AMRITA SCHOOL OF DENTISTRY

1. HEALTH
INFORMATION
SYSTEMS IN
INDIA
Seminar no:10

2. CONTENTS
• Introduction
• Organisation of healthcare administration
• Role of National Health Mission
• Role of National Health Authority
• Digital India
• Health Management Information Systems (HMIS)
• Ayushman Bharath Digital Mission (ABDM)
• Ayushman Bharat Health Account (ABHA)
• Conclusion
• References
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3. INTRODUCTION
• Electronic Medical Records (EMR) or Electronic Health Records (EHR) is an
effective application of Information and Communication Technology (ICT) that
can be used to improve delivery and extend the reach of health services in
India.
• Electronic Health Record (EHR) is defined by the International Organization
for Standardization (ISO) as “a repository of information regarding the
health status of a subject of care, in computer processable form”.
• EMR/EHR systems offer clear advantages over Traditional Paper Based
System (TPBS) of medical records and can help provide continuity of care
(CoC).
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4. ELECTRONIC HEALTH RECORD (EHR)
STANDARDS FOR INDIA- 2016
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5. A Health Information System (HIS) is a process whereby health data (input) are recorded, stored, retrieved and
processed for decision-making (output).
HEALTH INFORMATION SYSTEMS
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Data Sources Of Health Information Systems

6. ORGANIZATION OF HEALTH CARE ADMINISTRATION INTHE COUNTRY
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8. • National Health Mission (NHM) is a flagship Programme of the Government of India to address the health needs of
under-served rural areas and health concerns of the urban poor population.
• The mission is on establishing a fully functional, community owned, decentralized, rigorous monitoring &
evaluation against standards, improving health delivery system by innovations, flexible financing and interventions
with inter-sectoral convergence at all levels.
Role of National Health Mission (NHM)
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9. • NHM has two sub missions under it. National Rural Health Mission (NRHM) launched on 5 April 2005 and the
National Urban Health Mission (NUHM), launched in 2013.
• To monitor the performance and quality of the health services being provided under the NHM, the Ministry of
Health & Family Welfare has been committed to strengthen the monitoring and evaluation systems, through
Performance, Monitoring, Conducting adhoc surveys, supportive supervision, quality assurance, etc.
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10. • The emphasis of NHM is on establishing a fully functional, community
owned, decentralized health delivery system.
• This e-booklet is an effort to consolidate and present an ecosystem of
various IT initiatives under the scope of NHM.
• The e-Booklet is expected to be a useful repository consisting of key
information of ICT interventions and act as a ready reference
compendium for all the stakeholders.
• The information/data contained herein is made available and verified by
respective programme divisions of Ministry of Health and Family
Welfare. ePMU Consultant (Deloitte Touche Tohmatsu India LLP) has
assisted MoHFW in compilation of data and preparation of this e-
Booklet. Draft Booklet
Version 1.0, December 2020
IT INITIATIVESOF NATIONAL HEALTH MISSION
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11. IT Initiatives under NHM:
1. ANM-Online (ANMOL)
2. Comprehensive Primary Health Care - NCD
application
3. Drug & Vaccine Distribution Management System
4. Electronic Vaccine Intelligence Network
5. e-RaktKosh
6. Health and Wellness Centre
7. Health Management Information System
8. Integrated Disease Surveillance Program
9. Kala-azar Management Information System
10. Mera Aspataal
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12. 11. National Cold Chain Management
Information System (NCCMIS)
12. National Identification Number to Health
Facility of India
13. National Injury Surveillance Centre
14. National Programme for Control of Blindness
& Visual Impairment
15. National Viral Hepatitis Control Program
16. Nikshay
17. Nikshay Aushadhi
18. Rashtriya Bal Swasthya Karyakram
19. Reproductive & Child Health
20. Strategic Information Management System 12

