The Royal Hospital

INTRODUCTION
In 1995 the Sultanate of Oman resolved to channel its economy and its systems to an electronic environment and adopt advanced Information Technology (IT) systems. In keeping with this national mandate, the Ministry of Health too decided to implement the country’s electronic strategy.

The Royal Hospital had been exposed to a computerized mode of functioning ever since its inception in 1987. Initially the services were contracted to Oman Computer Services for the Wang computer system and later Medicom. With the successful implementation of the Ministry’s own Al Shifa HIS in hospitals throughout the country, the Royal Hospital decided to change over to that system too as it would be more effective, efficient and economical in the long run and it would be easier to network with other hospitals using the same HIS. The Directorate General of Information Technology (DGIT) was therefore requested to implement its in-house developed Al Shifa system at the Royal Hospital with effect from 1996.

The Al Shifa system is a comprehensive Hospital Information and Management System. It integrates patient data flow and creates a paperless environment to enhance the quality of service and save doctors’ and nurses’ time so that they can focus on patient care activities rather than on than on manual paper work. This system ensures online real-time paperless clinical documentation and the picture archival and communication systems across all areas including inpatient care, outpatient services, day-care, emergency services, pharmacies, stores, asset management, equipment repair, finance, administration, quality assurance and others. Moreover, this system offers an automatic SMS message reminder for patients regarding their clinic visits or admission appointments.

There are several international recognized standards, such as HL7, DICOM, LONIC, ICD10, etc. that has been adopted at the Royal Hospital. These standards are used to improve the integration of the applications within the same system, create flexibility, cost-effectiveness and make the interoperability between health information systems.

We believe that listening to and understanding the users’ requirement is the key to successful computerization, and therefore, we welcome feedback and suggestions from users.

STRATEGIC DEVELOPMENT
Vision
To implement paperless electronic healthcare records at the Royal Hospital.
To be a state-of-the-art IT healthcare organization and provide the most efficient and effective services.
Mission
To pursue the Hospital’s mission and objectives.
To enhance the quality care of patients via an excellent IT environment.
To enhance the use of IT at the Royal Hospital.
To provide reasonable and timely access of the MOH’s Al Shifa Hospital Information System to Hospital staff who needs to use the system.
To provide a full continuum of support in partnership with the Directorate General of Information Technology, MOH-HQ.
To train, enhance, develop, improve and build the employees and undergraduate students in Oman, IT infrastructure and coherent strategic framework.
Values
To ensure the delivery of care by adding value to our patient-care services and users.
We focus on organizational and user needs.
Listening to our users and understanding their needs is one of foremost endeavors’.
Innovative thinking and new ideas are always welcomed.
Supporting teamwork.
Respecting other's privacy.
Communicating positively with others.
We aim for quality in all our work.
Objectives
Improve the usage of IT and continued improvement of healthcare security.
Pursue the National e-Oman strategy.
Improve partnership communication.
Enhancing the clinical encounters, audits and outcomes by embracing Information and Communication Technology (ICT).
Build a fully electronic environment at our Hospital.
Services
Operates in a highly computerized environment.
Paperless with regard to a majority of transactions.
Enhance the use of ICT.
Using Wireless Connectivity.
Providing ADSL connection.
PC support for hardware repair and rectification of software problems.
Liaison with departments’ requirement and DGIT with regard to additional application software commitments.
Mailing system.
RH portal.

ABOUT US
The department is headed by Mr. Abdullah Hamood Al Raqadi, MBA (IT), Director of Information Technology. It is organized into 4 major sections (as shown below): Database, Technical Support, Networking and Information and Medical Records:

DATABASE SECTION
Mr. Mohammed Masoud Al Yahyai, Head of database Section, This e-mail address is being protected from spambots. You need JavaScript enabled to view it
Mr. Ahmed Abdullah Al Shahimi, Deputy Head of Database, This e-mail address is being protected from spambots. You need JavaScript enabled to view it
Programmers and Web Designers - 3
Al Shifa Support - 4

This section is divided into two units: Programming Unit and Al Shifa Unit:

The Programming unit provides a solution for those places that are not covered by Health Information Management System (Al Shifa) to automate and computerize their works consistent with our vision. They have already implemented various programs at Finance department, HRM, CPE, General Services, Administration...etc. In addition, this unit also looks after our internal portal (Intranet).

