Health Management Information System

Tamil Nadu Health Systems Project

Thiru.M.S.Shanmugam,I.A.S.

Project Director

“Health Service through ICT”

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 – 20

MC Hospitals – 45

Taluk – 160

Non-Taluk – 80

b HQ Hosp – 30

HSCs –

Total-270

8706

PHCs Ru

Urb

1754

135 Total-1889

Primary Care

Secondary Care

TertiaryCare

Population 7.21 Crores

HUDs-42

32 Revenue districts &42 Health unit districts

Health Management Information Systems (HMIS)

• III tier health care system in Tamilnadu state- Primary, Secondary &Tertiary care

• HMIS developed by Tamilnadu Health Systems Project for:-

(i) 270 Secondary care Hospitals

(ii) 20 Govt Medical Colleges & Hospitals,

(iii) 1889 Primary Health Centers

(iv) One Medical University

• Conceptualized to provide real time critical health data

• Rs.215 Crore project -funded by world bank

• IT infrastructure provided for Govt hospitals with centralized servers and TNSWAN

Connectivity for web based application

• Fifteen Thousand users and one lakh patients are cycled in the system daily

• On & off site data back up available

• No data entry operators-Medical and Paramedical staff handle user friendly screens

NRHM

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.

Birth rate 15.9 (2011)

SRS

Death rate 7.6 (2011)

SRS

Infant mortality rate 22 (2011)

SRS

Maternal mortality ratio 72 (2011)

SRS

Total fertility rate 1.7

Population7.21 Crores

(Census 2011)

Area 130,058 sq.kms.

Vital Statistics

1.Hospital Information System (HMS)

2.Management Information System (MIS)

3.College Management Systems (CMS)

4.University Automation Systems (UAS)

( Software developed by TCS/TNHSP )

5.Pregnancy &Infant Cohort Monitoring and evaluation (PICME)

(Software developed by NIC)

6.Dr.Muthulakshmi Reddi Maternal Benefit Scheme (MRMBS)

(Software developed by NIC)

7.Chief minister Comprehensive Health Insurance Scheme (CMCHIS)

(Software developed by Health Sprint / UIIC)

8.State Health Data Resource Centre (SHDRC)

Central Repository for all 17 vertical departments under H &FW

IT Initiatives of Govt of Tamil Nadu

(HMIS)

(Software developed by TNHSP)

Components of HMIS

It has got 4 Components

Clinical Components:

• HMS-Hospital Management System

• MIS-Management Information System

Academic Components:

• CMS-College Management System

• UAS-University Automation System

HMSAutomatic

Incorporation of data at the

Institutional level

Clinical Information

MIS

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

Application Software

• 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

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 meetingso 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

Nov 2009

Phase II – HMS in 222 secondary care hospitals

+HMIS in 1889 PHCs fully

online

INR3.06

Cr

INR11.29

Cr

INR 87.85 Cr

Phase III- 47 Institutions under Directorate of Medical Education

including 20 Medical Colleges +

Tamil Nadu Dr.MGR Medical University

INR52.23

Cr

August2010

July

2

01

1

Software development cost Rs:12.99 Cr

DITC:Rs: 4.57 Cr

Total Budget: Rs 172.15

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

These modules are regarded as patient management information system

OP Registration

OP Consultation

Pharmacy

LABORATORY

Sense of Pride

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, Filaria control, Blindness Control, Tuberculosis program, etc

MIS reports (public health information)are sent every month online to HQs

• Patient identification number (PIN) –unique identity For Patients

• On next visit, need not wait in long queue for registering again

• 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

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• Saves a lot of time For Doctors

• Drugs/Lab investigations can be grouped into packages for prescription.

• 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)

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-Future plans to interphase PIN with AADHAR(UID)

Advantages of HMS

• Drug stocks are updated upon each drug issue. For Pharmacists

• He 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.

• Transparency and accountability in managing drugs, equipment stocks.

