated connected system of healthcare services, further ensuring that the patients receive high quality care irrespective of there location of treatment facility (HMC, 2017).

Although the necessity for bed requirements were fulfilled through this initiative, there still exists the issue of management of the bed and capacity system as the increase in the number of beds have raised the problem of bed assignment that results in unnecessary delays in the allocation of beds to new patients. To overcome this issue, a new capacity management system is to be integrated that would aid in easy allocation of beds to the patients and avoid unnecessary waiting. It is important to initiate and optimise bed management and capacity management so as to maintain a steady patient management and reduce the unrequired waiting time of the patients. The introduction of the capacity management suite would aid Hamad Medical Corporation to overcome this situation and improve their efficacy regarding patient care. Capacity management suite improves the patient throughput, reduces patient wait times, decreases ED overcrowding and improves the access to care of the health care institutes of Hamad Medical Corporation (Tele Tracking, n.d.).

Governance models in the healthcare industry

The Capacity management suite comprises of preadmit tracking with electronic bed board, bed tracking, transport tracking and patient tracking portal. The preadmit tracking application automates the procedures of placing the patients so as to reduce their wait times and the consequent overcrowding throughout the hospital, in a single department like ED or across the health system. This brings visibility to the projected census and demands of all the patient intake regions such as PACU, ED, Cath Lab and the internal-external transfers. This system is complimented by the electronic bed board that provides a comprehensive view of the bed status present on each unit of the hospital and across the health system (Teletracking, n.d.).

Bed tracking aids in the optimisation of patient flow as it reduces the time lags in the bed turnover process and automates the communication system of the bed statues to all the patient flow stakeholders. Improve in the communication system aids in the reduction of the number of stat cleaning and has the ability of reducing the length of stay (LOS) through the process of faster bed availability. This also simplifies the staffing decisions through the rich reporting features, employee performances and volume trends. Transport tracking is an efficient transport management application and it streamlines the patient flow through the duration of their stay at the health care centre (Tele Tracking, n.d.). Through the use of configurable and intelligent dispatching logic for assigning the transport requests to the health care staff, the transport employee is able to use the same more efficiently. Using transport tracking as a part of capacity management suite system, the transports for discharges or transfers would automatically trigger notifications of dirty bed to the environmental services and the bed is turned without the need for any request from the ADT or the nurse. It also ensures that the department schedules are maintained at on-time by allowing the staff with the pre-scheduling of transport requests, even in the real-time (Tele Tracking, n.d.).

The solutions that have been previously identified and mentioned, with regards to the capacity management suite, are highly complemented by the patient tracking portal, which is a comprehensive nursing whiteboard for patient flow and provides the rounding care providers with quick glance at the visibility of the bed, with patient status and enables them to manage the care progression as well as discharge planning milestones. Additionally, this feature also enables the care professionals with quick view and the same is updated to the patients’ attributes (Tele Tracking, n.d.). These include isolation precautions, fall risks, dietary restrictions and core measures. With the help of capacity management suite patient and staff monitoring as well as the frequency of the care can also be increased. The use of RTLS with patient tracking portal aids in the management and monitoring of hand hygiene compliance, driving suitable washing behaviour and reducing infection. The implementation of capacity management suite would enable in reduction of the throughput time of the patients, by 59% with reduction in the ED wait time, by 70% (Tele Tracking, n.d.). The capacity management suite also reduces the cost and increases the workforce efficiency.

The Capacity Management Suite

Information is that accountability framework which enables an organisation to ascertain that the personal information that are recorded in the health care record in a secure, effective, efficient and legal manner. This also includes the functions, policies, processes, technologies and standards which allows the data to be created, stored, values, communicated and used in the manner that aids in the fulfilment and achievement of the corporate goals. While assessing the existing information governance of Hamad Medical Corporation and its capability to integrate capacity management suite, these aspects have been taken under considerations (Hamad Medical Corporation, 2012).

