He@lth 2015 Seamless Continuity of Care
Ministry of Health and Quality of Life
Government of the Republic of Mauritius
He@lth 2015
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Contents
1. The eHealth Context 5
2. The Current State of ICT in Health 11
3. Principal Intervention Areas 18
4. Recommended Technology Systems 25
5. The eHealth Action Plan 31
6. Conclusion 33
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1. The eHealth Context
Healthcare is the world’s most The eHealth revolution is also the key information intensive industry. Every to enhanced protection of privacy. Only Electronic health day the industry produces massive in an electronic world is it possible to information is volumes of data which, properly used, ensure that identifiable patient records fundamental to can improve clinical practice and are accessible to providers on a need- better health services outcomes, guide planning and resource to-know basis. Access to all or parts of delivery, planning allocation, and enhance accountability. an Electronic Health Record (EHR) can and protection of There will be no quantum leap forward be protected, and the identities of in health care quality and efficiency those who have looked at an EHR are privacy, otherwise without high quality, user-friendly known. Such protection is impossible impossible with health information compiled and with paper records, particularly in paper-based records. delivered electronically. hospitals and other institutions.
1.1 The Health Sector in Mauritius The general state of health in of cost throughout the country at the The general state of Mauritius is good- people live longer point of use to all its people. health is good and and fewer children die in their infancy; Mauritius is now life expectancy, in the last 30 years, At primary care level, the state health has increased from 63 years to 71 services have 135 facilities (Including aiming at attaining years and first year infant mortality is Area Health Centres, Medi-clinics, a health indicator 14 deaths for every 1000 live births. Community Hospital and Community levels that can be These indicators are better than those Health Centres) which provide matched only by for developing countries. The rate of medical, nursing, dispensary and developing countries. population growth is also low owing support services at local level. In to sustained governmental efforts and addition, there are 5 regional hospitals general access to educational and and 2 district hospitals with over 2500 employment opportunities. beds. Separate specialist hospitals include a mental hospital with 811 Mauritius is now aiming at attaining beds, and an Eye hospital, an Ear, indicators that are on par with the Nose and Throat hospital, a Cardiac developed world. Centre and a Chest hospital which Health services in together have over 200 beds. Mauritius are OVERVIEW OF CURRENT HEALTH provided free of cost SERVICES The regional hospitals and primary at the point of use to With 856 doctors, 3,000 nurses, about care centres or facilities benefit from a all Mauritians. 56 dentists and 22 pharmacists, health wide range of clinical and non-clinical services in Mauritius are provided free support services including pathology
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laboratories, X-Ray, CT scan and MRI, population. It also ensures that the The public healthcare pharmacy, blood collection and health sector is consolidated and that services delivery transfusion, public health and hygiene, the health services remains accessible includes 135 facilities medical records and information to every citizen. at primary level and 5 services, catering, laundry, transport and cleaning. NON-COMMUNICABLE DISEASES regional hospitals and Although in recent years, the 2 district hospitals that PRIVATE SECTOR IN HEALTH infectious diseases of the past have can accommodate over The private sector absorbs over 30% of been largely eliminated, Mauritius now 2500 in-patients. the total expenditure on health and faces growing problems of non- There are several employs over 544 doctors and communicable diseases including heart specialist hospitals in provides primary and secondary disease, diabetes, stroke, cancer, services with 14 private clinics, nearly tobacco and alcohol related diseases addition. 600 beds, 31 private medical and mental illness. The aim is to laboratories and 291 private eradicate the diseases or to contain pharmacists. In a year, the private them at their present low level. The private sector sector has about 77,000 admissions for accounts for over 30% in-patient treatment, undertakes In adults aged thirty and over, 20 per about 30,000 surgical operations and cent have diabetes, 30 percent have of the expenditure on delivers over 2,500 babies hypertension, and 40 percent are health and employs overweight. 