PROCESS REENGINEERING AND INFORMATION SYSTEM DESIGN FOR PHYSICAL EXAMINATION CENTER

PROCESS REENGINEERING AND INFORMATION SYSTEM DESIGN FOR PHYSICAL EXAMINATION CENTER Su Qiang1 1

Yao Xiaoyun1

Jiang Zhibin1

Zhang Guotong2

Department of Industrial Engineering & Management, Shanghai Jiao Tong Univ., Shanghai, 200030, China 2 Shanghai No.7 People’s Hospital, Shanghai, China

Abstract: Along with significantly increasing demand for physical examination in China, traditional physical examination centers need to improve their service quality and efficiency. In this paper, the operation process is modeled based on a thorough investigation at a local hospital’s physical examination center. The factors that affect service quality and efficiency are analyzed using the cause-and-effect diagram. By using the principles of modularization, standardization, digitalization, and humanity, a novel operation process model is designed. Furthermore, the corresponding management information system is developed and explained in detail. The new process and its information system can serve as an instructive model for the modern physical examination centers’ construction. Copyright © 2006 IFAC Keywords: Process Models; Business Process Reengineering (BPR); Information Systems; Flowcharts; Quality Control

1. INTRODUCTION The scope of the medical service has been expanding, not only covering the patients, but also covering healthy ones or potential patients. Therefore, the needs for medical treatment and healthcare service have been growing substantially in China. According to the statistics provided by the world health organization, around 70 percent of people are in the sub-healthy states all over the world. Many illnesses, such as, cardiovascular, cerebrovascular, tumour, and diabetes, etc., are much easier to treat if the phenomena can be discovered in early stage. With the view of discovering serious disease as early as possible, physical examination is one of the most important and effective means. In China, it is estimated that the capacity of the physical examination market will enlarge by quintuple times in the next ten years (Yuan et al., 2003). To fulfill these fast expanding requirements, on one hand, a lot of new physical examination centers must be set up; on the other hand, the service quality and efficiency of the existing ones should be reformed based on the patient-centric principle. Consequently, the operation process at physical 1

This paper is supported by the National Natural Science Foundation of China (70471005).

examination center needs to be redesigned to fit the new trends and coming needs of administrators, physicians and patients (Pascal et al., 2005). According to the case investigation about the current operation process, a cause-and-effect diagram is used to depict the possible causes of the service quality and efficiency problems. Focusing on these problems, an optimized operation process is established. Meantime, the information system should be employed in physical examination centers as an important component of the Hospital Information System (HIS). Since information technology can save time and improve accuracy in information exchanging, much of the human errors and repetitive tasks can be avoided. (Gunasekaran and Nath, 1997)

Actually, various information systems have already

been designed and applied in different aspects of healthcare industry (Amberg and Graber, 2000; Anderson, 1997; Ehlers et al., 2001; Greene et al., 2002; Nadzam et al., 2005; Vassilacopoulos and Paraskevopoulou, 1997). Besides, many researches have been conducting on HIS related topics. Some have pointed out several important principles on HIS development. First, the principle of humanity has the absolute priority over others (Constance and James, 2006). Second, the HIS should be designed according to the strategy of the certain examination center, so as to improve the service quality (Bose, 2003). Third, the

HIS must be combined with the streamlined operation (Schmidt et al., 2005). Based on these considerations, a computer aided physical examination process management information system was designed, which has integrated the advanced information technologies with the reengineered processes. The respective prototype system is realized according to the principles of modularization, standardization, digitalization, humanity, and efficiency. The paper is structured as follows. The current process model of the physical examination center is given and analyzed in section 1. In section 2, an improved process model is reengineered, and its characteristics are elaborated. Then, the function modules and some important interfaces of the corresponding computer aided physical examination process management information system are illustrated in section 3. Finally, the principle conclusions are given in section 4. 2. THE ANALYSIS OF THE PHYSICAL EXAMINATION PROCESS In order to understand the general workflow of the physical examination center, a survey is done at local hospital’s physical examination center in Shanghai by visiting and questioning its manager, doctors, nurses and personnel. With a thorough investigation, the complicated operation process has been analyzed and modeled by the flow chart shown in Fig.1. This center provides individual and group physical examinations, in which, three stages namely pre-examination, examination, and post-examination are included. To get the root causes of the system problem, four aspects, including machines, men, operation processses and environment, are analyzed and a cause-and-effect Pre-Examination

