‘'Love is to live another’s life'' said Honore de Balzac. You have probably witnessed that love is a very strong feeling, , it can succeed the impossible, and create miracles in your own lives. Does love be good to the cancer cell that decays the people we never know or the people we love a lot?  Can loving of human of the self and loving of others be helpful in this desperate fight? Is it possible to understand the suffering of others? Does love have a place with the sensation of being near death among the feelings like romantic love, loneliness, anger, longing, and happiness?  Probably there is a “yes” in all the answers to these questions. Like all in other diseases, probably the best helper of a person is himself or herself. But, in Ankara’s center, there is a health institution experienced in fighting cancer, and approaching the patients with love in addition to the modern medical fights: Dr. Abdurrahman Yurtaslan Onkologi Education and Research Hospital. To receive information regarding the hospital, we interviewed the Head Doctor As. Prof. Dr Mahmut Koç.

Would you give some information about the history and medical services of your hospital?

            Our hospital commenced activities in 1956 for the first time through the efforts of Turkish Cancer Research Institution, and the contributions of the voluntary persons and institutions as Ahmet Andiçen Hospital in the district of Kurtuluş. In 1989, our main building in Demetevler where we still operate started servicing. In 2007, with the new and modern annex building in Demetevler Urankent site, it started to provide modern and quality services regarding the childhood cancers. In the structure of this building, a bone marrow transplantation unit was established as well.

            Finally, in 2009, Cancer Early Diagnosis Scanning and Education Center (KETEM) building was completed and presented to servicing in Demetevler central campus.

            Our hospital is the only education and research hospital that provides services in oncology field in our country. Education services are given, in 10 branches as specialization, 4 branches as lateral-branch specialization,  totalling 14 branches in 20 education clinics. The patients applying to our hospital are provided with 35 branches of health services with the specialized personnel. Also in Cancer Early Diagnosis Scanning and Education Center building in Demetevler central campus and Ahmet Andiçen annex service building, it is active in 2 separate units.

A rapid increase in cancer cases is observed in the entire world.. ıt is the second cause of death in Turkey after the cardiovascular diseases that has the ratio of 22 percentage. What must we consider fighting cancer?

            Use of smoking and alcohol, staying under sunshine for a long time in the dangerous hours, being exposed to x-rays excessively, effects of chemicals, air pollution, radiation, imbalanced, and insufficient feeding, etc. are the factors that increase cancer risk.

            As is well known to fight cancer, early diagnosis is very important. Early diagnosis increases the chance of treatment, makes it easier, reduce treatment costs, prevents loss of tissues and organs, prevents injury. Tobacco use is the leading preventable cause of cancer. 80 to 90% of lung cancers and one-third of cancer deaths are due to tobacco and tobacco products. Among the cancers caused by tobacco products,  in addition to the lung cancer, head, neck, larynx, bladder, kidney, pancreas, and stomach cancers are also possible. Avoidance of use of all kinds of tobacco and prevention of passive exposure to provide effective protection. Excessive alcohol consumption increases the risk of head, neck, esophagus, breast, colon, and liver cancers. Alcohol intake of more than 25 grams a day (about 250 ml wine and 500 ml beer) increases the risk for cancers of the upper digestive system. Alcohol intake of 100 grams a day (about 1 litres of wine or 2 litres of beer) increases the risk for cancers 46 times compared to the light consumers or non-consumers. Reduction in the consumption of alcohol is an effective method in preventing cancer.

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One-quarter of the cause of breast and colon cancers are estimated to be not doing physical activity throughout the world.

It is well known that regular exercises reduce risk of breast and colon cancers. These benefits are independent of the positive effect on body weight control. Adults’ physical activities for 5 days a week, for a period of 30 minutes at moderate intensity reduces the risk for these cancers. School-age children and young people are required to do moderate or intense physical activity every day for  60 minutes.

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-          We interviewed Assistant Head Physician of the hospital Dr. Turgay Katlı, responsible for the Information System of the Hospital, about the Hospital Information System and Informatics.

There is an approach in some of our physicians; they only want to deal with their patients and stay away from the information technologies. But they do not want to leave it when they see the information technology had facilitated and rendered their works safer. How is this situation in your hospital?

Of course, this is a paradox. Our physicians have always experienced this paradox. Our physicians had some concerns about the use of the computers when they first met them. There were wrong comments that computers would do a physician’s job but the computers, or rather to say, information technologies facilitated their works of the physicians. Information technology constituted a building block in the works to be carried out by a physician. Physicians thought that information technologies will prevent their works which would cause lose of time. Information technologies gained them times and ensured that they conducted their works fast and safely. When they had this new vision, how can we use automation more? They sought answers to the question.

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-          As an administrator, what are the benefits provided by your Hospital Information Management System to you?

The most important plus in life is to learn knowledge. If you do not have the knowledge, you can not see the and therefore can not solve problems.

It is very important to reach and interpret statistical information. In the past we are making subjective comments that we were very efficient but we were not able to measure how efficient we were. We did not actually know if we were efficient. Today, we are able to receive rich statistical information through the Hospital Information Management System. We are able to review the current status of our hospital thanks to this information. This provides great convenience to management level.

-          Can you tell us about a few fundamental factors that in addition to a statistical reporting, must be available in a healthy HIMS? Can you make an assessment comparing it with the system you use?

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Hospital information management systems must be available in hospitals, not to create new problems but to solve the existing problems. If we make a comparison, in our hospital we did not have many problems with our Sisohbys'de we newly started in our hospital. The problems we encountered could be neglected. Eventually, human factors has also an important place in  information systems. We had some problems during the operation of the system resulting from the users.

