TN e-Health
as a
Healing Hand
to
Patients
1
Dr.P. SunilGavaskar M.B., B.S., D.A.,
Medical Officer–HealthManagement Informa...
Three Tier Health Care delivery
in Tamil Nadu
2
32 Revenue districts &
42 Health unit districts
3
Health Management Information Systems
(HMIS)
 HMIS developed by Tamil Nadu Health Systems Projectfor:-
 267 secondary ca...
Project Strategy
 ProjectRationale
 PolicyInitiatives
 ProcessInitiatives
 Paradigm Shift
5
HMIS – Project Rationale
 Noreal time data available to monitor the performanceof the hospital
 Evidence based program m...
HMIS - Policy Initiatives
 Issue of governmentordersfor:-
 Implementation, Sustainability & Usage
 Fixingofresponsibili...
HMIS - Process Initiatives
 For Softwarerequirement specifications(SRS)thoroughstudy of the entire healthsystem andits pr...
HMIS - Paradigm Shift
 Automation ofwork flow process at the hospitals
 Manual Registers/Records arepartly removedfromho...
Implementation overview
Pilot -5
hospitals
PhaseI –HMS in
36hospitals across
5districts
Phase II – HMS in 222 secondary ca...
Two Components of HMIS
Hospital Management System- (HMS) &
Management Information System-(MIS)
HMS MISClinical Informati...
Hospital Management System (HMS)
Modules
 Registration
 Out patient consultation
 Inpatient admission
 Lab ,X-ray & ot...
Advantages of HMS
ForPatients
 Unique Patient identification number (PIN)
 Onnextvisit, noregistration queue
 Prescript...
Advantages of HMS
ForPharmacist
 Drugstocksare updateduponeachdrug
issue
 Hecanmonitorexpirydates and batch
numberof eac...
Advantages of HMS
ForAdministrators
 This predominantly functions as decision support system
 Hospital level-forChief Me...
Registration Screen
16
Treatment Kit
Lab Test
Medication
Diagnosis
Kit name
17
Standard Treatment Guidelines
18
Stock View Screen
19
Injection OP Screen
20
Lab result Screen
21
Online Usage Statistics
up to Aug, 2013
22
Online Usage Statistics
for Aug, 2013
23
OP Registration
24
OP Consultation
25
Pharmacy
26
Laboratory
27
The Ultimate Goal
28
OP TicketBefore After
PIN&Reg.
details
Diagnosis
Findings
Lab Report
Prescription
M.O. Name
29
HMS - TNMSC Online Indent
 It facilitates the drugsupply management system
 Theindent raised by the hospital chief pharm...
HMS - TNMSC Online Indent Screen for
Warehouse
31
Online Indents view in Warehouse
32
Online Indents view in Warehouse
33
Management Information System (MIS)
Modules
 Unified Health Reporting system
 Clinical Information(autopopulate+)
 Pati...
MIS – Data Entry Form
35
MIS Report
36
MIS – Personal Module
 All details in SR will be digitised (DPH SR updation is complete &their personal module is live)
...
MIS – Personal Module
38
Forms in Personal Module of MIS
39
Employee Detail Entry Page
40
Sample SR Entries
41
Sample SR Reports
42
Mini SR Report
43
Sample Proceeding generated through MIS
44
HMIS (HMS/MIS) Application Software
 GoTN ownerof the application
 Developedby Tata Consultancy Services
 Centralized w...
HMIS Server Architecture (Current)
Web
Servers
App Servers
DatabaseServer
Backup Server
Report Server
NAS
Tape Library
46
Connectivity
Primary – TNSWAN
 PointofPresence(POP) –District& Taluk
 2Mbps
 CertainlocationsTalukPOPsare bypassedtoim...
Hurdles – But Still Running
 Lack ofcoordination among variousvendors (no single vendorfor IT infra)
 Mapping existing p...
Levers of success
 Strongownership and support fromTop HealthAdministration
 Communication to hospitals –byState authori...
