42nd RFHHA Sunday Panel Discussion on 23 Oct 2016 Final

April 5, 2018 | Author: Madhav Singh | Category: Electronic Health Record, Health Informatics, Cloud Computing, Health Care, Public Health


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White Paper onRFHHA Sunday Panel Discussion no 42nd held on 23 Oct 2016 Hospital Information Systems Series 1: Basic for Hospital administrators DR MADHAV MADHUSUDAN SINGH ©RFHHA www.rfhha.org Page 1 42nd RFHHA Sunday Panel discussion on 23 Oct 2016 , 1000- 1400 hrs Topic : Hospital Information Systems Series 1: Basic for Hospital administrators The discussion was held on Whatsapp ( +919560852592 ) , and on Face book https://www.facebook.com/groups/1416271691939651/ 10.00 -11.00 : Hospital Information Systems : Basic concept 11.00- 12.00 : General Requirements, Planning & Designing of HIS for a hospital ( Client vs Cloud Based ) 12.00 -13.00 : Trends in HIS development & Types of HIS Modules available 13.00 – 14.00 : Q & A from members All members are requested to invite your hospital administrators / IT In charge / management students to join this discussion on social media platform of RFHHA. To join this forum please sends your request on 9560852592. Any body interested to join as panellist , you are welcome. Dr M M Singh Panellist Topic : Hospital Information Systems Series 1: Basic for Hospital administrators The discussion will be held on Whatsapp ( +919560852592 ) , and on Face book Esteemed Panellist Col S Patole , SM , Director IT AFMS Shri A K Srivastava Director HIS , The Gemini India Mr Sujeet Kumar , ASG Hospital Pvt Ltd Shri R K Singh , TCS Dr M M Singh , AFMS ©RFHHA www.rfhha.org Page 2 you can send question directly. depends on its goals and objectives. They have become an integral part of the comprehensive health services in India. and efficiency of its management systems.NET + SQL Server 2008) https://www. You are also requested to invite your hospital administrators / IT Manager/ management students to join this discussion on social media platform of RFHHA.youtube. Effectiveness of a health institution . To join this forum please sends your request on 9560852592.rfhha.com/watch?v=rHivqzpDips Introduction “Hospitals are the key institutions in providing relief against sickness and disease.youtube. soundness of its operations.com/watch?v=zqaPfmfRb3w Advance Hospital Management System (VB.org Page 3 .All members are requested to attend. both curative and preventive. Dr M M Singh The sessions started with the some video on HIS in India as under: Health Information Management: Information Flow Across the Hospital https://www.hospitals or nursing homes.com/watch?v=VqVkYE2liGQ Health Information Management: Basics of Quality and Performance Improvement https://www. its strategic location. Significant progress has been made in improving their efficiency and operations.com/watch?v=d0N8sQUCutA Yanthrik Hospital Management System https://www.youtube.youtube. The administrator's effectiveness depends upon the ©RFHHA www. uses a Stand Alone Software.As you can see. visit and determining the therapeutic actions and orders are issued by physicians and are run by Nursing services. Some of the major factors determining the effectiveness of a health institution includes patient care management and patient satisfaction. For example. Effective computerised systems and procedures need to be implemented to ensure proper utilisation of limited resources toward quality health care” Dr M M Singh Dear Panellist.org Page 4 . is done transfer of patients between wards. all of these actions is performed ©RFHHA www. such as admission and discharge patients that is done in admission.rfhha. Administrators and professionals have to be extremely cost conscious. improve quality. Col S Patole Dear Panelist Q. and regardless of issues such as specialized information State any impact on clinical findings on treatment process and the need for integration of patient information in hospitals. Hospitals are very expensive to build and to operate. increase satisfaction and reduce costs. performing diagnostic procedures and matters such as settlement and others . Can you tell in detail what is Hospital information system? Hospital information system (HIS) is comprehensive software for patient’s information integration for sending and exchange comprehensive patient’s information between wards and other medical centers in order to expedite the process of patient care.efficiency with which he is able to achieve the goals and objectives. Q. How Preparation of software that performs functions Separate works in HIS? Each person or department administer feels commensurate with the appropriate knowledge. understanding and the need for computer and entrepreneurial it. in various duties in hospital units are done by different people during patient treatment. If for these actions is used separate software’s. most likely the software have been designed and prepared by different people in different intervals without regard to the necessary connection between them. operating system and programming language will be completely different and incompatible with each other.rfhha. ultimately ©RFHHA www. possibility of create networks and exchange patients information. pharmacy. therefore evolution with time and new systems development. there isn’t even in the future. software is provided with capabilities and its features . Using the computer. in this method will not be delayed between communication of systems like the first method. the desired goals in the hospital information management will not do.org Page 5 . and even in terms of used hardware will be incompatible completely . and if the relationship between dispersed systems is not done rapidly. All therapeutic actions. in fact any duty may be done faster and better. and this means loss of data.The format of the software. Suit the needs of them. Thus the use of computer software for doing hospital measures. management will be forced to change the existing systems. and management and financial actions of patient is done by comprehensive software that is made up of different parts . costs. but on different actions of treatment and their impact on patient's entire treatment process. Therefore the start time and end all actions will be identified and followed in the system.separately for each patient and is similar in all patients. and other units through the system and submitted their response is received . all therapeutic. and since being dispersed information in different systems cannot help to solve hospitals problems. medication orders and diagnostic services are sent to clinical and Para clinical and administrative centers such as accounting. and time is a dynamic management system. in every part. will create less accelerate probably because the different systems have no relationship to each other. warehouses. In this way. and will be taken to avoid a patient data entry form overlapping . that any act is done in treatment patient field by a person will be identified and investigated exactly. This reduction in total lead time reduces costs of treatment patients and the country's health system and will increase health care quality and patient satisfaction . Col S Patole Dear Panellist Q. Can you tell us some important goals of hospital information system (HIS) ? Main goals of hospital information system (HIS) :  Improving staff efficiency  To remove duplication and unnecessary procedures  Using computers as work tools  Statistics and data mining techniques faster and more accurate  Improving quality of health care status of  To create a modern working methods and systems and standardized hospital  Data communication systems.The system efficiency is.Also in this system. medical engineering  Data communication between hospitals and medical centers in  The country reaching a distributed database in the country and make its relationship with the World Health Networks  Promote community health Col S Patole ©RFHHA www. reducing patient treatment time through the introduction of blind spots in its treatment process. so the control issue in medical environments is possible to management easily.therapeutic patient will be exchanged faster and with broader communication between workstations of different treatment patient and therapeutic factors.rfhha.org Page 6 . org Page 7 . The first time it was created in a hospital Kamynv. Many countries including European countries have moved toward automation hospital information system since the early 1980 . IT has been a late entrant in the field of hospital administration and most hospitals. Using hospital information system (HIS)was introduced in Iran in 1978 and was launched in the hospital anymore. Until 1960. Mashhad. Q . Mountain).rfhha. to the national pilot with the cost of 800 million Rials . Although most early systems were created to provide financial and repayment goals. hospital information system (HIS) emerged and probably the first hospital information system. When HIS started in India ? A lot of hospitals in India are still rooted in traditional manual processes and are unable to cope up with the large volumes of data being generated. Shri R K Singh Dear Panellist . Mountain in December 1971 (EI Camino. ©RFHHA www. Can you some highlight on history of Hospital Information System (HIS) ? Reports relating to the use of computers returns to support clinical data management activities in 1950. in 1980 the country's first e-hospital. carried out in the 313-bed hospital Imam Hussein of Shahrood.One of the positive results of the implementation of electronic information system was 12 percent reduction of medication in this hospital. but they was the founder of modern electronic records. data systems was Technician that was created in the system of nursing stations.This system developed significantly until now. Thus. and it has been an integrated system and with the inner core that called electronic medical records (EMR) from one inconsistent system . Q.Dear Panellist. Yazd. and Zanjan be as a pilot project for the first time. The second generation of hospital information systems. which was introduced in early 1980s and focused on patient care planning and departmental solutions such as laboratory and pharmacy. Why I Should use HIS systems in my hospital ?  Generation of alert and Reminds: HIS systems help with the creation of Wake series warning messages to remind doctor in diagnosis. In very serious cases. they neither gave the desired results nor could they be integrated with newer systems. patient has an abdominal pain that is may be 45 diseases that have the same symptoms but doctor remembers only 10 of them. mainly served as financial systems and their main purpose was to transmit information from end users to financial systems. Most first generation HISs of 1960s and early 1970s did not succeed to match the hospitals needs for automation. It first came to AIIMS & KGMU Lucknow. Third generation of HIS’s. Q .care information automatically by them. However.org Page 8 .rfhha. that there isn’t the opportunity for doctor to decide. ©RFHHA www. which started in the late 1970’s was influenced by database technology.  