Leadership, Management & Governance: Technology Innovation for Better Health Management

1. Leadership, Management & Governance: Technology Innovation for Better Health Management e-health Records in a Public Hospital: Kapkatet District Hospital Presenter: Dr. Kenneth Sigilai Medical Superintendent

2. KAPKATET DISTRICT HOSPITAL Location: Bureti district, Kericho county, Rift Valley province.

3. In The Beginning • All our Medical records were Manual: • Patients carried OPD Books. • (OPD Card system collapsed long ago) • Patients Registered Manually as they came • Multiple registers maintained at every point • MR Receipt books used to collect cost-sharing revenue.

4. Medical Files archives

5. The Problem with manual system • OPD Book : • Got lost, torn & tattered. • Easily Landed on the wrong hands • Registers • Got torn • Difficult to trace Records • Consumed lots of stationary • MR receipts: • Money Disappeared

6. Our Solution • Hospital commissioned an integrated Hospital Management system. ( year 2006) • Tasked local vendors to develop a system tailored to GOK-MOH Data capture, clerkship and accounting norms • Development phased depending on funding ability. Funded largely using cost-sharing funds. • Currently covers the whole of Outpatient services and part of in-patient services

7. OPD Registration Desk

8. What Does It Do? • Register Patients • Used by outpatient clinicians for clerkship • Used by diagnostic services to post results • Used by pharmacy staff to dispense • Revenue collection • Generates reports for sectional heads & hospital managers

9. System modules • Out patient: • Registration • Clinic Officer • Laboratory • Payments • Pharmacy • In patient: • Admission • Ward Attendance • Payments • Discharge • Revenue • Receipts and payments • Laboratory • laboratory test, results and reports • Pharmacy • Purchases, stock control & dispensing • Maternity • maternity information • Reports • MOH standard reports

10. INFORMATION FLOW CHART OUT PATIENT PROCESS IN PATIENT PROCESS Lab Reg. CO. Admission. Patient-File. Revenue. Pharmacy. Pharmacy. Billing. Dismissed Discharge.

11. Milestones • OPD fully functional • Learning curve complete: most staff members now conversant and compliant • Over 50 computer terminals active • Future plans: • Roll out the system to cover all in-patient services

12. Paperless OPD

13. Impact • Waiting time drastically reduced in • OPD Reception/Registration area (2 minutes) • OPD Clinics (7 minutes) • Pharmacy (4 minutes) • Revenue office. (5 minutes) • Medical records trace-able • OPD reports instant and real time • Increased demand for service (more clients) • Revenue has increased 10 times (from 0.5 million in 2006 to 4.5 million, 2012 / month)

14. Lessons learnt • Its possible to apply technology in resource constraint settings • E-records significantly assist hospital management • Increased work-load and reduced revenue leakages leads to more resources for improving hospital environment, infrastructure and services • It requires visionary leadership to innovate

15. Recommendations • MOH should embrace IT, e-records & electronic HMS • There is need of standardization • Central sourcing of software could greatly cut cost and allow smaller facilities access e-records