HMIS Implementation in Hospitals

1. HEALTHCARE & ACADEMICS
MANAGEMENT INFORMATION SYSTEM
GMC & SirJJHospital, Mumbai
An“e- Governance”InitiativebyMedical EducationandDrugs
Department

2. An“e- Governance”InitiativebyMedical EducationandDrugs
Department
GGMC & SirJJHospital,
Mumbai

3. Introduction
HMIS Project

4. MEDDHMIS Project – Snapshot
 Medical Education and Drugs Department drew a comprehensive solution for
IT enabled services to encompass the operations of 14 Government Medical
Colleges and 19 teaching Hospitals by implementation of an Hospital
Management Information System for the purpose of education, training,
research and patient care related activities at the State Government run
Hospitals and Medical colleges
 The Service Provider, Hewlett Packard India Sales Pvt Ltd, to create IT
Infrastructure, conduct the Patient Registration Processes (Front office) for
Outpatient & Inpatient as an Outsourced function and manage the Created
IT infrastructure
 HP incurs all Capital investments upfront and Government of Maharashtra

5. MEDDHMIS Project at GGMC and SirJJHospital,
Mumbai
 GGMC and Sir JJ Hospital, Mumbai was shortlisted as
the Pilot location for the prestigious MEDD HMIS project
 The Central Server Repository Data Center for storing
the patient data across all 19 hospitals is located in this
institute
 The project went live on 18th
Oct 2008
5

6. Primary Objectives – MEDDHMIS Project
 To create Unique Health ID for the Patients visiting State
Government run Hospitals which will be used as permanent
MRD number for the patient
 Reduction in the waiting time for Patients at registration
counter
 Making all patient data including X-ray, CT, MRI images and
diagnostic reports available to the Clinician on screen
 Make Patient data available in Electronic format for easy
Management of Hospitals and Patient Care services
 To bring transparency and clinical audit trail facility in Patient
Data Management
6

7. Primary Objectives – MEDDHMIS Project
 To plug Loop holes for pilferage and bring accountability,
transparency and audit trail in all transactions
 To create MIS reports / Statistical Information at all levels
 Medical Research and Data Mining with patient data captured
across all 19 Hospitals in digital format
 To create a central repository of Patient records for the State
and accessibility to these records from any of these Hospitals
7

8. Features and Achievements
HMIS Project

9. HMIS Salient Features – Broad Perspective
 HMIS Modules are fully Integrated
 Radiology Information System, Laboratory Information System, Electronic
Medical Record, Inventory control and finance modules are accessed as one
application from Anywhere in he Hospital / Department
 HMIS Modules are Patient centric
 All Modules are configured, accessed based on patient work flow
 Integrated and standardized Workflow
 The HMIS system workflow is customized to meet requirements of Government
Hospitals
 Decision Support system
 Unified online reports on Patient information for supporting the Dean / HoD’s to
make decisions faster and provide better medical care to patients
 Uniformaccess to HMIS modules
 Simple Internet Browser based user-interface for all modules of application
9

10. HMIS Salient Features - Nutshell
 Unique Health IDforPatients
 Easy tracking of medical history of patients,
thereby assisting speedy and error-free care
 Reduction in the waiting time for
Patients at registration counter
 HP-provided skilled operators at counters to
ensure quick registration of service requests
 All patient data incl. X-ray/CT/MRI
images, diagnostic reports on screen
 Cost savings on film for hospital and ease of
use for patients
 Patient data available in Electronic
format, across locations
 Ready availability of data across state, Data
impervious to damage as with paper
 Audit Trail facility
 Plugs loopholes and pilferage, bringing
accountability and transparency in
transactions
 Rich MIS
 Up to date statistical reports to assist
administration
 Medical Research and Data Mining
features
 Analysis of patient data across state to assist
in better, pro-active and preventive
healthcare
10

11. HMIS Project Achievements
 Waiting time at registration counter reduced by 88%
 Reduced from 55 minutes to under 7 minutes
 Unique Health ID issued to 15, 56, 720 patients till date
 Unified medical history of patients
 Reduced time to commence treatment
 Totally 42, 63, 837 patients have been registered from HMIS
since Oct 2008
 Increase in revenue due to increased transparency at registration
and billing counters
 Registrations Revenue increased by about 82%
 Diagnostic Services Revenue increased by more than 400%
11

12. HMIS Project Achievements…..Contd
 Patient EMR and administrative reports available to authorized
users instantly
 Instant access to data, reducing non-clinical process time
 Patient prescriptions and dispensing of medicines through HMIS
is about 98 % (2 % of Patients go out of the queue )
 Better transparency in inventory audits and accounting procedures
 Central repository of patient records
 Accessibility to EMR from any MEDD computerized Hospital through
batch processing
 Demographic details of more than 15 Lakh Unique patients
available
 Data mining / Research can assist enhancement of preventive healthcare
12

