HMIS, the flagship of the Tamil Nadu Health System Project was implemented in a phased manner, started as Pilot (during the year 2008), followed by Phase- I (during the year 2009), Phase-II (during the year 2010) and finally Phase III (2011). Health Management Information System “HMIS” is a judicious combination of Information Technology (IT) and Management Systems, to deliver improved evidence based health care to the public at large. Health Management Information System also provides information based support for the implementation of cutting-edge reforms by the Tami Nadu Health Systems Project. Apart from Primary Health Centers and Secondary Care Hospitals, this project is envisaged to include all the Tertiary Care Hospitals including the Medical Colleges.

1. “Health Service through ICT”
Health Management Information System
Tamil Nadu Health Systems Project
Thiru.M.S.Shanmugam,I.A.S.
Project Director

2. Three Tier Health Care delivery in Tamil Nadu
Directorate of
Medical
Education
Directorate of
Medical & Rural
Health Services
Directorate of
Public Health &
Preventive
Medicine
Medical Colleges – 20
MC Hospitals – 45
Taluk – 160
Non-Taluk – 80
Tertiary
Care
Secondary Care
b HQ Hosp – 30
HSCs –
Total-270
8706
PHCs Ru
Urb
1754
135
Total-1889
Primary Care
Population 7.21 Crores

3. HUDs-42
32 Revenue districts &
42 Health unit districts

4. Health Management Information Systems (HMIS)
• III tier health care system in Tamilnadu state- Primary, Secondary &Tertiary care
• HMIS developed by Tamilnadu Health Systems Project for:-
(i) 270 Secondary care Hospitals
(ii) 20 Govt Medical Colleges & Hospitals,
(iii) 1889 Primary Health Centers
(iv) One Medical University
• Conceptualized to provide real time critical health data
• Rs.215 Crore project -funded by world bank
• IT infrastructure provided for Govt hospitals with centralized servers and TNSWAN
Connectivity for web based application
• Fifteen Thousand users and one lakh patients are cycled in the system daily
• On & off site data back up available
• No data entry operators-Medical and Paramedical staff handle user friendly screens

5. NRHM

6. 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.

7. Vital Statistics
Birth rate 15.9 (2011)
SRS
Death rate 7.6 (2011)
SRS
Infant mortality rate 22 (2011)
SRS
Maternal mortality ratio 72 (2011)
SRS
Total fertility rate 1.7
Population
7.21 Crores
(Census 2011)
Area 130,058 sq.kms.

8. IT Initiatives of Govt of Tamil Nadu
1.Hospital Information System (HMS)
2.Management Information System (MIS)
3.College Management Systems (CMS)
4.University Automation Systems (UAS)
( Software developed by TCS/TNHSP )
5.Pregnancy &Infant Cohort Monitoring and evaluation (PICME)
(Software developed by NIC)
6.Dr.Muthulakshmi Reddi Maternal Benefit Scheme (MRMBS)
(Software developed by NIC)
7.Chief minister Comprehensive Health Insurance Scheme (CMCHIS)
(Software developed by Health Sprint / UIIC)
8.State Health Data Resource Centre (SHDRC)
Central Repository for all 17 vertical departments under H &FW
(HMIS)
(Software developed by TNHSP)

9. Components of HMIS
It has got 4 Components
Clinical Components:
• HMS-Hospital Management System
• MIS-Management Information System
HMS
Automatic
Incorporation of
data at the
Institutional level
Clinical Information
Academic Components:
• CMS-College Management System
• UAS-University Automation System
MIS

10. 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

11. Project Strategy
1. ICT Initiatives
2. Policy Initiatives
3. Process Initiatives
4. Paradigm Shift

12. Application Software
• 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

13. 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

14. 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

15. 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

16. Implementation overview
Dec
2008
Pilot -5
hospitals
Nov
2009
Phase I – HMS in
36 hospitals
across 5 districts
Phase II – HMS in 222
secondary care hospitals
+
HMIS in 1889 PHCs fully
online
INR
3.06
Cr
INR
11.29
Cr
INR
87.85 Cr
Phase III- 47 Institutions under
Directorate of Medical Education
including 20 Medical Colleges
+
Tamil Nadu Dr.MGR Medical
University
INR
52.23
Cr
August
2010
July
2011
Software development
cost Rs:12.99 Cr
DITC:Rs: 4.57 Cr
Total Budget: Rs 172.15

