# A hospital management system built for Ethiopian hospitals > Wards, theatre, emergency, lab, imaging, pharmacy and billing on one record, with the HMIS return and Ethiopian calendar built in. Primary to specialized. Source: https://www.medicine.et/for/hospitals Site: Bloom Medicine — https://www.medicine.et --- Wards, theatre, the emergency department, lab, imaging, pharmacy and the running bill on one record — so what is done is charged, and what is charted is safe. For primary, general and specialized hospitals — private hospitals and the private wings of public ones. ## Measured in Ethiopia - **5%** — of 200 observed nurses in Amhara referral hospitals gave medications without breaching any of the six rights ([J Drug Assess, 2020](https://doi.org/10.1080/21556660.2020.1841495)) - **57%** — pooled magnitude of medication administration errors among nurses in Ethiopia, across 18 studies ([BMC Nursing, 2025](https://doi.org/10.1186/s12912-025-03186-7)) - **61.90%** — of 464 children at Jimma Medical Center’s paediatric emergency department had a prolonged stay ([J Pediatr Nurs, 2025](https://doi.org/10.1016/j.pedn.2025.10.001)) - **51.85%** — pooled EMR use among Ethiopian health workers — and training was the strongest predictor of use ([Research note · Paper to EMR](https://www.medicine.et/research/paper-to-emr-gap)) ## The problems we hear from hospitals - **Medication errors on the ward** — A paper drug chart cannot tell a nurse what is due now, what was held and why, or who witnessed the controlled drug. - **Charges that never reach the bill** — Bed nights, theatre time, tests and consumables are recorded in five departments and billed from one — and what falls between them is lost. - **A surgical checklist that is filled in, not followed** — A paper WHO checklist can be ticked after the case. Sign-out — counts, specimen labels — is the step most often skipped. - **A crowded emergency department** — Without a board, the sickest patient is not always seen first, and nobody can say how long anyone has waited for a doctor. - **Lab and imaging results that arrive late, on paper** — A result walked to the ward is a result that waits. A critical value phoned to nobody is worse. - **An EMR that was tried before and abandoned** — Many Ethiopian hospitals have watched a system arrive and fade. Use depends on training, manuals and support — not on installation. ## What changes - **One running bill** — Bed nights, procedures, tests, imaging and ambulance trips land on one inpatient bill, with deposits and refunds against the patient’s account. - **A MAR that shows what is due** — Dose slots, holds and witnessed controlled drugs — and prescriptions checked for interactions, dose and allergies before they reach the ward. - **A checklist the system enforces** — Consent and sign-in before the operation, time-out before the incision, sign-out before the patient leaves — the case cannot move on without them. - **Every department on the same patient** — The ED, the ward, the theatre, the lab, imaging, the blood bank and the pharmacy all record against one patient and one visit. ## Wards and nursing: bed census, MAR and observations The ward board shows every bed, every patient waiting for one, and the rounds list sickest first. Nurses record observations and progress notes on the stay, keep the charts the facility designs — fluid balance, neuro and more — and accept readings from bedside monitors rather than copying them. - Ward board with bed census and patients waiting for a bed - Medication administration record with dose slots, holds and witnessed controlled drugs - Nursing observations, progress notes and a rounds list, sickest first - Ward charts the facility can edit: fluid balance, neuro and others - Bedside-monitor readings waiting for a nurse to accept - A vacated bed released only when housekeeping has cleaned it ## Theatre and the emergency department Theatre sessions and case bookings check for clashes; the WHO surgical safety checklist is enforced step by step, and the theatre register records its four times. In the emergency department, the tracking board runs by zone and bay, sickest first, with door-to-doctor time and dispositions that admit, refer or discharge in one step. - Theatre sessions, case booking and the WHO surgical safety checklist - Theatre register and recovery board - ED tracking board by zone and bay, built on triage (ETAT+ or five-level) - Blood bank: compatibility enforced on every issue ## Rehabilitation and palliative care Physiotherapy runs as episodes with outcome measures — Barthel, FIM and muscle testing — and billed sessions, assistive products and prosthetics. Palliative teams record enrolment, home visits with symptom scoring, opioids on the WHO ladder, advance care planning and bereavement follow-up. - Rehabilitation episodes with Barthel, FIM and muscle-testing assessments - Billed therapy sessions, assistive products and prosthetics - Palliative home