Critical Pathway of Decisions: HIS systems help a doctor in serious cases. For example. these systems help the doctor and bring his response quickly in emergency cases.  Automatic reporting: one of advantages and performances of HIS systems is that can be provided report of patient’s diagnostic . Shri R K Singh Dear Panellist .which forayed into this area started with small systems that were developed in-house. no standardized solutions were available and these local innovations were the pioneers. They did not save any patient related information but were used only to store and retrieve financial information. which started in middle of 1970s and ended at the end of 1970’s. Till the middle 1990’s. In this case you won’t require performing additional tests and etc.  Data Presentation.  Reduce cost: HIS systems effect very significant in reducing the costs. physician can access patients and hospitals easily from your location or where he/she is present.  Access to diagnostic information – care of patient with a PC: using of the appropriate Work station. Properties and characteristics of hospital information system (HIS) should based on :  It acts based on standard. ©RFHHA www. you won’t need to review Problem Oriented of patient. Mr Sujeet Dear Panellist . fewer mistakes occur.rfhha.Therefore. better communication of information and decrease. Q . So if you have detection algorithms in the system.  Reducing errors: because all data have been collected in one place.  It doesn’t make any mandatory in existing manual system.org Page 9 . Thus make an Appointment is much easier. accessing to previous information of patient will be better. What Properties and characteristics of hospital information system (HIS) required in broad sense ? As per my opinion.  It acts based on "medical events" and is independent of the cycle of moving patients .  Better Managing & Following :patient management and follow patient can be done better in these systems .  Suitable Administration: One of the benefits of HIS systems is that allow the patient to call the hospital network from home and reserve time to meet with the doctor. but it matches itself with these systems. T-standardization. the previous manual and the current trend does not change much .  It increases the quality of decision making and managerial.  Smart cards are used for identification and control of hospital staff access to patient records (to enhance security) .  It allows to people’s common use of medical information recorded and Protocol Guide electronically.  The data entry are required to type in only 2 %of cases and in 98 %cases. clicking method is used by the help of the mouse.  It is equipped with video conferencing system between health care professionals.  Operation is very simple and completely visual and user-friendly.org Page 10 . ©RFHHA www.  It includes rich knowledge-based medicine databases such as SNOMED and ICD-10 .  Filing and retrieval of medical information dense is possible to easy access to the complex and stratified set of data.  It provides Access to information via the Internet to communicate with the mobile phone.  It is equipped with open standards for the implementation of local language.  Using this system.  It is equipped with knowledge-based intelligent system for diagnosis and treatment.  It keeps the old computer systems and promotes and improves their futures. for data entry.rfhha.  It offers the best solution for coordination between different lines of work and different units in the hospital  It coordinates all wards and hospital system. rfhha. management. and integration of electronic health information . Sri R K Singh Dear Panellist.  Software is designed Based on Object Oriented Technology. audio and video recording various Information is possible in it . In other words goal of HL7 is facilitating communication in configuration Health Care. What is HL 7 (Health-Care Level 7)? Health-Care Level 7 is accepted standard (protocol) in the world that provides the common language for information exchange and electronic patient records in both domestic and abroad . Q . What features of a hospital information system (HIS) software should be there ?  The software should be able to make a separate computerized record (EMR / CPR) for every admitted patient .org Page 11 .HL7 strives that we use of such standards within and between health care organizations to increase efficiency and effectiveness of health care activities such a manner that is in favor of all. Col S Patole HL7 is an international forum with health care that its goal is working with professionals and health scientists to create standards for information exchange.  Using multimedia technology.This world standard is recognized by the Common Market of Europe in 1992and Central Office in 1994 by ANSI and the WHO. Q . Col S Patole Dear Panellist .  System has accepted standard for transferring medical information between different medical centers. it means that different layers (different tasks) can be run separately from each ©RFHHA www. Also it has a closely coordination with other accepted standards of medical informatics.  