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Dr. gakombe uganda health care federation ams presentation
1. Innovation in Hospital Management Systems
The AMS 2000 System
EAST AFRICA HEALTHCARE FEDERATION
CONFERENCE
Kampala Sheraton
May 2012
Metropolitan Hospital ,Nairobi, Kenya KMA
Presented by:
Dr K.K Gakombe, MBCHB,MBA, CEO
2. Metropolitan Hospital profile
Founded 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 corporate
A preferred provider for insurance companies, parastatals and large
corporates
3. 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
4. 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
5. AMS 2000 Enterprise Management
System
AMS 2000 is a fully integrated hospital management system
Based on a modular design
Scalable from small to large hospitals
Robust and reliable
Utilizes open source development resources
Dynamic and under constant development and improvement
Runs on several platforms but Linux is the native environment
Developed in Java
Easily integrated with other 3rd party systems; Smart, messaging
system, NHIF etc
6. AMS 2000 HMIS System Modules
Patient management (Out & In patient)
oMedical Records(EMR-Electronic Medical Records)
oNurse care management
oOn-line Outpatient clinical management
oPharmacy
oLab
oBlood bank
oRadiology (X-ray & Ultra Sound)
oTheatre management
oBooking management
oDental
oAnte natal
oBirths & deaths registration
oNurse Call system integration
9. AMS 2000 Integration Capabilities)
Medical Equipment e.g. ECG and U/sound
Nurse call system
Image Management linked with EMR
Benefits validation systems
Claims administration
Banks payment systems (receipts & payments)
Mobile payment platforms (receipts & payments)
Instant Messaging (SMS & Email)
10. 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 & verification
Photo cards
Magnetic strip cards
Member data base/membership lists (member & non member options)
Online real time validation; membership & benefits-SMS and internet based
Smart Cards with biometric integration.
11. AMS 2000 Claims Management
capabilities- Clinicians Mgt
Diagnostic profile and outcome
Admission rate
Referral rate : other doctors and institutions
Lab utilization
Diagnostic imaging utilization
Drug utilization
Sick off rates
Cost per visit
Cost per diagnosis
12. AMS 2000 Claims Management
Provider Needs
Cash Flow/timely payments/reduced claim losses
Benefits administration(membership & pre-authorization)
Fraud prevention control
Debtors & customer relations management
Operational cost control (paper based claim processing from
notification to fund remittance)
Payer management (claim management process, performance
evaluation & bench marking)
Proper Service Agreement / Contracts
Health Industry Standardization
13. AMS 2000 Claims Management
- Payer Needs
Benefits administration(membership & pre-authorization)
Fraud prevention control
Liability management/timely claims administration
Operational cost control (paper based claim processing from
notification to fund remittance)
Provider management (appointment, performance evaluation
& bench marking)
14. AMS 2000 Claims Management
capabilities- Cost Mgt
Performance based parameter management reports such
as;
Cost per Admission
Cost per doctor
Cost per diagnosis
Cost per ward
Average cost per scheme
Average cost per member
Capitation costs/Capitation capable
15. 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