Health Management Information System(HMIS)
IT initiatives ofGovernment of Tamilnadu
Department of Health &Family Welfare
Pankaj Kumar Bansal, IAS,Additional Secretary & PD,
TN Health System Project,
HMIS
• Envisaged by the Health & Family welfare department of Govt of Tamil Nadu through Tamilnadu Health Systems Project as part of the on going initiatives for IT enablement of health sector.
• Conceptualized to provide critical health data across the health chain for quick and timely intervention by the health directorates.
• The World Bank’s involvement in the project has been extremely advantageous. It has helped in introducing new approaches in the health sector.
Three Tier Health Care delivery in Tamil Nadu
Directorate of Public Health & Preventive Medicine
Directorate of Medical & Rural Health Services
Directorate of Medical Education
Medical Colleges – 18
MC Hospitals – 41
Taluk – 161
Non-Taluk – 78
b HQ Hosp – 28
HSCs – 8706
PHCs – 1589
Primary Care
Secondary Care
TertiaryCare
3Population 7.21 Crores
No. of Districts-32No. of HUDs-42
32 Districts& 42 Health unit districts
NRHM
Birth rate 15.9 (2011)
Death rate 7.6 (2011)
Infant mortality rate 24 (2011)
Maternal mortality ratio 79 (2011)
Total fertility rate 1.7
Population7.21 Crores
(Census 2011)
Area 130,058 sq.kms.
Vital Statistics
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.
Duplication of records was again a setback within the hospital• Monthly reports sent as hard copy- a real challenge for data
analysis/comparison• Drug & equipment inventory - maintenance and tracking of
warranty/AMC-more cumbersome• Lack of standard names and codes
Project Strategy
1. ICT Initiatives
2. Policy Initiatives
3. Process Initiatives
4. Paradigm Shift
• Centralised Web based Application
• Infrastructure investments-Hard Ware /Connectivity/UPS etc
• Utilizing the existing Infrastructure investments by State
Government- State data centre /TNSWAN
1. ICT Initiatives
Application Software
• Developed and implemented by Tata Consultancy Services
• GoTN owner of the application
• Centralized web based application on open source platform
• J2EE (Java 2 enterprise edition)
• Postgre SQL 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
Patient IdentificationUnique ID-PIN
-•15 Digits•First digit indicates Directorate•Next five digits denotes institutional code•Last nine digits refers to patient number•This number is different from OP number•OP number has 17 digits•Two more digits next to institutional code makes 17 digits for op number
2. 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
o Periodic reviews &o Follow up action taken
• Help desk set upo Protocol establishedo Central helpdesk for facilitation and co-ordinationo Equipment break down also monitored by HD
• IT coordinators placed in each districto All infrastructure issues related activitieso Application support and training o Form e-core team in individual hospitals and solve IT issueso Three Server Administrators for Server Management
3.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
• Creation of new posts at district level and state level to support ICT interventions
• 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
4.Paradigm Shift
• Automation of work flow process at the hospitals• Manual Registers/Records 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
Implementation overview
Pilot -5 hospitals
Dec 2008
Phase I – HMS in 36 hospitals
across 5 districts
Phase I – HMS in 36 hospitals
across 5 districts
Nov 2009
Phase II – HMS in 222 secondary care hospitals
+HMIS in 1613 PHC’s fully
online
INR2.8
crores
INR5
Crores
INR 87 crores
Phase III- 47 Institutions under Directorate of Medical Education
including 17 Medical Colleges +
Tamil Nadu Dr.MGR Medical University
INR23
Crores
August2010
July
20
11
Users
• Primary Health Centers…….1589 centers• Secondary Care Hospitals….267 hospitals• Tertiary Care Medical College Hospitals..17 Medical colleges and a
Medical University…………………………………………………………………………………..• Doctors, Pharmacists, Nurses, Lab technicians, Hospital Workers and
other staff of hospitals & Administrators
HMIS
Two componentsI. Hospital Management System- HMSII. Management Information System-MIS
HMS MISClinical Information
Automatic Incorporation of
data at the Institutional level
HMSHospital Management System
Registration Out patient Inpatient Medical Records Lab ,X-ray & other investigations Pharmacy Stores Blood Bank Diet Linen Module for online daily report generation-MRD Final diagnosis is mapped to ICD-10 classificationThese module are regarded as patient management information system
MISManagement Information System
Unified Health Reporting system
Clinical Information (auto populate+) Patient census, Morbidity,
Mortality, Patient services, Immunization,
etc Ancillary Services ISMR
Blood Bank, Lab services, etc Administrative Information
Buildings, Finance, Personnel, Vehicle, etc
Program Information Malaria, Blindness control, etc.
