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Rochester Institute of Technology RIT Scholar Works
Theses Thesis/Dissertation Collections 2-13-
Implementing a Patient Information System inPublic Hospitals in Kosovo
Adriana Sejfia
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Recommended Citation Sejfia, Adriana, "Implementing a Patient Information System in Public Hospitals in Kosovo" (2015). Thesis. Rochester Institute of Technology. Accessed from
Submitted to A.U.K. as part of requirement for graduation
Implementing a Patient Information System in Public Hospitals in Kosovo
An Honors Society Project Presented to The Academic Faculty
By Adriana Sejfia
In Partial Fulfillment of the Requirements for Membership in the Honors Society of the American University in Kosovo
Acknowledgments I will take this opportunity to express my humble gratitude to every person that has contributed in one way or another in this capstone project. Special gratitude is extended to my technical adviser, hesitated to offer academic guidance and invaluable help throughout these past 6 months. Professor Edmond Muhaxheri, who has not
was crucial in determining the path of this project.^ Many thanks to my second technical adviser, Professor Blerim Rexha, whose experience in the field I am thankful to my supervisor challenging, have made me go the extra mile, Dr. Brian Bowen. His persistence and high expectations, although and have made this capstone project what it is today.
I remain thankful to all the doctors, nurses, patients nothing but eager to help me in this journey. and Ministry representatives who have been
I want to thank my family and friends for always being there for me. Their unconditional love and support have been very much appreciated.
Last, but not least, I want to extend my gratitude to the mos encountered: My Mom. Her presence and encouragement wtere the fuel that brought remarkable person I have ever me here.
List of Abbreviations HIS - Health Information System MoH - Ministry of Health in Kosovo MR- Medical Record PIS - Patient Information System WHO - World Health Organization
The overall cost approximately lower than 28 million USD. The data available to determine the price were limited, and of a Patient Information System in the seven hospitals in Kosovo would be hence this price level was not definitive.
Problem Definition
Kosovo^ The problem with the current patient management system employed in public hospitals in is that is very inefficient and disorganized. At the very best, it causes a chaotic environment in hospitals. However, when having to deal with health institutions, issues that might affect their treatment in the end. A visit in the nearest hospital is clear evidence in Kosovo citizens face numerous support of the abovementioned statement. The schedules are irregular and not respected, if they exist at all. Often patients have to change doctors due to this irregularity in the schedules and they have to tel or treatments that produced negative effects.l the new doctor their medical history. Many times, these irregularities caused ineffective treatments
a timely, efficient and qualitative manner, a different, one of the goals of this p^ Having in mind the importance of health institutions and its services that ought to be offered inroject will be to pinpoint the best information patient management system. Another goal would be to see how much a software distributed to all public hospitals in Kosovo would help the hospitals to manage their schedules and to have information on each step of the treatment of the patient. will evaluate Kosovo’s current Health Information Strategy against its findings. This will be achieved Moreover, this project through using samp different systems have to be analyzed and compared with the specific requirements the publicle hospitals throughout Kosovo. In order to reach this goal, the functionalities of hospitals in Kosovo have for such system.
improve their performance and many of them have found that these systems have proven to be very successful (WHO, 2012). Among praised attributes of letting a software handle most of the management of the terms of prescribing better treatments, reduced cost per patient as many bureaucratic procedures patients are increase in efficiency in terms of speed of handling patients and also in are cut in half, and increased patient self components (WHO, 2012). -treatment and interactivity between the three abovementioned
digitalized medicine f^ The^ systems’ flaws have surfaced during the course of time. One of the biggest challenges aaces is a slow input of the data (WHO, 2012). In addition, there are often complain Cunaku, personal comts from less technology literate individualsmunication, September 28, 2014). about the It has been empirically proven that usa user friendliness of these systems (^) ge of(I. such systems requires a certain understanding of technology which many dwellers of rural areas lack. This problem becomes even more visible and concerning when dealing with elderly groups. This group of citizens in many countries has not yet reached would enable them to understand ICT in medicine (Hernandez a functional level of technology literacy that-Encuentra, Pousada, and Gomez- Zuniga, 2009).
enjoying from th^ Most^ countries that have employed these systemsem outweigh their costs (WHO, 2012). T^ suggesthe commercial packages have continuously^ that the benefits that they are stated that the process of improving patient manage invested a considerable part of their capital in constantly updating the coding behment software is an ongoing one. Tind these systems sohey have that it can be more secure and easier to use (I. Cunaku, personal communication, September 28, 2014).
