“8th National Biennial Conference on Medical Informatics 2012”

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“8th National Biennial Conference on Medical Informatics 2012” at Jawaharlal Nehru Auditorium, AIIMS New Delhi on 5th Feb 2012,
The organizing committee consisting of Mr. S.K. Meher (Organizing Secretary), Major (Dr.) Anil Kuthiala (Jt. Organizing Secretary) and Ashu (Assistant to the Organizing Secretariat) worked hard and toiled to make the conference a grand success.
The scientific committee comprising of Dr. S.B Gogia, Prof. Khalid Moidu, Prof Arindam Basu, Dr. S Bhatia, Dr. Thanga Prabhu, Dr. Karanvir Singh, Tina Malaviya, Dr. Kamal Kishore, Dr. Vivek Sahi, Spriha Gogia, Dr. Supten Sarbhadhikari, Dr.Sanjay Bedi, Mr. Sushil Kumar Meher actively reviewed all papers for the various scientific sessions.

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“8th National Biennial Conference on Medical Informatics 2012”

  1. 1. Objectified Assessment ofRheumatoid Arthritis (RA) in Real-Time as an Aid for Treat-to-Target (T2T) Treatment Strategy Prof. A. N. Malaviya, MD, FRCP (Lond.), M-ACR, FAMS, FNASc Ex- HOD Medicine and Chief of Clinical Immunology & Rheumatology, AIIMS Consultant Rheumatologist, ISIC Superspeciality Hospital, New Delhi Dr. S. B. Gogia, MS (Surgery), Consultant Surgeon, Past President IAMI
  2. 2. Rheumatoid disease• A systemic multiorgan disease where the brunt of the disease is on the joints in the extremities• It is an autoimmune where the body’s own defence system attacks the body itself.• The disease has genetic basis.• What is (are) the trigger(s) for these genes to start attacking the body remain to be discovered (smoking is one of them)
  3. 3. Pathogenesis well characterised Imbalanced production of cytokines with excess of proinflammatory cytokines the main one being tumour necrosis factor – α (TNF-α)
  4. 4. Dramatic advances in the treatment of RA• Disease modifying drugs (DMARDs)• Biological response modifiers (Biologics)• Which drug; at what stage of the disease; what dose and routes: – Monotherapy – Combination therapy – Strategy for their use
  5. 5. RA treatment From being “There is not much that can be done, patient would die” It has now become a“Treatable condition where patients can lead a normal life”With dramatic advances in drug treatment of this disease
  6. 6. RA can now be compared todiabetes, hypertension and other chronic diseases They can be well controlled With almost a normal life span with good quality of life Don’t worry about ‘cure’ – Although ~ 20% go in drug-free remission
  7. 7. Basic treatment strategy for these diseases• Keep the disease under ‘tight control’ – Keep Hb-A1C < 6 (by proper close follow-up and regular blood testing) in diabetes – Keep BP <140/90 (will need to be adjusted for younger people) in patients with hypertension• This approach of treatment is called ‘treat-to- target’ (T2T)• How do we know what is the target in RA? There are so many domains in the disease, very unlike diabetes or hypertension!
  8. 8. RA has multiple domains• Pain in the joints• Swelling in the joints• Poor ‘general health’ due to disease• Poor ‘function’ due to joint involvement• Inflammation in the body All this needs to be measured How do we obtain a number that represents DISEASE ACTIVITY ON THAT DAY?
  9. 9. Composite indices• Disease activity index (44 joints) – DAS44 – With erythrocyte sedimentation rate (ESR) – With C-reactive protein (CRP)• Disease activity index (28 joints) – DAS28 – With erythrocyte sedimentation rate (ESR) – With C-reactive protein (CRP)• Clinical Disease activity index – CDAI• Simplified Disease activity index – SDAI – With erythrocyte sedimentation rate (ESR) – With C-reactive protein (CRP)
  10. 10. RA disease assessment using DAS28• DAS28 = 0.56 * sqrt(tender28) + 0.28 * sqrt(swollen28) + 0.70 * ln(ESR) + 0.014 * GH• < 2.6 = Remission• < 3.2 = Low disease activity• < 5.1 = Moderate disease activity• > 5.1 = High disease activity
  11. 11. RA assessment using CDAI and SDAI• SDAI = (28TJC) + (28SJC) + MDGA + PtGA + CRP* – Remission = <3.3 – Low disease activity = >3.3 to <11 – Moderate disease activity = >11 to <26 – High disease activity = >26• CDAI = (28TJC) + (28SJC) + MDGA + PtGA* – Remission ≤2.8 – Low disease activity = >2.8 to ≤10 – Moderate disease activity = >10 to ≤22 – High disease activity = >22
  12. 12. Assessment of RA• At each patient visit to the clinic we must know the status of disease activity to keep it under tight control i.e.:• In ‘remission’Or at least• In ‘low disease state’Therefore:• It becomes mandatory to have DAS28 or CDAI or SDAI at each visit To be able to adjust the drugs / drug dosages To keep the disease under ‘tight control’
  13. 13. Remember the formulae?• DAS28 = 0.56 * sqrt(tender28) + 0.28 * sqrt(swollen28) + 0.70 * ln(ESR) + 0.014 * GH• SDAI = (28TJC) + (28SJC) + MDGA + PtGA + CRP*• CDAI = (28TJC) + (28SJC) + MDGA + PtGA*• Can you imagine doing the calculations and finding out whether the patient is in: – Remission, low disease state or not?
  14. 14. Gadgets are needed• Pre-programmed calculators• On-line DAS calculators (now available)• Why not have an EMR that would help: – Permanent record of patient’s medical record including medical history, examination findings, laboratory test records – Sequential assessment details – Make drug prescriptions as well! That is the question Dr. Gogia asked us (rheumatologists) when he saw us struggling for the use of ‘T2T’ approach for our RA patients
  15. 15. Development of rheumatology-specific EMR• Two of us worked closely• Understanding each other’s way of working• Work-flow of a rheumatology clinic was understood by Dr. Gogia• ‘Objectified assessment methodology’ as discussed including all the composite indices for the assessment of disease activity and their formulae, cut-off points etc.• Final EMR (~ 2 ½ years in development) ready for use
  16. 16. Front sheet of the medical record
  17. 17. RA assessment in real-time
  18. 18. Prescription
  19. 19. Final appearance of the face-sheet now
  20. 20. Face-sheet at the last visit
  21. 21. Prescription handed over to the patient
  22. 22. Summary• Rheumatology-EMR has the following advantages: – Quick and objectified assessment for guiding treatment – Clearly stated disease status – Neat prescription with detailed instructions – Appointment, tests before the next visit – Many other benefits: more patients in the same time period, data-mining easy for research
  23. 23. Thank you
  24. 24. Significance Of An Appropriate Change Management Strategy In Successful Implementation Of A Health Management Information SystemDr. Aman Rana (IIHMR, Delhi) &Dr. Anandhi Ramachandran (IIHMR, Delhi)
  25. 25. HEALTH CARE INFORMATION SYSTEM • Corporate Social Responsibility • Benefits: for management- Workforce: an asset - track of health status -underlying occupational hazard -success of any health intervention -medi-claims easy Employees: -sense of security -all information at one place -reduced medical negligence
  26. 26. STUDY BACKGROUND:• Location A notable public organization, EMPLOYEE HEALTH MANAGEMENT SYSTEMS (EHMS) : Unsuccessful for past 2 years
  27. 27. OBJECTIVES• To understand the Knowledge and Attitude of the Employees towards EHMS• To ascertain the reasons for failure of EHMS adoption in the organization• To put forth an operational framework for successful adoption of EHMS• To evaluate the success of the interventions implemented• To provide a suitable recommendations for future continuous adoption of EHMS
  28. 28. METHODOLOGY• STUDY TYPE: Quantitative• SAMPLE SIZE: 353 employees• SAMPLING: Convenience Sampling• DATA UTILIZED: Primary and Secondary data• TOOLS USED: Questionnaires, Focus Group Discussions and Personal Interviews
  29. 29. PRE INTERVENTION STATUS:• Out of the 353 employees: • 5 = somewhat correct awareness of EHMS ( All Admin.) • 12= filled up self declarations • No one had filled up the detailed periodic health record. • 85 = had some where heard of EHMS but had no clear idea of what it is. • 251 = people had never heard of EHMS.• In house doctors (2 in number) found the system too technical to understand and time consuming to work on.
