Download Health Management Information System(HMIS) in Government Hospit

Health Management Information System
(HMIS)
IT initiatives of
Government of Tamilnadu
Department of Health &Family Welfare
Pankaj Kumar Bansal, IAS,
Additional Secretary & PD,
TN Health System Project,
HMIS
• Envisaged by the Health & Family welfare department of Govt of
Tamil Nadu through Tamilnadu Health Systems Project as part of the
on going initiatives for IT enablement of health sector.
• Conceptualized to provide critical health data across the health chain
for quick and timely intervention by the health directorates.
• The World Bank’s involvement in the project has been extremely
advantageous. It has helped in introducing new approaches in the
health sector.
Three Tier Health Care delivery in Tamil Nadu
Directorate of
Medical
Education
Directorate of
Medical & Rural
Health Services
Directorate of
Public Health &
Preventive
Medicine
Tertiary
Care
Medical Colleges –
18
MC Hospitals –
41
Taluk –
161
Secondary Care
Non-Taluk –
78
b
HQ Hosp –
28
Primary Care
Population 7.21 Crores
HSCs –
8706
PHCs –
1589
3
32 Districts&
42 Health
unit districts
No. of Districts-32
No. of HUDs-42
NRHM
Vital Statistics
Birth rate
15.9
(2011)
7.6
(2011)
Infant mortality rate
24
(2011)
Maternal mortality ratio
79
Total fertility rate
1.7
Death rate
Population
Area
(2011)
7.21 Crores
(Census 2011)
130,058 sq.kms.
Project Rationale
No real time data available to monitor the performance of the hospital
Evidence based program management was a challenge
Undue delays in receipt of data
Retrieval of old manual records was ineffective & time consuming.
Duplication of records was again a setback within the hospital
• Monthly reports sent as hard copy- a real challenge for data
analysis/comparison
• Drug & equipment inventory - maintenance and tracking of
warranty/AMC-more cumbersome
• Lack of standard names and codes
•
•
•
•
Project Strategy
1. ICT Initiatives
2. Policy Initiatives
3. Process Initiatives
4. Paradigm Shift
1. ICT Initiatives
• Centralised Web based Application
• Infrastructure investments-Hard Ware /Connectivity/UPS etc
• Utilizing the existing Infrastructure investments by State
Government- State data centre /TNSWAN
Application Software
• Developed and implemented by Tata Consultancy Services
• GoTN owner of the application
• Centralized web based application on open source platform
• J2EE (Java 2 enterprise edition)
• Postgre SQL data base
• Glass fish Application Server
• Solaris Operating System
• Follows industry standard-three tier architecture viz
(Presentation, Business logic and Data layer)
• SUSE Linux OS at the end user level-user friendly screens
Patient Identification
Unique ID-PIN
•15 Digits
•First digit indicates Directorate
•Next five digits denotes institutional code
•Last nine digits refers to patient number
•This number is different from OP number
•OP number has 17 digits
•Two more digits next to institutional code makes 17
digits for op number
2. Process Initiatives
• For Software requirement specifications (SRS) thorough study of the entire health
system and its process were studied
• Extensive training sessions were conducted for various categories
• Stakeholders meetings
o Periodic reviews &
o Follow up action taken
• Help desk set up
o Protocol established
o Central helpdesk for facilitation and co-ordination
o Equipment break down also monitored by HD
• IT coordinators placed in each district
o All infrastructure issues related activities
o Application support and training
o Form e-core team in individual hospitals and solve IT issues
o Three Server Administrators for Server Management
3.Policy Initiatives
Issue of government orders for:•
•
•
•
Implementation, Sustainability & Usage
Fixing of responsibility on the end users
Budgetary provisions for maintenance & support
Removal of Manual records
• Creation of new posts at district level and state level to support ICT
interventions
• Instructions to the Heads of Departments and Directorates to use data
from HMIS for purpose of monitoring, review and analysis
• Instructions to dispense away with the system of manual reporting and
instructions to audit teams
• Formation of a dedicated team at the Directorate
• Establishing a centralized help desk at the directorate
4.Paradigm Shift
•
•
•
•
•
•
•
•
Automation of work flow process at the hospitals
Manual Registers/Records removed from hospitals
Real Time monitoring of hospitals performances
Electronic Medical records
Standardization of health systems and processes
Computer skill development among the hospital staff
Online maintenance of drug inventory/equipment inventory
No data entry operators-involvement of regular staff
Implementation overview
crores
Dec
2008
Pilot -5
hospitals
Nov
2009
Phase II – HMS in 222
secondary care hospitals
+
HMIS in 1613 PHC’s fully
online
Phase I – HMS in
36 hospitals
across 5 districts
July
2011
INR
2.8
INR
5
Crores
August
2010
INR
87 crores
INR
23
Crores
Phase III- 47 Institutions under
Directorate of Medical Education
including 17 Medical Colleges
+
Tamil Nadu Dr.MGR Medical
University
Users
• Primary Health Centers…….1589 centers
• Secondary Care Hospitals….267 hospitals
• Tertiary Care Medical College Hospitals..17 Medical colleges and a
Medical University
…………………………………………………………………………………..
• Doctors, Pharmacists, Nurses, Lab technicians, Hospital Workers
and other staff of hospitals & Administrators
HMIS
Two components
I. Hospital Management System- HMS
II. Management Information System-MIS
Automatic
Incorporation of
data at the
Institutional level
HMS
Clinical Information
MIS
HMS
Hospital Management System
 Registration
 Out patient
 Inpatient
 Medical Records
 Lab ,X-ray & other investigations
 Pharmacy
 Stores
 Blood Bank
 Diet
 Linen
 Module for online daily report generation-MRD
 Final diagnosis is mapped to ICD-10 classification
These module are regarded as patient management information system
MIS
Management Information System