42 percent of men are over 540 doctors. THE MINISTRY OF HEALTH AND smokers and 16 percent of adults are QUALITY OF LIFE heavy drinkers. The typical diet in The Ministry of Health and Quality of Mauritius is high on salt and fat and Life (MoHQL) is the agency responsible low on vegetables, fruits and fibre. A high intake of salt for health status of the population. It This pattern of health risks gives rise to and fat coupled with a operates under the portfolio of the an increasing level of NCDs and a low input of Minister of Health and Quality of Life. growing avoidable burden on the vegetables, fruits and The aim of the Ministry is to improve health services. fibre has given rise to the quality of healthcare delivery with an increasing level of a view to increasing patient’s CURATIVE SERVICES satisfaction and enhancing social Greater emphasis than ever before has Non-Communicable equity through the provision of a wider been laid on curative services in the Diseases. range of health services to the whole past two years to bring Mauritius up- THE ISLAND OF RODRIGUES The population of 35,000 of Rodrigues has access to hospital and community health services. Recent improvements in facilities include the introduction of the NCD mobile screening services, an Intensive Care unit for the Queen Elizabeth hospital, haemodialysis services, a physiotherapy unit and a new incinerator for the hospital. The incentives to attract staff to work in Rodrigues have been improved and specialist services expanded with plastic surgery being provided in Rodrigues for the first time this year.
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to-date in medical technology for The management of Accident and The health services diagnosis and treatment of disease. Emergency Services has been operate through 5 The principal major projects in reformed to reduce waiting time and regions, each having its progress are the reconstruction of the increase the effectiveness of services own Health Advisory Dr Jeetoo hospital, new outpatients using a triage system of assessment and treatment services at Victoria with a fast track for urgent cases, Board to advise on Hospital, new national centre for elderly and children. Catering, health needs, mental health and regional mental reception, cleaning and complaints effectiveness and health services, extension of the procedures have been improved too. efficiency of services cardiac unit at Victoria and consumer matters. Hospital,reconstruction of Souillac HEALTH SECTOR MANAGEMENT hospital, renovation of health centres, The health services in Mauritius and improvements to catering operate through five regions and with departments. separate arrangements for Rodrigues. The MOHQL is Each region has its own Health responsible for overall CT scan, MRI and nuclear medicine Advisory Board to advise on the health policy, planning and services have been introduced to aid needs of the region, effectiveness and management, resource accurate diagnosis of a variety of efficiency of services and consumer disabling and life threatening matters. The management of the allocation and conditions. High technology treatment regions is the responsibility of regional regulation, together has been expanded to meet growing health directors. The Ministry of with parliamentary needs including a major expansion in Health and Quality of Life (MOHQL) is and international heart surgery at the Cardiac Centre, responsible for overall policy, planning matters. haemodialysis in four regions, and management, resource allocation transplant surgery, lithotripsy for and regulation, together with eradicating kidney stones, cobalt parliamentary and international radiotherapy for cancers and more up- matters. to-date equipment for theatres and Mauritius has a 3-tier intensive care units. healthcare services delivery comprising 1.2 MAURITIUS HEALTHCARE DELIVERY Primary (Area Health
FRAMEWORK Centre, Medi-Clinics, The Healthcare delivery framework patients who have direct access to Community Health can be considered at three levels them. They comprise the following Centres, Community
Primary facilities Hospitals and Family Secondary Area Health Centre Health Clinics), Tertiary Medi-Clinics Secondary (Regional Community Health Centres and District Hospitals) PRIMARY HEALTHCARE PROVIDERS Community Hospitals The primary healthcare providers are Family Health Clinics and Tertiary usually the first points of contact for (Specialized Hospitals)