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• Saves a lot of time- need not maintain too many registers For Nurses

• Diet, drugs & linen -indenting can be done from wards

• Ward inventory made easy, Drugs expiry dates monitored

• Lab investigations results can be viewed from the ward

• 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

Advantages of HMS

For 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

Advantages of HMS

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

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STQC -Standardization Testing and Quality Certification ensures all

mandatory requirements for TNSDC

HIPS- Host intrusion prevention system is provided for the application

Online usage statistics

OP Ticket

Before After

PIN & Reg

detailsIN

Diagnosis

Findings

Lab report

Prescription

M.O Name

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)-20 vendors

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 hardware

Frequent break down calls and 24X7 helpdesk role in downtime reduction

• TNSWAN Connectivity

• Redundant VPNoBB Connectivity

• POP power issues

• Server Stabilization

• LAN within hospital

• UPS at POP & at hospital

• Recurrent IT infra issues

Technical Constraints

1. Strong ownership and support from Top Health AdministrationCommunication to hospitals – by State authorities

2. Supporting Government orders Mandating usage of Online system

3. End users trained to use systemNo data entry support

4. Procurement PolicyTNMSC &ELCOT-as per norms

5. Implementation follow up by TNHSPRegular stake holders meeting to discuss various issues and resolve the issues

6. Utilizing State Investments in establishing the Infrastructure

7.World Bank’s periodical monitoring and review helps to attain the benchmarkduring implementation

Levers of success

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”• South Asia Manthan Jury Award for the year 2013

Dedicated to one and all using HMIS

Various Directorates of H&FW dept using HMIS

1.Directorate of Public Health

2.Directorate of Medical & Rural Health Service

3.Directorate of Medical Education &

4. National Rural Health Mission/TN Once SHDRC is established HMIS will be extended to remaining directorates

1.Pregnancy &Infant Cohort Monitoring and evaluation (PICME)

(Software developed by NIC)

2.Dr.Muthulakshmi Reddi Maternal Benefit Scheme (MRMBS)

(Software developed by NIC)

3.Chief minister Comprehensive Health Insurance Scheme (CMCHIS)

(Software developed by s/w vendor identified by UIIC)

4.State Health Data Resource Center (SHDRC)

Central Repository for all 20vertical departments under H &FW

Other IT Initiatives

List of Directorates

S. No List of Directorates Reporting System

1 Directorate of Public Health and Preventive Medicine

(DPH)

HMIS

ICDS under DPH MANUAL

2 Directorate of Medical and Rural Health Services (DMS) HMIS

3 Directorate of Medical Education (DME) HMIS FROM 2014. AS OF NOW

MANUAL DATA.

4 Directorate of Family Welfare (DFW) HMIS

5 National Rural Health Mission (NRHM) HMIS

MOTHER AND CHILD

TRACKING SYSTEM (MCTS)

6 State Bureau of Health Intelligence (SBHI) HMIS

7 Tamil Nadu Medical Services Corporation (TNMSC) TNMSC APPLICATION

8 Tamil Nadu State AIDS Control Society (TANSACS) SIMS

9 Directorate of Indian Medicine MANUAL

10 Directorate of Drug Control MANUALContinued…..

11 State Blindness Control Society MANUAL

12 Corporation of Chennai MIS

13 Municipal Administration MANUAL

14 RNTCP/State TB Cell EPICENTER

15 National Leprosy Eradication Program (NLEP) MANUAL

16 State Health Transport Corporation MANUAL

17 Dr.MGR Medical University MANUAL

18 Medical Recruitment Board OARS

19 Directorate of Food Safety MANUAL

20 Chief Ministers Comprehensive Health Insurance System

(CMCHIS) under TNHSP

CMCHIS APPLICATION

TNHSP HMIS

21 Private Sector Standard reporting module has

to be worked out.

Continued…..

State Health Data Resource Center

(SHDRC)-in progress

• Huge volume of Data collected through HMIS has to be analyzed, 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 20 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

New Initiatives

State Health Data Resource Centre in collaboration with ICMR

State Health Communication Resource Centre

State Health Research Resource Centre

Outsourcing of hospital services in 79 hospitals

Outsourcing of laboratory services in 7 major hospitals

Thank you 43