13. 21. Web Based Malaria Management Information System
22. NACO AIDS APP
23. m-Diabetes
This e-booklet contains objectives, user details,
training and data entry, technology and hosting , roll
out status, mobile app and dashboard, mode of
application development, key information (major data
elements, major KPIs and major reports, major
masters, data integration received, and data
integration shared) and contact details of program
division.
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• NHA is governed by a Governing Board chaired by the Union Minister for Health
and FamilyWelfare.
• To implement the scheme at the State level, State Health Agencies (SHAs) in the
form of a society/trust have been set up by respective States. SHAs have full
operational autonomy over the implementation of the scheme in the State.
• It is the apex body responsible for implementing India’s flagship public health insurance/assurance scheme called
“Ayushman Bharat Pradhan Mantri Jan Arogya Yojana” & has been entrusted with the role of designing strategy,
building technological infrastructure and implementation of “Ayushman Bharat Digital Mission” to create a National
Digital Health Eco-system.
• NHA has been set-up to implement PM-JAY
• National Health Authority is the successor of the National Health Agency, which was functioning as a registered
society since 23rd May, 2018. National Health Agency was reconstituted as the National Health Authority on 2nd
January 2019.
ROLE OF NATIONAL HEALTH AUTHORITY (NHA)

16. • DI is a flagship Programme of the Government of India with a vision to transform India into a digitally empowered
society and knowledge economy.
• The Digital India Programme is centered on three key vision areas: Digital Infrastructure as a Core Utility to Every
Citizen, Governance & Services on Demand and Digital Empowerment of Citizens
• Agencies enabling DI initiatives in health sector:
• Department of Empowerment of PersonsWith Disabilities (DEPWD)
• National Health Mission (NHM)
• National Institute of Health and FamilyWelfare
DIGITAL INDIA
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17. Digital AIIMS
The first step in the Digital AIIMS project was taken in January 2015 with the creation of
an effective linkage between AIIMS, Unique Identification Authority of India (UIDAI) and
the Ministry of Electronics and InformationTechnology (MeiTY).
e-Hospital
The application is a Hospital Management Information System (HMIS) for internal
workflows and processes of hospitals. This one-stop solution helps in connecting
patients, hospitals and doctors on a single digital platform. The application is developed
based on the global healthcare standards like HL7, SNOMED-CT, ICD10, and Meta Data
and Data Standards (MDDS) published by the Ministry of Health & Family Welfare
(MoHFW). e-Hospital is made available to Central Government/ State Government/
Autonomous/ Cooperative hospitals on cloud through SaaS (Software as a Service)
model. 17

18. MCESSATION
Ministry of Health & Family Welfare, in partnership with World Health
Organisation and the International Telecommunications Union, has started an
initiative for utilising mobile technology for tobacco cessation. WHO-ITU’s ‘Be
Healthy Be Mobile’ initiative, aims to reach out to tobacco users of all categories
who want to quit tobacco use and support them towards successful quitting
through constant text messaging on mobile phones.
NIKSHAY
To monitor Revised National Tuberculosis Programme (RNTCP) effectively, a web
enabled and case based monitoring application called NIKSHAY has been
developed by National Informatics Centre (NIC). This is used by health
functionaries at various levels across the country in association with Central TB
Division (CTD), Ministry of Health & Family Welfare. NIKSHAY covers various
aspects of controlling TB using technological innovations. Apart from web based
technology, SMS services have been used effectively for communication with
patients and monitoring the programme on day to day basis. 18

19. SMS-BASED MID-DAY MEAL MONITORING SCHEME
Mid-Day Meal mobile app is meant for effective monitoring of daily and monthly mid-day meal data to be sent by the
schools. The app provides additional data communicating mechanism for the MDM in-charge/teacher who has to send
the daily/monthly data using SMS. The app, once installed on android device, does not need Internet to send MDM
figures as user has option to send the figure through SMS from the app which simplifies the job of MDM in-charge.
The higher authorities at Block, District and State level have a very simple and effective mechanism in shape of this
app on their mobile devices for effective and efficient monitoring of daily as well as monthly data transmission by all
the MDM in-charge falling under their jurisdiction. The authorities can send SMS alerts to all defaulters using single
button available in the app 19

