TN e-Healthas a

Healing Hand to

Patients

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Dr. P. Sunil Gavaskar M.B., B.S., D.A.,Medical Officer – Health Management Information System

Tamil Nadu Health System Project

Three Tier Health Care delivery in Tamil Nadu

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32 Revenue districts &42 Health unit districts

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Health Management Information Systems (HMIS)

HMIS developed by Tamil Nadu Health Systems Project for:-

267 secondary care hospitals

20 Medical College (MIS along with CMS –college management system) & 49 hospitals

1614 Primary Health Centres

One Medical University (UAS – University Automation System)

Conceptualized to provide real time critical health data

126 Crores project funded by world bank (reimbursement loan)

IT infrastructure provided for Govt. hospitals with centralized servers and TNSWAN Connectivity for web based application

Ten thousand users and one lac patients are cycled in the system daily

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Project Strategy

Project Rationale

Policy Initiatives

Process Initiatives

Paradigm Shift

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HMIS – 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.

Drug & equipment inventory - maintenance and tracking of warranty/AMC-more cumbersome

Lack of standard names and codes

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HMIS - 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

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

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HMIS - 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 Weekly reviews & Follow up action taken

Help desk set up Protocol established - Escalation matrix followed

Central helpdesk for facilitation and co-ordination

IT coordinators placed in each district All infrastructure issues related activities

Application support and training

Form e-core team in individual hospitals and solve IT issues

Three Server Administrators for Server Management

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HMIS - Paradigm Shift Automation of work flow process at the hospitals

Manual Registers/Records are partly 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

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Implementation overview

Pilot -5 hospitals

Phase I – HMS in 36 hospitals across

5 districts

Phase II – HMS in 222 secondary care hospitals

+HMIS in 1613 PHCs fully online

Phase III- 49 Institutions under Directorate of Medical Education

including 20 Medical Colleges +

TN Dr. MGR Medical University

INR 8 Crores

INR 2.8 Crores

INR 87 Crores

INR 45 Crores

Dec, 2008

Nov, 2009

Aug, 2011

2013

Software development cost 9.69 crores

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Two Components of HMISHospital Management System- (HMS) &

Management Information System-(MIS)

HMS MISClinical Information

Automatic Incorporation of data at the Institutional level

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Hospital Management System (HMS) Modules

Registration

Out patient consultation

Inpatient admission

Lab ,X-ray & other investigations

Pharmacy & Main stores

Biomedical Waste Management

Blood Bank

Diet

Linen

Online daily report generation

Final diagnosis mapped to ICD-10 classification

Medical Records department

The Modules are unique for the type of usersThese modules are regarded as patient management information system

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Advantages of HMSFor Patients

Unique Patient identification number (PIN)

On next visit, no registration queue

Prescription & Lab reports printouts are given to the patient

Old records available on line -safe for a longer period of time

Patient can visit any secondary care hospital across TN with PIN and he record is readily available for review

For Doctors

Saves a lot of time

Drugs/Lab investigations can be grouped into packages (Treatment Kits) for prescription.

Can view previous clinical reports on line

Repetition of previous prescription with a single click – useful in Chronic diseases

In certain cases doctor can follow Standard treatment guidelines (Master data)

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Advantages of HMSFor Pharmacist

Drug stocks are updated upon each drug issue

He can monitor expiry dates and batch number of each drug.

The Warranty / AMC of equipment can be easily tracked.

Transparency and accountability in managing drugs, equipment stocks.

Interface with TNMSC software for online indenting.

Hospital can view the stock position of the warehouse & vice versa

For Nurses

Saves a lot of time- need not maintain too many registers

Diet, drugs & linen -indenting can be done from wards

Ward inventory made easy, Drugs expiry dates monitored

Discharge summary given to the patient as print outs

Ward transfer in & out managed effectively

Helps to monitor and manage the blood bag availability precisely

Handing over and taking over of charges, patients census- made accountable and transparent

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Advantages of HMSFor Administrators

This predominantly functions as decision support system

Hospital level-for Chief Medical Officers

District level-for Joint Directors of the districts

State level- for HODs/Directors

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Registration Screen16

Treatment Kit

Lab Test

Medication

Diagnosis

Kit name

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Standard Treatment Guidelines18

Stock View Screen 19

Injection OP Screen20

Lab result Screen 21

Online Usage Statisticsup to Aug, 2013

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Online Usage Statisticsfor Aug, 2013

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OP Registration24

OP Consultation25

Pharmacy26

Laboratory27

The Ultimate Goal28

OP TicketBefore After

PIN & Reg. details

Diagnosis

Findings

Lab Report

Prescription

M.O. Name

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HMS - TNMSC Online Indent It facilitates the drug supply management system

The indent raised by the hospital chief pharmacist, after online approval by the CMO, will be visible in the HMS - TNMSC Online indent screen for warehouse.

The Warehouse Pharmacist will down load the indent file & upload the same in TNMSC warehouse application software.

After the warehouse process the indent the Outward Goods Register (OGR) file will be downloaded from the TNMSC software and uploaded in the HMS - TNMSC online indent software.

The Pharmacist has to Physically verify the quantity in OGR and supplied quantity and accept the indent.

The Batch number & Expiry date of drugs will be auto-updated as entered in the OGR generated from the TNMSC software – avoids time consuming indented drug details in the software.