System could support Interface (hardware interfaces) of advanced devices such as radiography.  The software must be able to support multimedia capabilities (Multimedia).  Level of computer user’s access to file system is classified based on each individual task in patient treatment and position. What are the Standards in Healthcare IT and Interoperability used for HIS ? The data flow between different modules of the HIS and other disparate systems like third party software needs integration with existing and new architectures. etc.  System works in the network and covers all clinical and Para clinical units. application systems. CT scan. or with systems in ©RFHHA www. Q .  The Software has capabilities of Tele Communication & Tele Medicine. HL7 Standard has a lot of flexibility information exchange in the types of the hardware and software infrastructure. Shri R K Singh Dear Panellist . and can be used in all health care environments. so it can implement in various center of health systems.  Standard Numbering and archive systems are predicted in it. and services. other and be implemented. These systems further need to go beyond their geo-graphical boundaries and share clinical information with clinical systems of other hospitals in the same city.org Page 12 . MRI.  Software persuades users to use it or is User Friendly. country.rfhha.  Data confidentiality is guaranteed by certain methods . The Systematized Nomenclature of Human Medicine (SNOMED) International. These are some of the main standards and namespaces used in healthcare informatics and are followed in hospital information systems with international standards implemented in hospitals that provide world class patient care. and vocabulary. It is vital for information sharing that clinical information is captured in systems using internationally understood codes and language. uninformative. or confusing master data. Laboratory Observation Identifier Names and Codes (LOINC). Health Level Seven (HL7).other countries. Redundant. Struggling with balance among different departments .end users and stakeholders. What are the Implementation difficulties are found in hospital?: 1. Standardization of data definitions. Infrastructure. International Classification of Diseases (ICD) codes. Classical example of this clinical data sharing is in cases of medical tourism where patients travel to different countries for cheaper and international quality of healthcare services. and independent physician groups. 2. Q . Clinical Data Representations (CODES).rfhha. and organization of the implementation processes. (IEEE). external systems.org Page 13 . 6. ©RFHHA www. representation. 4. Inc. Integration of different information systems. Some of the commonly used standards involved in healthcare information infrastructure are Digital Imaging and Communications (DICOM). application. 5. 3. (Medical Data Interchange Standard (MEDIX). Institute of Electrical and Electronic Engineers. management of end user contribution. Col S Patole Dear Panellist. inaccurate. EHR standards were released in August 2013 by the Ministry of Health & Family Welfare. So. The AADHAR number will serve as the unique patient identifier for all healthcare organizations across the nation. Q . 9. besides the inclusion of National UID or AADHAR number.rfhha. 10. 12. may be used to identify the patient within the CDO and as a reference in its EMR system. which will be a longitudinal health record of a citizen’s lifespan with several clinical encounters in different care set-tings. Col S Patole Dear Panellist. Software immaturity. 8. End user training.7. The other ID. 11. Is there is any plan of GOI to include National HER standards with National UID or AADHAR? With uniformity in this view. These standards emphasize the use of National UID or AADHAR number as the primary or secondary Unique Health Identifier (UHID) of a patient visiting a healthcare facility. The basic idea of the EHR standards is to have a country wide rollout of EHR for all healthcare organizations and link it to the National UID of the patient ©RFHHA www. End user profile and resistance. Lack of information about HIS implementation. going forward. Technical requirements planning. 13. The EHR standards were formed after a thorough study and analysis of National EMR/EHR and Healthcare IT (HCIT) programs implemented in the world. Ignorance of administrative needs of hospital. The EHR standards also define the Healthcare IT (HCIT) Standards applicable for India.org Page 14 . Government of India. the AADHAR number will act as the unique identifier for the EHR of an Indian citizen. Support after implementation. for supporting better clinical decisions. Shri R K Singh Dear Panellist. How much will be annual spent on HIS with respect to annual operating expenses ? Hospitals spent approximately 2-3% of annual operating expenses on IT. Once clinical data begins to get captured in the HIS. Often clients and servers communicate over a computer network on separate hardware. will surely see the foreseen success. but if giv-en aggressive timelines and adequate impetus of implementation. called servers.based medical records will be replicated if not replaced by the electronic medical records.org Page 15 . EHR of an Indian patient may even be accessible by care providers of other countries and vice versa. in the coming years. A server host runs one or more ©RFHHA www. Shri R K Singh Dear Panellist.rfhha. called clients. Connecting rural and urban healthcare delivery systems through UID and EHR standards seems like a magnanimous task for now. Q . Q . EMR’s created by the various care providers that a person visits during his/her lifetime will be stored in a central clinical data repository or at least be shareable through the use of interoperable standards prescribed by the EHR standards.