TN e-Health as a Healing Hand to Patients
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TN e-Health as a Healing Hand to Patients Presentation Transcript

  • 1. TN e-Health as a Healing Hand to Patients 1 Dr.P. SunilGavaskar M.B., B.S., D.A., Medical Officer–HealthManagement InformationSystem Tamil Nadu Health System Project
  • 2. Three Tier Health Care delivery in Tamil Nadu 2
  • 3. 32 Revenue districts & 42 Health unit districts 3
  • 4. Health Management Information Systems (HMIS)  HMIS developed by Tamil Nadu Health Systems Projectfor:-  267 secondary carehospitals  20Medical College (MISalongwith CMS –college managementsystem) & 49hospitals  1614PrimaryHealthCentres  OneMedical University (UAS – University Automation System)  Conceptualized to provide real time critical health data  126 Croresproject funded by world bank (reimbursementloan)  IT infrastructure provided for Govt. hospitals with centralized serversand TNSWAN Connectivity forweb based application  Tenthousand users and one lac patients arecycledin the system daily 4
  • 5. Project Strategy  ProjectRationale  PolicyInitiatives  ProcessInitiatives  Paradigm Shift 5
  • 6. HMIS – Project Rationale  Noreal time data available to monitor the performanceof the hospital  Evidence based program management was a challenge  Unduedelays in receiptof data  Retrievalof old manual records was ineffective &time consuming.  Drug& equipment inventory - maintenance and tracking of warranty/AMC-more cumbersome  Lack of standard names and codes 6
  • 7. HMIS - Policy Initiatives  Issue of governmentordersfor:-  Implementation, Sustainability & Usage  Fixingofresponsibilityon the end users  Budgetaryprovisionsfor maintenance& support  RemovalofManualrecords  Instructions to the Heads ofDepartmentsandDirectoratesto use datafromHMIS forpurpose of monitoring, review andanalysis  Instructions to dispense awaywith the system ofmanual reporting and instructions toaudit teams  Formationof a dedicatedteamat the Directorate  Establishing a centralizedhelp desk atthe directorate 7
  • 8. HMIS - Process Initiatives  For Softwarerequirement specifications(SRS)thoroughstudy of the entire healthsystem andits process were studied  Extensivetrainingsessions were conducted for various categories  Stakeholdersmeetings  Weeklyreviews & Follow up action taken  Helpdesk set up  Protocol established -Escalation matrix followed  Central helpdesk forfacilitation and co-ordination  IT coordinators placedineachdistrict  All infrastructureissuesrelatedactivities  Application support andtraining  Forme-core teamin individual hospitals andsolve IT issues  ThreeServerAdministratorsfor ServerManagement 8
  • 9. HMIS - Paradigm Shift  Automation ofwork flow process at the hospitals  Manual Registers/Records arepartly removedfromhospitals  Real Time monitoring of hospitals performances  Electronic Medical records  Standardization ofhealth systems and processes  Computer skill development among the hospital staff  Online maintenance of drug inventory/equipment inventory  Nodata entry operators-involvement of regular staff 9
  • 10. Implementation overview Pilot -5 hospitals PhaseI –HMS in 36hospitals across 5districts Phase II – HMS in 222 secondary care hospitals + HMISin 1613 PHCs fully online PhaseIII- 49 Institutionsunder DirectorateofMedical Education including20 Medical Colleges + TNDr. MGR Medical University INR8Crores INR2.8Crores INR87 Crores INR45 Crores Dec, 2008 Nov, 2009 Aug, 2011 2013 Software development cost9.69 crores 10
  • 11. Two Components of HMIS Hospital Management System- (HMS) & Management Information System-(MIS) HMS MISClinical Information Automatic Incorporationofdata at theInstitutionallevel 11
  • 12. 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 reportgeneration  Final diagnosis mapped to ICD-10 classification  Medical Recordsdepartment TheModulesare uniqueforthetype ofusers Thesemodules areregardedas patient management information system 12
  • 13. Advantages of HMS ForPatients  Unique Patient identification number (PIN)  Onnextvisit, noregistration queue  Prescription & Lab reports printouts aregiven to the patient  Oldrecords available online -safe for a longerperiod of time  Patient can visit any secondary carehospital acrossTN with PIN and he recordis readily available forreview ForDoctors  Savesa 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 doctorcan follow Standard treatment guidelines (Master data) 13