  30. 30. BARRIER TO ADOPTION• Technical Barriers• User Perception of EHMS• Resisting Change
  31. 31. USE OF IT TO INITIATE CHANGEMANAGEMENT People Process Technology
  32. 32. 8 Steps to Transform an Organization(‘Harvard business review on change’ by John P.Kotter)1. Establishing a sense of Urgency2. Forming a powerful guiding coalition3. Creating a vision4. Communicating the vision5. Empowering others to act on the vision6. Planning for and creating short-term wins7. Consolidating improvements and producing still more change8. Institutionalizing new approaches
  33. 33. FRAMEWORK PROPOSED
  34. 34. INTERVENTIONS ADOPTED
  35. 35. POST INTERVENTION STATUS• AWARENESS REGARDING EHMS: all 353 employees.• SELF- DECLARATIONS FORMS STATUS: 226• PERIODIC HEALTH EXAMINATION STATUS: 26• DOCTORS’ CONSULTATION Motivated and trained. Patient Consultation and Drugs dispensing through the system.
  36. 36. CADRE WISE RESPONSE TO THE INTERVENTION PROGRAMME• Management staff: ▫ Out of 172 people, 107 filled up declaration forms.• Non Management staff/ Clerical Staff: ▫ 90 out of 124 gave in their self declarations.• Labor staff: ▫ 29 out of 57 filled up their self declarations
  37. 37. ASSESSMENT OF THE CHANGEMANAGEMENT PROCESS• 100% awareness raised• 64% of the staff entered self declaration forms• Which contained preliminary health data.• 7% people filled PHR forms which included detailed information about person’s health data and past medical history.• Implies in spite of awareness, the workforce still needs to accept and be a part of EHMS endeavor. So, the people still need to know more about PHR. Awareness needs to be accompanied with some visual fringe benefits.• Privacy and confidentiality issues
  38. 38. RECOMMENDATIONS PROPOSED FORFUTURE ACTION• A Change Management Champion.• Administration should embrace the change in the process, communicate vision and promote health seeking behavior in the staff.• Doctors: not just acceptors but also propagator.• Doctors, Administrator and staff should sharea good rapport.• Periodic review: every six months• Teams: Seniors and Juniors equal mix.
  39. 39. POINTS TO BE REMEBERED• Change management is not an event but a process which needs a focused vision and a visionary.• The employees should be involved in the process from the initial level.• It is the responsibility of top management to assure that the workforce stays motivated throughout.• The leaders, who will propagate the change should be the ones who are trusted by all and share excellent rapport with everyone.• The more aware people are, the easier is the acceptance.• The Employees’ expectations from the product should be kept realistic throughout.• It is as essential to retain the change as it is to bring the change.
  40. 40. REFERENCES• McCarthy,M., and Eastman, D., Change Management Strategies for an Effective EMR Implementation. Ohio: HIMSS; 2010. Available from: www.himss.org/content/files/Change Management.pdf. Accessed 2011.• Strebel, P., „Why Do Employees Resist Change?‟ Harvard Business Review May–June 1996• Cohen D. The Heart of Change Field Guide: Tools and Tactics for Leading Change in Your Organization. Boston, MA: Harvard Business School Press; 2005.• .Bridges W. Managing Transitions: Making the Most of Change. 2nd ed. Cambridge, MA: Perseus Publishing; 2003.• Campbell, Robert James. Change Management in Health Care. Health Care Manager. 27(1):23- 39, January/March 2008.• Abraham J, Feldman R, Carlin C,Understanding Employee Awareness of Health Care Quality Information: How Can Employers Benefit? Health Services Research 39:6, Part I (December 2004)• Heeks R. (2006) Health information systems: failure, success and improvisation. Int J Med Inform. Feb; 75(2), 125-37.• Al-Mashari, M., and Zairi, M. (1999) BPR implementation process: An analysis of key success and failure factors. Bus. Process Manag. J. 5(1), 87–112• Beynon-Davies, P., and Lloyd-Williams,M. (1999) When health informationsystems fail. Top. Health Inf. Manage 20(1), 66–79.• Chang, R., Process Reengineering in Action: A Practical Guide to Achieving Breakthrough Results. Jossey-Bass Pfeiffer, San Francisco, 1999.
  41. 41. Hardeep Singh, MD MPH Invited Panelists: Houston VA Health Services Research Max Health Care EHR Team Center of Excellence (Divye Chhabra, Nikhil Mishra, Neena Pahuja, Shubnum Singh) Dean F. Sittig, PhD And The University of Texas Health Science Kanav Kahol, PhD,Center School of Biomedical Informatics Public Health Foundation of India
  42. 42.  Momentum for large scale health reform to improve delivery and patient outcomes Transformation must leverage use of technology Technology use must be accompanied by a strategic approach accounting for the context of the environment where implemented.
  43. 43.  A Hospital system implements an EHR but a year later has to switch to another one U.K. Scrapping National Health IT Network “…(after) nine years and £11.4 billion ($18.7 billion), the British government is about to scrap its attempt to build a massive, nationwide health IT network for the 52 million residents of England, a London news report says…”
  44. 44.  Efficiency - 10% reduction Inconsistent Clinical Decision Support outcomes We expect quality & safety to improve, but…  22 types of computerized provider order entry (CPOE) errors  Unexpected downtimes  900 patients mistakenly given Viagra instead of Zyban due to an error in the dispensing pharmacy’s medication mapping table
  45. 45.  National electronic health record (EHR)- based intervention in VA  Required all pathology results (normal or abnormal) to be transmitted to ordering providers via mandatory automated notifications We analyzed 2 hospitals…results were a bit surprising… Laxmisan et al Under Review
  46. 46. Is this ALL bad health IT?
