Healthcare reform using information technology

1. MANAGEMENT INFORMATION SYSTEMS
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Clinical Information Systems
BY
YANAMALA VIJAY RAJ
BT14M004
Submitted to
Dr Saji Mathew
DOMS, IIT Madras.

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CONTENT
1. BACKGROUND AND SIGNIFICANCE……………………………………...…….3
2. Hospital Information systems……………………………………………...…….4
3. Clinical Information systems……………………………………………...……..5
4. Clinical Decision Support……………………………………………….………6
5. Electronic Medical Records (EMRs)…………………………………….……….7
6. Health care strategy making…………………………………………….…….7-9
7. Computer Aided Learning in clinical field …………………………….……….9
8. Value chain in clinical sectors…………………………………………...…10-14
9. IT companies working on Health Care (Care Study)……….…………...….15-18
a) Infosys
b) Cisco
c) TCS
10. Care Study of Christian Medical College Vellore………………………...……….19-35
11. Conclusion………………………………………………………………………….....36
12. References …………………..…………………………………………………...…...37

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1) BACKGROUND AND SIGNIFICANCE
Health care (or healthcare) is the diagnosis, treatment, and prevention of disease, injury, and
other physical and mental complications in human beings. Health care is delivered by
practitioners in allied health, dentistry, midwifery (obstetrics), medicine, nursing, optometry,
pharmacy, psychology and other health professions. Health care runs on the established
knowledge in medicine proclaimed by various eminent Scientists in biology and Medical
Practitioner. Further with imparting latest technologies in Instrumentation and Biomedical
engineering, health care has stood one of the most established sectors.
Despite of technological advancements, Health care has seen its own problems like declining
resources for public health, rapidly growing knowledge and poor coordination between medical
knowledge. The available resources couldn’t meet with the need of rapid expansion of health
care. With the tremendous efforts put on medical research, the need to coordinate, store, retrieve,
transmit and manipulate data became a big problem. Further implementing, analyzing, designing
and evaluating medical data worsened the situation.
The Digital Revolution, which is the change from analog, to digital technology with the wide use
of digital computers and digital record keeping. Along with digital revolution and Information
Technology revolution has changed the face of health care as never before. With the
implementation of IT in health care, clinical systems has revitalized the costs saving and system
managements, and finally offered better care to patients.
Information technology has offered overwhelming solutions for health care because of its
uncompromisable advantages it provided,
Cut down barrier of information transfer
Promote information exchange among medical institutes
give professional support to the doctors
Increase effectiveness of health care sector
Promote better health behavior by automation

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2) Hospital Information System (HIS)
A hospital information system (HIS) is a part of health informatics that emphasis mainly on the
administrational needs of the hospitals. In many implementations, a HIS is a comprehensive,
integrated information system designed to manage all the aspects of a hospital's operation, such
as administrative, financial, medical, and legal issues and the corresponding processing of
services.
It is defined an interdisciplinary system of information science, computer science, social science,
which deals with the resources, instruments, and procedures for required optimizing of the
acquiring , storage, retrieval, and use of information in health and medicine. Health informatics
tools include computers, , medical technologies, and information and communication systems. It
is mainly applied in the areas of pharmacy, nursing, clinical care, public health..
It mainly focusses on the integration of all clinical, financial and administrative applications
and thus could also be called an integrated hospital information processing systems (IHIPS).
Components of a hospital information system consist of nursing, pharmacy, clinical and
financial information systems. A look at the list above shows how complex a hospital
information system can be. No hospital information system can be regarded as a success unless
it has the full participation of its users.
3) Clinical information system (CIS)
A Clinical Information System (CIS) is a computer based system that is designed for collecting,
storing, manipulating and making available clinical information important to the healthcare
delivery process in clinical firms.
The clinical information system (CIS) project aims to amend the existing clinical applications
which will provide:
a single consolidated, transparent statewide system
enable to maintain a health record for all patients

5. reduce the need for paper based records which is stored at individual health services
will provide a shift platform for clinicians and care providers to share patient
information and clinical knowledge
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Some of the benefits are:
 Easy Access to Patient Data : it can provide easy access to medical records at all points of
care.
 Structured Information: The clinical information captured in Clinical Information
Systems is well organized, and makes it more structured

