INTRODUCTION

Hospital Information System (HIS) variously also called clinical information system (CIS) is a

comprehensive, integrated information system designed to manage the administrative,
financial and clinical aspects of a hospital. This encompasses paper-based information
processing as well as data processing machines.
It can be composed of one or a few software components with specialty-specific extensions as
well as of a large variety of sub-systems in medical specialties (e.g. Laboratory Information
System, Radiology Information System).

BACKGROUND
The implementation of Clinical Information Systems (CIS) is key to the production of quality
care, adequate management of rare resources and productivity. A recent study has revealed an
objective correlation between the degree of adoption of technologies in healthcare and
reduction of complications and mortality in hospitals. This is clear evidence that a real return on
investment for these systems is possible. Healthcare IT is a necessity that is imposed on all the
countries of the North and South alike. However, a critical question arises and is yet to be
answered. Namely, given the differences in financial, technological, and human resources,
should developing countries consider a different strategy to achieve implementation and
adoption of healthcare IT? The implementation of information systems can succeed if two main
conditions are met, and these both come with a financial burden:

(1) A rigorous and consistent organization of the actors and processes of care in which they are
involved. Without this organizational approach any attempt to computerization is likely to fail.

(2) A clear choice for the establishment of infrastructure (hardware and software) which always
requires substantial financial investment.

Although costly in human, organizational, and structural resources, the first condition appears
to be available to everyone as long as the hospital management is informed, tenacious,
thorough and methodical. The concept of process is not always clearly identified (probably even
less in the South than in the North) and the complexity of care processes when combined with
inadequate management of these processes is a source of non-quality, and of costly and
avoidable medical errors. Within a hospital, implementation of a CIS is based on the
computerization of care processes as well as of support processes (administrative, accounting,
logistics, etc.) to ensure coherence, feasibility and effectiveness of the clinical and business
activities of the institution.

To meet the second condition, the method adopted in the North is mostly based on the
purchase of software available in the marketplace. Most hospital entities no longer develop
their own solutions in-house. This response is problematic for developing countries at two
levels. First, they do not have the financial resources to acquire a commercial CIS. Second, they
do not have the same culture and organization that are implicitly or explicitly imposed and
implemented as part of the commercial solutions coming from the developed countries and for
which these applications have been developed and tested.

Several studies have examined the North-South transfer of information systems, including an
important one by Richard Heeks . He concluded that the information systems that succeed are
those that best incorporate the key technical, social, and organizational environment aspects in
which they are implemented. Heeks also noted that the failures are mainly due to a North-
South transfer of information that does not take into account the context, or the local attitudes
towards modernization and rationalism.

Therefore, developing countries face an important risk of being excluded from the path
towards the computerization of healthcare facilities or systems, even as these are more
necessary than ever to better manage the quality of care and the limited resources available to
developing countries.

If commercial software packages seem out of reach for many poor countries, the fundamental
principles behind the emergence of Open Source software and the acquisition cost of software,
often free of charge, is a great opportunity for developing countries. Moreover, as stressed by
Didier Lamouche , the interest of Open Source is also in its ability to allow firms and nations to
possess and better manage their information systems.

Our article aims to analyze this particular situation while taking into account the emergence of
Open Source software, and to propose a suitable and accessible development strategy that can
be mastered by the South. Today, to the best of our knowledge, no country in French speaking
Africa does possess a computerized information system that is adapted to the challenges of
healthcare. In contrast developing countries of Latin America or other countries in Asia have
made significant progress toward the computerization of healthcare processes in part through
the use of Open Source software .

We will try to understand the opportunity of the Open Source movement in healthcare In
particular; we report our experience with the use of Mediboard Open Source HIS at the
Hospital Mère-Enfant le "luxembourg" in Mali.