Unified Health Reporting system





Clinical Information (auto populate+)
 Patient census, Morbidity,
Mortality,
 Patient services, Immunization,
etc
Ancillary Services
ISMR
 Blood Bank, Lab services, etc
Administrative Information
 Buildings, Finance, Personnel,
Vehicle, etc
Program Information
 Malaria, Blindness control, etc.
MIS
ISMR-(Institutional service monitoring report)
PIN
Consultation
with Doctor
Patient
Registration
Common
Disease list
Comprehensive List of
tests
No Data
Entry
Operators
Order
Investigations
Generate
Prescriptions
Diagnosis
Lab
OUT PATIENT DEPARTMENT WORKFLOW
Patient
History; Lab
results
Online
Current Status

Hospital Management System (HMS)
o

210 hospitals out of 267 secondary care hospitals on line
Health Management Information System (MIS)
o
PHC’s under Directorate of Public Health & Govt Hospitals under
Directorate of Medical and Rural Health Services- send monthly
reports online (1589 PHCs and 267 Secondary care hospitals)
Advantages
For the Patient
• Patient identification number (PIN)
• On next visit, patient can approach the consultant directly, need not wait in long queue
for registering again
• Print out of the prescription is given to the patient
• Old records not required on review-it is available on line
• The clinical records of the patient are safe for a longer period of time
• Patient can visit any secondary care hospital across TN with PIN
• The Patient identification Number (PIN) can be interfaced with UID
Advantages of HMS
For Doctors• Saves a lot of time
• Drugs/lab investigations can be grouped into packages and more often a package
may be prescribed.
• Can view the previous clinical history ports on line
• Specialty OP- Doctors with a single click, can repeat the previous prescription.
• In certain cases the doctor can follow the Standard treatment guidelines (master
data)
Advantages of HMS
For Staff Nurses
Saves a lot of time- need not maintain too many registers
Diet, drugs &linen -indenting can be done from wards
Ward inventory easy maintenance
Lab investigations results can be viewed from the ward
Discharge summary given to the patient as print outs
Handing over and taking over of charges, patients census- made accountable and
transparent
• Ward transfer in & out managed effectively
• Monitor and manage the blood bag availability
•
•
•
•
•
•
• Drug expiry dates –monitored on a real time basis.
Advantages of HMS
For Pharmacists
• Transparency and accountability in managing drugs, equipment stocks.
• Drug stocks are updated upon each drug issue.
• The pharmacist can monitor the expiry dates and the batch number of each drug.
• Need not count the tokens & consolidate them for stock position.
• The Warranty/AMC of equipments can be easily tracked.
Levers of success
1. Strong ownership and support from Top Health Administration
Communication to hospitals – by State authorities
2. Supporting Government orders
Mandating usage of Online system
3. End users trained to use system
No data entry support
4. Procurement Policy
TNMSC &ELCOT-as per norms
5. Implementation follow up by TNHSP
Regular stake holders meeting to discuss various issues and resolve the issues
6. Utilizing State Investments in establishing the Infrastructure
7.World Bank’s periodical monitoring and review helps to attain the benchmark
during implementation
Challenges in Implementation
 Mindset and Involvement of the hospital staff
 Change Management and Total system transformation
 Lack of co ordination among various vendors (no single vendor for IT infra)
 No senior IT consultant to co ordinate all IT activities. Only Medical Officers handle
 Connectivity and server stabilization still continues to be major challenges
 Man power shortage at the user-end.(HR of Directorate)
 Lack of basic computer knowledge - training on BCK, HMS & MIS
 Mapping existing process and rationalization of input forms for standardization
 Safe custody of hardware
Frequent break down calls and 24X7 helpdesk role in downtime reduction
Recognition
• Winner of the e- India jury award for “e- Health- best Government Initiative/policy
for the year 2009”
• Selected paper for Oral presentation at e-Asia 2009 International conference at
Colombo during Dec 2-4, 2009
• Selected paper for Oral presentation at Med-e-Tel 2010 International conference at
Luxembourg during April 14-16, 2010
• International Publishing houses -VDM International Publishers, Mauritius and
Lambert Academic of Publishing(LAP), Germany -have offered to publish HMIS
implementation in the form of a book
• Finalist CSI –Nihilent e-governance awards 2011-12
• National e-governance award-Gold 2011-12 under category ”exemplary reuse of
ICT based solutions”
Online usage statistics
up to March 2012