  47. 47.  Design, development, implementation, use, and evaluation of health information technology is complex and prone to failure Need a method of understanding the relationships to get it “right” Sittig & Singh JAMA 2009
  48. 48.  Discuss a multi-faceted “socio- technical” approach to safe and effective health IT implementation and use Discuss how these socio-technical concepts could apply to health IT projects currently underway in India
  49. 49.  Dean F. Sittig, PhD - Model Dimensions Hardeep Singh, MD MPH – U.S. Case Studies Discussion of model application in India:  Private health system (Max Health Care IT Team and Leadership)  Public health system (Kanav Kahol, PhD, Public Health Foundation of India)
  50. 50. Hardware and Monitoring Software Workflow and Content Communication Issue Under Study State and User Federal Interface Rules Organizational Personnel CharacteristicsJAMA. 2009;302(10):1111-1113
  51. 51.  Must be capable of supporting ALL required clinical activities. EHR should be able to:  Calculate a medication dose  Transmit the order to the appropriate department  Notify the nurse of a placed order
  52. 52. Hardware and Monitoring Software Workflow and Content Communication Issue Under Study State and User Federal Interface Rules Organizational Personnel CharacteristicsJAMA. 2009;302(10):1111-1113
  53. 53.  Standard medical vocabularies to encode clinical findings Clinical knowledge to create specialty- specific features and functions Must be evidence-based, carefully constructed, monitored, complete, and error free
  54. 54. Hardware and Monitoring Software Workflow and Content Communication Issue Under Study State and User Federal Interface Rules Organizational Personnel CharacteristicsJAMA. 2009;302(10):1111-1113
  55. 55.  Allows clinicians to quickly grasp a complex system safely and efficiently Displays all the relevant patient data so clinicians can rapidly perceive problems, formulate responses, and document actions. Physical aspects of the interface (e.g., keyboard, mouse, or touch screen) may also contribute to error in input or selection of information. ? Common user interface standards
  56. 56. Hardware and Monitoring Software Workflow and Content Communication Issue Under Study State and User Federal Interface Rules Organizational Personnel CharacteristicsJAMA. 2009;302(10):1111-1113
  57. 57.  Trained and knowledgeable personnel are essential  System developers  Trainers, implementers, and maintenance staff  Users Close interaction among informatics experts, clinical application coordinators, and end users is essential
  58. 58.  Staff of dedicated knowledge engineers Subject matter experts Clinical content committees
  59. 59. Hardware and Monitoring Software Workflow and Content Communication Issue Under Study State and User Federal Interface Rules Organizational Personnel CharacteristicsJAMA. 2009;302(10):1111-1113
  60. 60.  Disruptions in workflow or information transfer are fertile grounds for inefficiencies Careful workflow analysis that accounts for health IT use could lead to identification of potential breakdown points Errors may result from interventions that are not delivered at the best point in the workflow
  61. 61. Hardware and Monitoring Software Workflow and Content Communication Issue Under Study State and User Federal Interface Rules Organizational Personnel CharacteristicsJAMA. 2009;302(10):1111-1113
  62. 62.  Work environment Culture of innovation, exploration, and continual improvement are key Organizations should:  Actively facilitate reporting of errors or barriers to care resulting from health IT use,  carefully review their existing policies and procedures before implementation.
  63. 63. Hardware and Monitoring Software Workflow and Content Communication Issue Under Study State and User Federal Interface Rules Organizational Personnel CharacteristicsJAMA. 2009;302(10):1111-1113
  64. 64.  Regulations may act as barriers or facilitators for safe EHR use Patient privacy Policies must address safety and effectiveness of health information exchange across organizational boundaries State and federal governments should create an environment compatible with widespread use and interoperability
  65. 65. Hardware and Monitoring Software Workflow and Content Communication Issue Under Study State and User Federal Interface Rules Organizational Personnel CharacteristicsJAMA. 2009;302(10):1111-1113
  66. 66.  Organizations must continually evaluate usability & performance of systems after implementation to:  Reliably measure benefits  Assess potential e-iatrogenic effects
  67. 67. Acknowledgments: VA, NIH, AHRQ, ONC Eight Rights of Safe Electronic Health Record Use JAMA. 2009;302(10):1111-1113Safe electronic health record use requires a comprehensive monitoring and evaluation framework JAMA. 2010 Feb 3;303(5):450-1A new sociotechnical model for studying health information technology in complex adaptive healthcare systems. Qual Saf Health Care. 2010 Oct;19 Suppl 3:i68-74.
  68. 68. Hardeep Singh, MD, MPH Chief Health Policy Quality Program, Houston Veterans Affairs Health Services Research & Development Center of Excellence Michael E. DeBakey VA Medical Center & BCMDirector, Houston VA Patient Safety Center of Inquiry
  69. 69.  Research and evaluation case studies in:  Communication of diagnostic test results  CPOE prescriptions  Electronic Referrals How can the model guide us towards a high performing “EHR enabled work- system”
  70. 70.  Safety issues related to communication and coordination breakdowns prevalent What affect will technology have on communication and coordination of test results and referrals? Singh & Graber JAMA 2010
  71. 71. ▫ Alert in “View Alert” window
  72. 72. Example of a criticalimaging alert
  73. 73.  Communication more than information transfer  Response and appropriate follow-up action Providers may not acknowledge all alerts they receive; some lost to follow-up Timely follow-up should occur if they acknowledge an alert Singh et al JAMIA 2007
  74. 74.  Evaluation of timely follow-up actions on abnormal test result notifications communicated through the View Alert system  1,163 outpatient abnormal labs & 1,196 abnormal imaging results  7% labs lacked timely follow-up despite acknowledgment  8% imaging lacked timely follow-up despite acknowledgment Singh et al AJM 2010 and Archives of IM 2009
  75. 75. “One of the issues is just thesheer volume of alerts, andthere’s a number of alerts thatin all honesty [you] really don’thave any business seeing.”