In future both the software are planned to be integrated so that the indents from hospitals through HMS can directly flow in & out of TNMSC software

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HMS - TNMSC Online Indent Screen for Warehouse

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Online Indents view in Warehouse32

Online Indents view in Warehouse33

Management Information System (MIS) Modules

Unified Health Reporting system

Clinical Information (auto populate+)

Patient census, Morbidity, Mortality,

Patient services, Immunization,

Ancillary Services

ISMR-Institutional Services monitoring & report

Blood Bank, Lab services, etc.

Administrative Information

Buildings, Finance, Personnel, Vehicle, etc.

Program Information

All the National programs like Malaria control, Filariacontrol, Blindness Control, Tuberculosis program, etc.

MIS reports (public health information)are sent every month online to HQs

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MIS – Data Entry Form35

MIS Report36

MIS – Personal Module

All details in SR will be digitised (DPH SR updation is complete & their personal module is live)

Updation of old data will be done by the application developer after getting the details from respective Directorate in Excel format.

When the modules are made live individual hospital has to update their staff details daily on a regular basis

SR entry to be made online.

Most of the proceedings will be generated from the MIS-Personal module

The respective directorate will have the vacancy position online and can be used for appointments / transfer counselling.

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MIS – Personal Module38

Forms in Personal Module of MIS39

Employee Detail Entry Page

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Sample SR Entries41

Sample SR Reports42

Mini SR Report43

Sample Proceeding generated through MIS

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HMIS (HMS/MIS) Application Software GoTN owner of the application

Developed by Tata Consultancy Services

Centralized web based application on open source platform

J2EE (Java 2 enterprise edition)

PostgreSQL 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

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HMIS Server Architecture (Current)

Web Servers

App Servers

Database Server

Backup Server

Report Server

NAS

Tape Library

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Connectivity

Primary – TNSWAN

Point of Presence (POP) – District & Taluk

2 Mbps

Certain locations Taluk POPs are bypassed to improve connectivity

Redundant – VPNoBB

Initially 512 kbps

As per the load of the hospitals enhanced to 1 or 2 Mbps

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Hurdles – But Still Running Lack of co ordination among various vendors (no single vendor for IT infra)

Mapping existing process and rationalization of input forms for standardization

Damage caused by local factors – Construction , Drainage work etc.

Power crisis and poor backup from UPS

Mind-set and Involvement of the hospital staff

Change Management and Total system transformation

Disruption of connectivity

Delay in server stabilisation

Lack of basic computer knowledge

Safe custody of HMIS supplies (hardware)

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Levers of success Strong ownership and support from Top Health Administration

Communication to hospitals – by State authorities

Supporting Government orders Mandating usage of Online system

End users trained to use system No data entry support

Procurement Policy TNMSC &ELCOT-as per norms

Implementation follow up by TNHSP Regular stake holders meeting to discuss various issues and resolve the issues

Utilizing State Investments in establishing the Infrastructure World Bank’s periodical monitoring and review helps to attain the benchmark during

implementation

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Various Directorates of H&FW Dept. using HMIS

Directorate of Public Health

Directorate of Medical & Rural Health Service

Directorate of Medical Education &

National Rural Health Mission/TN

Once SHDRC is established HMIS will be extended to remaining directorates

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State Health Data Resource Centre(SHDRC)-in progress

Huge volume of Data collected through HMIS has to be analysed, hence SHDRC proposed.

It will act as a 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

Contribution from ICMR / NRHM / WB apart from State Govt. funds

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SHDRC: Goals

Purpose Driven Data Monitoring for Evidence Based Decisions

Preventive Action

Corrective Action

Epidemic Response

Resource Planning

Performance Management

Policy Analysis

Health System Research

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Future Plans

HMS

Linking PIN to Adhaar (UID) Card

Integrating HMS & TNMSC for fully automated online indent system

Incorporating Picture Archiving & Communication System (PACS) in HMS

Collection of Private Medical institution’s clinical data through MIS for comprehensive health

data analysis in SHDRC

Appointment system for speciality investigations like CT-Scan, MRI-Scan, Angiography etc.

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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”

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Other IT Initiatives of TN Health Management Information System (HMIS)

Hospital Management System (HMS) Management Information System (MIS)

(Software developed by TCS)

College Management System (CMS)(Software developed by TCS)

Pregnancy &Infant Cohort Monitoring and Evaluation (PICME / MCTS)(Software developed by NIC)

Dr. Muthulakshmi Reddy Maternal Benefit Scheme (MRMBS)(Software developed by NIC)

Chief Minister Comprehensive Health Insurance Scheme (CMCHIS)(Software developed by s/w vendor identified by UIIC)

State Health Data Resource Centre (SHDRC) Central Repository for all 17 vertical departments under H &FW

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Websites of TN e-Health ProjectsApplication Software Website

HMS www.tnhmis.org/tnhsphms/

MIS www.tnhmis.org/hmis/

TNMSC Online Indent (Warehouse) www.tnhmis.org/tnmsc

CMS www.tnhmis.com/tnmgrmucms_v3

College Website Website registration in progress

NRHMwww.nrhm-mis.nic.in

www.tamilnadu.nhsrc-hmis.org

PICME www.picme.tn.nic.in

MRMBS www.mrmbs.tn.nic.in

CMCHIS www.cmchistn.com/

SHDRC In Progress

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Lives are precious, Handle them with (e-)care

Thank You

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