We focus our remarks on hospital information systems that represent a clear and pressing need
for developing countries, even if other applications, such as systems to aid in decision-making,
to support HIV/AIDS, public health reporting, or clinical research are not of lesser importance.
For example, the use of technologies such as portable PDAs in epidemiological surveillance is an
interesting opportunity worthy of study as demonstrated by Yu P and all.
 The rationale of "Open Source" software
Mainly based on the sharing of source code and the collaborative development by the users
themselves, Open Source software in the developed and developing countries has seen a steep
increase over the last ten years. An example of this development is Linux which has now a
significant market share of Operating Systems (Linux in 1997 accounted for 1% of the server
market against 30% in 2007). Concerns about lack of standardization and security in Open
Source software have been expressed for a long time and have limited their use in production
systems. These concerns are now disappearing, as demonstrated by several studies. It is likely
that Open Source is reaching its maturity phase. Several nations have already mandated the use
of Open Source in government agencies, as for instance in Brazil and South Africa. A recent bill
has passed in the US senate aiming at the same (Jay Rockfeller - April 23, 2009).

HOSPITAL INFORMATION SYSTEM DESCRIPTION

Hospital OS Software
Hospital OS is a Hospital Information System for managing hospital operations. It is a Client -
Server software in which the server works as a central unit that stores all of the information and
the clients are the units that feed the information into the server.

Hospital OS Server uses the Linux operating system and PostgreSQL as the database. Both Linux
and PostgreSQL are open source programs available for download on the Internet. The Client
software is developed by using Java and it can be used with Windows 98, ME, 2000, XP, Linux
and other operating systems that have the Java Virtual Machine installed.

FEATURES OF HOSPITAL INFORMATION SYSTEM:

1. User Interface
2. Workflow Management
3. Registration
4. Screening
5. Diagnosis
6. Ordering
7. Appointment
8. Service History and Order
History
9. Pharmacy
10. Billing
11. Lab
12. X-ray
 13. Emergency Room (ER) and
Trauma
14. InPatientDepartment(IPD)
 User interface

Menu Bar: each user may see different sets of menus depending on their
authorization.

Patient Status Pane: This area contains the patient's basic information e.g. HN
(hospital patient number), VN/AN (visit number / in-patient admission number),
name, age, insurance scheme, etc. Users can see the patient's current status
(e.g. current service point, previous service point, etc.) and take further action
e.g. transfer patient record to the next service point, unlock the record (read
only), etc.

Patient Transaction Tabs: Users enter the transaction details into corresponding

tabs i.e. Personal Data, Visit Data, Symptoms, Orders, Diagnosis, Cashier, Lab, X-
ray. 

Task Status Bar: Task Status Bar indicates whether the transaction completes
successfully or not. An error message will be displayed if the transaction fails.
 Workflow Management:

Queue: The 'Queue' Tab displays a list of the patients waiting at a service point which is
defaulted to the user's service point. Users are also able to display a queue of another service
point and select to work with another patient record. When a patient record is selected, the
lock indicator will be changed from green to red, which will allow other users to have a 'read
only' access.

The queue indicator differentiates the clinic each patient is heading towards, while the
sequence number not only determines the sequence of patient arrivals, but also can be used as
a counter for the number of patients currently in queue at each service point.
Patient Transfer: After patients complete their transactions at the current service point,
they will be transferred to the next service point where their names will appear in the
destination's queue.

Patient Query: Users can search for a patient record by either entering the HN or
searching for the patient's name (by entering the complete or partial part of the name)
or ID. The system will display a list of patients with similar names.
 Registration: 

Personal information: The system provides tools to make it more convenient to enter

personal information e.g. calculating patient's age from the birth date, validating the
national ID number, identifying the default address of the contact person from the
patient's address, matching gender with the title (e.g. Mr., Miss, Count, Countess, etc.).

Insurance Scheme: Users can identify which insurance schemes the patient has and the
one(s) to use for the current visit from a list of available schemes. The sequence of the
insurance scheme identifies the priority. In the case of an existing patient, the system
will use the sequence from the previous visit as a default.
Patient Referral: For either refer-in or refer-out patients, the patient's referral
information and results are recorded in the screen below.
 Screening: 

For each visit, a screening nurse is able to record vital sign information as many times as
needed. The nurse can enter primary and current symptoms from a list of keywords
provided and enter the patient's drug allergy information. A 'Drug Allergy' label will be
displayed in the patient's information pane on the top of the screen.
 Diagnosis:

Diagnosis: After the patient is investigated, the doctor's diagnosis can be entered in the
Diagnosis Tab. A list of diagnosis keywords is provided. The doctor's diagnosis will be
displayed at the patient's information pane.