The main objective of the Al Shifa unit is to enhance the work flow of the hospital health information management system and coordinate with Directorate General of Information Technology at the Ministry HQ whenever there is a new development module or to solve any errors that have occurred in the applications. Besides that, the unit handles user queries and guides them to use the system properly. Generating reports, checking system performance, rectifying errors, answering users calls, meeting users, discussing their requirement, analysing the needs, and many other issues related to Health Information Management System (Al Shifa) are other issues looked after by the unit. It is staffed by 4 staffs and works at morning shift and on-call after working hours for any emergencies cases.

NETWORKING SECTION
Mr. Sajid Aziz Al Balushi, Head of Networking Section, This e-mail address is being protected from spambots. You need JavaScript enabled to view it
Mr. Abdullah Salim Al Riyami, Deputy Head of Networking, This e-mail address is being protected from spambots. You need JavaScript enabled to view it
NT Technician - 2

The Networking section plans and coordinates the maintenance of the hospital network in terms of adding new switches, connecting additional PCs, printers, adding extra computer points in the network, servers, antivirus, and PACS. The hospital network is divided into two: local health information network and internet access. Besides the wired outlets, the hospital widely uses the Wi-Fi connectivity for both networks around the hospital.

The network system is based on star topology. It is compliant with EIA/TIA & ISO 11801 performance standards in all of its components including cables and hardware.  This standard is flexible and is capable of supporting multiple products and applications.

Currently the hospital equipped with 15 servers. 7 are dedicated for the Al Shifa system as application and DB servers, file servers, active directory and run time server, and standby server. 4 servers are dedicated for PACS, 2 for web-servers and 2 for applications Server. There are also the following servers: LANDesk server, Al Shifa antivirus server, ADSL antivirus Server, finance server, test database server and human resource server.

TECHNICAL SUPPORT SECTION
Mr. Talal Said Al Jardani, Head of Technical Support  Section, This e-mail address is being protected from spambots. You need JavaScript enabled to view it
Mr. Humaid Mohammed Al Ismaili, Deputy Head of Technical Support, This e-mail address is being protected from spambots. You need JavaScript enabled to view it
IT Technicians - 8

This section is divided into two units: maintenance and supports. The technicians work on two shifts to resolve problems related to hardware or software. There are also 2 on-call technicians for emergencies arising after the working hours. The maintenance unit looks after the hardware devices, PCs, printers, scanners, monitors, etc. The support unit attend on work requests done by users to solve their problems. All requests are received electronically, which are monitored via LANDesk software from the department locally. All the computer equipment are addressed and tagged via Asset Management System.

INFORMATION AND MEDICAL RECORDS SECTION
Mr. Shihab Hamed Ali Al Subhi, Dip in Medical Records, Head of Information & Medical Records  Section, This e-mail address is being protected from spambots. You need JavaScript enabled to view it (on study leave)
Mr. Khalid Khalfan Al Zakhwani, Dip in Medical Records, Acting Head of Information & Medical Records  Section, This e-mail address is being protected from spambots. You need JavaScript enabled to view it
Mr. C.R. Bhat, BSc, DMRSc, Dip in Personnel Management, Medical Records Officer, This e-mail address is being protected from spambots. You need JavaScript enabled to view it
Mr. Ayoob Al Balushi, Dip Medical Records, Head of Outpatient Unit, This e-mail address is being protected from spambots. You need JavaScript enabled to view it
Mr. Sultan Saif Bader Al Rubaiey, Dip Medical Records, Head of Inpatient Unit, This e-mail address is being protected from spambots. You need JavaScript enabled to view it
Mrs. Asma Moosa Jaffer Al Lawatia, Dip Medical Secretary, Head of Medical Coordinators’ Unit, This e-mail address is being protected from spambots. You need JavaScript enabled to view it
Mr. Ravi Gnanakumar, Statistical Officer, This e-mail address is being protected from spambots. You need JavaScript enabled to view it
Technician: 20
Medical Records Clerks: 32
Medical Coordinator: 29
Murasils: 7

The Information and Medical Records section is organized into 3 units: Inpatient, Outpatient and Medical Coordinators. These units are responsible for registration, admissions and appointments; medical records archive; records processing and statistics; and release of information. In addition, the MRD is responsible for deployment of medical secretaries to all the clinical departments.