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SECONDARY HEALTHCARE PROVIDERS TERTIARY HEALTHCARE PROVIDERS The secondary healthcare providers The tertiary healthcare providers are are usually the first referred points of usually the second referred points of contact for patients. However, in case contact for patients. However, in case of emergency direct access could also of emergency direct access could also be provided. They comprise the be provided. They comprise the following the District Hospitals and Specialised Hospitals in Mauritius the Regional Hospitals
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Specialised Hospital Cardiac Centre Poudre D’Or Brown Sequard 5 SBharati Eye Hospital ENT Hospital R E F E R R A L S
Regional Hospital District Hospital 3 Dr A Gafoor Jeetoo Long Mountain SSRN Mahebourg Flacq Souillac 5 Victoria Queen Elizabeth J Nehru
R E F E R R A L S ACCESS EMERGENCY Area Health Centre 23 2 1 Bambous Goodlands Quatre Bornes Beau Bassin (Lady Twinning) La Ferme Riviere Des Anguilles (Tyack) Bel Air Riviere Seche Long Mountain Area Health Riviere du Rempart 108 Bramsthan Mahebourg Rose Belle Cassis (Dr Bouloux) Montagne Blanche Rose Hill Castel Mont Lubin Saint Pierre (Dr Quenum) Central Flacq Plaine Verte (Dr Goomany) Triolet Chemin Grenier Quartier Militaire Vacoas (la Caverne) DIRECT ACCESS Curepipe (CPE Road)
Medi Clinic Community Hospital Family Health Center Mont Roches Lady Ramgoolam Dr Yves Cantin Trefles L’Escalier (Riviere Noire) Henrietta
Community Health Centres
Albion Curepipe (Forest Side) Mare D’Albert Quatre Cocos Amaury Curepipe (Wootun) Mare La Chaux Quatre Soeurs Baie du Cap D’Epinay Médine Camp de Masque Ripailles Baie du Tombeau Dagotière Melrose Rivière des Creoles Barlow Dubreuil Midlands Rivière du Poste Community Hospital Beau Bassin (Odette Leal) Eastern (St Francois) Moka Roche Bois Beaux Songes Ecroignard Mont Roches Roches Noires Belle Mare Flic en Flac Rose Hill (Hugnin) Family Health Clinic Morc. St André (BonAir) Belle Vue Maurel Floreal New Grove Sébastopol Bon Accueil Fond du Sac (Shri Ram) Nouvelle France St Hubert Area Health Center Calebasses Glen Park Olivia St Julien D’Hotman Camp de Masque Grand Bay Ollier (SSR) St Julien Village Camp Diable Grand Bois Pailles Ste Croix Community Health Camp Ithier Grand Sable Palma (Shri R. Jugnauth) Tamarin Camp Thorel Center GRSE Pamplemousses Terre Rouge Cap Malheureux (Percy Selwyn) Highlands Pandit Sahadeo The Vale Caroline L’Esperance (M. d’Espeville) Pellegrin (Ronald Palmer) Tranquebar Regional Hospital Case Noyale L’Esperance Trebuchet Petit Raffray Trois Boutiques Chamarel La Gaulette Petite Rivière Trou D’Eau Douce Chamouny (Prof. Cerene) La Laura Vacoas (Club Road) District Hospital Phoenix Cite La Cure (Dr Mahler) La Lucie Roy Piton Vacoas (Hollyrood) Clemencia La Tour Koenig (Michael Leal) Plaine des Roches Vallée des Prêtres Specialised Hospital Cluny Lallmatie Plaine Lauzun Industrial Vallée Pitot Congomah Laventure Plaine Magnien Vieux Grand Port Coromandel Le Hochet (Mrs K Patel) Pointe aux Piments Ville Bague Cottage Poste de Flacq Volcy Pougnet Medi-Clinic Pointe aux Sables Creve Coeur Poudre D’Or
Figure 1 1.2 MAURITIUS HEALTHCARE DELIVERY FRAMEWORK
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2. The Current State of ICT in Health in Mauritius
EXISTING INFRASTRUCTURE AND the quality and effectiveness of the Efforts to computerize COMMUNICATION -MOH Health services and to provide timely healthcare units began INFORMATION PLAN information to the decision makers. way back in 1990 In 1990, an information plan in three phases was prepared by the State Table 1 shows the current status of the when an information Informatics Limited (SIL) to computerise projects implemented so far. plan was formulated all the healthcare units. The project was that aimed at scheduled to be completed in 1998. INFORMATION PLAN PHASES computerizing all The projects were scheduled to be healthcare units by The scope of the project was to provide implemented in fives phases. A 1998 with projects to a scenario for the future integration in a Management Advisory Committee and a National Health Network System. The Project Steering Committee were set up be implemented in 5 objectives were to improve the quality to manage the projects till completion. phases. and effectiveness of the Health services The implementation tasks were planned and to provide timely information to the for a period of 5 years starting in 1992 decision makers to give them the tools and ending in 1998 as shown in Figure 2. for informed decision to be made. INTEGRATED HOSPITAL MANAGEMENT Computerisation of MoHQL was a AND PATIENT CARE SYSTEM (IHMPCS) priority for the government in the The IHMPCS was developed on a pilot 1990’s. The objectives were to improve basis by State Informatics Limited.