Order History: The 'Order History' button allows users to see the list of previous orders of the
patient according to the selected type of treatment (lab, medicines, etc.) and time period. In
case of lab/x-ray orders, users can select an order to display its results. 
Users can review all lab results of the current visit on the same page.
 Ordering: 

After diagnosing a patient, users can prescribe drugs and order lab tests, x-rays, etc. through
the Ordering tab as follows:

Order Search: Order Search Pane provides a list of order items according to the specified
keyword and order category. A 'Set Order' button displays predefined groups of specific orders
for common symptoms, for example, a 'Cold Set' may contains 20 tablets of paracetamol, 1
bottle of cough syrup, and 20 tablets of nasal decongestion. The 'Re-Med' button displays
previous orders of the patient from any selected previous visit. 

Order Details: Order Details Pane specifies a dosage, duration, and special instructions of each
order. The 'Special Instruction' checkbox allows users to enter free text in case of a special
instruction e.g. 1 tablet in the morning and 2 tablets at bed time. 

Order Summary: Order Summary Pane displays all items ordered for this patient in the current
visit according to the selected order category and period. 
 Service History & Order History:

Users can retrieve a list of patient's previous visits with the corresponding date-time and status
and a list of patient's previous orders with the corresponding date-time, status and dosage.
 Pharmacy:

Preparing & Dispensing: After orders are confirmed, pharmacists can select a patient from the
pharmacy's queue to prepare the order, print labels and dispense orders in the 'Order' Tab.
Drug Return: The system allows users to return drugs which were already dispensed in the
return window.
 Billing:
Calculate Expenses: Patient's expenses can be calculated and summarized by insurance scheme
for users to review before the invoice is issued. The expenses which were assigned to each
insurance scheme can be reassigned and recalculated as appropriate. 

Invoice: Note that the expense calculation is for user review only; the calculation results will
not be recorded until users click 'Save', which will also generate an invoice and display it on a
Billing Tab. 

Payment: All invoices of the patient in the current visit will be displayed in the 'Invoice' Pane.
The 'Generate Receipt' button will calculate all expenses from these invoices and generate a
receipt, while the 'Pay' button will display all expenses by billing group, where users can record
the transaction and print the receipt.
 Lab: 

On the 'Lab' tab, a list of lab orders will be displayed along with its status and 'Refer Out'
indicator. Each order's indicator will be defaulted as 'X', which means a refer-out is not
required. For refer-out orders, users can change the indicator to '?' by selecting the orders and
choosing 'Refer Out' button. 

Users can also add new orders, enter and submit the lab results. In case some lab results are
not ready, users can suspend the results by choosing 'Suspend'. 
 X-ray:

An 'X-ray' tab displays a list of x-ray orders to be processed and a list of completed x-ray orders
separately. Users can enter related details for each order e.g. the quantity of x-ray films used,
the x-ray position, etc. 
 ER & Trauma:

From the menu 'Patient ' Trauma', users can search for a patient and enter details related to
the accident in one page. The system provides lists of keywords commonly used for each field
e.g. patient condition, vehicle, etc. to make it more convenient.
 IPD:

Previous Day Re-Med:Users can order the same items as previous day (same visit). The system
will display a list of orders by date.

Continuous Order: In case of orders e.g. drugs, meals, rooms, etc., which will be ordered
regularly, users can set these orders as continuous orders, which the system will generate
orders automatically according to the schedule provided. The continuous indicator will display a
green tablet for a continuous order, and a red tablet for a regular order.
EXPENSES OF HOSPITAL INFORMATION SYSTEM:

Operating system: linux – open source - 0.0 php

PostgreSQL OS- open source -0.0 php

Units/ no. of PC: 8 units of desktops Pentium 4 intel inside -76000

8 video card of 16 gb -40000

Internet access: Smart broadband -1400php/month

Router connectors: 1 unit of 8 connection - 7,500php