MISISMR-(Institutional service monitoring report)
Patient Registration
Consultation with Doctor
Order Investigations
Generate Prescriptions Diagnosis
Lab
PIN
Common Disease listComprehensive List of
tests
OUT PATIENT DEPARTMENT WORKFLOW
Patient History;
Lab results Online
No Data Entry
Operators
Current Status
Hospital Management System (HMS)
o 210 hospitals out of 267 secondary care hospitals on line
Health Management Information System (MIS)
o PHC’s under Directorate of Public Health & Govt Hospitals under
Directorate of Medical and Rural Health Services- send monthly
reports online (1589 PHCs and 267 Secondary care hospitals)
Advantages
For the Patient
• Patient identification number (PIN) • On next visit, patient can approach the consultant directly, need not wait in long queue
for registering again• Print out of the prescription is given to the patient• Old records not required on review-it is available on line• The clinical records of the patient are safe for a longer period of time• Patient can visit any secondary care hospital across TN with PIN• The Patient identification Number (PIN) can be interfaced with UID
Advantages of HMS
For Doctors-• Saves a lot of time• Drugs/lab investigations can be grouped into packages and more often a package
may be prescribed.• Can view the previous clinical history ports on line• Specialty OP- Doctors with a single click, can repeat the previous prescription.• In certain cases the doctor can follow the Standard treatment guidelines (master
data)
Advantages of HMS
For Staff Nurses• Saves a lot of time- need not maintain too many registers• Diet, drugs &linen -indenting can be done from wards • Ward inventory easy maintenance • Lab investigations results can be viewed from the ward• Discharge summary given to the patient as print outs• Handing over and taking over of charges, patients census- made accountable and
transparent • Ward transfer in & out managed effectively• Monitor and manage the blood bag availability
• Drug expiry dates –monitored on a real time basis.
Advantages of HMS
For Pharmacists
• Transparency and accountability in managing drugs, equipment stocks.
• Drug stocks are updated upon each drug issue.
• The pharmacist can monitor the expiry dates and the batch number of each drug.
• Need not count the tokens & consolidate them for stock position.
• The Warranty/AMC of equipments can be easily tracked.
1. Strong ownership and support from Top Health Administration Communication to hospitals – by State authorities
2. Supporting Government orders Mandating usage of Online system
3. End users trained to use system No data entry support 4. Procurement Policy TNMSC &ELCOT-as per norms5. Implementation follow up by TNHSP Regular stake holders meeting to discuss various issues and resolve the issues6. Utilizing State Investments in establishing the Infrastructure
7.World Bank’s periodical monitoring and review helps to attain the benchmark during implementation
Levers of success
Challenges in Implementation
Mindset and Involvement of the hospital staff Change Management and Total system transformation Lack of co ordination among various vendors (no single vendor for IT infra) No senior IT consultant to co ordinate all IT activities. Only Medical Officers handle Connectivity and server stabilization still continues to be major challenges Man power shortage at the user-end.(HR of Directorate) Lack of basic computer knowledge - training on BCK, HMS & MIS Mapping existing process and rationalization of input forms for standardization Safe custody of hardwareFrequent break down calls and 24X7 helpdesk role in downtime reduction
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”
Online usage statisticsup to March 2012
Module No. Of Records
Registration 24146259
Lab 7826647
Pharmacy 10816475
Clinical 13505675
HMS Consolidated report for March 2012
Back-up at State Data Centre
In case of disaster we have:-1.Tape back-up 2.NAS-Network array storage (cluster hard disc) (Two NAS available –on site & off site)3.Disaster Recovery site for TNSDC -proposed ------------------------------------------------------------------------------------------------