Modules Description Current Status
Patient The system is operational Functions as the Patient’s physical medical Medical since 1995 and contains folder. It contains information on the Records loopholes which need to be patient and his health / medical history. addressed. Hospitals provide catering services for in Catering patients. The module will handle the The catering service Services operations management of the caterer module is not operational and the quality of products - services and has never been used. supplied to the patients. Implies computerisation of all the sections The laboratory software of the Central Health Laboratory . This has been completed but is Laboratory includes recording of requests as well as not deployed / used results of tests because staff resources is
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Modules Description Current Status not available
The module is operational Computerisation of blood transfusion Blood since 1996 however a services at Victoria Hospital and the four Bank manual system is used in Blood Collection Centres at Jeetoo, Nehru parallel causing duplication , SSRN and Flacq Hospitals of work. Drug Store The module is not used at Inventory full capacity. Some – Main Computerisation of the pharmacy store activities are performed store manually and the system is still under parallel run. Computerisation of the internal Pharmacy The pharmacy system is pharmacy. It handles the prescription dispensing operating since 1996. New from the doctor to the delivery of the features are required medicine to the patient The system is operational X-Ray Computerisation of the X Ray department. since 2001 and is still under parallel run. Table 1 Main ICT Projects Undertaken and their Status STATUS OF THE IMPLEMENTATION its full capacity. Most of the staff Most systems The computerisation of the Ministry trained on the registry system has been developed in the 1990s of health is still underway since transferred to other departments of suffer from a lack of inception in 1990. These systems are the ministry and the new joiners have not fully used and part of the not been trained. The result is that part sustained use owing to operations is still manual. Moreover of the data is on Excel and the other an indifferent the deployment of the systems at part on the registry system resulting in deployment. Training other regional and district hospitals a non homogeneous system. efforts undertaken has not been completed. A wide area have not been followed network planned to be implemented CENTRAL SUPPLIES DIVISION – STOCK through and staff has at the Ministry of Health and Quality MONITORING SYSTEM of life and the MIS to be The system has been developed and relapsed into manual implemented at the headquarters is installed since 1996. It is planned that ways. still outstanding. the system will be upgraded shortly. The hardware has been purchased ADMINISTRATION AND REGISTRY and is being deployed.