20. MOTHER & CHILDTRACKING SYSTEM (MCTS)
Mother and Child Tracking System (MCTS) is an initiative of Ministry of Health & Family Welfare to leverage
information technology for ensuring delivery of full spectrum of healthcare and immunization services to pregnant
women and children up to 5 years of age. It facilitates and monitors service delivery and also establishes a two way
communication between the service providers and beneficiaries.
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21. • HMIS portal is a gateway to wealth of information regarding the health indicators of India. The information
available on this portal is derived data from data uploaded by the States/ UTs.
• HMIS data specifically designed to support planning, management, and decision making based on Grading of
facilities, various indicators at Block, District at State as well as National Level.
HEALTH MANAGEMENT INFORMATION SYSTEM (HMIS)
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22. • Health Management Information System (HMIS) is a Government to
Government (G2G) web-based Monitoring Information System that
has been put in place by Ministry of Health & Family Welfare
(MoHFW), Government of India to monitor the National Health
Mission and other Health programmes and provide key inputs for
policy formulation and appropriate programme interventions.
• HMIS has been utilized in Grading of Health Facilities,
identifications of aspirational districts, review of State Programme
Implementation Plan (PIPs), etc.
• The analytical reports generated through HMIS also provides gap
analysis and evidence-based course correction.
• HMIS was launched in October 2008. Currently, around 2 lakh health
facilities (across all States/UTs) are uploading facility wise service
delivery data on monthly basis, training data on quarterly basis and
infrastructure related data on annual basis on HMIS web portal. 22

23. • HMIS captures facility-wise information as follows:
• Service Delivery (Reproductive, Maternal and Child Health related, Immunization, family planning,Vector borne
disease,Tuberculosis, Morbidity and Mortality, OPD, IPD Services, Surgeries etc. data) on monthly basis.
• Training Data (Trainings imparted to Medicals and Paramedics staff at District and State level data) on quarterly
basis.
• Infrastructure (Manpower, Equipment,Cleanliness, Building,Availability of Medical Services such as Surgery etc.,
Super Specialties services such as Cardiology etc., Diagnostics, Para Medical and Clinical Services etc. data) on
annual basis.
• The HMIS Portal facilitates the flow of physical performance from the Facility level to the Sub-district, District, State
and National level using a web-based Health Management Information System (HMIS) interface.The portal provides
periodic reports on the status of the health services performances and Human Resources and Infrastructure services
facilities available.
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24. • The necessity of sound information system as a support to the various developmental activities of the Health
sector in India was identified as early as Bhore committee report soon after the independence.
• The national health policy of India (1983)in inter states with appropriate decision making and program
planning in the health and related fields is not possible with out establishing an effective health information
system and that nationwide organizational set up should be established to procure essential health information
which may provide support for the local management of the health care and effective decentralization of the
activities.
• The National Health Information Systems provide the inputs in the formulation of regional and global health
policies.
EVOLUTION OF HMIS
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27. ORGANIZATIONAL ARRANGEMENTS FORTHE HMIS IN INDIA
The organizational arrangement of HMIS and the agencies responsible for it is discussed in the three levels namely
central, state and district.
A. Central level
At the central level there are three major agencies dealing with the HMIS.
1. Central Bureau of Health Intelligence (CBHI)
2. Statistics division in the department of health and family welfare
3.The Sample Registration System (SRS)
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28. B. State level organization – an example from Andhra Pradesh
C. Organization at the district level
Organisation of Health Management Information in Andhra Pradesh 28