(AADHAR). sooner or later create electronic health record or EHR of the person bringing his complete health information together. the paper. This will. this dream will eventually come true. but both client and server may reside in the same system. With a boom in global medical tourism trends. and service requesters. What is client–server model? The client–server model is a distributed application structure that partitions tasks or workloads between the providers of a resource or service. and more coordinated care amongst various care providers. With more and more hospitals adopting HIS in India. org Page 16 . A health or medical ©RFHHA www. tablets and smart phones and any Ethernet enabled device such as Home Automation Gadgets. network printing. A client does not share any of its resources. computer networks.server programs which share their resources with clients. and the World Wide Web. applications and services). Some of these devices—cloud clients—rely on cloud computing for all or a majority of their applications so as to be essentially useless without it. laptops. such as desktop computers.rfhha. Q . It is a model for enabling ubiquitous. on-demand access to a shared pool of configurable computing resources (e. What is Cloud computing based serve model ? Cloud computing is a type of Internet-based computing that provides shared computer processing resources and data to computers and other devices on demand. storage.. Q . digital medical library in which information are collected and stored in digital formats and accessible by computers. Users access cloud computing using networked client devices.g. Clients therefore initiate communication sessions with servers which await incoming requests. Mr Sujeet Dear Panellist. Cloud computing and storage solutions provide users and enterprises with various capabilities to store and process their data in third-party data centers that may be located far from the user–ranging in distance from across a city to across the world. What is Digital Health Knowledge Resource ? Digital health knowledge resource is a concept where contents are stored in digital format e. which can be rapidly provisioned and released with minimal management effort. servers.g. but requests a server's content or service function. Examples of computer applications that use the client– server model are Email. Mr Sujeet Dear Panellist. especially in the context of serving a billion plus population of India. It has several advantages. Q . and ensuring efficient healthcare program& service delivery by rolling out a number of IT systems and applications. To handle the growing volume of electronic publications. Ministry is making use of ICT to obtain reliable health information and near real-time data for policy making. It needs little space for storage. Large scale and sustainable implementation of ICT interventions in healthcare services i. Medical libraries are typically found in hospitals. assess or evaluate health care. What is the Current ICT Solutions in on Govt Platform in India ? ©RFHHA www. new tools and technologies have to be designed to allow effective automated semantic classification and searching. Q .rfhha. in improving the efficiency of the healthcare system and also in improving the quality and expanding reach of healthcare services. eHealth has a significant potential in addressing such challenges. health professionals. Shri R K Singh Dear Panellist. It can be accessed at any point of time and from any location where internet facility is available. The cost of maintenance is much lower than that of a traditional library. Digital libraries are user-friendly interfaces.e. patients. and private industries and in medical or health associations. students. consumers and medical researchers in finding health and scientific information to improve. update. medical schools. Shri R K Singh Dear Panellist. giving clickable access to its resources.org Page 17 . What is role of technology in Health sector? Technology can play an important role in overcoming the various challenges faced in Indian health care system.digital library is designed to assist physicians. state and national levels. some of them on a large scale.  Mother and Child Tracking System & Facilitation Centre for efficient delivery of Health care services to expectant mothers and children with an objective of improving IMR.rfhha.  Integrated Disease Surveillance Programme for disease surveillance with surveillance units at centre.  Human Resource Management Systems for optimising human resource utilisation have been in place.  National Health Portal. connected through IT network.Various tele-medicine pilots have also been initiated in many states over the years. and morbidity in women and children. ©RFHHA www. to monitor and track services and status relating to screening. Some states have rolled out state- wide Hospital Information Systems to cover all public hospitals across the state.  