Various Directorates of H&FW Dept.
using HMIS
DirectorateofPublic Health
DirectorateofMedical &RuralHealth Service
Dire...
State Health Data Resource Centre
(SHDRC)-in progress
 Hugevolume of Data collected through HMIS has to be analysed, henc...
SHDRC: Goals
 Purpose DrivenData Monitoring
for EvidenceBased Decisions
PreventiveAction
CorrectiveAction
Epidemic Respon...
Future Plans
HMS
 Linking PIN to Adhaar (UID) Card
 Integrating HMS &TNMSC for fully automated online indent system
 I...
Recognition
 Winner of the e- India jury award for “e- Health- best Government Initiative/policy for the year2009”
 Sele...
Other IT Initiatives of TN
 HealthManagementInformationSystem(HMIS)
 Hospital Management System (HMS)
 Management Infor...
Websites of TN e-Health Projects
ApplicationSoftware Website
HMS www.tnhmis.org/tnhsphms/
MIS www.tnhmis.org/hmis/
TNMSC O...
Lives are precious, Handle them with (e-)care
Thank You
57
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TN e-Health as a Healing Hand to Patients

  1. 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. 2. Three Tier Health Care delivery in Tamil Nadu 2
  3. 3. 32 Revenue districts & 42 Health unit districts 3
  4. 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. 5. Project Strategy  ProjectRationale  PolicyInitiatives  ProcessInitiatives  Paradigm Shift 5
  6. 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. 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. 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. 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. 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. 11. Two Components of HMIS Hospital Management System- (HMS) & Management Information System-(MIS) HMS MISClinical Information Automatic Incorporationofdata at theInstitutionallevel 11
  12. 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. 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. 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. 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. 16. Registration Screen 16
  17. 17. Treatment Kit Lab Test Medication Diagnosis Kit name 17
  18. 18. Standard Treatment Guidelines 18
  19. 19. Stock View Screen 19
  20. 20. Injection OP Screen 20
  21. 21. Lab result Screen 21
  22. 22. Online Usage Statistics up to Aug, 2013 22
  23. 23. Online Usage Statistics for Aug, 2013 23
  24. 24. OP Registration 24
  25. 25. OP Consultation 25
  26. 26. Pharmacy 26
  27. 27. Laboratory 27
  28. 28. The Ultimate Goal 28
  29. 29. OP TicketBefore After PIN&Reg. details Diagnosis Findings Lab Report Prescription M.O. Name 29
  30. 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. 31. HMS - TNMSC Online Indent Screen for Warehouse 31
  32. 32. Online Indents view in Warehouse 32
  33. 33. Online Indents view in Warehouse 33
  34. 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. 35. MIS – Data Entry Form 35
  36. 36. MIS Report 36
  37. 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. 38. MIS – Personal Module 38
  39. 39. Forms in Personal Module of MIS 39
  40. 40. Employee Detail Entry Page 40
  41. 41. Sample SR Entries 41
  42. 42. Sample SR Reports 42
  43. 43. Mini SR Report 43
  44. 44. Sample Proceeding generated through MIS 44
  45. 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. 46. HMIS Server Architecture (Current) Web Servers App Servers DatabaseServer Backup Server Report Server NAS Tape Library 46
  47. 47. Connectivity Primary – TNSWAN  PointofPresence(POP) –District& Taluk  2Mbps  CertainlocationsTalukPOPsare bypassedtoimproveconnectivity Redundant– VPNoBB  Initially512kbps  Asper theloadofthehospitalsenhancedto1or2Mbps 47
  48. 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. 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. 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. 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. 52. SHDRC: Goals  Purpose DrivenData Monitoring for EvidenceBased Decisions PreventiveAction CorrectiveAction Epidemic Response ResourcePlanning PerformanceManagement PolicyAnalysis HealthSystemResearch 52
  53. 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. 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. 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. 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. 57. Lives are precious, Handle them with (e-)care Thank You 57
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