Physical Examination Process

Group/ Individual Physical Examination

G

Make Appointment

Advice of Charge

I

Fill in the Personal Information

Choose the Examining Items, Imfrom the Patients Number and Calculate the Fees

Physical Examination Report

Fill in the Personal Information Manually

Fill in the Report Manually Lack of Advanced Digital Equipment

Machines

Men

Lack of On-line Ruleless Calculation Query Service Process of Physical Examination Fee

Lack of On-line Reservation Service

Not Verify Patient s Identity

Lack of Supervision









Lack of On-line Service

Pay the Fee at the Center

Service Quality and Efficiency

Long Queue

Redundant Procedures

Write the Advice of Charge Manually Calculate Physical Examination Fee Manually

Inresponsible

Lack of Humanity

Lack of Report Query Service

Fill in the Report Manually

Collect Sample Without Digital Technique Lack of Various Convenient Methods To Pay Fee

Operation Processes

Environment

Fig. 2. The Cause-and-Effect Diagram diagram is obtained as shown in Fig. 2. In terms of the service efficiency, the following problems are identified: 1 Every patient needs to fill out the complicated and duplicated forms before examination. 2 To the group physical examination, the customer representative has to walk in the center to make an appointment and pay for the examination fees. This is a time-consuming and burdensome procedure because a list of names and the respective personal information need to be processed carefully. 3 The physicians need to fill out various forms including the examination results, conclusions and instructions. It forms the substantial burden for the physicians especially for the person who is in charge of the group physical examination. 4 After examination, usually, patients need to spend some time on waiting for the physicians to make judgments and manually write the conclusions on the reports. In terms of the service quality, the problems are: 1 Manually calculating of the physical examination fees is prone to mistakes. Sometimes, the physical examination fees might be determined arbitrarily. 2 The physicians may omit the procedures of checking and validating the patient’s identification card before examination.




Advice of Charge Choose the Examining Items and Calculate the Fee

Pay the Fee

Physical Examination Reports

Summit the List of Patients and Fill in the Examination Papers

Pay the Fee

Examination Exam and Collect Sample

Collect the Reports

3 It is prone to making mistakes since the examiner fills the reports by hand. 4 Since most of examinations cannot be concluded in the same day, the customer or patient must go to the physical examination center again for the results.

Post- Examination Exam the Samples By Examiner

Examiner Writes the Result of Exam

Physician Writes the Conclusion and Instruction

Patient Takes the Finished Report

End

Fig.1.The Operation Process Model

3. THE PROCESS REENGINEERING According to the principles of modularization, standardization, digitalization, humanity and efficiency, the process of the physical examination center is reengineered as shown in Fig.3. Furthermore, a corresponding computer aided physical examination process management information system was designed,

Pre-Examination

Optimized Physical Examination Process

G

Group/ Individual Physical Examination

I

Choose the Exams, Fix the Fee and Print the Bar Code Ticket

Arrange For Reservation

Choose the Examination Items, Inform the Patients Number And Calculate the Fees

Bar Code Ticket

Pay the Fee



3.4 Humanity

On-line Payment Or Transfer through Bank

Bar Code Ticket

Summit the List On the Website and Print the Bar Code Ticket Automatically

Examination

Exam and Collect Sample Automatization 



Post-Examination

physicians are asked to validate the patient’s identity according to the information provided by the system. If the physician does not follow this procedure, the following examination procedures will be forbidden.

Exam the Samples By Examiner Automatization 



Physician Writes the Conclusion and Instruction Provide Module 



Remind Patient to query and Take the Finished Report Examination Subject Takes the Finished Report Or Query It on the Website

End

Fig. 3.The Reengineered Operation Process which can assist the physicians to manage and monitor the operation processes. The characteristics of the process and the related management information system can be summarized as follows. 3.1 Modularization The examination services are broken down into several independent modules. The information of each module is stored in the computer-aided management information system, containing its title, content, executor, requirement, instruction, report and fee. For a patient, the medical personnel can make the examination scheme just by selecting the desired examination modules. And according to the circumstances’ variation, the administrator can add or delete modules and amend the information of the existing ones. 3.2 Digitalization A number of digital equipments are applied in the physical examination center to facilitate the patients to pay the fees, take the examinations, query the results, and get the reports. Whenever the physical examination scheme has been formed, the system will automatically generate a bar code and print it on a ticket with some other important information. Using the ticket, the teller can collect the fees by scanning the bar code on it. And the physicians can validate the patient by scanning the ticket. Furthermore, the patients can check the results and print out the reports through Internet. 3.3 Standardization The examination service fees and discount rules will be stored in the system so that the subjective changing is forbidden. On the other hand, before examination, the

