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TN e-Healthas a
Healing Hand to
Patients
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Dr. P. Sunil Gavaskar M.B., B.S., D.A.,Medical Officer – Health Management Information System
Tamil Nadu Health System Project
Three Tier Health Care delivery in Tamil Nadu
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32 Revenue districts &42 Health unit districts
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Health Management Information Systems (HMIS)
HMIS developed by Tamil Nadu Health Systems Project for:-
267 secondary care hospitals
20 Medical College (MIS along with CMS –college management system) & 49 hospitals
1614 Primary Health Centres
One Medical University (UAS – University Automation System)
Conceptualized to provide real time critical health data
126 Crores project funded by world bank (reimbursement loan)
IT infrastructure provided for Govt. hospitals with centralized servers and TNSWAN Connectivity for web based application
Ten thousand users and one lac patients are cycled in the system daily
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Project Strategy
Project Rationale
Policy Initiatives
Process Initiatives
Paradigm Shift
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HMIS – Project Rationale No real time data available to monitor the performance of the hospital
Evidence based program management was a challenge
Undue delays in receipt of data
Retrieval of old manual records was ineffective & time consuming.
Drug & equipment inventory - maintenance and tracking of warranty/AMC-more cumbersome
Lack of standard names and codes
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HMIS - Policy Initiatives Issue of government orders for:-
Implementation, Sustainability & Usage
Fixing of responsibility on the end users
Budgetary provisions for maintenance & support
Removal of Manual records
Instructions to the Heads of Departments and Directorates to use data from HMIS for purpose of monitoring, review and analysis
Instructions to dispense away with the system of manual reporting and instructions to audit teams
Formation of a dedicated team at the Directorate
Establishing a centralized help desk at the directorate
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HMIS - Process Initiatives For Software requirement specifications (SRS) thorough study of the entire health system and its process
were studied
Extensive training sessions were conducted for various categories
Stakeholders meetings Weekly reviews & Follow up action taken
Help desk set up Protocol established - Escalation matrix followed
Central helpdesk for facilitation and co-ordination
IT coordinators placed in each district All infrastructure issues related activities
Application support and training
Form e-core team in individual hospitals and solve IT issues
Three Server Administrators for Server Management
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HMIS - Paradigm Shift Automation of work flow process at the hospitals
Manual Registers/Records are partly removed from hospitals
Real Time monitoring of hospitals performances
Electronic Medical records
Standardization of health systems and processes
Computer skill development among the hospital staff
Online maintenance of drug inventory/equipment inventory
No data entry operators-involvement of regular staff
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Implementation overview
Pilot -5 hospitals
Phase I – HMS in 36 hospitals across
5 districts
Phase II – HMS in 222 secondary care hospitals
+HMIS in 1613 PHCs fully online
Phase III- 49 Institutions under Directorate of Medical Education
including 20 Medical Colleges +
TN Dr. MGR Medical University
INR 8 Crores
INR 2.8 Crores
INR 87 Crores
INR 45 Crores
Dec, 2008
Nov, 2009
Aug, 2011
2013
Software development cost 9.69 crores
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Two Components of HMISHospital Management System- (HMS) &
Management Information System-(MIS)
HMS MISClinical Information
Automatic Incorporation of data at the Institutional level
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Hospital Management System (HMS) Modules
Registration
Out patient consultation
Inpatient admission
Lab ,X-ray & other investigations
Pharmacy & Main stores
Biomedical Waste Management
Blood Bank
Diet
Linen
Online daily report generation
Final diagnosis mapped to ICD-10 classification
Medical Records department
The Modules are unique for the type of usersThese modules are regarded as patient management information system
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Advantages of HMSFor Patients
Unique Patient identification number (PIN)
On next visit, no registration queue
Prescription & Lab reports printouts are given to the patient
Old records available on line -safe for a longer period of time
Patient can visit any secondary care hospital across TN with PIN and he record is readily available for review
For Doctors
Saves a lot of time
Drugs/Lab investigations can be grouped into packages (Treatment Kits) for prescription.
Can view previous clinical reports on line
Repetition of previous prescription with a single click – useful in Chronic diseases
In certain cases doctor can follow Standard treatment guidelines (Master data)
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Advantages of HMSFor Pharmacist
Drug stocks are updated upon each drug issue
He can monitor expiry dates and batch number of each drug.