  • 14. Advantages of HMS ForPharmacist  Drugstocksare updateduponeachdrug issue  Hecanmonitorexpirydates and batch numberof eachdrug.  The Warranty/AMC of equipment canbe easily tracked.  Transparencyand accountability in managing drugs,equipment stocks.  InterfacewithTNMSC software for online indenting.  Hospital canview the stock position of the warehouse& vice versa ForNurses  Savesa lot of time- neednotmaintain toomany registers  Diet, drugs &linen -indenting can bedone fromwards  Wardinventory made easy, Drugs expiry dates monitored  Discharge summary given to the patient as print outs  Wardtransfer in & out managed effectively  Helps to monitor and manage the blood bag availability precisely  Handing overand taking overof charges, patients census- made accountable and transparent 14
  • 15. Advantages of HMS ForAdministrators  This predominantly functions as decision support system  Hospital level-forChief Medical Officers  Districtlevel-forJoint Directorsof the districts  Statelevel- forHODs/Directors 15
  • 16. Registration Screen 16
  • 17. Treatment Kit Lab Test Medication Diagnosis Kit name 17
  • 18. Standard Treatment Guidelines 18
  • 19. Stock View Screen 19
  • 20. Injection OP Screen 20
  • 21. Lab result Screen 21
  • 22. Online Usage Statistics up to Aug, 2013 22
  • 23. Online Usage Statistics for Aug, 2013 23
  • 24. OP Registration 24
  • 25. OP Consultation 25
  • 26. Pharmacy 26
  • 27. Laboratory 27
  • 28. The Ultimate Goal 28
  • 29. OP TicketBefore After PIN&Reg. details Diagnosis Findings Lab Report Prescription M.O. Name 29
  • 30. HMS - TNMSC Online Indent  It facilitates the drugsupply management system  Theindent raised by the hospital chief pharmacist, after online approval by the CMO, will bevisible in theHMS - TNMSC Online indent screenfor warehouse.  TheWarehouse Pharmacist will down load the indent file & upload the same in TNMSC warehouse application software.  Afterthe warehouse processthe indent the Outward Goods Register (OGR)file will be downloaded fromthe TNMSC software and uploaded in the HMS - TNMSC online indent software.  ThePharmacist has to Physically verifythe quantity in OGR and supplied quantity and accept the indent.  TheBatch number &Expiry date of drugs will be auto-updated as enteredin the OGRgenerated from theTNMSC software –avoids time consuming indented drugdetails in the software.  In future both the software areplanned to be integrated so that the indents fromhospitals through HMScandirectly flow in & out of TNMSC software 30
  • 31. HMS - TNMSC Online Indent Screen for Warehouse 31
  • 32. Online Indents view in Warehouse 32
  • 33. Online Indents view in Warehouse 33
  • 34. Management Information System (MIS) Modules  Unified Health Reporting system  Clinical Information(autopopulate+)  Patientcensus, Morbidity, Mortality,  Patientservices,Immunization,  AncillaryServices  ISMR-Institutional Servicesmonitoring & report  Blood Bank,Labservices,etc.  AdministrativeInformation  Buildings, Finance, Personnel, Vehicle, etc.  ProgramInformation  All the National programs like Malariacontrol, Filaria control,Blindness Control, Tuberculosis program, etc. MIS reports (public health information)are sent every month online toHQs 34
  • 35. MIS – Data Entry Form 35
  • 36. MIS Report 36
  • 37. 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 developerafter getting the details from respectiveDirectorate in Excel format.  When the modules aremade live individual hospital has to update their staff details daily on a regularbasis  SRentry to be made online.  Most of the proceedings will be generatedfrom the MIS-Personal module  Therespectivedirectorate will havethe vacancyposition online and can be used forappointments /transfer counselling. 37
  • 38. MIS – Personal Module 38
  • 39. Forms in Personal Module of MIS 39
  • 40. Employee Detail Entry Page 40
  • 41. Sample SR Entries 41
  • 42. Sample SR Reports 42
  • 43. Mini SR Report 43
  • 44. Sample Proceeding generated through MIS 44
  • 45. HMIS (HMS/MIS) Application Software  GoTN ownerof the application  Developedby Tata Consultancy Services  Centralized web based application on open sourceplatform  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 andData layer)  SUSELinux OSat the end user level-user friendly screens 45