The operations of the administration section of the Ministry of health are DECISION SUPPORT SYSTEMS partly manual. The registry The decision support systems consist of department has been computerised a database which would allow members and the hardware infrastructure of the public and of the health sector to deployed. The system is not used at access relevant data concerning the
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health sector. The setting up of this Accounting System (TAS). The system is Since 1990 the database was included in the accessed through an Intranet. The Ministry has spent information plan and its development is ministry is in the process of updating the more than Rs 65 outstanding to date. system to cater for programme based budgeting. million on both SYSTEM AT CENTRAL LABORATORY capital and recurring An Integrated system is being used at TRANSPORT DEPARTMENT expenditure towards the Central Laboratory since 1995. This The Transport Department is still IT systems in the system is partly manual and it was found working on a manual system, the health sector. that it contains many weaknesses. The transport monitoring and workshop Central Laboratory has since renewed management scheduled to be installed However, save a few their hardware equipment and are there has not been developed. places, hardware has planning to upgrade / change their mostly turned application. They are considering a INVESTMENT IN ICT system which is being used in other Since 1990, the Ministry of Health has obsolete and manual laboratories worldwide. invested more than Rs 65 Million for systems continue to capital expenditure and Rs 50M for be used. CARDIAC CENTRE recurring expenditure on IT. A new system has been installed at the Cardiac centre by an Indian Firm Sobha INFRASTRUCTURE Renaissance, on a pilot basis. The The hardware infrastructure in the development and deployment of the different entities of the Ministry of
system has been completed and the Health and Quality of Life was purchased system is now under production. in the early or mid 1990’s. In some department of the Ministry the FINANCE DEPARTMENT SOFTWARE hardware was not renewed and these The finance departments of the MOHQL PCs are either out of date or not like the other Ministries’ finance supported or not being used. department are using the Treasury
2.1 The Principal Pain Areas
Table 2 brings about some principal pain areas in the current state and their possible resolution through an eHealth system Pain Area Resolution
Patients wait a long time for their “turn” to come at the Scheduling and Appointment systems hospitals
Application software needs to get implemented No integration of Patient that is same for all the healthcare facilities with History data centralized data storage
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Pain Area Resolution
The set of processes that are Processes need to be agreed upon between the being followed are not different stakeholders and recorded into officially recorded anywhere comprehensive process manual
Data gathered manually Data needs to be electronically captured, stored collected, stored and and retrieved through user-friendly application retrieved software.
Appointments on paper in a Technology solutions need to be implemented for piecemeal way with no scheduling, notifying and sending alert messages to automatic notifications all parties of every appointment.
Medical Record leads to high volume of paper and lot of Electronic Medical Record system will be able to time is wasted in retrieval of solve most of these issues. Also, there needs to be patient’s file; there are cases proper data backup and archiving schedules that of patient’s medical record should form a part of the delivered applications. getting lost
No integration of laboratory Integration of hospitals and laboratory through with the hospital which lead eHealth system will save lot time in the generation huge waiting time for test and transfer of test report. results to reach doctors
Better inventory management of the drugs at the Tracking of inventory of drugs pharmacy and assessment of the inventory level of in the pharmacy and other the pharmacy in different hospital and distribution unit is difficult of drugs in case of crisis in other institutions.
Drug abusers falsely generate medical records by changing Linking each and every patient with one unique their identity to sell or identifier (for e.g. National Identity no.) consume drugs prescribed by the doctor. Table 2 The Principal Pain Area
2.2 The Way Forward for eHealth in Mauritius In consultation with stakeholders the Ministry has worked out the complete strategic framework for the adoption of eHealth in the country (He@lth 2015). In doing that it has used the famed Logical Framework Approach following the hierarchy VisionObjectivesOutputsActivitiesResources ensuring that every stage in this chain was linked to the one preceding it.
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2.2.1 eHealth Vision
To exploit ICT to extend seamless continuity of care through affordable, high-quality, user- centric service to all healthcare stakeholders in Mauritius and to promote knowledge networking among them
2.2.2 eHealth Objectives The following are conceived to be the objectives for eHealth towards realization of the above Country eHealth Vision: MoHQL a single integrated source of information and a focal point of reference
on all matters related to health; improve clinical outcomes through better client-centric service delivery & high levels of internal efficiency and effectiveness; guide resource planning, allocation, monitoring and evaluation through use of appropriate technology; improve health awareness levels in citizens and residents of key issues in personal/public health & use of technology; enhance competency levels of health care staff at all levels and across organization types towards ICT to deliver better healthcare; and to improve levels of collaboration between the sector stakeholders with interoperability, standardization and cooperative knowledge exchange.
Figure 2 brings out the complete Strategic framework to be adopted for the comprehensive adoption and use of ICT in the health sector in Mauritius.