visits with symptom scoring - Opioids on the WHO ladder, with the pharmacy’s controlled-drug register ## The modules hospitals use - [Inpatient Wards](https://www.medicine.et/features#inpatient) (add-on) — Wards, beds and the stay itself — from the admission waiting list to the discharge clearance. - [Operating Theatre](https://www.medicine.et/features#theatre) (add-on) — Sessions, case booking and a WHO safety checklist the system actually enforces. - [Emergency Department](https://www.medicine.et/features#emergency) (add-on) — A tracking board for the ED, with dispositions that admit, refer or discharge in one step. - [Laboratory](https://www.medicine.et/features#laboratory) (add-on) — Ordering from the room, a worksheet for the bench, and results that keep their corrections. - [Radiology & Imaging](https://www.medicine.et/features#imaging) (add-on) — A modality worklist that runs scan, report and verify, and lands the impression in the chart. - [Blood Bank](https://www.medicine.et/features#blood-bank) (add-on) — From donor to transfusion, with compatibility checked by the system rather than by memory. - [Pharmacy](https://www.medicine.et/features#pharmacy) (add-on) — A dispensing window that knows the prescription, the stock and whether the visit is paid. - [Billing & Payments](https://www.medicine.et/features#billing) — One balance per visit, however many counters and bills it passed through. - [Insurance & Claims](https://www.medicine.et/features#insurance) (add-on) — The payer and patient share split on the bill, and claims batched per payer. - [Support Services](https://www.medicine.et/features#support-services) (add-on) — The kitchen, the cleaners, the mortuary and the ambulance — each with its own list. - [HMIS & Surveillance](https://www.medicine.et/features#hmis) — The national returns a facility is legally required to file, produced from the work already recorded. ## Questions ### Which modules does a primary, general or specialized hospital need? Every hospital gets the core — patients, appointments, charting, billing, staff and reports. Most add Inpatient, Laboratory, Pharmacy and Inventory; general and specialized hospitals typically add Operating Theatre, Emergency, Imaging and Blood Bank. Each is switched on per facility. ### Does it have a medication administration record? Yes. Dose slots for every order, holds, and a witness for controlled drugs. ### Is the WHO surgical safety checklist built in? Yes. Consent and sign-in, time-out and sign-out are enforced, with a theatre register and recovery board. ### Can patients pay a deposit and run a bill? Yes. Patient deposits, refunds and a running bill for inpatients, with bed nights charged automatically. ### Does it produce the HMIS return? Yes — the monthly, quarterly and annual HMIS service return, the OPD and IPD disease returns, and a DHIS2 export keyed by FMOH indicator code. It produces the export; it does not submit to DHIS2 for you. ### We are on a national EMR. Can Bloom work alongside it? Bloom does not integrate with SmartCare, Bahmni or PulseCare. It offers FHIR R4 read access and CDA documents for exchange. It fits best where there is no national EMR — private hospitals, private wings, or where billing, stock and departments need one system. ### Does it work offline? Recording work needs a connection. The staff mobile app keeps records readable offline, but new entries wait for the connection. ## Cited research - [EMR in Ethiopia: adoption is not the hard part, use is](https://www.medicine.et/research/paper-to-emr-gap) — Roughly half the Ethiopian health workers who have an EMR in front of them use it. The evidence points squarely at training, manuals and management — not at software features — and the paper baseline being replaced is worse than most comparisons assume. - [Reporting on time and reporting correctly are different problems](https://www.medicine.et/research/dhis2-data-quality) — Ethiopia runs one of the world's largest DHIS2 deployments — 30,000+ facilities, 95% reporting rates. The national maturity assessment scores data quality and infrastructure far lower. Submitting a report and submitting a correct one are not the same achievement. - [Who pays: out-of-pocket, insurance, and why billing accuracy is a supply problem](https://www.medicine.et/research/who-pays-for-care) — The most-quoted figure for Ethiopian out-of-pocket spending is 31%. The WHO-sourced series puts it at 46.3% for 2023. Both are cited here, because the gap between them is the whole point about dated statistics. - [The workforce math: more graduates, unfilled posts, and an $800m gap](https://www.medicine.et/research/health-workforce-gap) — Ethiopia's health labour market analysis projects steadily rising supply of nurses, midwives and doctors through 2030 — and a financing gap large enough that graduates go unemployed while services stay understaffed. When clinician time is the scarcest input, admin minutes are clinical minutes.