Hamad Medical Corporation has received Joint Commission International (JCI) re-accreditation for all the health care institutes that are maintained by it and also manages its ambulance and home health care services under the JCI accreditation. Hamad Medical Corporation in collaboration with Weill Cornell Medical College in Qatar, along with certain other health care, academic and research partners, are able to integrate all these elements to become the highest possible quality health care facility in Qatar (Hamad Medical Corporation, n.d.). The current capacity management system that is being used by Hamad Medical Corporation has certain limitations associated with it and these can be discussed in details, as follows.

As per the guiding principles, the overall responsibilities and accountability of the management of the information governance is the responsibility of particular named individual(s). With respect to Hamad Medical Corporation, this responsibility rests on managing Directors of the corporate. The existence of a formalised governance and management structure ensures that that the accountability is maintained at each level of the organisation. This implies that within the corporate, each of the individual or management team is required to be aware of their respective accountabilities and responsibilities, with respect to the information governance (Hamad Medical Corporation, 2012). Therefore, to ensure that the respective responsibilities are maintained, necessary training is provided to the required individuals and they are adequately trained, educated and informed about their respective responsibilities and tailor-made training programs are also developed or them, ensuring that the same is included with the corporate training plan. The information governance manager of Hamad Medical Corporation holds the responsibility to ensure that all the necessary legislations are followed and maintained, along with maintenance regarding local and national policies (Hamad Medical Corporation, n.d.). Any changes or amendments with regards to the governance policies require following various policies and relevant regulations and legislations that would ensure the compliance of the same by the organisation.

Associated Risks

The utilisation of the capacity management suite has certain risk associated with it, within the context of its application at Hamad Medical Corporation. The fundamental risks that have been identified would include data privacy and confidentiality, and information security. The privacy and confidentiality of the patient data may be get affected due to any leakage in the database management system. Since the capacity management suite of Hamad Medical Corporation requires regular transfer and exchange of patient records and data, it is susceptible to external attacks that may result in the loss acquisition of these information. There also exist the issue of authentication and identification. With respect to the capacity management suite of Hamad Medical Corporation, the patient information is shared only amongst the designated workforce and therefore, care is taken to ensure the maintenance of its confidentiality and security as it requires continuous monitoring and assessment (Hamad Medical Corporation, n.d.). The other limitation is information security. As Hamad Medical Corporation is a large organisation, it possesses a large database of innumerable patients and this database in maintained through the cloud servers. The database is maintained through the online sources and the same can be accessed only through permitted passcodes. Any breach in the security or unauthorised attempts to access the database is prevented through the use of such technological developments that protect the integrity and security of the clients (Hamad Medical Corporation, n.d.).

Preadmit Tracking

The capacity management system will be comprised of an integrated array of solutions that will be specifically programmed to reduce the operational costs and better utilisation of the equipment and beds. Rather the proposed system is planned to be designed to handle real time of data. End results will be maximised utilisation of the bed resources, reduction in over or miss allocations and staffing requirements for monitoring the bed capacities. Even in emergency situations, the proposed system will be able to display the availability of bed, both long and short duration stays, which will help the management in dealing with medical cases required occupancy for couple of hours. Effective management of the bed capacities will lead to better scope for offering services to a greater number of patients. This system will automate the work process related to the flow of flow of patients to the stakeholders, enhance the discharge process with increased bed turnovers, remove the process of bottlenecking the patient flow, delay and hold times in bed allocation for the patients (Balaji and Brownlee, 2018).

The proposed system will consist of four main modules related to

Live bed tracking for comprehensive supervision of bed turnover process, making use of the environmental services

Pre-admit tracking facilities for access and placement of the already registered patients

Transport tracking for containing information related to shift of the patients to other beds or care units

Live patient tracking for a real time monitoring of the patient flow for the inhouse units

The preadmit application will facilitate the process of information about possible bed allotments for a patient, using automotive techniques for reducing overcrowding and patient wait times, not only for beds in main care unit but also for beds available for other individual units like ED. This module will be useful for monitoring the demand form the patient intake or admission request areas like Labs, ED, PACU, including external and internal patient transfers.