For a healthy HIMS it is important to adapt innovation and changes fast. Minimizing the hospital's financial losses, or even taking it to zero level if possible, is one of the crucial features expected from a HIMS. Ease of use is another expectation. If you fail to establish a system that is easy-to-use, after a while, the number of users that are resistant use the information system grow rapidly.

Sisohbys that we have been using in our hospital for a while, regained the amendments by the Ministry back in the system in a short time. Our program requirements  have been met within a reasonable time. Our capability to use new applications in a short time prevented financial losses.

For the prevention of our material losses, Sisohbys provided us with benefits. Invoice billing department could easily issue invoices for the first time. Our invoice amount was 3.5 million and became over 7 million. This amount was the real amount that corresponds to our targeted hospital volume of transactions.

We prevented the resistances that may occur in the users thanks to Sisohbys user-friendly interfaces. The system’s simple use also facilitated the training during the installation.

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-          Finally, what do you think about PACS? Foreign products are 4-5 times more expensive than products produced in Turkey. However, when you see the capabilities of PACS products produced in our country, no difference can be figured out compared to foreign companies. If PACS was different, it would not meet the requirements of PACS Acquisation Frame Principles set by the Ministry of Health. What do you think about this?

My opinion on this issue is that we must adapt what happens in the world in the field of information technologies in our country. Now we need to be in the forefront in the field of information technology as well. Our young engineers, software designers extremely open to these issues. I think we are in a good place as a country. But we must move forward. Hospitals can be a very good laboratory.

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We can present new technologies, new applications to our  physicians and our staff. There are very good works conducted in our universities. There are very good works conducted by our software designers. We have young generation and people with broad horizons. There are companies who make use of such persons too.

Setting aside all these things, when we pay more money for the software having the same capabilities as and our money goes abroad. With the money going abroad, dreams of of or-or youth are also going.

-          We have received information from Hacı Murat Şahin, Information Processing Assistant Manager in charge of the hospital Information Technologies regarding the Hospital Information Management System and the invoicing unit.

-          Are there differences you have encountered after the changes in your hospital information management system? For example, what were the difficulties and conveniences experienced in invoicing units as an element to be measured in terms of ease?

Previously, our invoicing unit staff needed to reach the patient transactions one by one and training support personnel or even software designers for issuing an invoice. This process was not in the for of on-site intervention, but rather as a remote connection. Ultimately, these setbacks were affecting the amount of invoices. We can see the difference if we compare the current statistics with the statistics of that period.

-          If within this process, there was not a new unit opened within the hospital, there was no increase in the number of physicians and healthcare workers, there was no big increase in the patients’ mobility, how must we understand such difference?  Could you give numerical examples to make us understand more concretely?

The quantity of invoices in the past was approximately 3.54 million and today are we have reached at 7.58 million. This is of course a very large proportion. I am thinking that in the increase in the efficiency billing unit arrangements, the improvements, more regular the records of the involvement, the new program was effective. We had a very radical changes in the invoicing unit. As of the first months of the establishment of the system, even during the installation and training phases, we received positive responses.

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-          Are there any problems you encounter in sending your patients' financial information to MEDULA?

We often encounter problems with connecting to MEDULA. The system becomes blocked toward the termination period of the invoicing. We think that such problems are absolutely due to the other party. For this reason, we have to operate our invoicing unit at night, when the traffic is less in the system. Our system works quite well unless there is an error from other side. Also the automatic invoicing system solves a substantial amount of our work. It takes the burden from the shoulders of the personnel in our invoicing staff to a great extent. Thus the invoicing staff can allocate time in order to evaluate the problems caused by incomplete and inaccurate records.

-          You mentioned the automated invoicing process. Could you give us some brief information on this subject?

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Automated Billing System is used for nvoicing of out-patient services more frequently. In the invoicing of outpatient services to patients, in the closing of the service records, the invoicing process is carried out without the need for human intervention. It is possible to adjust the system to the desired time interval, mainly for the hours of the night. And the the invoices for the transactions are issued without any problems automatically. The Automated invoicing does these things instead of us. Inpatient care of our patients should be evaluated once more with the human eye.

-          Some of the companies operating in the field of HIMS meet the basic requirements of state hospitals. They comply with the Framework Principles created by the Ministry of Health on this subject. However, you are a special branch hospital. What are reflexes of your Information Management System to meet the the underlying needs on this subject?

We are an education and research hospital. While there are differences  between educational research hospitals and government hospitals, there are also differences between two educational research hospitals. In educational research hospitals, almost every clinic operates as a separate branch. Besides these features, our hospital is also important in Turkey with its feature of being the oncology hospital without an alternative. Moreover, we also have the feature of being an arbitrator hospital. For this reason, we cannot bear errors and shortcomings of the recording. With this sensitivity our information system must have structure that cause no problem.

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-          As you know, one of the most common problems in information systems encountered from the first phase of installation is the user. Do you have practical recommendations regarding the resistances made by your users while adapting to a new program?

If your users are not willing to learn what is new they certanily resist against a thing imposed from outside. They want to maintain the system they are used to even if they are not very correct. In fact, I think it is inherent in man. Computer use is not in the forefront for many people. There are those who think they are forced to use a computer. Of course, if there is a few people showing resistance, you could solve this problem easily. But when it spread over a wide area, it is not so easy to solve in a short period of time.