HEALTHCARE & ACADEMICS MANAGEMENT INFORMATION SYSTEM
GMC & Sir JJ Hospital, MumbaiAn “e- Governance” Initiative by Medical Education and Drugs Department
An “e- Governance” Initiative by Medical Education and Drugs Department
GGMC & Sir JJ Hospital, Mumbai
Introduction
HMIS Project
MEDD HMIS 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 pays back to HP on a monthly payment basis.
MEDD HMIS Project at GGMC and Sir JJ Hospital, 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
Primary Objectives – MEDD HMIS 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
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Primary Objectives – MEDD HMIS 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
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Features and Achievements
HMIS Project
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
Uniform access to HMIS modules Simple Internet Browser based user-interface for all modules of application
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HMIS Salient Features - Nutshell
Unique Health ID for Patients 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
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HMIS Project Achievements
Waiting time at registration counter reduced by 88% Reduced from 55 minutes to under 7 minutes
Unique Health ID issued to 16, 75, 915 patients till date Unified medical history of patients Reduced time to commence treatment
Totally 43, 61, 098 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%
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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 16 Lakh Unique patients
available Data mining / Research can assist enhancement of preventive healthcare
in MEDD owned hospitals
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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
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Statistics
HMIS Project
OPD Registrations Statistics15
The OPD Registration has been on the increasing trend since Go-Live of HMIS project
Data collated till Sept 2014
IPD Admissions Statistics16
The IPD Admissions has been on the increasing trend since Go-Live of HMIS project
Data collated till Sept 2014
Free & Repeat Patients Statistics – Loyalty Index17
The number of repeated patients are on an increasing trend emphasizing their trust on the patient care management.
* Data collated till Sept 2014
Senior Citizens Visiting Sir JJ Hospital18
Senior Citizens visiting Sir JJ Hospital has been increasing every year depicting faith on the treatment received in the hospital
Data collated till Sept 2014
Surgeries – Major & Minor19
Major and Minor Surgeries Details of Sir JJ Hospital has been increasing every year
Data collated till Sept 2014
Service Department Statistics - Orders Processed20
The processing capacity of the service departments has been increasing since 2008 depicting increase of revenue through investigations
Data collated till Sept 2014
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
5,14,930 in Sept 2014 i.e. an increase of
above 100%
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 over 400%.
(Note: The revision of rates has also contributed to the steep
increase in revenue)
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415.25%
103.97%
Research Details22
PublicationsYEAR 2008 2009 2010 2011 2012 2013Total 10 29 36 36 51 57
219
Paper/Poster PresentedOn going Research
Year 2008 2009 2010 2011 2012 2013 2014Total 6 43 34 51 55 61 80
250
Benefits
HMIS Project
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
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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
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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 -
improved efficiency and reduces scope for malpractices and pilferages.
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HMIS Project – Benefits27
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.
Computerized Nursing documentation – simplifies documentation for Nurses
Nurses have more time available - Repetitive manual writing eliminated
HMIS Project – Benefits28
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
HMIS Project – Benefits29
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
HMIS Project – Benefits30
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
HMIS Project – Benefits31
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
Challenges
HMIS Project
Challenge 1: Huge Patient Volume33
Over 5, 00,000 Patients visit OPD and over 45,000 admissions in Large hospitals (Large hospitals - having bed capacity over 1000 Beds) in a year, due to the patient rush in Out patient department the key challenge was to develop the system in such a manner that it’s a single operation screen for all patient care activities that consultant will work upon
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
Challenge 2: Non standard maintenance of Data34
There are no universal standards to record or to keep medical Data. The availability of accurate and exhaustive master data as the data was available in bits 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
Challenge 3: Management of Change35
This was the most challenging piece in the hospital as the users were more comfortable using paper and pen for doing patient care related activities and they were to be migrated from Paper based system to On line system which due to lack of time was difficult. Also setting up right expectations from the management and users in the hospital on the effort required for internalizing this Programme was a difficult 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
Challenge 4: Inconsistency in Capturing Data36
Designing user friendly interfaces in HMIS as each user has his own way of looking at patients and then capturing data for creating EMR
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
Challenge 5: Outdated Equipments37
Interfacing OLD Equipments - like X-Ray, Biochemistry Machines not compatible to current day HMIS
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
Challenge 6: Lack of IT knowledge38
Lack of any IT related module in Medical course(MBBS/BAMS/BHMS)
Solution New Joinee induction programme for junior most consultants and Nursing
staff includes HMIS Orientation and Training
Challenge 7: Infrastructure rollout39
Right infrastructure in terms of right sizing, the servers and PCs, LAN design, equipment security etc, this typically was a key point at most of the government hospitals are hosted out of old stone buildings / structures in which setting infrastructure is difficult due to its build and where most of the route diagrams / floor layout blue prints are not available
Solution Detailed existing workflow study was 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
Thank You
HEALTHCARE & ACADEMICS MANAGEMENT INFORMATION SYSTEM FOR GGMC & SIR JJ HOSPITAL, MUMBAI