The main operational module for capacity management will be the Live bed Tracking element which must be designed for optimising the patient flows at HMC through reduced time lags in bed turnover process and establishing automated communication procedures to the stakeholders of patient flow. Improved communication will result in reduced LOS (length of stays) along with quicker bed availabilities.

Transport tracking module will help in streamlining the patient flow process over the entire medical stay duration. Through use of customised smart dispatch logic instructions for assigning requests for patients’ transfers, the management will be able to ensure highly efficient utilisation of transport staff. In case of transfer requests for discharge of patients, the cleaning and servicing notifications for the dirty beds will be automatically triggered to the cleaning and hygiene service staffs, so that the beds can be made ready or turned without the need for initiating a request form the ADT or nurses. This will result in better maintenance of the on time departmental schedules, further enabling the staffs for prescheduling advanced transfer requests and monitor the requests over real time basis. Transport tracking is anticipated to deliver easy to understand reports of response times, optimised performance, request volume and productivity.

Bed Tracking

The fourth element will be the Live patient tracking that will provide caregivers on surveillance rounds to glance at patient status, bed status almost instantly, further allowing them to manger discharge planning and care progressions targets. Besides the new system will enable for quick viewing and updating of various attributes like isolation precautions, fall risks, dietary limitations and core measures.

The amalgamation of Real Time Locating System with patient tracking, hygiene and cleaning compliances can be enforced into the management system of HMC.

Top level Data flow Diagram

External Entity Templates

External Entity Name	Admin
Purpose in Summary	Highest authority with universal access
Input Data Flow(s)	Intelligence, reports and assessments
Output Data Flow(s)	Circulars, guidelines, instructions

External Entity Name	Patient
Purpose in Summary	Provide information and medical history, along with the requirement for bed
Input Data Flow(s)	Consent from, medical instructions, tests required
Output Data Flow(s)	Input data into the PID system

External Entity Name	Bed capacity management
Purpose in Summary	Accessing the data from the master maintenance
Input Data Flow(s)	Search query, report generation
Output Data Flow(s)	Bed number, last occupancy information, Status

External Entity Name	Emergency Department Physician
Purpose in Summary	Accessing the data from the bed management department
Input Data Flow(s)	Search query
Output Data Flow(s)	Mail from the capacity department hl7 or FHIR smart

Data Flow Name	All privilege and limitless authorization
Alias(es)
Description	Director approve for the changes in the capacity management
Source/ Origin	Director of HMC
Destination	Admin
Data Flow Name	All privilege and limitless authorization
Alias(es)
Description	Director approve for the changes in the capacity management
Source/ Origin	Director of HMC
Destination	Admin

Data Flow Name	Data Submitted to System
Alias(es)
Description	Admission and capacity management department verifies that information present on the Tracking system is being updated with every admissions and discharge
Source/ Origin	Admission department
Destination	IPD

Data Flow Name	Data gets updated into the system
Alias(es)
Description	feed the patient information PID database by completing registering process
Source/ Origin	Patient Flow System, Admin
Destination	Patient Information Database

Process Number	1
Process Name	Notifications to HMC system
Purpose in Summary	gives authorization for the admission department
Input Data Flow(s)	Service Details, Bed Details, Doctor Details
Output Data Flow(s)	MD sends notification and mails
Data Stores Used	HMC management system server
Detailed process description	Admin informs the admission and bed capacity management division, enquiry request, that a system has been developed for bed management at HMC. The Admission department co-ordinates the admission process thereafter

Process Number	2
Process Name	Admission department gathers information
Purpose in Summary	Directors gives authorization for the admission department
Input Data Flow(s)	Request to Capacity management systems
Output Data Flow(s)	sends notification and mails
Data Stores Used	HMC management system server, Patient flow system
Detailed process description	Details about the available beds and the beds whose patients will be discharged on the same day