started using them.^ Many countries have found the features that such a system offers very appealing and have WHO reports that there is a visible discrepancy between less developed and developed countries when it comes to technologizing medicine and hospitals (2012). Developed countries make use of their vast resources. A crucial factor contributing to a larger cover of these systems in that of less developed countries. The technology literacy combined with a high level of technology developed countries is the level of technology literacy, which is high when compared to coverage, i.e. access to internet, and developing countries (WHO, 2012). are important factors that explain the difference between developed
issues they face when it comes to health care would be solved or at least their impact would^ Developing countries are encouraged to adopt patient management software because the main be
mitigated (WHO, 2012). A patient information system provides developing cou information, a critical element. This information is crucial not only in solving individual cases but alsontries with tracing epidemics, pinpointing weak points in the medical policies. system and provides a swift feedback to
1.2.1. Functionalities of a Patient Information System The main functionality anticipated from a patient management system is collection and storage of patient data. Reliable storage of data and protectio system. The data includes patient medical history and all financial transactions conducted from patientn of these data provide the backbone of such a to the hospital (Wei, 2011). Of special importance are visual data, a functionality widely known as Picture Archiving and Communication System (PACS). This importance comes from the fragility of these data. In order to be reliable, they have to be very accurate, especially when shared or exchanged (Aggelidis and Chatzoglou, 2012). As such, a patient information system must be able to offer high quality visual data.
kind stored in the databases of average patient management software should be easily accessible by all^ The second functionality is a clear flow of the data (Wei, 2011). Put simply, information of any the relevant and authorized parties, including here also schedules of commonly known in the world of bioinformatics as interoperability of the data (WHO, 2012) the doctors. This is most
interactive processes of communication between hos^ Another very important feature of a patient management system is that is should allow forpital staff themselves and between hospital staff and patients. This enables patients to communicate during each step of the treatment with the doctor and it enables the doctors to receive information about an incoming patient in real time (Wei, 2011). An (Aggelidis and Chatzoglou, 2012). This feature ensures easier ways of integral part of the interactivity would be the possibility of conducting safe financial transactions conducting payments. Most importantly, it provides a means for the government or th track its financial situation at any point in time. e administration of the hospital to be able to
cumulated data and statistics based on authorized user’s preferences^ The third set of functionalities that patient management software should offer includes (WHO, 2012). In other words, this system should be able to offer the user, which might be a doctor or a manager, statistics about patients treated with a specific medication process or with patients treated within a day. These reports
The costs of these commercial packages vary with the size of the hospital. 1.2.3. Patient Information System In a study, the health systems of 19 less developed countries were analyzed in detail, with a s in Developing Countries special focus on their ICT countries’ progress on incorporating ICT in their medical processes was evaluated through a standard incorporation in medicine (Vital Wave Consulting, 2009). In this study, the set by the researcher as follows: Level 1 reporting; Level 4- operational systems such as pharmacy, radiology, laboratory, and Level 5- Manual; Level 2- Optimization; Level 3 - Electronic- total integration of the data from public and private clinics or hospitals. The statistical results of this research are presented in the pie chart in Figure 1.1. Figure 1.1. Source: How developed is ICT in medicine in L Vital Wave Consulting (2009) ess Developed Countries
have come up with some recommendations for developing countries when it comes to^ In addition to simply reflecting the situation in developing countries, this and other studies PISs. The recommendations include using simple and relevant technology, to build used, and to incorporate in the process of decision-making all the relevant stakeholder (Vital Wave upon what is already being Consulting, 2009; WHO, 2012; Chetley, 2012). 1.2.4 Models to Evaluate Progress in Patient Information System There are several models used to evaluate the level of pervasiveness of ICT in hospital management in a particular country (WHO, 2012). These models are helpful for a government to assess its progress in this field and to estimate the potential future investments needed. The most widespread models will be briefly presented below.
ICT in medicine in LDC Level 1-Manual Level 2 or 3- Optimization/Electronic reporting Level 3 firmly - Electronic Reporting Level 4-Operational Systems
software, i.e. paperless hospitals, would require 5 stages or levels. Based on the levels of^ Capability Maturity Modes^ predicts that the full pervasiveness of patient management pervasiveness each currently stands (WHO, 2012). The following table summarizes each of the stages with its respective country can evaluate itself its own policies and determine the level in which it anticipated progress. Table 1. Source: 2 Capability Maturity Modes World Health Organization (2012) levels and their description
Level 1 Main characteristic Ad hoc Description Starting point 23 RepeatableDefined The technological processes produce roughly reliable outcomesThe technological processes become standards in the field 45 ManagedOptimized The standards are applied in almost all of the casesThe processes and standards are improved to fit the circumstances
implementation^ Enterprise Architecture. It is more directed toward^ –^ This model does not focuss improvements of established technology. The initial^ largely in the initial phases of phases, according to this model, require setting a framework and main principles of use. After that, the life of the software depends on a continuous improvement based on a standard process that fixes errors and incorporates innovations (WHO, 2012).