13. HMIS Project Achievements…..Contd
 Increase in number of patients registered is about 75%
 Computerized registration has helped curb number of unregistered
patients
 HMIS handles over 90% of transactions
 Proves successful user acceptance of computerization at Sir JJ Hospital
13

14. Statistics
HMIS Project

15. OPDRegistrations Statistics
15
The OPD Registration has been on the increasing trend since Go-Live of
HMIS project
Data collated till May 2014

16. IPDAdmissions Statistics
16
The IPD Admissions has been on the increasing trend since Go-Live of HMIS
project
Data collated till May 2014

17. Free & Repeat Patients Statistics – Loyalty Index
17
The number of repeated patients are on an increasing trend emphasizing their
trust on the patient care management.
* Data collated till May 2014

18. SeniorCitizens Visiting SirJJHospital
18
Senior Citizens visiting Sir JJ Hospital has been increasing every year
Data collated till May 2014

19. Surgeries – Major& Minor
19
Major and Minor Surgeries Details of Sir JJ Hospital has been increasing every
year
Data collated till May 2014

20. Service Department Statistics - Orders Processed
20
processing capacity of the service departments has been increasing since 2008
icting increase of revenue through investigations
DatacollatedtillMay2014

21. Revenue Growth provided by HMIS
 Registrations Revenue at Sir JJH, before
HMIS implementation was Rs 2,52,417
and after HMIS implementation it is Rs
4,94,070 in May 2014 i.e. an increase of
about 82%
 Diagnostic Services Revenue at Sir JJH,
before HMIS implementation was Rs
9,12,587 whereas after implementation it
has sprung to Rs 47, 02, 086 in May 2014
i.e. an increase of over400%.
(Note: Therevisionof rates has also contributedto thesteep
21
415.24%
82.54%

22. Research Details
22
Publications
YEAR 2008 2009 2010 2011 2012 2013
Total 10 29 36 36 51 57
219
Paper/PosterPresented
On going
Research
Year 2008 2009 2010 2011 2012 2013 2014
Total 6 43 34 51 55 61 76
250

23. Benefits
HMIS Project

24. HMIS Project – Benefits
Benefits to Patients
 A unique patient ID for Life long as MRD number
 No loss of patient data including X-ray, CT, MRI images and accessible
from any locations
 Reduction in the waiting time at registration and consultation since all
demographic details of the patient are captured for life long
 Speedy access to investigation reports since they are available online
leading to early diagnosis
 Patients do not have to go MRD section / Record room to draw their old
records prior to consulting the doctor
24

25. HMIS Project – Benefits
Benefits to Patients…contd.
 Below poverty line / senior citizen “exempt” process simplified through
central data – no moving from one counter to another
 Prescriptions are available online to the pharmacist even before the
patients reach pharmacy counter – quick disposal
 Online prescriptions reduce medication error
 Reduced chances of specimen mismatch through unique MRD number
link improving the accuracy of patient’s investigation report.
 On admission bed allocation is dynamic saving lot of time
 Simplified Patient transfer system through online bed transfer
 Patient data integrity and accuracy maintained - saved cannot be
modified or erased
25

26. HMIS Project – Benefits
Benefits to Doctors /Nurses and Administrative staff
 Availability of Electronic Medical Record for recall at any point, from
anywhere within the network
 The process of diagnosis and treatment has been hastened -
availability of patients past history, diagnostic study reports and ‘quick
prescription’ etc…
 Proper medical audit through audit trail
 Patient referral/second opinions simplified through online referral
 Doctors can do consultation from anywhere, anytime within the
network
 Cash collection process within Hospital - simplified and transparent.
 Automatic generation of cash collection and inventory reports -
26

27. HMIS Project – Benefits
27
Benefits to Doctors /Nurses and Administrative staff…..Contd.
 Inventory management – efficient, transparent – less chances of
pilferage
 Easy for hospital administrators – supervise from their desk through
the computerized system.
 The seamless availability of patient data on Central Server helps the
doctor in conduct of Medical Research and Data Mining.
 Doctor’s while performing surgery are able to accurately view the
required images in various dimensions, thus helping him in
performing precise surgeries.
 Medical errors are reduced since repetitive writing work is eliminated
through this automated process.