  76. 76.  Barriers & solutions span multiple dimensions:  Software (functionality for saving, tracking, and retrieving alerts)  Content (e.g. what alert types are absolutely necessary)  Usability/ UI (improving existing functionality to improve signal to noise ratio)  Workflow (e.g., surrogate alerts when providers out of office)  Providers (e.g. knowledge)  Organizational (e.g. training, policies for follow-up) Singh et al Under review
  77. 77.  Of 532 scripts reported to have inconsistent communication  20% errors had potential for severe harm, if they reached the patient Issues: training, complex orders Singh et al Arch Int Med 2009
  78. 78.  Transmission and tracking of referrals finally possible!  Of 61,931 referrals, 36% discontinued and 0.8% unresolved at 30 days  Unexplained lack of follow-up actions by subspecialists in 6.3% of all referrals  Unexplained lack of follow-up by PCPs in 7.4% of discontinued referrals Singh et al JGIM 2010
  79. 79.  Marked differences in PCPs and subspecialists communication views (e.g. content) Lack of an institutional referral policy, Lack of standardization in referral procedures, Ambiguity in roles and responsibilities, and Inadequate resources to adapt and respond to referral requests effectively Very few technology barriers Hysong et al Impl Science 2011
  80. 80. Information TechnologyMeasuring and Tracking the Progress of Implementing a Comprehensive Electronic Health Record: A Mixed- Methods Approach February 5, 2012
  81. 81. AuthorsSandeep Budhiraja MD1Nikhil Mishra1Divye Chhabra MD1Dean F. Sittig, PhD2Hardeep Singh, MD, MPH3Neena Pahuja PhD11Max Health Care Institute Ltd., New Delhi2Professor,School of Biomedical Informatics, University of Texas Health Sciences Center, Houston, Texas, USA3Chief,Health Quality and Policy Program, Houston Veterans Affairs Health Services Research and Development Center of Excellence and Baylor College of Medicine, Houston, Texas, USA
  82. 82. DisclaimerNo conflict of interest
  83. 83. Some Published Statistics: IT supporting HealthcareRef: http://www.bbc.co.uk/news/health-15340102• Death rates gone down by 17% among emergency patients (16,000 deaths preventable)• Higher accountability of staff• Lower cases of missed medicine• Medication allergy alerts supports safer healthcare• Reduction of medication errors to ½.• Checks on infection control
  84. 84. Hospital Group Level Systems Integration Evolutionary need for Health Information Exchange •Network of 8 hospitals in NCR •Expanded by 4 new, spreading to rest of north India. Altogether ~1900 beds •EHR implementations complete in 4 hospitals Hospital Data Group level integration Centre Sheer Health Volume of Patient care information ‘cloud’51
  85. 85. Information Technology
  86. 86. eCare - Key Terms• CPRS - Computerized Patient Record System• EHR - Electronic Health Record• HIS - Hospital Information System• CPOE- Computerized Physician Order Entry• BCMA - Bar Coded Medication Administration• COWs – Computer On Wheels
  87. 87. The eCare vision• To have a patient centric clinical record• Embracing change to standardize care processes across the organization• To improve electronic access and availability of patient clinical information• To capture multi- disciplinary patient information• The implementation of a minimum data set ensuring foolproof documentation
  88. 88. Rationale EHR Implementation• Complete IT Outsourcing• WorldVistA integrated to Max-HIS• Rationale – Potential reduction of medical errors – Improved medication management – Rapid access to vital and accurate information – Reduced duplication of services and cost – Access to a more comprehensive picture of health for promoting advances in the diagnosis and treatment of illnesses – Improved and informed decision making – Providing continuity of care to patients 55
  89. 89. Preparation for EHR Implementation• External Consultants• Process mapping of as-is workflows• Data Cleaning• Design Future-State Workflows (Map “as-is” to system functionality)• Approach – Prepare patient demographics integration – Prepare for Lab, Radiology & Pharmacy – BCMA (e-MAR + closed loop medicine administration) – CPOE 56
  90. 90. Preparation for EHR Implementation• Training, Training & more Training• Change Management is the key• Big-Bang approach for IT- systems – Phased approach “Slow change” for humans• Super-Users and Change Managers• 23rd July 2011 6 months 57
  91. 91. Study Methodology• Mixed method for measuring and tracking progress of EHR implementationFirst – quantitative approach – six “automated” metrics – extracted from Mumps database (Backbone) Senior ConsultantsSecond Junior Consultants Floor Mentors – interviewed four groups of representative users Nursing Supervisor – Content analysis of interviews identify major themesThird – fact-finding questionnaires A total of 5 months of Data 58
  92. 92. Barcode Medical AdministrationCOW*– NurseLogin Barcoded PatientIdentifying the nurse Wrist Band Identifying the patient Barcoded Label on Drug- Identifying the DrugRight Patient, Right Drug, Right Time* COW- Computer on wheels 59
  93. 93. Results I- Quantitative Approach – 6 automated Metrics Implementation Metric % Use 1) Use of Progress Notes 76% 2) Use of CPOE for medications, procedures, lab and 100% imaging tests 3) Documentation of 2 daily inpatient progress notes 65% (morning and evening) by a consultant on all inpatients 4) Use of Problem lists involving selection from ICD-9 15% coded problems 5) Documentation of Input and Output logs by nurses 82% in IPD, Critical care on parallel paper process 6) Use of BCMA by nurses Real Time MAR 41%, however including after the fact goes upto 78%EHR-Structure 60
  94. 94. Results II- Interviews with representative groupsQualitative AnalysisYounger Doctors -more comfortableSenior Consultants -hesitant with new technology -had low degree of adoption.Typing issues - Only 28% were comfortableEHR system “complexity” - main concern of participants (mainly senior consultants)Perceived reduction of efficiency- due to time required in day to dayHowever most users- post 2-3 days of hands-on EHR use -perceived its benefits -reported high degree of comfort in its use. -Divide between resistors and early adopters 61
  95. 95. Results II contd- Interviews with representative groupsDifferences between doctors and nurses also emerged – 100% nurses had to use the system from day one – Also had attended all training sessions – Doctors were hard pressed for time for training as well as day to day use – Ongoing SupportFacilitators of the process• Leadership role (Top Management)• Clinical Transformation & Change Management• User friendly clinical templates• Easy accessibility of all Max enrolled patients’ records – Any Max facility – Any Patient• Light System (client application) - quick response time & stability – also be credited with aiding its acceptance. 62
  96. 96. Results III- Fact-finding Questionnaires• “Did You Know” type features of system identified – 12 in number, All Specific to doctors, 5 of these generic to nurses – Nurses faired 5/5 – Doctors varied from 5-8• Additionally 18 specific fact finding questions ranging from – Rate your own usage, comfort level, perceived improvements perceived benefits, suggestions for improvement 63
  97. 97. Results III contd- Fact-finding Questionnaires Five level scale used (Very Low Low Medium High Very High) Question Group Majority Others Comfort level in using system 65% Low to Medium 13-18% on both extremes Viewing of existing notes/progress notes 83% Medium to High rest Very High scattered result 50% low to Usage of templates on CPRS very few High Medium Usage of Orders (lab/radio/drug/procedures) 83% High to Very High _ Frequency of entering findings of consult 52% Medium to high 30% LowViewing of reports on CPRS software Majority high to Very High _ Surprisingly High to Very Comfort level of typing High Ease of use of CPRS software 78% Medium to High Rest Low, none very high Rate the overall improvement in time taken for activities 80% Medium to High 10% low Rate the overall improvement in the efficiency for activities 90% Medium to High _In your deptt. How would you rate the Scattered results ranging benefit of using systems over the 64 _ existing process from low to very high
  98. 98. Challenges Identified• CPOE- Filling time for STAT medication orders, only 90% compliance Identified as an area for improvement• An increase in the overall time in the discharge process when the EHR was only used partially - both paper + electronic records - expected to be transitional phase 65