 Improved Drug Prescription and Patient Safety : it improve drug dosing and this leads to
the reduction of adverse drug dosage and help in delivering specified drug delivery
while promoting more appropriate pharmaceuticaleffect.
Despite the benefits being offered by Clinical Information Systems, it too have disadvantages.
These include some of the following:
 Initial cost of acquisition : the high cost of software, every hospital cant afford
 Privacy and Security: there is still huge problem regarding privacy of patients data
 Clinician Resistance : The time lag factor
 Integration of Legacy Systems : Systems integration of data which is often tough task.
Clinical Information Systems provide a clinical data such as the patient’s history of illness and
the interactions. The archive encodes information capable of helping physicians decide about
the patient’s condition, various treatment options for patients, the status of decisions, actions
undertaken and other relevant information regarding patients.
It is critical that the efficiency, speed, and safety of health care be continually enhanced
which paved way for emerging role of electronic medical records (EMRs) in the field of
medicine.

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4) Clinical decision support system
Clinical decision support (CDS) systems provide clinicians, nurses, staff, patients, and
other clinical associates with knowledge and person-specific information, that’s filtered
properly and presented at right time , to enhance health care systems of clinical institutes.
Common features of CDS systems that are designed to provide patient-specific guidance
include the knowledge base (e.g., compiled clinical information on diagnoses, drug
interactions, and guidelines), a program for combining that knowledge with patient-specific
information, and a communication mechanism—in other words, a way of
entering patient data into the CDS application and providing relevant information (e.g.,
lists of possible diagnoses, drug interaction alerts, or preventive care reminders) back to
the clinician. CDS can be implemented using a variety of platforms (e.g., Internet-based,
local personal computer, networked EMR, or a handheld device). Also, a variety of
computing approaches can be used. The choices among these elements might depend
more on the type of clinical systems already in place, vendor offerings, workflow, security,
and fiscal constraints than on the type or purpose of the CDS.
5) Electronic Medical Records (EMRs):
In order to avoid errors, medical data being used in healthcare need to be constantly reviewed
and updated. The quality of the data is equally important and this can only be assured by the
following:
The accuracy of the data as compared to a standard.
Precision of the data is repeatability.
Resolution is at a detailed level.

7. Integration of the Electronic Medical Records (EMR) with clinical research systems
has the potential to greatly speed up the efficiency, speed, and safety. New hypothesis could
be made and overall a reduction in cost loss is seen.
Electronic Systems to be Integrated:
Clinical Research Data Systems:
Clinical data management system or CDMS is a tool used in clinical research to manage
data of clinical trial. The clinical trial data gathered at the investigator site in the case report
form are stored in the CDMS. It reduces the possibility of errors in finalizing data.
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Electronic Healthcare Data System:
The data of patients bio-data ought to be saved on a internet based data base so that it can be
saved and retrieved when needed.
EMR is a blend of both Clinical Research Data Systems and Electronic Healthcare Data System.

8. Goals to be Achieved Through CDMS -EMR System Integration:
Secondary Use of Data
Automated Decision Support Systems
Rationale for Integrating the CDMS with the EMR
Approaches to Integrating CDMS and EMR Systems:
Point-to-Point Data System Integration
Data Warehousing
Challenges of Integrating CDMS and EMR System:
Benefits of Electronic Medical Records
An EMR is more beneficial than paper records because it allows providers to:
Track data over time
Identify patients who are due for preventive visits and screenings
Monitor how patients measure up to certain parameters, such as vaccinations and blood pressure
readings
Improve overall quality of care in a practice.
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6) HEALTHCARE IT STRATEGY MAKING
Development of an IT strategy can be done using the following stages
Planning – A good plan is to be formulated with sound knowledge of problem faced in
clinical fields
Acquisition of Information – Data must be acquired without any errors

9. Analysis – The acquired data must be analyzed by a team and important portions are to
be retained while unimportant portions are to discarded
Delivery the Strategy –This is followed by the delivery of strategy.
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7) COMPUTER AIDED LEARNING
The use of software packages to give its users information to learn but also tests the users’
knowledge and give feedback on those tests. Thus it imparts knowledge to users and could also
be used to evaluate imparted knowledge.
Current research indicates that computer connected databases and computer assisted learning
(CAL) may enhance learning and also help clinician with decision making syste. Sometimes
CAL may also include audio and video files. These are mainly used for interactive learning.
CAL gives users the opportunity to learn on their own in more interactive way. The animation
touch to these systems can may studies even more clearer to users.
These packs may be developed by IT companies sometimes by the clinical IT team itself.
Clinical data collected from different medical intuitions can be arranged in presentable way and
by putting it on cloud; data could be accessed by everyone without regulation.
Thus by collaborative approach of IT companies and Clinical outlets, Computer aided learning
could be made more attractive and useful.
8) Value chain in Clinical Sector:
The important issue of health care is the value of health care that has been given.
improvement in value will require fundamental looking at health
care delivery,
Patient choice and freedom and competition for patients are important forces to encourage
and attract rapid improvement in value and restructuring of care.