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30. CONTENT AND FLOW
OF HMIS
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31. MONITORING OF INFORMATION AND EVALUATION SYSTEM (MIES)
• The Statistics Division in the Ministry of Health & FamilyWelfare is responsible for monitoring and evaluation of
the Health care services provided by the health facilities in the country.
• The information flows from the primary levels and is consolidated at Sub-district, district and the State level
before the information is sent to the center for the national level consolidation.
• The system for capturing information on health care programmes has evolved over the years based on the
changing needs of the government where daily reporting of facilities is required.
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32. ACHIEVEMENTS OF HMIS
• HMIS is an effective tool for monitoring the system monthly by web-based dynamic data to the Ministry and States.
• Over a period of time, HMIS data is being widely utilized by National and State Governments for monitoring of
facilities, policy planning and decision making.
• Some of the major achievements of HMIS are ;
• HMIS data has been playing a pivotal role in reviewing the performance of States/UTs during annual Programme
Implementation Plans (PIPs),
• Programme Divisions have been utilizing HMIS data for fixing targets for key programs under National Health
Mission (NHM),
• HMIS has provided a very robust and effective platform for regular monitoring of health facilities and officials as
well,
• HMIS has become a sole source of information related to individual health facilities for all purposes. No other
MIS platform in India provides such exhaustive information regarding Government Health facilities.
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33. CHALLENGES FOR EXISTING HMIS
• In spite of nearly 94% coverage of government health facilities and huge efforts put in by National and State
Governments particularly in terms of manpower, data of HMIS is neither close to the National survey figures
nor to the estimated values.
• Though it is one of the largest MIS across the globe, still quality and usability of data remain its areas of
concerns.
• Since existing data does not have desirable quality, its utilization in designing policies and making decision at
district or local level planning is nominal.
• Major challenges for National HMIS of India are ;
a) At present, paper-based recording system exist across India which contributes to duplication,
compilation and data entry errors.
b) India is a vast country with 217780 health workers/ANMs. Lack of time to time training of health workers
including data entry operators and MIS officials result in poor data quality.
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c) Government hospitals in major cities have incorporated IT software in their payment and billing system,
however, integration of IT in clinical system is still far away.
d) Poor integration of diverse software systems within hospital impedes inter-hospital information exchanges
and creates problem in consolidation of data.
e) HMIS is a centrally funded program and State or local governments have lesser stake for development of IT
infrastructure required.
f) Poor coverage and reporting of private sector hospitals is also one of the major impediments for success of
HMIS.

35. • Multiplicity of institutions and fragmented data
Structural issues
• Exhaustive information collected but hardly used
• Extra effort by PHC staff in compiling the reports
• Even general information is collected every time and reported afresh.
• Codes for everything
• Absence of feedback defeats the purpose of information collection
• Higher the level of hospital and the lesser the information send up wards.
• The primary supplier and user of information in general has not much interest in the information
Procedural
• Mostly service utilization statistics.
• Only summarized information reaches at higher level.
• Not user friendly
Content related
• Absence of training and motivation.
Human resources related
• Manual paper-based systems – no databases
Technological issues
PROBLEMS OR CONSTRAINTS OF HMIS IN INDIA
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37. Systems model on the problems of HMIS
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39. • The aim is to develop the backbone necessary to support the integrated digital health infrastructure of the
country. It aims to bridge the existing gap amongst different stakeholders of healthcare ecosystem through
digital highways.
• Anyone who wishes to participate in ABDM and have their health records available digitally must start by creating
ABHA (Ayushman Bharat Health Account). ABHA is a randomly generated 14-digit number used for the purposes
of uniquely identifying persons, authenticating them, and threading their health records (only with their informed
consent) across multiple systems and stakeholders.
• NHA is leading the implementation for Ayushman Bharat Digital Mission (ABDM) in coordination with different
ministries/departments of India.
AYUSHMAN BHARAT DIGITAL MISSION (ABDM)
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40. Building blocks of ADHM
Health ID
• It is important to standardize the process of identification of an individual across healthcare
providers.
• This is the only way to ensure that the created medical records are issued to the correct
individual or accessed by Health Information User through appropriate consent.
• In order to issue the UHID, the system must collect certain basic details including demographic
and location, family/relationship, and contact details.
• Ability to update contact information easily is the key.
• The Health ID will be used for the purposes of uniquely identifying persons, authenticating them,
and threading their health records (only with the informed consent of the patient) across multiple
systems and stakeholders.
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41. Health Facility Registry (HFR)
• It is a comprehensive repository of health
facilities of the nation across different systems
of medicine.
• It includes both public and private health
facilities including hospitals, clinics, diagnostic
laboratories and imaging centers, pharmacies,
etc.
Healthcare Professionals
Registry (HPR)
• It is a comprehensive repository of all
healthcare professionals involved in delivery of
healthcare services across both modern and
traditional systems of medicine.
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42. Personal Health Records(PHR)
• A PHR is an electronic record of health-related information on an individual that conforms to nationally
recognized interoperability standards and that can be drawn from multiple sources while being
managed, shared, and controlled by the individual.
• Salient feature of the PHR is that the information it contains is under the control of the individual.
• Key features of the ABDM Health Records (PHR) mobile application are :
-Creation of Health ID
-Discovery of Health Information
-Linking of health records/ with a given Health ID
-View Health Records
-Management of consents
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43. Key to digital healthcare journey
Using ABHA (earlier known as Health ID) is the first step towards
creating safer and efficient digital health records. ABHA is a hassle-
free method of accessing and sharing users health records digitally.
Users can opt-in to create a digitally secure ABHA, which allows them
to seamlessly access and share their health data with their consent,
with participating healthcare providers and payers.
AYUSHMAN BHARAT HEALTHACCOUNT (PREVIOUSLY HEALTH ID)
Creating India's digital health ecosystem
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44. CONCLUSION
The HMIS is the only data source in India at the facility level capable of providing micro-level information every
month for improving the delivery of health care services. But its potential remains unutilized because of the failure
to train the staff and incorporate accountability within the system. Few challenges are:
• Strengthen the health information workforce to ensure improved availability of trained HMIS resources
• Ensure dissemination of standardized data definitions and data collection guidelines to ground-level facilities and
ensure use of standardized reporting formats by all health facilities
• Formalize data management practices and processes for data verification, correction, and feedback and
supervisory support
• Improve data use for planning and management of health services, especially for day-to-day managerial planning
and decision making at the facility level
• Strengthen IT infrastructure, particularly to ensure regular internet connectivity
• Improve coverage of private facilities in the HMIS, perhaps through regulatory guidelines and customized
reporting formats 44