Seven registration counters have been set up at different locations (Admission Office, OPD, Adult Emergency, Pediatric Emergency, Delivery Suite, OBGY Clinics and Oncology Centre). Each patient, treated on an outpatient or inpatient basis, is registered and assigned a unique hospital number following the unit record system (one record, one patient, one number). Further outpatient visits are registered clinic-wise in order to get on-line information of outpatient attendance. All booked and direct inpatient admissions are registered and admitted to the respective wards. Inter-ward/inter-service transfers and discharge of patients are updated by the nursing staff promptly in the computer system. On an average, 75 patients are admitted per day. Daily mid-night census is taken to verify and ensure the accuracy of information about the ward-wise as well as service-wise occupancy.

The patient’s electronic medical record, stored permanently on the computer, contains the patient’s demographic particulars, administrative and clinical details of all episodes of outpatient, inpatient and emergency care, procedures, investigations, and reports.

The computerized appointment system provides efficient outpatient service for referred patients from other hospitals. Requests for appointment are received centrally from MoH Hospitals/Health centers linked through e-referral system and through fax referrals from all other referring institutions. All such referrals are forwarded to the respective clinic to vet the urgency and justification of the request. The appointment confirmation particulars are informed through online system and for others are faxed back.

In the medical record archive, files are stored following terminal digit filing system. Presently, around 350,000 records are maintained in the primary filing area and around 8000 death case records are stored in the secondary filing area. Computerized track-out/in system is followed to achieve control over the movement of records. Efforts are being made to computerize all aspects of clinical documentation to achieve total paperless environment. Forms which are yet to be computerized are scanned and archived separately.   

The Records processing section checks all patient records for completion. Diagnostic conditions and operations/procedures pertaining to all inpatient, outpatient and emergency encounters are coded and indexed by the qualified coders as per the International Classification of Diseases (ICD-10) publication of the WHO.

Release of information deals with issue of birth certificates, death certificates and medical reports. This unit, after scrutinizing the request for its authenticity, refers the file to the concerned doctor for preparing the medical report. Certificates/reports are issued on payment of prescribed fees, wherever applicable.

Statistical reports are reviewed for their accuracy and important reports are made available in the computerized Management Information System module. Data on deaths are submitted to the Ministry on a monthly basis. Infectious diseases like HIV etc. are reported to the concerned authorities in the Ministry.

To improve qualitative aspects of documentation the Medical Records Department has taken the following initiatives in the recent past:

• Liaison with clinicians to develop and streamline the various modules of the computerized clinical information, including development of a paperless medical records system;
• Regular lectures/demonstrations to new interns, residents and staff on medical record systems.
• In coordination with Internal Medicine Team A, a study was carried out to demonstrate the inadequacies in writing death notification, following which sessions were held to train junior doctors in improving the quality of such documentation;
• Several audits were carried out jointly with clinical departments such as 'Documentation of Cause of Death' statements, 'Death Notification', and 'Documentation of Diagnostic Statements on Admission - Discharge Record', etc.

In order to streamline the type, methodology and quality of data generated by various MoH healthcare facilities and thereby ensure proper reliability and validity of statistical information, the Health Information Department at the Directorate General of Planning, MoH-HQ oversees the appointment of Statistical Officers in various Regions.

The Statistical Officer compiles data in the format prescribed by MoH-HQ and submits the same on a monthly basis. Beyond responding to other data queries requested by MoH on a random basis, he also fulfils the Hospital's requirements for data on on-going activities and special studies undertaken.

Education and Research Activities:

• The Information and Medical Records Section regularly holds orientation lectures on Medical Records Systems for newly joined doctors, nurses and all other staffs.
• It conducts lectures on documentation requirements for OMSB resident clinicians.
• It has been collaborating with the MoH-HQ in imparting didactic and practical training to Medical Record technicians and Asst. Medical Record technicians.
• It also provides assistance to clinicians in conducting research/study projects by providing information as well as medical records.