Process Number	3
Process Name	Admission department checks for bed schedules
Purpose in Summary	Capacity management department checks for the number of beds readily available for emergencies and scheduled admissions
Input Data Flow(s)	Requesting access to the master records
Output Data Flow(s)	Pre-admit tracking and Bed tracking
Data Stores Used	Patient flow system of HMC capacity management
Detailed process description	The newly designed capacity management will be collecting information from electronic bed board and return results in the form of reports and sheets

Process Number	4
Process Name	Admission department confirms with the referring physician
Purpose in Summary	Checks for the treatment details, number of days the patient needs to occupy the bed, requirement for bed transfers
Input Data Flow(s)	Pre-admit tracking and Bed tracking
Output Data Flow(s)	Confirmation of bed allocation to the patient
Data Stores Used	Patient flow system from bed management department
Detailed process description	The reports and processes of the bed management department will generate reports with patient medical records and the quality of the bed allocated, attaching the HL7 message

Process Number	5
Process Name	Physicians consult the medical records
Purpose in Summary	Checks for the treatment details, schedule for the treatments and operations
Input Data Flow(s)	Check with patient ID
Output Data Flow(s)	Medical history of the patient
Data Stores Used	Unified e-health servers
Detailed process description	About the treatments received by the patient, with their reports

Name of Attribute	Bed ID
Description	Unique Bed number
Data Type	Alphanumeric
Lengths	16
Constraints	Indexed non-duplicated entries

Name of Attribute	Patient Name
Description	Name of the patient
Data Type	Alphabet
Lengths	50
Constraints	Prefix of Mr., Mrs, Miss,

Name of Attribute	Patient ID
Description	Unique identification number
Data Type	Numeric
Lengths	12
Constraints	Indexed non-duplicated entries

Name of Attribute	Department ID
Description	Identification number for the enquiring department
Data Type	Numeric
Lengths	12
Constraints	Indexed non-duplicated entries

Name of Attribute	Occupancy status
Description	Condition of the bed
Data Type	Yes or no
Lengths	10
Constraints	Limited to three variable- booked, available, occupied

Name of Attribute	Refer department
Description	Information of the department referred
Data Type	Numeric
Lengths	25
Constraints	Indexed non-duplicated entries

Name of Attribute	Date
Description	Date of occupancy, discharge, operations
Data Type	Date format dd/mm/yyyy
Lengths	8
Constraints	Linked with Google calendar

Name of Attribute	Patient Name
Description	Name of the patient
Data Type	Alphabet
Lengths	50
Constraints	Prefix of Mr., Mrs, Miss,

Name of Attribute	Patient ID
Description	Unique identification number
Data Type	Alphanumeric
Lengths	12
Constraints	Indexed non-duplicated entries

Name of Attribute	Date
Description	Date of admission
Data Type	Date format dd/mm/yyyy
Lengths	8
Constraints	Linked with Google calendar

Name of Attribute	Patient info
Description	Medical history of the patient
Data Type	Attachment
Lengths	Variable
Constraints	Primary Key; Required. Triggered after authorisation

The database management tool used for creating the tables and the relationship diagram for the table is Ms Access. The tables created in MS Access is provided below:

Interoperability can be described as the extent to which the data provide in the system can be exchanged, interpreted and shared easily. For any two or more systems to be interoperable the system should be able to fetch and deliver the data and also they should be able to represent the data efficiently so that it can be understood very easily by any user. In healthcare management systems it is to be noted that interoperability is defined as the ability of communicate, exchange data and make use of information with the help of software application. The data within the healthcare would be shared among the different departments of the healthcare organization. Interoperability would help the different sectors of the system in working together with each other and also across the boundaries of the organization.

Foundational:
The interoperability Allows the integration of one of the information system with another system which is operating under the main system for the organization. This would allow efficient data transfer opportunities in between two information systems developed within the organization.