Module
No. Of Records
Registration
24146259
Lab
7826647
Pharmacy
10816475
Clinical
13505675
HMS Consolidated report for March 2012
Back-up at State Data Centre
In case of disaster we have:1.Tape back-up
2.NAS-Network array storage (cluster hard disc)
(Two NAS available –on site & off site)
3.Disaster Recovery site for TNSDC -proposed
------------------------------------------------------------------------------------------------STQC -Standardization Testing and Quality Certification ensures all
mandatory requirements for TNSDC
HIPS- Host intrusion prevention system is provided for the application
Current Reporting system
DPH/DM&RHS/NRHM/DME
S.No
1
Directorates
Project/Mission
Web Based
Application
Institution
Periodicity
Contents
NRHM
www.nrhm-mis.nic.in
www.tamilnadu.nhsrc
-hmis.org
District Monitoring
unit
Monthly,
quarterly and
Annually
NRHM report
(GOI)
Monthly
XML file from
tnhmis.org
ISMR, Form 9
and other
reports
(bridging between state to
central-encrypted data
transmission)
2
NRHM-TN
DPH
3
DPH
4
DM&RHS,DPH,
5
NRHM
www.tnhmis.org
PHC
www.picme.tn.nic.in,
www.mrmbs.tn.nic.in
PHC
www.tnhmis.org
www.nrhmmcts.nic.in
Monthly
Daily, Weekly MCH - MCR &
CCR
DETAILS,
Maternal
Benefit details
Secondary care
hospitals &PHCs
Daily
& Monthly
State NIC
Weekly
(transferring
data from
picme state
portal to
central portal)
OP, IP,Clinical
data
ISMR,
Service
delivery of
pregnant
women and
children
www.tnhmis.org
www.tnhmis.org
www.tamilnadu.nhsrc-hmis.org
www.nrhm-mis.nic.in
Mother and Child tracking system
(picme)
Pregnancy and Infant Cohort Monitoring and Evaluation (PICME)
•Started on 1st April 2008,sw developed by NIC
•To find the missing pregnancy outcome being reported by the VHN
•To reduce MMR and IMR
•Pregnant mother details from the date of AN Registration is captured in
PICME till the 1st birthday of the Infant by the VHN
•Till date, the system has captured details of more than 35 lakhs mothersc
•The pregnant mothers and infants are given a unique ID called “PICME Number”
•Using this number, the details of the pregnant mother and infant can be viewed
anywhere.
•Generate work plan for pregnant women and infants
• EMRI -108 Ambulance service has list of EDD mothers from the system
www.picme.tn.nic.in
Dr.Muthulakshmi Reddy
Maternity Benefit Scheme
•
Rs. 12,000/- is given in 3 installment as Maternity Benefit to Pregnant mothers delivering in Government Institutions on
conditional basis
•
This scheme is monitored online with certain conditions such as first two live births with BPL
For 1st Installment
Minimum 3 AN visits in Govt. institution, Early AN registration, Compulsory recording of BP ,Weight, Blood grouping
& typing ,Blood sugar, HIV testing and TT immunisation
•
Minimum one ultrasound scan
2nd Installment
–
Delivery at any Govt. institutions
3rd Installment
–
Should have received 2nd installment
–
Completion of 3rd dose of immunization within 6½months
1.
Duplicate Application given to mothers with the details of residence , Passport size Photo, Bank account
details
2.
Mothers has to fill up and submit it to PHC, to be entered online with PICME number.
3.
Money will be transferred from BMO account to beneficiary through e.transfer
Shows who logged in from
where
Disabled as these are not
the functions of this user
Fund Flow
• State Level Budget Allocation – Directorate
• District Level Budget Allocation - DDHS
• At Block Level - Block Medical officer claims from treasury &
deposited in BMOs account.
• Municipalities/Corporation - Commissioner account
• To all Beneficiaries thro’ Bank –Transfer of Funds
• More than Rs 320 Crores disbursed online
SHN Login
Entry of Application
into the system
Reviewing
eligible and
ineligible list
Verification by
SHN
Logout
Take decision
whether to
forward or not
Forwarding the
applications
Logout
PHC MO
Reviewing
applications verified
by SHN
CHN Login
Viewing the
applications
forwarded
Ascertain all PHCs
have forwarded
applications
Advise BMO to
generate
Proceedings
Logout
Submit the bill to
Treasury , receive
cheque
Generate ECS list
and submit to
bank for fund
transfer
Logout
BMO Login
Generate
proceedings
installment wise
State Health Data Resource Center
(SHDRC)
• Central repository of data for all tertiary, secondary and primary health
care facilities in the state (currently 17 verticals reporting health data)
• To utilise the data and convert them into information and knowledge to
improve the health outcomes in the state through performance, policy
evaluation and enhancement
Secondary Care Hospital
Out-Patient Registration
Clinical Out-Patient Department
Before Before
After
Before
Out Patient Slip
After
Pharmacy
Pharmacy
Before
Pharmacy Slip
After
Laboratory Entries
LAB Slip
Before
After