  • 46. HMIS Server Architecture (Current) Web Servers App Servers DatabaseServer Backup Server Report Server NAS Tape Library 46
  • 47. Connectivity Primary – TNSWAN  PointofPresence(POP) –District& Taluk  2Mbps  CertainlocationsTalukPOPsare bypassedtoimproveconnectivity Redundant– VPNoBB  Initially512kbps  Asper theloadofthehospitalsenhancedto1or2Mbps 47
  • 48. Hurdles – But Still Running  Lack ofcoordination among variousvendors (no single vendorfor IT infra)  Mapping existing processand rationalization of input forms for standardization  Damage caused by local factors –Construction , Drainage work etc.  Powercrisis and poor backup fromUPS  Mind-set and Involvement of the hospital staff  Change Management and Total system transformation  Disruptionof connectivity  Delay in serverstabilisation  Lack of basic computer knowledge  Safecustody of HMIS supplies (hardware) 48
  • 49. Levers of success  Strongownership and support fromTop HealthAdministration  Communication to hospitals –byState authorities  Supporting Governmentorders  Mandating usage ofOnline system  End userstrained to use system  Nodataentrysupport  ProcurementPolicy  TNMSC&ELCOT-aspernorms  Implementation follow up by TNHSP  Regularstakeholders meeting todiscuss various issuesand resolve the issues  Utilizing State Investments in establishing the Infrastructure  World Bank’speriodical monitoringandreview helps to attainthe benchmarkduring implementation 49
  • 50. Various Directorates of H&FW Dept. using HMIS DirectorateofPublic Health DirectorateofMedical &RuralHealth Service DirectorateofMedical Education& NationalRuralHealth Mission/TN OnceSHDRCis established HMISwill be extendedto remainingdirectorates 50
  • 51. State Health Data Resource Centre (SHDRC)-in progress  Hugevolume of Data collected through HMIS has to be analysed, henceSHDRC proposed.  It will act as a central repository of data forall tertiary, secondary and primary health care facilities in the state (currently17 verticals reporting health data)  Toutilise the data and convertthem into information and knowledge to improvethe health outcomes in the state through performance,policy evaluation and enhancement  Contribution fromICMR /NRHM/ WB apart fromState Govt. funds 51
  • 52. SHDRC: Goals  Purpose DrivenData Monitoring for EvidenceBased Decisions PreventiveAction CorrectiveAction Epidemic Response ResourcePlanning PerformanceManagement PolicyAnalysis HealthSystemResearch 52
  • 53. 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 forcomprehensivehealth data analysis in SHDRC  Appointment system forspeciality investigations like CT-Scan, MRI-Scan, Angiography etc. 53
  • 54. Recognition  Winner of the e- India jury award for “e- Health- best Government Initiative/policy for the year2009”  Selectedpaperfor Oralpresentation at e-Asia 2009 International conferenceat Colombo during Dec 2-4, 2009  Selectedpaperfor Oralpresentation at Med-e-Tel 2010 International conferenceat 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 formof a book  Finalist CSI –Nihilent e-governanceawards 2011-12  National e-Governance award-Gold 2011-12 under category”exemplary reuseof ICT based solutions” 54
  • 55. Other IT Initiatives of TN  HealthManagementInformationSystem(HMIS)  Hospital Management System (HMS)  Management Information System(MIS) (Softwaredeveloped byTCS)  College ManagementSystem(CMS) (SoftwaredevelopedbyTCS)  Pregnancy&InfantCohortMonitoringand Evaluation (PICME/ MCTS) (Softwaredevelopedby NIC)  Dr.MuthulakshmiReddy MaternalBenefitScheme(MRMBS) (Softwaredevelopedby NIC)  ChiefMinisterComprehensiveHealthInsuranceScheme(CMCHIS) (Softwaredevelopedby s/w vendor identifiedbyUIIC)  StateHealthDataResourceCentre(SHDRC)  Central Repositoryforall 17 vertical departments underH &FW 55
  • 56. Websites of TN e-Health Projects ApplicationSoftware Website HMS www.tnhmis.org/tnhsphms/ MIS www.tnhmis.org/hmis/ TNMSC OnlineIndent (Warehouse) www.tnhmis.org/tnmsc CMS www.tnhmis.com/tnmgrmucms_v3 College Website Websiteregistrationinprogress NRHM www.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 56
  • 57. Lives are precious, Handle them with (e-)care Thank You 57