  99. 99. Discussion• Early experience Largest implementation of its kind – 4 facilities, comprehensive EHR, large health care system• Several lessons learned by measuring and tracking – Patience and aggressive Change Management is key – Focus and Support from Leadership – People don’t like to put in data, but once its there they really value it – Benefits are perceived only by the ones who use more and vice- versa – Early adopters benefit more than laggards – Laggards resist most – Aggressive Supporting required at least till ratio tips in favor of adopter 66
  100. 100. Thank You
  101. 101. Further Benefits• Chronic Care Management using clinical reminders – Clinical reminders – automated reminders – for the clinicians based on rules (diagnosis/ lab result/ drug allergy etc)• Diabetic care – Reminders setup for – Periodic Glycosylated Hemoglobin (HbA1c) – Diabetic Foot Exam (Skin and Neurological) – Diabetic Eye Exam – Data of these reminders when due is periodically passed to Endocrinology team who in turn suggest the same to patients – Services with Ophthalmology, Podiatry and Lab services is coordinated through Endocrinology 68
  102. 102. Appendix
  103. 103. Ancillaries• COWS*• Wrist Bands• Drug Labels*COWS- Computer On Wheels
  104. 104. Change Management Is Key• It is not an IT project…..its an operations project• Leadership support• Support support support…..evolve…support• Train train ….retrain….evolve….support• Help on call- 24 hour support …..Human aspects• Workshops• As is workflows/future state• Ease everyone in. 71
  105. 105. Change Management After Go-Live• Healthcare- Standardized but flexible• Operations cannot slow down to support change• Shaken users prone to errors• Real time support• Leadership support 72
  106. 106. Results III contd- Fact-finding Questionnaires Five level scale used (Very Low Low Medium High Very High) Question Group Majority Others Comfort level in using system 65% Low to Medium 13-18% on both extremes Viewing of existing notes/progress notes 83% Medium to High rest Very High Usage of templates on CPRS scattered result 50% low to Medium very few High Usage of Orders (lab/radio/drug/procedures) 83% High to Very High _ Frequency of entering findings of consult 52% Medium to high 30% Low Viewing of reports on CPRS software Majority high to Very High _ Comfort level of typing Surprisingly High to Very High Rate the availability of the COW(computer on Scattered results ranging from low to wheels) in a ward _ very high Ease of use of CPRS software 78% Medium to High Rest Low, none very high Rate the overall improvement in time taken for activities 80% Medium to High 10% lowRate the overall improvement in the efficiency for activities 90% Medium to High _In your deptt. How would you rate the benefit of Scattered results ranging from low to using systems over the existing process _ very high 73
  107. 107. Kanav KaholDivision of Affordable Health TechnologiesPublic Health Foundation of Indiakanav.kahol@phfi.org
  108. 108. Recommendation 3.6.4 Establish a Health IT Network
  109. 109. Hardware and Monitoring Software Workflow and Content Communication Issue Under Study State and User Federal Interface Rules Organizational Personnel CharacteristicsJAMA. 2009;302(10):1111-1113
  110. 110.  Mhealth Solutions. Portable with long or extended battery life. Enable non-physicians to deliver care with supervision and monitoring Example: Swasthya Slate
  111. 111. Hardware and Monitoring Software Workflow and Content Communication Issue Under Study State and User Federal Interface Rules Organizational Personnel CharacteristicsJAMA. 2009;302(10):1111-1113
  112. 112.  Indigenized and local language support. Allow co- development by central agencies and local players through computer supported collaborative platforms. Need support for empowerment of patients and the healthcare workers.
  113. 113. Hardware and Monitoring Software Workflow and Content Communication Issue Under Study State and User Federal Interface Rules Organizational Personnel CharacteristicsJAMA. 2009;302(10):1111-1113
  114. 114.  Use of semiotics and images is helpful Simplified questionnaires and sets. Affordance of the user interface is key.
  115. 115. MyPortal State and District Portals MyHealth Epidemiology MyAppointments Early Warning Systems MyMessages Messaging Center MyTreatments Certification Portal Learning Portal Community Health Portal eHealth/mHealth PortalsPhysician and Hospital Portal National Portal Patient Alerts Certification Standards and Results Scheduling Manager Health Promotion Message Center National Security Portal Information ReportingFinancial Management Portal
  116. 116. Hardware and Monitoring Software Workflow and Content Communication Issue Under Study State and User Federal Interface Rules Organizational Personnel CharacteristicsJAMA. 2009;302(10):1111-1113
  117. 117.  Technology illiteracy is rapidly reducing. People born in 1994 will be 22 in 2016. Creation of suitable cadres already a part of the UHC Report. Usable technology is the key Gap skills training will have to be undertaken.
  118. 118. Hardware and Monitoring Software Workflow and Content Communication Issue Under Study State and User Federal Interface Rules Organizational Personnel CharacteristicsJAMA. 2009;302(10):1111-1113
  119. 119.  Public Health Decision Support System Use algorithms from supply chain and related fields to help with optimal resource usage and allocation. West Bengal and Drishti.
  120. 120. Hardware and Monitoring Software Workflow and Content Communication Issue Under Study State and User Federal Interface Rules Organizational Personnel CharacteristicsJAMA. 2009;302(10):1111-1113
  121. 121.  Promote use of HealthIT Use grants and universal payer mechanism to ensure compliance.
  122. 122. Hardware and Monitoring Software Workflow and Content Communication Issue Under Study State and User Federal Interface Rules Organizational Personnel CharacteristicsJAMA. 2009;302(10):1111-1113
  123. 123.  Use single payer as a leverage for adoption along with grants. Clearly define telemedicine (Use telemedicine law draft) Define privacy and security laws. Ensure the right to connectivity.
  124. 124. Hardware and Monitoring Software Workflow and Content Communication Issue Under Study State and User Federal Interface Rules Organizational Personnel CharacteristicsJAMA. 2009;302(10):1111-1113
  125. 125.  Monitoring Financial and Clinical measures is the key. EHR enables a method of authentication and verification. Case in Point: Mother Child Tracking System and Immunization Records. Use cloud. Caveat: Make reporting easy. Caveat: Reporting is not the only or the most important feature of ICT.
  126. 126. Personal Eternal Health Passbook By Dr. G. D. Mogli, Ph.D., MBA., FHRIM (UK), FAHIMA (USA) Chief Executive Officer & MD Dr. Mogli Healthcare Management Consultancy www.drmogliit.com gdmogli@yahoo.com Formerly served as WHO Consultant and Sr. Consultant /Adviser to the Ministries of HealthIndia, Afghanistan, Iran, Kuwait, Saudi Arabia, Oman, Bahrain, Qatar, UAE & Sr. Consultant eHealth Management HEARTCOM INC. (USA)
  127. 127. Evolution of medical records EHR/PH R???? Comprehe Computer • card nsive UnitWriting on records based Outpatient medical records walls s records Comprehensive unit records Outpatient cards
  128. 128. Personal Eternal Health Passbook The “Personal Eternal Health Passbook (PEHP) containing the ID, is a lifelongelectronic, universally available document, initiated at the time of birth, containing,mother’s delivery information including congenital anomaly, immunizations given.This will contain entire information such as episodic, hospitalization, self medicationsand other habits including significant events. This is maintained by parents/guardianand contains immunizations, growth charts, significant events and health status. ThePEHP information is contributed by health care providers and self and maintained ina secure and private environment, with the individual determining rights of access”. Definition by--- Dr G. D Mogli
  129. 129. PEHP PEHP kept by individual, EHR by Hospital PEHP is owned by individual and contain every detail. PEHP information is managed by (care providers and himself). Right of access of record is owned by PEHP owner.
  130. 130. What EHR cannot have? But What PEHP can have? Awareness among patients through media. Internet forums and blogs for medical information. Persons suffering from minor ailments, doesn’t visit, hospitals, Applies self medication, self care/treatment. Extensive information leads to Self-medication too. This kind of information is not recorded in a EHR which could prove to be detrimental for patient care.
  131. 131. Non Allopathic treatment Many types of medicine are coming to light and being practiced. Ex: Unani, Acupuncture, homeopathy, ayurvedic, yogic healing etc.. EHR is based on allopathic only. other medications / therapies underwent by the patient is not recorded.