A website is set up to provide the on-line services. Also, some computers with touch screens are placed at the lobby of the physical examination center. The patients can make appointments, pay the fees, query and print the reports using the touch screen or through the Internet. For the patient’s convenience, on-line payment and bank transfer functions are provided. Furthermore, the system will remind the patients when the reports are ready or directly send the reports to the customers by post mails or emails according to the customers’ preference. Moreover, customers can get some helpful information on the web-pages including the introductions of the service products, the charges and discounts, the layout of the center, and so on. 3.5 Efficiency In the optimized operation process, many tasks, such as, the calculation of the physical examination fees, etc., are carried out automatically by the computer system. In addition, a glossary of the medical terms and some standard sentences are stored in the database, so that the physician can choose them when writing examination results, conclusions and instructions. Meanwhile, the system provides the analysis tools for the disease statistics, financial calculations, medical personnel performance evaluations, and facility efficiency calculations, etc., which may support the administrators to make decisions and manage the center more scientifically. 4. THE MANAGEMENT INFORMATION SYSTEM According to the above descriptions, a computer aided physical examination process management information system was designed. Its functions include entry management, service management, product management, and report query management as shown in Fig 4. Individual Physical Examination Management Routine Physical Examination Management

Group Physical Examination Management

Entry Management Physical Examination for College Entrance Examination Management The Computer Aided Physical Examination Process Management Information System

Driver Physical Examination Sheet

Service Management Physical Examination for Driver Management

Occupational Health Examination

Automobile Driver Physical Condition Certification

Product Management

Report Query Management

Fig. 4.The Function Modules of the System

Fig. 7. Examination Products Management

. Fig. 8 Statistic Interface

Fig. 5. Individual Service Management 4.1 Entry Management The system is designed for three different kinds of roles namely customer, medical personnel, administrator. After inputting the ID and PW, the user can log in the system and operate the corresponding functions that have been assigned to him/her. 4.2 Service Management In the service management module, various sub-modules are designed for different kinds of physical examinations, including routine physical examination, physical examination for college entrance, physical examination for driver, and occupational health examination. The routine physical examination management is continuously separated into two

sub-modules as individual examination and group examination. As shown in the Fig.5, in the individual service sub-module, the patient’s personal information can be inputted, the desired examination items can be selected, and the fee can be calculated out automatically. As shown in the Fig.6, in the service management interface, the physician can verify the patient’s identification, upload his personal information, and input the examination results, conclusions, and instructions if any. 4.3 Examination Products Management The administrator can check, revise, delete the existing examination products, or add new products (see the Fig.7). 4.4 Report Query Management Module The system provides various query functions for the patients and the physicians respectively. For the patients, it is convenient for them to query examination results and print out the reports. For the physicians, they can query the patients’ physical examination reports and the statistic analysis as shown in the Fig.8. 5. CONCLUSIONS

Fig. 6. Interface of Service Management

This paper’s purpose is to promote the patients’ satisfaction and the service efficiency of the physical examination centers in China. Based on the investigations, the current management process model of China physical examination centers is established and the main problems are identified using the cause-and-effect diagram. Then, a reengineered process model is proposed and the corresponding computer aided physical examination process management

information system is designed. It offers a digital platform to satisfy the market’s demand in China’s modern society. This system possesses the following advantages. 1) With the assistance of the improved process and the corresponding computer aided management system, numerous unnecessary activities have been eliminated so that the efficiency is improved significantly. For example, the time for patient to go to physical examination center is decreased from two to one, because the procedure of taking back examination report is removed in the improved process. 2) It has extricated the medical personnel from arduous and non-value added works, so that they can pay more attention to the service quality. After using the information system, the time for medical personnel to copy the patient’s personal information is decreased, and it is self-evident that the whole waiting time will be shortened profoundly. 3) The system can prevent the medical personnel from influencing the physical examination results. Accordingly, as the final examination institutions, the physical examination centers can ensure the authority and justness of the physical examination results. 4) Combing the reengineering results with the advanced IT technologies, the research provides a patient-centric resolution for today’s physical examination centers in China. ACKNOWLEDGEMENTS The authors would like to express their sincere thanks to Dr. Wang Guoqing and Dr. Zhao Deming, et. al., who provided substantial helps on this project and the writing of this paper. REFERENCES Amberg M. and Graber S. (2000). Specifying hospital information systems using process modelling. Stud. Health Technol. Infor,. 77, 51-56.

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