Health Management Information System to monitor delivery of services at facility level has been adopted extensively across the country at district.a citizen portal for health to provide authentic information on health various issues to public and serve as a single point of access for consolidated health information and services has come into operation recently. supporting administrative and clinical functions and providing electronic medical records.  Hospital Management Systems have been put in place by many hospitals and health centres. thus enabling continuity of care within the state.org Page 18 . diagnosis. all State/UT head quarters and all 640 districts in the country. treatment and follow-up of Tuberculosis cases.  “Nikshay” for Tuberculosis control programme.  Telemedicine. MMR. record keeping. Mobile Academy have demonstrated good health outcomes by strengthening of health frontline workers.  Social Media platform – use of MyGov.rfhha. Kilkari. efficiency. You Tube etc. Apart from getting health and disease information from the web. ©RFHHA www. people are also using mobile applications to get information and often doing home care for medical conditions (mHealth/Tele- home care). thereby enabling hospital administration to make better decisions on time. Shri R K Singh Dear Panellist. for dissemination of information & interaction with citizens. It has helped in meeting the short-term objectives of computerization.  Mobile Health solutions -Swasthya Slate. patient safety. and management reporting and also the long-term goals to build and maintain patient database for analysis of data to facilitate decision-making process. What are the changes you have observed in the healthcare industry in the last one year? There is an increased demand for health information. In computerized hospitals. It has provided easy access to critical information. plugged in revenue leaks and pilferages and has reduced costs. Shri R K Singh Conclusion: Integrated Hospital Information System (HIS) is vital to good decision making and plays a crucial role in the success of a hospital.org Page 19 . especially from the patients and their caregivers. HIS has enabled improved patient care. Twitter. to reduce costs and improve the accuracy and timeliness of patient care. accounting and administration. Q . org Page 20 . Jai Hind Dr M M Singh ©RFHHA www. Dr M M Singh Respected Members This concludes the 42nd RFHHA Panel Discussion on Hospital Information Systems Series 1: Basic for Hospital administrators.Hospitals in India. You critical comment is welcome. Till then...... I thank all panellist and administrative staff. must ensure computerization of all its departments in due course of time and contribute towards developing an Integrated Healthcare Delivery System for In-dia.. All the technical inputs by the panel have been taken from references has been given in this white paper. hence. members for their active participation. Next week we will meet on another topic.rfhha.. USA 9. New Technologies in Hospi-tal Information Systems. A Master’s Paper.al.References 1. Meth- odologies. Bedi B. International Journal of Medical Informatics. Little Johns. M. Ministry of Health & Family Welfare.Journal of American Medical Infor-matics Association. USA 3. IOS Press. 2009. Netherlands 10. Springer. Benson. Volume 1. Weitekamp M.A Cross-Site Qualitative Study of Physician Order Entry.rfhha. 2002. M.S.. 1997. P. 2001. Hospital Information Systems: Perspectives on Prob-lems and Prospects.. 4. Introduction to Clinical Informatics. Dudeck. Degoulet. Ball. 2003. Evaluating Comput- erized Health Information Systems: Hard Lessons Still to be Learnt. Why General Practitioners Use Computers and Hospital Physicians do not—Part 1: Incentives.. Medical Information Science Reference. Mishra S. Wyatt. Integrated Health Systems. 1997.Fieschi. and Applications. B.com 8. J.Logic. Pennsylvania State Universi-ty.P. 1997.org Page 21 . New York 2. Tools. Gorman PN.J. Infor-mation and Strategy. T.K. USA 6. India ©RFHHA www. W. Ash JS. Lavelle M. Health Information Systems: Concepts. Lordieck. M. British Medical Jour-nal. Recommendations on Electronic Medical Records Standards in India.V. BMJ Publishing Group Ltd. et. Blobel. Berg. BMJ.Mani S. Joel Rodrigues. et al. International Journal of Medi-cal Informatics. USA. 2003. 2003. Government of India. UK 7. J. Implementing Information Systems in Health Care Organizations: Myths and Challenges. & Garvican L.R. USA 5. April 2013. C. Managing a Modern Hospital 2nd Edition. 11. Kumar. Hospital Managerial Services.Chandra Ballabh. India 13. 1998. Clinical Information Sys- tems.rfhha.L Goel. Springer.V Srinivasan. New York. Deep & Deep Publications. R.S. 2002. New Delhi. 2008.Rudi Van de Velde. SAGE Publications India (P) Ltd. Encyclopedia of Hospital and Health Services Management Volume – 5 Modernisation of Health Services. New Delhi.BM Sakharkar.Verlag. USA 12.Hospital Administration in the 21st century. India 14. Alfa Publications.org Page 22 . 2008. New Delhi. A Component Based Approach.A. Jaypee Brothers Medical Publishers (P) Ltd. India 15. India TO JOIN THIS PANEL DICUSSION SEND A MESSAGE ON +91 9560852592 ©RFHHA www. Patrice Degoulet. Principles of Hospital Administration and Plan-ning. 2003.
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