  132. 132. Types of PEHP Paper based. PC-based. Web based. (maintained on private line-accessed by username and password) Hybrid (desktop/Web-based.) A mix of both PC’s and Online PEHP. PEHP. Connecting through USB port to the computers.
  133. 133. Personal Eternal Health Passbook
  134. 134. What should the PEHP contain Patient Identification Data. Health Summary.  Hospitalization. Child Development.  Obstetrics & Gynecology. Immunizations.  Surgeries/Therapy.  Chronic Disease (old age). Self care/treatments.  Allergies and Drug Medications.  sensitivities. Investigations.
  135. 135. Patient ID format 3 parts Part I contains: Personal data. Part II contains: allergies, blood group, significant health problems. Part III contains: other habits such as food, alcoholic, smoking, any addiction, environmental, exercise, etc.
  136. 136. Patient Care Summary For recording chronological data. Should record details of visits to OP,IP,ER etc.. Self care or other treatments.
  137. 137. Child Development Growth chart for children from 0-5 or 0-14 years.
  138. 138. Immunizations Mainly for children and also can be used for adults. Indicates due dates for other immunizations e.g. 1st dose, 2nd dose etc..
  139. 139. Self-care for medication / treatment A unique feature of PEHP. Available only with the PEHP and not found in the allopathic healthcare organizations.
  140. 140. Medications Chronological account of medications used and being used currently. E-prescription, refills, and address of the pharmacies
  141. 141. Investigations Chronological account of investigations carried out will be available.
  142. 142. Hospitalization record Chronological account of all admissions and discharges with the results.
  143. 143. Obstetrics & Gynecology For women patients from child bearing age onwards. Periodic Mammography check information is also recorded.
  144. 144. Therapy Different types of therapies such as physical, occupational, speech, optometric refractions, radio therapy etc. are recorded.
  145. 145. Implementing PEHP People Born prior to implementation New born records –to be maintained by the care taker Carry a pen-drive, external hard drives or any other portable devices on move. Patient with conditions (heart diseases, diabetes, hypertension) should carry Alert devices for Emergency.
  146. 146. Conclusion….. EHR at health institution level and PEHP at personal level to gain complete 360 degree information. For providing continuity of care to patient, at right time, at right place and at right cost. PEHP prevents duplication of investigations, medications, delay in care, check on risk and cost.
  147. 147. Continue……………… Standardizing of PEHP information for continuity of care. PEHP allows practitioners from different settings and disciplines to share information. Allows the patient to carry this information with him or her upon referral, transfer, or discharge.
  148. 148. Normal condition Update PEHP Physician treatmentDiseasestate Self medication Non allopathic therapy
  149. 149. Effects of PEHP on the PatientsAdvantages Disadvantages Information on the go.  Cumbersome for Ensure Information is maintaining. accurate and complete.  Access to the Computers. Self medication is updated.  Illiteracy. Different physicians opinion recorded.  Costs him extra. Careful  Security concerns. Handy in Emergency.  Accessing the web in Quick treatment remote places. prevents duplication
  150. 150. Effects of PEHP for the PhysiciansAdvantages Disadvantages Complete Information.  Distrust on Information Quick treatment. viability. Opinions of other physicians.  Doesn’t like to expose his opinion. Disease pattern is easy to understand.  Fear of medico-legal issues.  Duplication of records.  Increased workload.
  151. 151. Medical record MR history parallels the history of medicine. Contains medical information of an individual from “Womb to Tomb”. “A clear, concise and accurate history of the patients life and illness, written from the health point of view, and is a complete compilation of scientific data derived from many sources, coordinated and integrated into an orderly document for further multifarious uses”. --Dr G.D Mogli
  152. 152. Necessity Contains patient demographic information, history, physical examination, progress notes, investigations, consultations opinions, diagnosis, treatment including medical, surgical, therapies.Necessary for various reasons. Insurance sector Medico legal cases & analysis Also for effective Patients forget but Records remember"
  153. 153. Advantages of EHR Manual records Electronic recordsInaccessibility, parts of Decentralized,the records are simultaneous access allgeographically widely the time.distributed. Active it can triggerPassive: unable to certain actions accordingtrigger certain actions to the data “Manual” linkage “Increased” linkage with external health careTime consuming to providersexplore for clinical orfinancial studies Excellent basis to conduct clinical and financial studies
  154. 154. Some Current PEHP Providers And many more……
  155. 155. Problems with EHR Interoperability Vendors develop readymade software’s / In-house tailor made to suit only certain health institutions. Survey indicates old people want to follow the manual records. These are problems which can be solved by developing of standards.
  156. 156. EHR (Electronic health record) Refers to an individual patients longitudinal medical record in digital format. Easy to maintain. Usually accessed on a computer, often over a network. Instantly accessible to all authorized from different stations.  High end gadgets are available for making the recording easy.
  157. 157. Precautions In selecting a PEHP provider Ensure Security of the records. Maintain Confidentiality of records. Ensure Privacy. Technologically stable and advanced. Should be Interoperable. Cost. Provide long term support.
  158. 158. A Wireless Sensor Network based FallDetection and Activity Monitoring System for the Elderly By Prof. Subrat Kar, Sanat Sarangi and Akshat Bisht Bharti School of Telecommunication Technology and Management, IIT Delhi, India NCMI 2012, AIIMS
  159. 159. Motivation Prevalent technologies-  Smart Insole, Smart Cane and Smart Headset monitor underfoot pressure, improper usage behaviour and EEG signals respectively.  Armbands, waistbands and ankle-bands have been developed that measure skin temperature, energy spent (calories) and activity. Our concern is to not just to create a smart device but a smart space using a number of such devices – a sensor network. A sensor network helps communicate events of interest over large geographic distances without using a legacy network.
  160. 160. Sensor NetworksSensor Nodes: Low-cost Resource-constrained Autonomous Form a resilient Mesh Network, hence the term- Sensor Network Fault Tolerant
  161. 161. Gaitsense (Gait Assessment System) Consists of  A sensor network formed by gait nodes and relay nodes.  A multi-tier control and notification system (consisting of a gateway, user application and DBMS) that talks to Internet and cellular networks.  Gateway acts as an interface between the sensor network and the GUI-based user application and logs all communication in the DBMS.  User Application provides multi-dimensional visualization capabilities for sensor events through charts, tables and maps.  User Application runs custom algorithms that take specific actions based on user requirements and sends appropriate notifications.
  162. 162. Gait Node Consists of a sensor node and an accelerometer. The Sensor node has a extremely low-power micro-controller and on-board radio transmission capabilities. The accelerometer can sense acceleration on upto three axes. Acceleration is used to recognize gait characteristics. Gait Node can be conveniently worn at the waist or ankle to detect the state of the subject- standing, sleeping, walking, running, fallen. Status of gait node 1 as seen in user application Gait Node
  163. 163. Deployment Scenario A Geriatric care unit as shown, can be a possible application scenario for GaitSense. The objective is to monitor residents wearing gait nodes and auto-notify events such as postural changes, activity changes or number of steps taken. Fixed relay nodes installed at strategic positions and the gait nodes form a sensor network that reliably streams events to the gateway and user application in the administrative section. Services like email, twitter or sms are used to send notifications.