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competition in health care is not aligned with value.
Value: Patient health outcomes per dollar spent
How to design a health care delivery system that
dramatically improves patient value.
How to construct a dynamic system that keeps rapidly
improving.
Financial success of Patient =/= system participants success
Creating positive-sum competition on value is fundamental to health care reform in every
country.
Principles of Value-Based Health Care Delivery
The overarching goal in health care must be value for patients, not access, cost
containment, convenience, or customer service.

11. Outcomes are the health results that matter for a patient’s condition over the care cycle.
Costs are the total costs of care for a patient’s condition over the care cycle.
Quality improvement is the most powerful driver of cost containment and value
improvement, where quality is health outcomes.
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 Prevention of illness
 Early detection
 Right diagnosis
 Fewer complications
 Faster recovery
 Reduced need for ER visits
 Slower disease progression
 Less care induced illness
Creating a Value-Based Health Care Delivery System (The Strategic Agenda)
1. Organize Care into Integrated Practice Units (IPUs) around Patient Medical Conditions
2. Measure Outcomes and Cost for Every Patient,
3. Reimburse through Bundled Prices for Care Cycles,
4. Integrate Care Delivery Across Separate Facilities,
5. Expand Areas of Excellence Across Geography
Organizing Care around Patient Medical Conditions:
Migraine Care in Germany
Affiliated
Imaging Unit

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Imaging
Centers
West German
Headache Center
Neurologists
Psychologists
Physical Therapists
“Day Hospital
Affiliated Network Neurological
Outpatient
Psychologists
Inpatient
Treatment
and Detox
Units
Primary Care
Physicians
Outpatient
Physical
Therapists
Outpatient
Neurologists
Primary
Care
Physicians
Essen
Univ.
Hospital
Inpatient
Unit

13. Building an Enabling Information Technology Platform:
• Combine all the typed of data for each patient,
• refine data entry ,
• Allow access to all involved parties, including with patients,
• Templates for medical conditions to enhance the user interface and user make it more user
friendly,
• Architecture that makes the process simple
• Easy access of communication among different provider.
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Human Resource for Health Information System” (“HRHIS”)
is a system for collecting, processing, managing and dissipating data and information.
Depending on the level of standard of a country's health care system and the organization of
its workforce, an HRHIS can be computerized or paper-based.
In countries like Tanzania an open-source software solution for human resource information
system information management is issued.

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10) IT companies working on Health Care:
Cisco, Accenture, wipro, TCS are working on developing IT solutions to health care units.
TCS
The Clinical Trial Ecosystem:

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Pics are taken from TCS website,
programme
governance
Digital
Clinical
Trial Supplies
Control T ower
Analytical
Capability
decision
processing
Trading
Partner
Connectivity
programme
governance
Digital
Clinical
Trial Supplies
Control T ower
Analytical
Capability
decision
processing
Trading
Partner
Connectivity

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Vision for the Control Tower:

17. Wipro:
Based on the Microsoft .NET platform, Wipro Hospital Information System has been created by
clubbing all 40 robust modules and is employed in some of the biggest cooperate and public
hospitals across India, the Middle East and western world.
Wipro Hospital Information System has robust functionality covering billing and
administration, electronic medical records, electronic health records, clinical systems, supply
chain modules and business intelligence.
The clinical system comprises an electronic patient record which forms the core of the system
and links to all other departments in the hospital. This helps in providing improved clinical
outcomes and better diagnosis and care to the patients. The administrative and supply chain
modules improve productivity and efficiency, driving down costs and waste.
According to wipro website, Wipro Hospital Information System incoperates the following
systems:
 Doctors and nurses can access case sheets, order tests and prescribed medication to
patients with ease, earlier cross referring written records made the task difficult to
doctors.
 Doctors can customize templates for various surgical operations
 OT notes are fully automated
 Discharge summary with reports of tests, and doctors notes
 All clinical areas are automated through modules like Laboratory Information Systems
and other corresponding modules offered by wipro
 Interfaces to all lab equipments, PACS, diagnostic equipments
For the first time in India, Wipro brought the innovative “Pay per Use” model for the small
hospital and nursing home community where traditionally investing heavily in buying
hardware software and maintenance was a deterrent towards IT automation. In the “pay per
use” model of wipro user hospital have to pay monthly charges which prompted even small
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18. hospitals to go for automated information systems. The system will help doctors maintain
patient data efficiently, provide better care and diagnosis to their patients, reduce patient
waiting time by managing the services and billing processes better. It also drives profitability
in the hospitals through strong MIS and business intelligence and it provides integration for all
departments.
According to Dr Deepak Jain., Medical Director, Paras hospitals ” We have decided to go in for
the Pay per Use Model because it reduces our one-time investment and also takes away our
headaches of running , maintaining , upgrading the software. In a small set up it is not only
cost effective; it is very simple and convenient too”.
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19. 9) CLINICAL WORKSTATION: An in-house Hospital Information System (HIS):
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INSTITUTE: Christian Medical College, Vellore
Christian Medical College, Vellore (CMC) is an unaided, Christian minority health care
institution which is committed to delivering world class health care to all sections of society,
aided by the use of caring, cost effective technology. An institution of this magnitude brings
with it a raft of administrative and organizational complexities, which need to be
continuously addressed in order to facilitate CMC’s goal of excellence in education, service and
research.
In order to integrate the functions of various sections of the hospi tal – Laboratories, Medical
Records Department (MRD), Pharmacy, Dietary, in-patient (IP) and out-patient (OP) areas,
CMC required a fully integrated Hospital Information System (HIS) for the Main Hospital
and peripheral centres. Since it would have been prohibitively expensive to outsource the
development of a user friendly program that would be sophisticated enough to meet the needs of
an ever expanding institution, CMC’s Department of Centralised Hospital Information
Processing Systems (CHIPS) took up the challenge of developing, in-house, a program with the
desired specifications. This HIS covers the patient registration and appointment system,
admission-discharge-transfer (ADT) process, Outpatient and Inpatient billing, Company &
Insurance billing and Reimbursement procedures, and is integrated with MRD, Laboratories,
Pharmacy Department, Operation Theatre, Anaesthesia Department, Dietary and Laundry. It
includes the Clinical Workstation that is an interface by which doctors can view and
manipulate patient data.
The HIS has resulted in a tremendous increase in efficiency at all levels of the health care
delivery process within CMC - allowing prompt service, reducing costs, minimizing the
margin for human error and providing a tool for Continuous Quality Improvement (CQI)
strategies by CMC. Challenges faced before deployment of the project CMC started with stand-alone
microcomputers to perform Billing and Accounts procedures.
However, as the services of the hospital expanded and the number of patients soared, so also did
the need for storage and sharing of data. Results entered in the labs would previously take at
least a day to reach the doctors desk based on which treatment would be modified. The lack of
integration caused significant delays in patient billing, increased waiting time, and
incurred additional costs in terms of finance and resources. Retrieving patient and financial
information was difficult, thereby limiting decision-making processes. Manual processes were
subject to entry errors. Information was available at limited areas and sometimes could not be
provided in real-time. Gathering information for statistics and research was a complex operation.
Generating financial statements was a phenomenal task.

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Objectives of the project
1. To develop a fully integrated HIS for various areas of the hospital – Emergency
Services, Pharmacy, Labs, MRD (Patient registrations, doctor schedules and OP/IP charts),
IP areas (wards & intensive care units, billing, reimbursement and credit authorizations),
OP areas (OPDs) and Dietary services
2. To develop an integrated, user friendly Clinical workstation for doctors to view
appointments, results, clinical images, theatre postings and inpatient lists; schedule doctor
appointments & procedures; order investigations and prescriptions; and generate medical
reports and discharge summaries – all at a single click.
3. To allow acquisition and availability of relevant real-time information and allow
billing to be automated with data entry.
4. To ensure transaction security and minimize human errors.
5. To incorporate a Self-Service Module allowing ease of access to an individual’s
information.
6. Description of the implemented project The Department of CHIPS in CMC set about the
arduous task of developing an integrated HIS in-house in 2003.
7. The following modules were developed and incorporated into the HIS:1. Patient registration
and appointment system using multiple portals (Manual, Call centres, Web, Smart Card)
8. Paperless Lab orders and authenticated online investigation results
9. Paperless Blood collection area: this has been linked with a pneumatic chute system to
transfer samples from the collection point to lab areas, thus minimizing delay and human error
10. A system of optional alerts for lab results which are grossly abnormal or presumed to have a
high clinical impact
11. A Clinical Work station that:
Allows doctors to view appointments, results, clinical images and
summaries for admissions & prescriptions; schedule doctor appointments
& procedures; order online IP/OP investigations and prescriptions, facilitate online
billing for services and operative charges;
finalize theatre postings; and generate medical reports and discharge summaries
Alerts physicians regarding potential drug interactions with each prescription
Provides online patient and doctor alerts via software/SMS