45. • Blockchain technology has the potential to revolutionize interactions
between governments, businesses and citizens in a manner that was
unfathomable just a decade ago.Though very often grouped with
technologies such as artificial intelligence (AI) or IoT (Internet of
Things).
• NITI Aayog organized this initiative with a host of partners in the
healthcare and technology domain.
• A unique Indian model of digital foundational infrastructure such as
Aadhaar, UPI, e-Sign and Digilocker along with digitally enabled tax
governance networks like GSTN or digitally enabled health coverage
such as Pradhan Mantri Jan ArogyaYojana(PM-JAY).
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46. • PM-JAY is the world’s largest healthcare initiative with ~500 million beneficiaries covered , ~119 million e-cards
issued so far, ~8 million hospital admissions
• In India, fake medicines are a major concern with approximately 3% of drugs being substandard or counterfeit, as
per National Drug survey 2014-2016, conducted by National Institute of Biologics, Ministry of Health & Family
Welfare.
• Blockchains also allow the identification of exact locations of medicines at each point of transaction and allow for
‘batch reminders’ to be sent out efficiently to ensure safety of patient’s health.
• Challenges (HMIS) : Utilization data recorded by health workers is written onto systems like MCTS (Mother and
ChildTracking System) and HMIS (Health Management Information System).These systems are not interoperable.
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48. 48

49. • https://www.who.int/india/news/detail/30-06-2019-mohfw-launches-new-real-time-health-management-information-
system-online-portal-in-five-states
• https://cdn1.sph.harvard.edu/wp-content/uploads/sites/114/2012/10/rp176.pdf
• https://healthid.ndhm.gov.in/
• https://hmis.nhp.gov.in/#!/aboutus
• http://www.himaindia.com/
• https://nhsrcindia.org/
• Tripathi S, Sharma R, Nagarajan S. Health Information Systems in India: Challenges and way forward.
• Srivastava D. Health system monitoring using Health Management Information System (HMIS) in India and suggested
enhancements to this platform. International Journal of Scientific & Engineering Research. 2015;6(9):1245-8.
• HFG Project- strengthening-the-health-management-information-system-pilot-assessment-of-data-quality-in-five-
districts-of-india
REFERENCES
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50. Thank You
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