The Workload of Hospital Staffs for HIS Replacement in Whole from ...

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7 nov. 2013 (il y a 7 années et 10 mois)

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The Workload of Hospital Staffs for HIS Replacement in Whole from a
Mainframe to Server Client Computer System
Tetsuo Sakamaki,M.D.and Toshihisa Takayama,B.S.
Medical Informatics and Decision Sciences,Gunma University Hospital,
Maebashi 371-8511,Japan
Background.We changed our hospital information system
(HIS) in whole from a mainframe to server client (S/C) type
because it brings us many advantages.We had lines for this
replacement,i.e.,1) all functions of the previous HIS should
be transferred to the new one,2) all patient data should be
preserved,3) interruption of clinics when the new machines
are installed should not exceed one week of new year
In this replacement we had to do much because only
medical staffs know the hospital work flow precisely;indeed
the replacement might not be succeeded in without their
self-sacrificing work.Herein we report the workload of our
hospital staffs.This may be informative for others who
intend to replace a HIS.
Previous System.Our HIS based on a order-entry system
started as a mainframe computer system in 1988,and it
grew up (ACOS-3600 and 410 workstations,NEC,Japan) in
1993 since the works were expanded and the requirements
were exceeded the ability ofthe early system.
The network covered 15 wards with 665 beds,a blood
test laboratory,a X-ray laboratory,a dispensary,surgical
rooms,out-patient clinics and an accounting office.The
physicians ordered prescriptions,blood tests,X-ray exams,
ECG,etc.,and retrieved patient data from early 1988.
Nurses,technicians,pharmacists,dietitians,clerks and
almost every staffs also worked on the system.This system
worked till Dec.25,1998 just before the setting of new
New System.Our hospital contracted with NEC on July,
1998,and the new system started to work on Jan.2,1999.
This consists of one mainframe computer for accounting,
one main server for order-entry,14 servers for each division
(a blood test laboratory,a X-ray laboratory,a dispensary,
etc.),24 interface servers to connect the above servers,and
532 clients.The network consists of an ATM switch and
155Mbps optical cables.
A Web-based picture archiving and retrieving system for
radiology,pathology and endoscopy,and a bedside
computing system for nursing were newly added on the
previous HIS functions.
The workload of each WG is shown as a person-hour
which is a product of number of persons attended to
meetings or operations and the hours spent (Table).The
WGs were immediately activated,and their workloads were
489 person-hours in Aug.,1998.The workloads became
twice and came down to 117 in Dec.when customization
was mostly finished.
The work for the prescription and pharmacy was finished
early,but the work for both endoscopy and pathology started
late because the company could not prepare the prototype.
The most busy WG was for blood test.They had 35
meetings during 5 months,and their workloads were up to
780 person-hours in total.The blood test laboratory had
many automated machines more than 50 which connected to
HIS through 45 interface computers.To make a check on
these machines were so complex that the work was hard.
Conclusions.The workloads of the hospital staffs were
tremendous up to 3000 person-hours which are approximate
to 250 thousand dollars if it was paid to Japanese system
engineers.It is worth to say that the tremendous amounts of
work of staffs in wide area led to success in the HIS
replacement in whole.
Evaluation of Workload for Replacement.On July,1998,
we organized 13 WGs (Table) consisted of 114 staffs
including 41 physicians,15 nurses and 27 medical clerks.
The WGs have roles of 1) giving suggestions to system
engineers for customizing softwares,2) cording and making
master tables,3) making a check on each subsystem if it
works as the staffs want.
1091-8280/99/$5.00 1999 AMIA,Inc.
Working group name Aug.Sept.Oct.Nov.Dec.
1) Prescription and pharmacy 55 52 0 0 0
2) Blood test and 160 254 254 101 15
3) ECG and physiology 20 24 65 21 0
4) X-ray exam.and 20 44 89 45 0
5) Endoscopy and 0 0 25 38 10
6) Pathology and 0 81 66 62 39
7) Nursing 20 44 154 44 0
8) Surgery room management 0 32 45 9 15
9) Transfusion control 0 55 56 0 0
10) Medical stock control 53 55 28 0 0
11) Meal service 55 124 48 15 0
12) Accounting service 65 78 1 1 21 0
13) Coordination of WGs 41 95 132 259 38
total 489 938 973 612 1 17