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12. Customized SMS Gateway for alerts to employees and patients
13. Web paging, multi-line telephonic paging and CART (Cardiac Arrest Resuscitation
Team) paging for priority paging
14. Surgery and Anesthesia Management with scheduling, automated billing and logbooks for
doctors
15. Pharmacy management – Quotations and Purchase Order Management integrated with
Finance module, Stores, Dispensing and Returns
16. Admission-Discharge-Transfer management with automated billing
17. Credit authorization for cashless transactions and reimbursement for patients
18. Online Dietary orders
19. Antenatal records linked with birth registers
20. Doctors schedule management integrated with Patient appointments
21. Procedure appointment module
22. MRD module: IP and OP chart tracking and International Classification of Diseases (ICD)
coding
23. Electronic Medical Records (EMR): Using a unit based proforma with options for
entry of patient’s history, vital signs, diagnosis, prescription and imaging; OP Followup, PDF
creation, and patient correspondence
24. Online patient calling system in OPD
25. Automated Casualty Module: incorporating Doctor’s alerts and Patient tracking based on
priority
26. HR Module: Integrated with Finance, and including leave management, auditing of
concessional benefits, and a Biometric attendance management system
27. Inventory programs
28. Built in Security with authentication for all levels of information
29. Payment

22. All HIS modules are integrated with the Billing module, Company and Insurance
billing, and reimbursements
Payment is also possible via CHRIS card (CMC debit card) and credit card
30. Finance and Accounting: All HIS modules are integrated with the Finance Module
31. Purchase of all equipment has also been computerized along with stores management
process
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Software: Oracle and VB, VB.net, ASP, ASP.net.
Hardware: RAC (Real Application Cluster) 3 Node environment with a two node RAC for
business continuity (Disaster Recovery) and a separate data mining server.
Other technologies/solutions employed:
CMC debit card (CHRIS card), which can be used for payments at cash counters and
kiosks within hospital, for online payment and payment through the CMC Call Centre
Machine interfaces in labs
Security implemented via passwords and/or contactless security card
Customized SMS Gateway for alerts to employees and patients
Web paging, multi-line telephonic paging and CART (Cardiac Arrest Resuscitation
Team) paging for priority paging
Complete CISCO switched network with Virtual Private Networks and security walls
was put in place, which extended Clinical services to the entire CMC residential
campus through broadband or LREs
Audit vault

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Comparison of the pre-deployment scenario and post deployment benefits
Prior to development of the HIS, the system was plagued by delays in reporting of
investigations, admission-discharge-transfer management, billing and procurement.
Retrieving patient information for clinical care and research, and generating financ ial
statements to aiding decision making was difficult. The dependence on manual entry led to
document storage issues and increased the risk of human error.
a. The development of the HIS brought about a sea change in the organizational capabilities
of the institution, besides boosting efficiency at every level.
b. Speed of service has increased significantly
c. Patient billing delays have decreased dramatically
d. Secure, real-time, relevant information is now available anywhere on the institutional
campuses
e. MIS for Administration and Auditors
f. Online investigation results available as soon as they are ready, thus aiding clinical
decision making. Trend of lab investigations over a time period can be studied using
graphical displays.
g. Information regarding drug interactions is available in real-time, as a prescription is being
written
h. Speed of service has increased significantly
i. Patient billing delays have decreased dramatically
j. Patient reports are generated quickly without needing re-entry of data.
k. Research information is easily retrievable; alerts can be generated for study
participants and patients enrolled in clinical trials
l. Change in workflow can be easily managed since an in-house team has developed the
solution
Note on the cost effectiveness of the project
1. In terms of Cost savings
The cost of Oracle licenses is 4.5 lakhs and the expenditure on Salary for all staff employed in
CHIPS is approximately 12.5 Lakhs per year. This is a cost effective solution for CMC, since in
addition to the cost saved on purchase of software, maintenance and alteration costs are
also reduced as all solutions are developed in-house.
2. In terms of improving customer service a customized, cost-effective, smart card solution
with full security features (CHRIS card) was introduced. E-account holders of banks like Punjab