ALSHIFA HOSPITAL INFORMATION SYSTEM
The Al Shifa Hospital Information Management System is a fully integrated graphical user interface application system for hospital management that is built around Oracle 10G database and developed using Oracle Developer 6i that runs under the platform of Windows 2000.  It integrates patient data flow and creates a paperless environment to enhance the quality of service and save doctors’, nurses’ and other professionals’ time to concentrate on patients rather than paper work.

It also provides extensive on-line data inquiry reports based on the user-defined search criteria for retrieving and displaying only the desired information that can be viewed from any workstation.

Within the system, access to the different functions and processes is controlled through the user identification and password to restrict unauthorized users to gain access only to the modules connected to the person’s work and responsibilities. The system allows on-line access to admission, discharge, transfer, radiology and laboratory test results, etc. as per user access privileges. Moreover, it has the ability to maintain an audit trail that keeps track of the information prior to making any changes, it documents the changes made, the user who made the changes, and the date and time of the changes.

Currently, the Directorate General of Information Technology is working on developing a new version called 3+ to enhance the system performance and create more user friendly system with meets the user needs.

This applications software has ensured an almost paperless system of clinical documentation and work processes at the following areas:
Adult & Pediatric Emergency
Anesthesia
Dental
General Medicine
General Surgery
Nephrology & Renal Dialysis
Obstetrics & Gynecology
Child Health
Psychiatry
Billing
Stores
Pharmacy
Medical Records
Para Medical Services
Laboratory
Radiology
Management Information System (MIS)
E-Referral
Oncology
Quality Assurance
Operation Theatres
Medical and Non-Medical Purchase
Engineering
Asset Management System

Access Security
A strict security procedure is enforced so that only authorized users are allowed to gain access to the Hospital Information Management System.  A unique username and password is provided to each user to to log into the system.  Within the system, access to the different functions is controlled through the user identification and/or password. This allows full data security linked to the username/password which limits the user only to specific functions and processes according to the user’s privileges.  It also restricts unauthorized users to gain access to modules which they are prevented from entering and/or updating.

Clinical System
The Clinical System is a sub-system of the Hospital Information Management System that brings a patient’s comprehensive medical record to a single screen.  It provides the physician instant access to almost any desired level of underlying clinical details.  The system also protects information from inappropriate access and control over who is exactly permitted to read, write and delete patient information.

The Clinical System is categorized into sub-modules and processes which allow the doctor to perform tasks such as visit creation and admission, enter vital information and history, document examination, procedures, diagnosis and progress, order laboratory and radiology tests, prescribe and administer medication, enter nursing notes and other information relating to a patient’s care.

The Clinical workbench runs through a single user interface which enables the doctor to take notes, place new orders for the patient, review existing orders, pre-operation orders, inpatient discharge orders, etc. The doctor can transmit messages to other departments involved in providing service and link orders together for execution.  Moreover, doctors can also access the notes and records documented by the nurses such as vital signs, nursing notes, IV fluids, nursing procedures, medication executions and other related nursing care.

Nursing System
The Nursing module is a subsystem of the Hospital Information Management System that assists the nurses in OPD and Wards to document the care given to the patient as well as keeping track of the medication, progress and procedures required for the patient.  

Nurses assigned for outpatients can record the physical findings, vital signs and nursing procedures such as injection, dressing, pre and post-operative procedures and other relevant nursing procedures,

Nurses assigned for inpatients can enter details of the ward admission, ward discharge and bed transfer and other information including vital signs and kardex, patient’s medication, nursing notes and other interventions taken for the patient and relevant information in rendering nursing care.

The system also facilitates other functions such as patient inquiry, indent preparation, bed availability list, pending ward admissions, pending ward discharges, patient medication and duty roster management.

Medical Records System
The Medical Records Module is a subsystem of the Hospital Information Management System that provides a complete outpatient and inpatient clinical information registered at the hospital through a unique patient identification number.

It is the central storage of all patients’ information that includes patient history, laboratory and x-ray findings, final diagnosis, procedures, medication, operation, admission and discharge information.

The Medical Records System includes functions such as patient registration, emergency registration, appointment, billing and reports like clinical statistics, inpatient statistics, operation statistics, referred reports, ICD report, emergency reports and appointment listing.