  164. 164. Example Deployment
  165. 165. Conclusion A fall detection and activity monitoring system for the elderly is proposed and its integration with the public communication infrastructure is discussed to enable its widespread adoption. By notifying events like a fall, the system promises to help reduce human casualties by allowing effective rescue and remedial operation-planning. The systematic automated recording of all behavioural aspects could also provide valuable information to doctors for analysing medical conditions.The work done in this paper is supported by DST project titled “Development of a wireless sensor network based gait assessment system for fall prediction in elderly patients” vide sanction ref- SSD/NI/020/2007-TIE dt. 31 Jan, 2008.
  166. 166. Thank You Contact: Prof. Subrat KarProfessor, Electrical Engineering & Bharti School of Telecom, IIT Delhi, Hauz Khas, New Delhi – 110016 Ph: (011) 26591088 Email: subrat@ee.iitd.ac.in
  167. 167. MediCall: Hospital Resource System Based on VistA implemented at JPNATC, AIIMS Easily Accessible, Affordable & Advance Healthcare Solution GTI Infotel http://www.gtiinfotel.com Corporate HQ: A-51 SECTOR 8, NOIDA, UP; Tel: +91-120-427-3656; Fax: 433-7855
  168. 168. Table of Contents Affordable, Accessible & Advance Healthcare for Hospital & Patients VistA Implementation & Integration with HIS Integrated HRS Implementation at JPNATC, AIIMS: – Block Diagram – Back ground & Service provided at JPNATC, AIIMS Integrated HRS: Components – Hospital Information System:  Registration, ADT, OPD, Stores, Inventory, Display, Equipment management & Utilization, Waiting times, In-patient Bed status – CRM:  Patient data, Appointments, Complaints, Information, IPD Data & SMS/Email, Integration with PACS & other HIS. – Website:  Real time data of OPD, IPD, Stats, etc. Hospital Info, Faculty Info Awards received
  169. 169. Affordable, Accessible & Advance Healthcare for all  GTI MediCall Hospital Resource System helps in providing affordable, accessible & advance healthcare for Patients as well as Hospitals: – Developed on the most stable healthcare platform VistA developed over decades of research. – Accessible over the internet – Accessible over telephone – Availability of Patient Data & Healthcare provider at lower cost – Available 24x7 over the internet, telephone (Call Center) & on-site (at the hospital)
  170. 170. Healthcare computing: Mapping industry needs to technology capabilitiesThere are several reasons why GTI MediCall HRS issolution to the health industry’s unique blend ofrequirements: It can lead to easier update and higher quality patient data—a feature especially important in health care, where fragmented, redundant, and inconsistent data is rampant today. SaaS-based electronic medical record (EMR) solutions area natural fit for small physician practices to which most physicians belong because of their affordability, ease of use, and small requirement for ongoing technical support.
  171. 171.  The exoskeleton nature of the cloud makes it relatively easy to inter-connect disparate systems from different health organizations, and provide an elastic infrastructure that can start inexpensively and quickly scale as adoption increases. Thus, it provide an ideal architectural alternative for Health Information Exchanges (HIEs). There are promising advances across a broad spectrum of patient-facing and telemedicine/telehealth applications. There is also growing attention on providing direct, continuous engagement between patients and providers through “in the cloud” relationships that include advanced continuous home and portable monitoring. Technopak Healthcare, a consulting firm, expects spending on health care in India to grow from $40 billion in 2008 to $323 billion in 2023.Sources: Gartner, Factiva [from Accenture ‘Cloud Computing in Healthcare’ deck, date Feb 19 2010,
  172. 172. On the Cloud or Physically Co-located Solution? GTI can provide both On the Cloud as well as Physically Co-located solution for the Hospital. The Hospital can choose between the two solutions or a hybrid of both solutions (as implemented at AIIMS) Both Systems provide equivalent & optimum solution for the Hospital.
  173. 173. MEDICALL HOSPITAL RESOURCE SYSTEM :SOLUTION IMPLEMENTED AT JPNATC, AIIMS(VISTA INTEGRATION)IN ANOTHER FIRST BY AIIMS, AN INTEGRATED HRS STARTED OPERATIONS FORJPN APEX TRAUMA CENTRE, AIIMS
  174. 174. Integration & Implementation of VistA &Development of HIS on top of the VistA Engine The company specializes in Implementation of VistA for Hospitals & integration with HIS & PACS The current system has been Integrated with: • VistA at the Hospital • PACS at the Hospital
  175. 175. MediCall Hospital Resource SystemServices that includenot only call centerfor the patients &doctors but a totalback office support tothe entire hospital.We integrate withyour existing databaseor develop newsoftware for you tooffer round-the-clockservices.
  176. 176. MediCall Hospital Resource System (HRS)Communication Call Center Hospital Resource System: - Website - Hospital Info System - Call Center CRM Hospital Mobile Support
  177. 177. Our Solution features: End-to-end solution with Software, Hardware & Manpower: The systems & processes are ready & available to be deployed on-site or on the cloud. Hence, providing the right solution deployable in 2-3 weeks is now possible. Completely outsourced and scalable: This frees up valuable real estate at the Hospital besides potentially decreasing the overheads like electricity, parking and toilets which an on-site facility would use. Being completely scalable, the call centre can quickly ramp up operations in line with increased demand and in case of disasters. Professional operations: The call centre will provide best-in-class service to clients with quality control at every stage and 100% call recording for auditing and quality purposes. Patient services: With the main thrust on improving the quality of patient care, the call centre will manage all appointments and follow-up of patients. The call centre will also answer queries on all admitted patients and will provide information on all diagnostic & therapeutic services available, the procedure and pricing of getting a specific service or test done and the approximate wait- times. Thus the patients may not need to approach anyone physically for information. Research: Research is one of the key mandate of AIIMS and the call centre will facilitate research by ensuring follow-up of patients, administering surveys and ensuring authenticity of data. Centralized help desk & support: The call centre will take over the responsibility of logging & initial troubleshooting software & hardware problems helping in providing professional 24 X 7 support services Inventory Management & support: The call centre will act as the single window for all inventory related issues for the Hospital. The call centre can provide completely audit trail for any breakdown or even and follow up with the vendor and end user to ensure optimal utilization of resources.
  178. 178. MediCallHRS: Hospital Info System Modules (partial listing) Registra tion Inventor Roster y Mgmt Equipm ent Billing Mgmt & Maint. Equipm ent OPD Utilizati HIS on Surgery ADT Patient Waitlist Real Call Time Pt. Centre Mvmnt & CRM Nursing In- Display Quality patient Imp. Bed Mgmt Status
  179. 179. Solution Overview1 Hospital Info. Benefits System (HIS)A ADT Registration - Admission - Discharge - Transfer - RegistrationB OPD Out Patient Department Management - Takes care of all the Waiting lists, Queue management, Appointments etc.C Billing Integrated BillingD Duty Roster Includes duty roster as well as time schedule, leaves, monitoring, etc.E Laboratory Investigations & reporting on all the Lab findings & integrating with other modulesF Radiology Supports DICOM for direct access to equipments.