17. 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
These modules are regarded as patient management information system

18. OP Registration

19. OP Consultation

20. Pharmacy

21. LABORATORY

22. Sense of Pride

23. 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, Filaria control,
Blindness Control, Tuberculosis
program, etc
MIS reports (public health information)are sent every month online to HQs

24. Advantages of HMS
• Patient identification number (PIN) –unique identity For Patients
• On next visit, need not wait in long queue for registering again
• 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
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• Saves a lot of time For Doctors
• Drugs/Lab investigations can be grouped into packages for prescription.
• 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)
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-Future plans to interphase PIN with AADHAR(UID)

25. • Drug stocks are updated upon each drug issue. For Pharmacists
• He 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.
• Transparency and accountability in managing drugs, equipment stocks.
----------------------------------------------------------------------------------------------------------------------
• Saves a lot of time- need not maintain too many registers For Nurses
• Diet, drugs & linen -indenting can be done from wards
• Ward inventory made easy, Drugs expiry dates monitored
• Lab investigations results can be viewed from the ward
• 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
Advantages of HMS

26. For Administrators
Advantages of HMS
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

27. 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

28. Online usage statistics

32. OP Ticket
Before After
PIN & Reg
detailsIN
Diagnosis
Findings
Lab report
Prescription
M.O Name

33. 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)-20 vendors
 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

34. Technical Constraints
• TNSWAN Connectivity
• Redundant VPNoBB Connectivity
• POP power issues
• Server Stabilization
• LAN within hospital
• UPS at POP & at hospital
• Recurrent IT infra issues

35. 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
Levers of success

36. 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”
• South Asia Manthan Jury Award for the year 2013
Dedicated to one and all using HMIS

37. Various Directorates of H&FW dept using HMIS
1.Directorate of Public Health
2.Directorate of Medical & Rural Health Service
3.Directorate of Medical Education &
4. National Rural Health Mission/TN
Once SHDRC is established HMIS will be extended to remaining directorates

38. Other IT Initiatives
1.Pregnancy &Infant Cohort Monitoring and evaluation (PICME)
(Software developed by NIC)
2.Dr.Muthulakshmi Reddi Maternal Benefit Scheme (MRMBS)
(Software developed by NIC)
3.Chief minister Comprehensive Health Insurance Scheme (CMCHIS)
(Software developed by s/w vendor identified by UIIC)
4.State Health Data Resource Center (SHDRC)
Central Repository for all 20vertical departments under H &FW

39. List of Directorates
S. No List of Directorates Reporting System
1 Directorate of Public Health and Preventive Medicine
(DPH)
HMIS
ICDS under DPH MANUAL
2 Directorate of Medical and Rural Health Services (DMS) HMIS
3 Directorate of Medical Education (DME) HMIS FROM 2014. AS OF NOW
MANUAL DATA.
4 Directorate of Family Welfare (DFW) HMIS
5 National Rural Health Mission (NRHM) HMIS
MOTHER AND CHILD
TRACKING SYSTEM (MCTS)
6 State Bureau of Health Intelligence (SBHI) HMIS
7 Tamil Nadu Medical Services Corporation (TNMSC) TNMSC APPLICATION
8 Tamil Nadu State AIDS Control Society (TANSACS) SIMS
9 Directorate of Indian Medicine MANUAL
10 Directorate of Drug Control MANUAL
Continued…..

40. 11 State Blindness Control Society MANUAL
12 Corporation of Chennai MIS
13 Municipal Administration MANUAL
14 RNTCP/State TB Cell EPICENTER
15 National Leprosy Eradication Program (NLEP) MANUAL
16 State Health Transport Corporation MANUAL
17 Dr.MGR Medical University MANUAL
18 Medical Recruitment Board OARS
19 Directorate of Food Safety MANUAL
20 Chief Ministers Comprehensive Health Insurance System
(CMCHIS) under TNHSP
CMCHIS APPLICATION
TNHSP HMIS
21 Private Sector Standard reporting module has
to be worked out.
Continued…..

41. State Health Data Resource Center
(SHDRC)-in progress
• Huge volume of Data collected through HMIS has to be analyzed, 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 20 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

42. New Initiatives
 State Health Data Resource Centre in collaboration with
ICMR
 State Health Communication Resource Centre
 State Health Research Resource Centre
 Outsourcing of hospital services in 79 hospitals
 Outsourcing of laboratory services in 7 major hospitals

43. Thank you
43