32. National Bank and IOB can now make web payments and appointments online through a
module provided by CHIPS. Credit card holders of any bank can make payments and book
appointments through the payment gateway of ICICI Bank.
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Information is available at kiosks with the use of the CHRIS card
Patients have benefited from a dramatic reduction in billing and appointment delays and
significant increase in speed of service
Drug and Investigative history being available to doctors at the time of treatment means
that drug interactions, duplicate orders and payments can be avoided.
CHRIS CARD – Christian Medical College’s innovative in-house debit card
Overview of the project
The Christian Medical College, Vellore (CMC) is an unaided, Christian minority health care
institution with a special mandate to offer world class health care to all sections of the society,
using cost effective, caring technology.
One of the fundamental problems faced by patients and their relatives in accessing health care, is
the unavailability of ready cash to book appointments and pay for investigations, medications
and in-hospital care. ATMs place a limit on the amount of money that can be withdrawn per
day; many patients do not have credit or debit cards; and while carrying around large sums of
money, patients fall prey to pickpockets, touts and other antisocial elements.
From an organizational point of view, patients counting large sums of money at cash counter
cause delays, and introduce an element of inefficiency which is detrimental to the smooth
functioning of a large health care institution. Recognizing this, the CMC’s Department of
Computerized Hospital Information Processing Services (CHIPS), came up with an in-house
innovation - the CMC debit card, dubbed the ‘CHRIS’ card, which helps patients pay for their
appointments, investigations, medications, and inpatient bills.
The CHRIS card is issued to patients who do not want to carry hard cash in hand and has a
microchip which can store information and cash similar to any debit card. Each CHRIS card is
patient ID specific with a protected password, has lifetime validity, and no service charges

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10) Conclusions:
In conclusion, at long last Clinical Information Systems have come of age and this
technology is fast bringing about a revolution in healthcare, just like information
technology brought about a revolution in other fields like finance, banking and travel.
Those healthcare organizations that wish to be of international caliber will have to
embrace this technology and implement it, as this technology will be a benchmark
criterion in qualifying as a healthcare organisation of international standard.
No doubt, not only clinical information systems has made management easier for
hospital, but also incorporated necessary implementation that reduced the overall
expenditure on maintenance by hospitals.
In addition with the proper study of portal supply chain and gaining insight of
loopholes it in, IT is found to be only adherent solution that can rectify various
problems faced in clinical environment.
Different strategies involved in clinical management systems are studied and by
imparting IT to this tremendous benefits are seen both in terms of money saving and
customer satisfaction.
Care studies of various IT giants are studied and their strategies are analyzed. In another
care study Christian Medical College Vellore is taken and clinical information systems
implemented is studies as part of this project. Various backdrops present before
implementations and various benefits after implementation of management system are
noted. Such a huge hospitals like CMC Vellore could run only because of efficient
administration automated by clinical information systems.
And finally conclusions drawn from this project are, as far as the dimensions of
knowledge spreading is concerned, there is no end to it, and many technical and
managerial problems earlier faced in clinical field too found it solutions from
information systems applied in clinical systems called shortly as CIS.

37. References:
1) Clinical Research Systems and Integration with Medical System Joyce C. Niland and Layla
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Rouse.
2) Clinical Information System (CIS) Inventory* *This worksheet was adapted from a 2011 book
published by the Healthcare Information and Management Systems Society (HIMSS) entitled
"Improving Outcomes with Clinical Decision Support: An Implementer's Guide, Second
Edition.
3) TESTING A MODEL TO PREDICT SUCCESSFUL CLINICAL INFORMATION SYSTEMS by
Dianna Garcia-Smith.
4) AN INTEGRATIVE HEALTH INFORMATION SYSTEMS APPROACH FOR FACILITATING
STRATEGIC PLANNING IN HOSPITAL SBrenda L. Killingsworth East Carolina University
killingsworthb@mail.ecu.edu Elaine Seeman East Carolina University
seemane@mail.ecu.edu
5) .Metnitz PGH, Lenz K. Patient data management systems in intensive Care – the situation in
Europe. Intens Care Med 1995;21:703-715.
6) Urschitz M, Lorenz S, Unterasinger L, Metnitz P, Preyer K, Popow C. Three years experience
with a patient data management system at a Neonatal intensive care unit. J Clin Monit
Comput 1998;14:119-125.
7) Keizer NF de, Stoutenbeek CP, Hanneman LAJBW, Jonge E de. An Evaluation of Patient Data
Management
8) CMC Vellore official Website