Structural:

The structural interoperability is the intermediate level that is used basically for the description of the format of the data for the system which would be exchanged. The movement of data across the healthcare organization is uniform, for instance the data of the clinical department and the operational department remains almost the same and the syntax of the data is defined by the structural interoperability which is to be exchanged. It is noted that the data exchanges that have taken place would be interpreted easily at the field of data level.

Semantic:

The highest level of interoperability is known as the Semantic interoperability. This provides two or more than two information systems to exchange information among themselves and use the information which are exchanged in between them. The semantic interoperability receives advantage from both the structure of the data which is being exchanged and data codification process which includes the vocabulary of the receiving technology so that the recipient would be able to interpret the data which is received by them very easily. This is the highest level and this can support the exchange of summary information of the patients in the system and the data is then distributed to the caregivers within the organization so that they would be provide the required help needed to the patients. The system would also help the authorization of the processes that are integrated with the healthcare system developed for the organization. The systems would be working towards the improvement of the quality, efficiency and safety of the system.

The Cures Act is being used in the healthcare organization for development of the new policies and standards that would be supporting the Health IT technology infrastructures which would create an enhancement for the use of data exchange methods that would help the medical breakthroughs for the organizations. In addition to this, there are secure messaging vendors such as Telstra Health and Global Health have already achieved two-way interoperability. The ReffralNet and Argus platform already helps in securing the exchange of the clinical documents and other health related documents within the system securely.

However, problems have arisen with the healthcare organization not supporting the adoption of the secure messaging options and still trusting the conventional but insecure option of data exchange process. Hence there has been discussions among the organizations and the Australian Digital Health Agency and procedures to integrate newer technologies has been focused on in the discussions.

Conclusion

For conclusion it can be said that main focus of the report has been provided on the healthcare system development and adoption by the Hamad Medical Corporation which is one the prestigious health care organisations of Qatar and there has been attempts to improve the integration of the healthcare facilities available to the organization. Hence it is recommended that the Fast Healthcare Interoperability Resources is deployed for the organization in order to make efficient data transactions in-between the different sectors of the healthcare organization. For the development of the system it is proposed that a JAVA layer is implemented with the use of the i2b2 database model so that the data of the CDW can be exposed as a resource for the Fast Healthcare Interoperability Resources. The structural and semantic mapping of the i2b2 model and the FHIR RM is very important and for accomplishing the desired result the developers and the designers should be browsing the specification of the FHIR standard manually and also the source code is to be made available for so that the database can be adopted on other systems as well.

Reference List

Balaji, R. and Brownlee, M., 2018. BED MANAGEMENT OPTIMIZATION. [pdf] Available at: https://www.infosys.com/industries/healthcare/Documents/hospital-bed-management.pdf > [Accessed 22 November 2018].

Hamad Medical Corporation, 2012. Annual Report 2010/11 Putting the patient first. [pdf] Available at: <https://www.hamad.qa/Publication/English_report_2010_2011.pdf> [Accessed 18 November 2018].

Hamad Medical Corporation, n.d. Our accreditations. [online] Available at: <https://www.hamad.qa/EN/About-Us/Our-Accreditations/Pages/default.aspx> [Accessed 18 November 2018].

HMC, 2017. Qatar’s World-first Implementation of Electronic Patient Medical Records Highlighted at HIMSS Conference and Exhibition. [online] Available at: https://www.hamad.qa/EN/news/2017/December/Pages/Qatars-World-first-Implementation-of-Electronic-Patient-Medical-Records-Highlighted-at-HIMSS-Conference-and-Exhibition.aspx> [Accessed 22 November 2018].

PWC, 2015. National E-Health and Data Management Strategy. [pdf] Available at: < https://www.who.int/goe/policies/qatar_ehealth2016_2020.pdf> [Accessed 22 November 2018].

Tele Tracking, n.d. Capacity Management™ Suite. [pdf] Available at: <https://www.teletracking.com/media/1144/teletracking-capacity-management-suite-data-sheet.pdf?width=3000&upscale=false> [Accessed 18 November 2018].

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