Presented by:Dr K.K Gakombe,

MBCHB,MBA, CEO

Innovation in Hospital Management Systems

The AMS 2000 System

EAST AFRICA HEALTHCARE FEDERATIONCONFERENCE

Kampala SheratonMay 2012

Metropolitan Hospital ,Nairobi, Kenya KMA

Metropolitan Hospital profileFounded in mid 1995 as a public limited liability company with a diverse group of shareholders.Most comprehensively equipped private medical institution in the Eastern part of Nairobi.The hospital was founded on the belief that it is possible to offer quality, cost effective and affordable health care services.70 bed hospital offers a diverse range of inpatient services and a busy outpatient . Leading user of ICT for quality healthcare. Has won several awards for ICT deployment .70% of clientele is corporateA preferred provider for insurance companies, parastatals and large corporates

The adversity • Growing revenues accompanied by growing

losses• Losses due to poor credit control coupled

with collapse of HMOs• Lack of timely & poor management decision

support information.• A growing feeling of being in charge but not

being in control • Unable to afford imported hospital mgt

systems

The innovation • Creating a home grown and in house HMIS

to address the identified management needs• Focusing on financial management in order

to save the resources to expand system into other areas

• Leveraging open source tools available for system development in order to cut development cycle and cost

• Raising the bar for ICT usage in hospital management

AMS 2000 Enterprise Management System

AMS 2000 is a fully integrated hospital management systemBased on a modular designScalable from small to large hospitalsRobust and reliableUtilizes open source development resourcesDynamic and under constant development and improvementRuns on several platforms but Linux is the native environmentDeveloped in JavaEasily integrated with other 3rd party systems; Smart, messaging system, NHIF etc

AMS 2000 HMIS System ModulesPatient management (Out & In patient)oMedical Records(EMR-Electronic Medical Records)oNurse care managementoOn-line Outpatient clinical managementoPharmacyoLaboBlood bankoRadiology (X-ray & Ultra Sound)oTheatre managementoBooking managementoDentaloAnte nataloBirths & deaths registration oNurse Call system integration

AMS 2000 HMIS System ModulesPayer managementoScheme membership & benefits validationoClaims management

Finance managementoStock & Inventory managementoGeneral ledgeroDebtors ledgeroCreditors LedgeroConsultants /3rd party providers ledger oOther ledgers; Loans , Cash book, Assets

AMS 2000 HMIS System Modules (Continued)

Operations managementoPayroll management & Human Resource managementoInstant Messaging (SMS & Email)oSystem security including biometric identification of usersoCourier ManagementoFleet/Transport ManagementoShare register oImportant documents mgt; cheque books, govt documents etc

AMS 2000 Integration Capabilities)Medical Equipment e.g. ECG and U/soundNurse call systemImage Management linked with EMRBenefits validation systemsClaims administrationBanks payment systems (receipts & payments)Mobile payment platforms (receipts & payments)Instant Messaging (SMS & Email)

AMS 2000 Claims Management capabilities Real time financial data e.g. visit notification, admission notification, dispatched invoices etc. Electronic claim switching capable System based modes of identification & verificationPhoto cardsMagnetic strip cardsMember data base/membership lists (member & non member options) Online real time validation; membership & benefits-SMS and internet basedSmart Cards with biometric integration.

AMS 2000 Claims Management capabilities- Clinicians MgtDiagnostic profile and outcomeAdmission rateReferral rate : other doctors and institutionsLab utilizationDiagnostic imaging utilizationDrug utilizationSick off ratesCost per visitCost per diagnosis

AMS 2000 Claims Management Provider Needs

Cash Flow/timely payments/reduced claim lossesBenefits administration(membership & pre-authorization)Fraud prevention controlDebtors & customer relations managementOperational cost control (paper based claim processing from notification to fund remittance)Payer management (claim management process, performance evaluation & bench marking)Proper Service Agreement / ContractsHealth Industry Standardization

AMS 2000 Claims Management - Payer Needs

Benefits administration(membership & pre-authorization)Fraud prevention controlLiability management/timely claims administrationOperational cost control (paper based claim processing from notification to fund remittance)Provider management (appointment, performance evaluation & bench marking)

AMS 2000 Claims Management capabilities- Cost Mgt Performance based parameter management reports such as;Cost per AdmissionCost per doctorCost per diagnosisCost per wardAverage cost per schemeAverage cost per memberCapitation costs/Capitation capable

The benefits/pay back Growing ICT driven competitiveness

Improved market, financial and managerial performance

Evolution of new revenue stream from sale of HMIS to other hospitals providers.

Development of an ICT driven franchise business model.

Standardization of contracting between payers & providers

Opportunity to drive use of standard codes for diagnosis, procedures and consumables