divides the path towards full adoption of^ The HIMSS EMR Adoption Model software in managing patients in seven stages.-^ takes an approach similar to Capability Maturity Model. It The subject being analyzed through this model is clinics, not an entire country. It looks at the permeation of patient management technologies in several departments of the hospital, which are pharmacy, radiology and laboratory and then progresses to digitalizing documents and medications and standardizing the processes (WHO, 2012). These stages are presented in the table 1.3.
Chapter 2 “Kosovo’s Medical System” Kosovo’s health system is based considerably on the Semashko model, which is characterized by central planning and service specialization (Percival and Sondorp, 2010; Uka and is regulated by the Ministry of Health, which is governed by the Law on Health No 2004/4. As it is Muzik, 2014). It established in the law, Kosovo’s health system is organized in three main levels: primary, secondary and tertiary (Law on Health, 2004). The primary level operates under the funding of respective municipalities and its range of services is more general the first institution to be contacted by the patient (Percival and Sondorp, 2010; Law on Health and for more immediate purpose. It constitutes 2004). The secondary level offers more specialized services and it is funded directly by the Ministry of Health. Patients should be authorized by the primary level to be considered in this level (Percival and Sondorp, 2010; Law on Health 2004). The tertiar responsible for higher education and for carrying out academic and scientific research projects (Lawy level, in addition to offering specialized services, is on Health, 2004). The services in each of the public institutions should be paid partly by the pa and partly through subsidies or funding by the Ministry of Health. The budget dedicated to second andtient third level of health system for 2013, 2014 and 2015 are presented in table 2.1. Table 2.1 Budget for secondary and tertiary levels of health syste Source : Ministry of Finance (2013) m
Level Secondary 2013 (in Euros) 30,773,263 2014 (in Euros) 31,113,263 2015 (in Euros) 31,113, Tertiary 37,033,959 37,033,959 37,218,
2 .1. Problems with Health System in Kosovo All of these levels of the health system in Kosovo, especially hospitals, have been under
scrutinizing criticism. Immediately after the war, the health sector suffered from supplies such as water and electricity (Percival and Sondorp, 2010). Now, many articles suggest that a lack of basic the problems with the health system vary from Most importantly, research has pointed out to the lack of doctors (Percival and Sondorp, 2010; Ukaj a lack of basic medicines to high level of corruption. and Balidemaj, 2013). standard in Switzerland is 4 doctors per 1000 residents, in Slovenia 3, As it can be seen in Table 2.2., there is one physician per 1000 residents. The and in Serbia 2 (WHO, 2012). The statistical significance of the erroneous prescriptions of treatments has also been regarded as a
problem itself was responsible for a number of patients which were not treated correctly the first time. (Percival and Sondorp, 2010; Ukaj and Balidemaj, 2013). Hence, partially, the health system The level of communication bet inefficiencies present (Percival and Sondorp, 2010). Because Kosovo’s health system favorsween different clinics is close to zero, which only serves to amplify the specialization, each hospital has divided clinics which, unfortunately, fail to coordinate Sondorp, 2010). (Percival and
Table 2.2. Number of human resources in health sector for 2012 Source: Uka and Muzik (2014)
Staff Number in Public Sector Number per 1000 habitants in public sector
Number in private sector
Number per 1000 habitants
Doctors 2003 (19.0%) 1.15 1806^ in total 1. Nurses Non-medical 6043 (57.2%) 3.48 1666 3. coworkers Dentists^ 1996 (18.9%)321 (3.0%) 0.150.19^ No informationNo^ 0.
Other 337 (1.9%) No information informationNo^ 0. information^ No information
hospitals^ Technical problems also prevail within the walls of Kosovo’s health institutions, specifically (Holst, Fuchs, and Berishaj, 2007). Long wait lines are a characteristic of these institutions. There is less to none automation of bureaucratic proce storing and saving patient’s data, have contributed to the erroneous prescription of treatment bydures. These technical procedures, particularly hospital staff. Usually, the record of a patient’s medical history remains in the office of the doctor that patient visits more often(Percival and Sondorp, 2010). When that patient is forced to change doctors, the new doctor does not have access to that patient’s medical past and has to base his or her decision for the best treatment on conjecture. This problem has continued to top the lists for one of the main problems when it comes to medicine in Kosovo.