28. HMIS Project – Benefits
28
Benefits to Service Departments (Labs & Radiology)
 On line viewing of LAB & Radiology investigations
 LIS - Interfacing of Lab Equipments with HMIS –
 Direct Result entry in Reports saving time
 Avoids error due to manual data entry
 PACS - Interfacing of Imaging Modalities with HMIS –
 No need to process films
 No need to carry and preserve the films – Any image can be viewed
at any time for diagnostic/comparison purpose
 Clinically critical cases’ images can be used for academic purpose

29. HMIS Project – Benefits
29
Benefits to Medical Store & Pharmacist
 Avoids error due to misinterpretation of Drugs
 Receives alerts on near Expiry stock & Low stock level
 On line Indent Request/Issue for speedy delivery
 Hassle free inventory management

30. HMIS Project – Benefits
30
Benefits to MRD(Record) Department
 All medical records (Normal as well as MLC) can be preserved for
very long time – no space constraint
 Easy to retrieve any case records
 All Statistics on a single click – No need to prepare manual reports
and statistical reports

31. HMIS Project – Benefits
31
Benefits to Hospital Administration
 All MIS & Statistics on a single click. For Example -
 Total OPD/IPD & Casualty patients visiting to Hospital (Consultation Reort)
 Total Free/Repeat Patients
 OPD & IPD revenue
 Drugs ordered and Dispensed
 Investigation ordered and Processed
 Statics of Surgeries
 Bed transfer
 Indent reports
 Inventory reports ETC…..
 Helps in taking quick decisions and action in case of emergency
/shoot up of any communicable disease

32. Challenges
HMIS Project

33. Challenge 1: Huge Patient Volume
33
Over5, 00,000Patients visit OPDandover45,000admissions inLargehospitals (Large
hospitals - havingbedcapacityover1000Beds) inayear, duetothepatient rushinOut
patient department thekeychallengewas todevelopthesysteminsuchamannerthat it’s
asingleoperationscreenforallpatient careactivities that consultant willworkupon
Solution:
 Single window for Patient Service
 Customized Template designed for case notes to capture details seamlessly
 Ready made templates of signs and symptoms for common diseases thus managing
70% to 80% of patient work load

34. Challenge 2: Non standard maintenance of Data
34
Thereareno universal standards to recordorto keepmedical Data. Theavailability
of accurateandexhaustivemasterdataas thedatawas availableinbits and
pieces.
Solution
 Requirement gathering of the workflow across state government hospitals to
standardize the templates
 Scrutiny of past records / Circulars /Notices / GR’s issued for capturing relevant
data fed into HMIS system
 This master data was put forth for user acceptance and other statutory approvals
as per government norms
 Standardized data formats developed with consultative approach involving all
Stakeholders

35. Challenge 3: Management of Change
35
This was themost challengingpieceinthehospitalas theusers weremorecomfortable
usingpaperandpenfordoingpatient carerelatedactivities andtheyweretobemigrated
fromPaperbasedsystemto Onlinesystemwhichduetolackof timewas difficult. Also
settingupright expectations fromthemanagement andusers inthehospitalontheeffort
requiredforinternalizingthis Programmewas adifficult task.
Solution: Structured manner of implementation encompassing -
 24 X 7 Training Facility
 User Acquaintance program
 Executive Training Program
 Creation of Core team
 Class room Training of users
 Handholding of User’s in real Time Environment
 Creating Departmental Champions
 Refresher training

36. Challenge 4: Inconsistency in Capturing Data
36
Designinguserfriendlyinterfaces inHMISas eachuserhas his ownwayof
lookingat patients andthencapturingdataforcreatingEMR
Solution:
 Preparation of standardized Templates
 Creation of Detailed Standard operating procedures for all modules of HMIS
to bring consistency and accuracy in the HMIS implementation

37. Challenge 5: Outdated Equipments
37
InterfacingOLDEquipments - likeX-Ray, BiochemistryMachines not compatible
to current dayHMIS
Solution
 Detailed study of the equipments available in various diagnostic centers
 Developing a composite application was developed for reading both ASTM
and Non ASTM compatible data so as to integrate with the existing HMIS
application

38. Challenge 6: Lackof IT knowledge
38
Lackof anyITrelatedmoduleinMedical course(MBBS/BAMS/BHMS)
Solution
 New Joinee induction programme for junior most consultants and Nursing
staff includes HMIS Orientation and Training

39. Challenge 7: Infrastructure rollout
39
Right infrastructureinterms of right sizing, theservers andPCs, LAN design, equipment
securityetc, this typicallywas akeypoint at most of thegovernment hospitals arehosted
out of oldstonebuildings /structures inwhichsettinginfrastructureis difficult duetoits
buildandwheremost of theroutediagrams /floorlayout blueprints arenot available
Solution
 Detailed existingworkflowstudywas conducted in each of the hospitals location to
understand the Geographical scope of HMIS users within the campus based on which
 Computers in ratio of 1-1 (One Doctor – One computer)
 Installed latest Blade servers to ensure processing speed of the data is always high.
 All Servers of Application and Database are configured in High Availability mode
with Network switches in auto failover mode
 Rigorous discussion with hospital authorities was done and based on the previous
experience of making infrastructure ready, some key assumptions were made to
design and execute LAN infrastructure piece. Once all the infra readiness work was
completed the route diagrams were submitted to hospital authorities for future
reference and record purposes

40. Thank
You
HEALTHCARE & ACADEMICS
MANAGEMENT INFORMATION
SYSTEMFORGGMC & SIRJJ
HOSPITAL, MUMBAI