Tamil Nadu Health Systems Project Pankaj Kumar Bansal I.A.S. Project Director
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1 Health Management Information System (HMIS) Tamil Nadu Health Systems Project Pankaj Kumar Bansal I.A.S. Project Director
2 HMIS project World Bank aided project Hospital Management System (HMS) Pilot covering 5 hospitals Phase 1 5 districts covering 38 hospitals Phase 2 rest of districts covering 222 hospitals Health Management Information System (MIS) Unified Health reporting system across all Directorates DME, DMS, DPH
3 Highlights The Largest healthcare implementations in India (currently 41 hospitals online) Centralized web based solution Scalable Solution on fully open standards technologies Comprehensive Hospital Management System and a State wide unified Health Reporting System No data entry support
4 Hospital Management System Modules Registration, Inpatient, Medical Records, Lab, Pharmacy, Stores, Blood Bank, Diet, Linen, Biomedical Waste Management Implemented in 41 hospitals Million Patients registered to date 6.5+ Million Patient Medical Records online 20,000 Patients/Day cycled through system currently Users Trained 400+ Doctors; 100+ Pharmacists 200 Hospital Workers, 600+ nurses
5 Features of HMIS applications Unique identifiers for Hospital, patients, users Simple, user friendly forms Alerts for end users Provides for patient referral across the health chain Online health records ease of retrieval Real time data available (Centralized database) eg. Drug inventory across institutions Diagnosis, treatment patterns across institutions Standardization Reuse of codes drugs/districts as per other departments in Govt. ICD 10 codes for diagnosis Drug, equipment, Institution, Lab test, etc - codified Standard nomenclature - for names for departments, wards, etc.
6 Hospital Management System Sample list of activities handled online Doctors OP Record Investigations Prescription ANC Record Assessment Prescription Nurses Activities Ward management transfer/discharge of patients Diet for patients Linen and laundry management Drug Indents/issues online Biomedical waste management Inpatient details (doctors instructions/handover, takeover, etc.) Injection details
7 Clinical OP record - alert
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10 Diagnosis Trends TOP TEN DIAGNOSIS IN JULY % 4% 4% Upper Respiratory Tract Infection 5% 31% Myalgia Lower Respiratory Tract Infection 6% Osteoarthiritis Low Backache 7% Asthmatic Brochitis Acid Peptic Disease 7% Essential (primary) hypertension Viral Fever 8% 23% Non-insulin-dependent diabetes mellitus
11 Paracetamol Vit B Complex Chlorpheniramin Ranitidine HCL Amoxycillin Cap. Diclofenac Aluminium Ibuprofen Tab. Calcium Lactate Theophylline Trends in Prescriptions and Investigations TOP TEN DRUGS PRESCRIBED ONLINE - JULY 2011 TOP TEN LAB TEST ORDERS ONLINE - JULY Drug Name LabTest Urine - Glucose Urine - Protein Blood - Hb Urine - Deposit Blood - Differential... Blood - ESR Total Leucocyte C... SERUM - Glucose... Urine - Bile Pigments
12 Management Information System (MIS) Unified Health Reporting system Clinical Information Patient census, Morbidity, Mortality, Patient services, Immunization, etc Ancillary Services Blood Bank, Lab services, etc Administrative Information Buildings, Finance, Personnel, Vehicle, etc Program Information Malaria, Blindness control, etc.
13 MIS Rationalized the input formats to standardize across all 3 Directorates Implemented in all 1539 PHCs Fully online since April 2010 for Clinical Module NRHM reports being exported online from HMIS Training completed for all DMS hospitals Equipment inventory online Personnel data data upload in progress
14 Rank Report State wide - DPH 1539 Primary Health Centers
15 Equipment Aging Report
16 Grading Report State wide - DMS
17 Issues/challenges prior to automation Maintenance of Manual Records No Outpatient records for patients maintained in hospitals Time consuming data entry Duplication of data entry Huge effort in data consolidation and reports preparation Reports related Periodic reports sent as hard copy Challenge for data analysis/comparison Number of copies sent high Delays in receipt of data Lack of standard names and codes followed No real time data available to monitor the performance of the hospital Drug inventory/equipment inventory Maintenance and tracking of warranty/amc-more cumbersome Current Manpower status Evidence based program management lack of adequate data
18 Impact for Government Health Sector Transition into digital record keeping Quick Retrieval of patient records Online access to information across locations Expected Improved delivery drugs, resources, etc Single unified reporting platform across all health directorates in the State Collation/ consolidation of data saving in time and effort Uniformity and standardization of reporting forms and processes in all directorates
19 Challenges in Implementation Change Management - Mindset of the hospital staff Total system transformation Mapping existing process and rationalization of input forms for standardization Several iterations Infrastructure connectivity/power Training the hospital staff Lack of computer knowledge 6
20 Project Strategy Multi pronged approach ICT Initiatives Policy Initiatives Process initiatives
21 ICT Initiatives Application Software development Centralized Web based application Development and implementation partners- M/s Tata Consultancy Services Application software on Open Source Technology Infrastructure investments Hardware investments Servers, Desktops, Printers Connectivity UPS LAN Utilization of Infrastructure investments by State Govt. State Data Center for co-location of servers TNSWAN Connectivity For secure wide area network 4
22 Policy Initiatives Government infrastructure strengthening Increasing facilities and hospitals to ensure healthcare services available within reach of common man Issue of government orders Orders for sustainability Usage Inclusion in budgets for ongoing maintenance, support Removal of Manual records maintenance as soon as online system stabilizes Streamline areas of interventions with suitable reference orders Directorate level orders and follow up communication Manpower training Basic computer Training through TNEGA/ELCOT Application training Rationalization of manpower Creation of new posts to support ICT interventions
23 Process Initiatives Stakeholder meetings Periodic reviews Follow up on action points Helpdesk set up Central helpdesk Protocol established IT coordinators at district level Coordinate all infrastructure issues related activities Application support and training as needed Motivation to end users Close monitoring and reviews on online performance/usage by Top Administration team - Project Director; Director of Medical Services Hospital/District level etc. Daily online usage monitoring E-nodal team set up at each hospital HMIS part of Quality circle meeting agenda for review
24 Levers of success of HMIS No data entry support end users trained to use system Strong ownership and support from Top Administration Team (Health and IT departments) Principal Secretary, Special Secretary Health, Director of Medical Services, Director of Public Health, Mission Director State Health Society, etc. Supporting Government orders issued Mandating usage of Online system Providing for Removal of Manual registers maintained after system stabilizes Tapping into the State Investments in Infrastructure TNSWAN for connectivity State Data center to house the Servers for Health Department applications Agencies like ELCOT / TNMSC for procurement and infrastructure management
25 Levers of success of HMIS Centralized Web based application Cost Effective Maintenance and Management Open source software savings in cost and maintenance For end client machines Linux For Server software open source Infrastructure support Placement of IT coordinators in districts Establishing a Central Helpdesk for call management Phased Implementation Investments and scale up in phased manner to ensure optimal utilization of resources
26 10 Investments Overview INR 5 Crores Phase II HMS in 222 secondary care hospitals + HMIS in 1500 PHC s INR 82 crores projected INR 2.8 crores Dec 2008 Pilot -5 hospitals Nov 2009 Phase I HMS in 36 hospitals across 5 districts Hardware installation in progress Phase III- 47 Institutions under Directorate of Medical Education including 18 Medical Colleges + Tamil Nadu Dr.MGR Medical University Up next.. INR 50 Crores projected
27 Online usage statistics upto July 2011
28 Kanyakumari District upto July 2011
29 THANK YOU
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