The Warranty / AMC of equipment can be easily tracked.
Transparency and accountability in managing drugs, equipment stocks.
Interface with TNMSC software for online indenting.
Hospital can view the stock position of the warehouse & vice versa
For Nurses
Saves a lot of time- need not maintain too many registers
Diet, drugs & linen -indenting can be done from wards
Ward inventory made easy, Drugs expiry dates monitored
Discharge summary given to the patient as print outs
Ward transfer in & out managed effectively
Helps to monitor and manage the blood bag availability precisely
Handing over and taking over of charges, patients census- made accountable and transparent
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Advantages of HMSFor Administrators
This predominantly functions as decision support system
Hospital level-for Chief Medical Officers
District level-for Joint Directors of the districts
State level- for HODs/Directors
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Registration Screen16
Treatment Kit
Lab Test
Medication
Diagnosis
Kit name
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Standard Treatment Guidelines18
Stock View Screen 19
Injection OP Screen20
Lab result Screen 21
Online Usage Statisticsup to Aug, 2013
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Online Usage Statisticsfor Aug, 2013
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OP Registration24
OP Consultation25
Pharmacy26
Laboratory27
The Ultimate Goal28
OP TicketBefore After
PIN & Reg. details
Diagnosis
Findings
Lab Report
Prescription
M.O. Name
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HMS - TNMSC Online Indent It facilitates the drug supply management system
The indent raised by the hospital chief pharmacist, after online approval by the CMO, will be visible in the HMS - TNMSC Online indent screen for warehouse.
The Warehouse Pharmacist will down load the indent file & upload the same in TNMSC warehouse application software.
After the warehouse process the indent the Outward Goods Register (OGR) file will be downloaded from the TNMSC software and uploaded in the HMS - TNMSC online indent software.
The Pharmacist has to Physically verify the quantity in OGR and supplied quantity and accept the indent.
The Batch number & Expiry date of drugs will be auto-updated as entered in the OGR generated from the TNMSC software – avoids time consuming indented drug details in the software.
In future both the software are planned to be integrated so that the indents from hospitals through HMS can directly flow in & out of TNMSC software
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HMS - TNMSC Online Indent Screen for Warehouse
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Online Indents view in Warehouse32
Online Indents view in Warehouse33
Management Information System (MIS) Modules
Unified Health Reporting system
Clinical Information (auto populate+)
Patient census, Morbidity, Mortality,
Patient services, Immunization,
Ancillary Services
ISMR-Institutional Services monitoring & report
Blood Bank, Lab services, etc.
Administrative Information
Buildings, Finance, Personnel, Vehicle, etc.
Program Information
All the National programs like Malaria control, Filariacontrol, Blindness Control, Tuberculosis program, etc.
MIS reports (public health information)are sent every month online to HQs
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MIS – Data Entry Form35
MIS Report36
MIS – Personal Module
All details in SR will be digitised (DPH SR updation is complete & their personal module is live)
Updation of old data will be done by the application developer after getting the details from respective Directorate in Excel format.
When the modules are made live individual hospital has to update their staff details daily on a regular basis
SR entry to be made online.
Most of the proceedings will be generated from the MIS-Personal module
The respective directorate will have the vacancy position online and can be used for appointments / transfer counselling.
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MIS – Personal Module38
Forms in Personal Module of MIS39
Employee Detail Entry Page
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Sample SR Entries41
Sample SR Reports42
Mini SR Report43
Sample Proceeding generated through MIS
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HMIS (HMS/MIS) Application Software GoTN owner of the application
Developed by Tata Consultancy Services
Centralized web based application on open source platform
J2EE (Java 2 enterprise edition)
PostgreSQL data base
Glass fish Application Server
Solaris Operating System
Follows industry standard-three tier architecture viz.
(Presentation, Business logic and Data layer)
SUSE Linux OS at the end user level-user friendly screens
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HMIS Server Architecture (Current)
Web Servers
App Servers
Database Server
Backup Server
Report Server
NAS
Tape Library
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Connectivity
Primary – TNSWAN
Point of Presence (POP) – District & Taluk
2 Mbps
Certain locations Taluk POPs are bypassed to improve connectivity
Redundant – VPNoBB
Initially 512 kbps
As per the load of the hospitals enhanced to 1 or 2 Mbps
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Hurdles – But Still Running Lack of co ordination among various vendors (no single vendor for IT infra)
Mapping existing process and rationalization of input forms for standardization
Damage caused by local factors – Construction , Drainage work etc.