  180. 180. 1 Hospital Info. Benefits System (HIS)G Registration - Computerized for future access & control - Maintain databaseH Inventory/Stores - Control pilferage - Know status of each item - Know movement of each item - Know low stock details for ordering - Paperless systemI Equipment - Monitor AMC of all medical equipment Management & - Less breakdown Maintenance - No burden on hospital manpower for maintenance issuesJ Utilization of - Equipment wise utilization details Equipment - Know the utility & cost/use of each equipmentK Surgery Waitlist - Transparent & seamless maintenance - Patients get information from the call center regarding dateL Real-time Patient - Movement of patient recorded Movement - Realtime info seen by attendants, hence reducing burden on the Display staff - Helps patients to know his movements
  181. 181. # Functions Benefit2 CRM integrated - Appointment system for the Doctors & Patients with VistA & Call - Queue-less OPD Center - Appointment information on phone/SMS - Change of appointment by Patient/Doctor now possible - Patient Information on phone - Hospital Information available on phone - Complaint handling & monitoring - 24x7 availability to patients, attendants, staff3 Website - Hospital Information on the internet - Real time appointment & wait-time info to patients
  182. 182. 1. Hospital Info System: HIS home based on VistA
  183. 183. Registration Parameters captured: – Name, Address, Phone, Symptom, General ID/Ref. No., custom reports, Diagnosis, Pupil, Injury & much more General Registration Specialty Registration based on Gen. Reg: – Ortho/Neurosurgery/Surgery Output: – Online Reports, Specialized Reports, Admin, etc. Logistics: – Operation Timings: 24x7 – Manpower Required: Minimum 5 for 24x7 operation – Hardware: PC with 30mins UPS – Internet Access: Data Card/Broad band
  184. 184. General Registration
  185. 185. ED Registration
  186. 186. Neuro Registration
  187. 187. Update Form
  188. 188. Patient General Report
  189. 189. Admin Report
  190. 190. Inventory Management System Inventory of – Consumables like medicines, tables, powder, etc. – Disposables like syringes, gloves, etc. – Utilities like bed, etc. – Equipment – Complete detail including location of the Inventory Output: – Status, Stock levels at wards/stores/etc., Indents, etc. Logistics: – Different types of Alarms at various predefined levels – Operation Timings: 6 days a week (7 hrs x 6 days)
  191. 191. Inventory Management
  192. 192. Stores Report
  193. 193. Equipment Management & Maintenance module Assist to monitor the AMC/Warranty of all medical equipments Book complaints Monitor performance of Contractor under AMC/Warranty Identify Repeat faults Take Preventive maintenance Replacements of active elements in time Mandatory calibration of equipment
  194. 194. Equipment Utilization Equipment wise utilization: – By day – By week – By month Utilization efficiency of: – Machine – Operator Equipment Applied & removal days Equipment used on which Patient Breakdown & likely repair time estimation
  195. 195. Surgery Patient Waitlist & OT Management Patients earmarked for surgery Type of Surgery Doctor allocated to carry out the surgery Waitlist in weeks/months Weekdays for surgery according to its allocation to individual Doctor Patients to be informed accordingly on – Phone/SMS/Email Admission to Surgery after waitlist OT Management
  196. 196. Patient Waiting List
  197. 197. Waitlist
  198. 198. Admission to Surgery
  199. 199. OT Management
  200. 200. Real Time Patient Movement Display System Patient (under treatment) movement display system Helps attendant to know movement of patient undergoing different tests/stages Displays on 40” LCD monitor include – Patient Name – Department – Process Helps patients in moving from one test to another Specialty Dept does their own data entry & the same is displayed Realtime Bed Availability: for the patient & Doctor alike
  201. 201. Display: LCD
  202. 202. ED: Data entry
  203. 203. Ortho: Data entry
  204. 204. Bed Availability Entry
  205. 205. In-patient Bed Status Real time bed status / availability of Beds. Data can be sorted as per – Ward – Doctor – Date – Department Criticality of Patient including complete detail online Number days stay & much more
  206. 206. Nurse Quality Improvement Mgmt Captures the Error incident detail done by the Nurse Helps in monitor Nursing Quality service Capture Patient Care lapse Patient wise details are captured Nurse wise details are captured
  207. 207. 2. CRM: Integrated with real-time info for the call centerCall Center CRM to be deployed at the call center/Cloud to havefollowing functions: Patient Information Appointments Staff Information/Rosters Dashboard for Faculty/Doctor SMS/Email Reports Complaints handling & monitoring Inventory/Stores Integration with VistA/PACS & other HIS.
  208. 208. Patient Information & Search
  209. 209. Appointment Information & Search
  210. 210. Staff Information & Search
  211. 211. Complaints Registration & Monitoring
  212. 212. SMS to Patient/Staff/Faculty
  213. 213. Appointment Details# Patient Existing Appointment Call Status TC No. Name Disc. Date Resident Dr. Ward Diagnosis Procedure Date Time Exec Rem DR. MAMRAJ Connected/1 195719 Akash FEB 1,2010 GUPTA TC6-15 BTA WITH SPLENIC LACERATION non operative management Feb 6,2010 10:00am Bhavana Ist Call confirm LEFT ICD WITH WATER SEAL DRAIN LEFT A/E GUILLOTINE AMPUTATION RTC WITH MULTIPLE RIBS # WITH LEFT UNDER BRACHIAL PLEXUS BLOCK ON DR. AMAR Shri Ram HEMOTHORAX WITH GANGRENOUS 19/10/2010 DELAYED PRIMARY Connected/2 193779 JAN 31,2010 NATH TC6-01 LEFT FEOREARM CLOSURE OF LEFT A/E AMPUTATION Feb 6,2010 10:10am Bhavana Ist Call Naresh MUKERJI confirm STUMP UNDER GA ON 25/1/2010 EXPLORATORY LAPAROTOMY, ILEAL DR. ANURAG RTA WITH BTA AND ILEAL TRANSECTION EXTERIORIZED AS3 195089 Pramod JAN 31,2010 GUPTA TC6-19 TRANSECTION DOUBLE BARREL ILEOSTOMY, Feb 6,2010 10:20am Bhavana Wr Number Ist Call PERITONEAL LAVAGE AND CLOSURE BLUNT TRAUMA ABDOMEN WITH DR. ANURAG EXP. LAP. & PERITONEAL LAVAGE WITH Connected/4 192915 Satpal JAN 11,2010 GUPTA TC6-18 HEMO. & PNEUMOPERITONEUM WITH DRAINAGE. Feb 6,2010 10:30am Bhavana IInd Call LIVER LACERATION confirm
  214. 214. Dashboard for the Faculty displaying Faculty’s Appointments, Patients, Stats, Roster ,etc.
  215. 215. HIS implementation at AIIMS: OPD & Doctor Consultation
  216. 216. Gen & OPD Registration & Reception
  217. 217. Token Generation for OPD
  218. 218. Server Room & Computer Facility
  219. 219. 3. Website: JPNATC dynamic website
  220. 220. Real time stats on homepage
  221. 221. Week, Month & Yearly Statistics
  222. 222. eINDIA 2010 award at Hyderabad
  223. 223. mBILLIONTH 2010 award at N. Delhi
  224. 224. eWorld 2011 Award at N. Delhi
  225. 225. THANK YOUROHIT@GTIINFOTEL.COM098114-12342

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