-STQC -Standardization Testing and Quality Certification ensures all mandatory requirements for TNSDCHIPS- Host intrusion prevention system is provided for the application
Current Reporting system
DPH/DM&RHS/NRHM/DME
S.No DirectoratesProject/Mission
Web Based Application
Institution Periodicity Contents
1 NRHM www.nrhm-mis.nic.inwww.tamilnadu.nhsr
c-hmis.org(bridging between state to
central-encrypted data transmission)
District Monitoring unit
Monthly, quarterly and
Annually
Monthly
NRHM report (GOI)
XML file from tnhmis.org
2 NRHM-TN DPH
www.tnhmis.org PHC Monthly ISMR, Form 9 and other reports
3 DPH www.picme.tn.nic.in, www.mrmbs.tn.nic.in
PHC Daily, Weekly MCH - MCR & CCR DETAILS, Maternal Benefit details
4 DM&RHS,DPH, www.tnhmis.org Secondary care hospitals &PHCs
Daily& Monthly
OP, IP,Clinical data ISMR,
5 NRHM www.nrhm-mcts.nic.in
State NIC Weekly (transferring
data from picme state
portal to central portal)
Service delivery of pregnant women and children
6 DMEProposed Phase III
www.tnhmis.org Medical College institutions
Daily & monthly
OP, IP,Clinical data ISMR,
www.tnhmis.org
www.tnhmis.org
www.tamilnadu.nhsrc-hmis.org
www.nrhm-mis.nic.in
Mother and Child tracking system(picme)
•Started on 1st April 2008,sw developed by NIC•To find the missing pregnancy outcome being reported by the VHN •To reduce MMR and IMR•Pregnant mother details from the date of AN Registration is captured in PICME till the 1st birthday of the Infant by the VHN•Till date, the system has captured details of more than 35 lakhs mothersc•The pregnant mothers and infants are given a unique ID called “PICME Number”
•Using this number, the details of the pregnant mother and infant can be viewed anywhere.
•Generate work plan for pregnant women and infants
• EMRI -108 Ambulance service has list of EDD mothers from the system
Pregnancy and Infant Cohort Monitoring and Evaluation (PICME)
www.picme.tn.nic.inwww.picme.tn.nic.in
Dr.Muthulakshmi Reddy Maternity Benefit Scheme
• Rs. 12,000/- is given in 3 installment as Maternity Benefit to Pregnant mothers delivering in Government Institutions on conditional basis
• This scheme is monitored online with certain conditions such as first two live births with BPL
For 1st Installment
Minimum 3 AN visits in Govt. institution, Early AN registration, Compulsory recording of BP ,Weight, Blood grouping & typing ,Blood sugar, HIV testing and TT immunisation
• Minimum one ultrasound scan
2nd Installment
– Delivery at any Govt. institutions
3rd Installment
– Should have received 2nd installment– Completion of 3rd dose of immunization within 6½months
1. Duplicate Application given to mothers with the details of residence , Passport size Photo, Bank account details
2. Mothers has to fill up and submit it to PHC, to be entered online with PICME number.
3. Money will be transferred from BMO account to beneficiary through e.transfer
Disabled as these are not the functions of this user
Shows who logged in from where
Fund Flow
• State Level Budget Allocation – Directorate
• District Level Budget Allocation - DDHS
• At Block Level - Block Medical officer claims from treasury &
deposited in BMOs account.
• Municipalities/Corporation - Commissioner account
• To all Beneficiaries thro’ Bank –Transfer of Funds• More than Rs 320 Crores disbursed online
Entry of Application into the system Reviewing
eligible and ineligible list
Verification by SHN Logout
SHN Login
Reviewing applications verified
by SHNTake decision
whether to forward or not
Forwarding the applications Logout
PHC MO
Viewing the applications forwarded Ascertain all PHCs
have forwarded applications
Advise BMO to generate
ProceedingsLogout
CHN Login
Generate proceedings
installment wiseSubmit the bill to
Treasury , receive cheque
Generate ECS list and submit to bank for fund
transfer
Logout
BMO Login
State Health Data Resource Center(SHDRC)
• 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
Secondary Care Hospital
Out-Patient Registration
Clinical Out-Patient Department
Before After
Before Out Patient Slip
Before After
Pharmacy
Pharmacy Pharmacy Slip
Before After
Laboratory Entries
LAB Slip
Before After
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