Power crisis and poor backup from UPS
Mind-set and Involvement of the hospital staff
Change Management and Total system transformation
Disruption of connectivity
Delay in server stabilisation
Lack of basic computer knowledge
Safe custody of HMIS supplies (hardware)
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Levers of success Strong ownership and support from Top Health Administration
Communication to hospitals – by State authorities
Supporting Government orders Mandating usage of Online system
End users trained to use system No data entry support
Procurement Policy TNMSC &ELCOT-as per norms
Implementation follow up by TNHSP Regular stake holders meeting to discuss various issues and resolve the issues
Utilizing State Investments in establishing the Infrastructure World Bank’s periodical monitoring and review helps to attain the benchmark during
implementation
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Various Directorates of H&FW Dept. using HMIS
Directorate of Public Health
Directorate of Medical & Rural Health Service
Directorate of Medical Education &
National Rural Health Mission/TN
Once SHDRC is established HMIS will be extended to remaining directorates
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State Health Data Resource Centre(SHDRC)-in progress
Huge volume of Data collected through HMIS has to be analysed, hence SHDRC proposed.
It will act as a central repository of data for all tertiary, secondary and primary health care facilities in the state (currently 17 verticals reporting health data)
To utilise the data and convert them into information and knowledge to improve the health outcomes in the state through performance, policy evaluation and enhancement
Contribution from ICMR / NRHM / WB apart from State Govt. funds
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SHDRC: Goals
Purpose Driven Data Monitoring for Evidence Based Decisions
Preventive Action
Corrective Action
Epidemic Response
Resource Planning
Performance Management
Policy Analysis
Health System Research
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Future Plans
HMS
Linking PIN to Adhaar (UID) Card
Integrating HMS & TNMSC for fully automated online indent system
Incorporating Picture Archiving & Communication System (PACS) in HMS
Collection of Private Medical institution’s clinical data through MIS for comprehensive health
data analysis in SHDRC
Appointment system for speciality investigations like CT-Scan, MRI-Scan, Angiography etc.
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Recognition
Winner of the e- India jury award for “e- Health- best Government Initiative/policy for the year 2009”
Selected paper for Oral presentation at e-Asia 2009 International conference at Colombo during Dec 2-4, 2009
Selected paper for Oral presentation at Med-e-Tel 2010 International conference at Luxembourg during April 14-16, 2010
International Publishing houses -VDM International Publishers, Mauritius and Lambert Academic of Publishing(LAP), Germany -have offered to publish HMIS implementation in the form of a book
Finalist CSI –Nihilent e-governance awards 2011-12
National e-Governance award-Gold 2011-12 under category ”exemplary reuse of ICT based solutions”
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Other IT Initiatives of TN Health Management Information System (HMIS)
Hospital Management System (HMS) Management Information System (MIS)
(Software developed by TCS)
College Management System (CMS)(Software developed by TCS)
Pregnancy &Infant Cohort Monitoring and Evaluation (PICME / MCTS)(Software developed by NIC)
Dr. Muthulakshmi Reddy Maternal Benefit Scheme (MRMBS)(Software developed by NIC)
Chief Minister Comprehensive Health Insurance Scheme (CMCHIS)(Software developed by s/w vendor identified by UIIC)
State Health Data Resource Centre (SHDRC) Central Repository for all 17 vertical departments under H &FW
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Websites of TN e-Health ProjectsApplication Software Website
HMS www.tnhmis.org/tnhsphms/
MIS www.tnhmis.org/hmis/
TNMSC Online Indent (Warehouse) www.tnhmis.org/tnmsc
CMS www.tnhmis.com/tnmgrmucms_v3
College Website Website registration in progress
NRHMwww.nrhm-mis.nic.in
www.tamilnadu.nhsrc-hmis.org
PICME www.picme.tn.nic.in
MRMBS www.mrmbs.tn.nic.in
CMCHIS www.cmchistn.com/
SHDRC In Progress
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Lives are precious, Handle them with (e-)care
Thank You
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