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2.2.3 The eHealth Complete Strategic Framework VISION OBJECTIVES OUTCOMES ACTIVITIES RESOURCES
• A Web Portal for Health sector - to make MoHQL a single • Determine information with • Detailed technology requirement in Mauritius that provides integrated source of MoHQL & agencies specifications. and RFPs/ tech infrastructure information in an integrated information &focal point of • eHealth portal best practices • Availability of staff with appropriate skills way on all matters related to • Define Portal Requirements • Availability of portal vendor reference on matters on health in a user-centric • Operationalise Portal • Skilled Programme Mgrs health in Mauritius manner
• Comprehensive set of services to improve clinical outcomes • Identify and prioritize services • Detailed technology reqmt specs. supported by information through better client-centric and systems for eHealth • and RFPs/ tech infrastructure systems for the associated service delivery through high • Prepare technology • Availability of staff with appropriate skills stakeholders using effective specifications for the above • Availability of solution vendor levels of internal efficiencies and workable technology • Engage technology vendor • Skilled Programme Mgrs and effectiveness solutions
• Executive information systems • Identify information needs for • Detailed decision-support reqmt specs. to guide resource planning, for policy makers decision-making for policy and • Digitized cartographic systems allocation, monitoring and • Citizens and other programme formulation • Availability of senior staff with appropriate evaluation through use of stakeholders’ feedback • Prepare typical technology skills appropriate technology counters on services/issues specs for the above • Availability of solution vendor • International networking • Engage technology vendor • Skilled Programme Mgrs
to improve health • Well-developed technology- • Gage current health sensitivity • Information dissemination materials awareness in citizens and enabled thematic forums for levels in the country • Annual eHealth Conferences citizens and stakeholders • • Availability of staff with appropriate skills residents of key issues in Identify ways and means to • Health awareness raising spread awareness • International and national linkages personal/public health and events and literature for • Disseminate information • National eHealth Status Report. Newsletters use of technology for same dissemination • Address competency gaps etc operationalise solutions to enhance competency • A complete set of eHealth levels of healthcare staff at team and resources to • Assess skillset availability • Availability of appropriate staff with identified implement initiatives skill requirements all levels and across • Determine skill gaps and • Well-agreed capacity building training requirements • Realizing the Organisation Design/Recruitment organization types towards promote knowledge networking among them among networking knowledge promote plans for technology adoption • Design eHealth Org Structure • Communication of Org Design to staff
using ICT for better care and usage • Realize Org Structure
centric service to all healthcare stakeholders in Mauritius and to and Mauritius in stakeholders healthcare all to service centric -
• Collaborative technology- • Determine knowledge to improve collaboration • Collaboration-oriented staff in MoHQL and enabled knowledge exchange requirements between stakeholders with agencies exchange platforms • Develop indicative KM specs interoperability, • Availability of technology vendor or internal • Collectively agreed for databases, e-libraries, e- development sources standardization and interoperability, security and forums etc • knowledge exchange • Operationalise solutions Skilled Programme Managers
To exploit ICT to extend seamless continuity of care through affordable, high affordable, through care of seamlessextendcontinuity to exploitICT To privacy standards quality, user quality, Figure 2 eHealth Complete Strategic Framework
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3. Principal Intervention Areas
He@lth 2015 recommends interventions in the two large areas of Technology and People with the former including the complete suite of solutions required to operationalise computerized delivery of health services in Mauritius and the latter including not just capacity building of MoHQL officials and staff but also a complete institutional framework required for eHealth on a sustained basis. 3.1 TECHNOLOGY MEASURES Portal
Inputs Consumer-centric Provider-centric Supplier-centric Outputs Components Components Components
Patient Details Clinical Information Systems Administration DSS Prescription Hospital Management System Financial Drug requirement & Patient Diagnosis Management usage report Patient Electronic Registration Medical Record HR WHO Standards (Drug Management Budget forecasting & protocol etc.) Budgeting utilisation report Patient Bed & Ward Inventory Admissions Management Management WHO declarations Disease trends Laboratory& Registry Nursing Care Blood Bank Management Management Health Indicators ICD codes Fixed Assets Data Management report Pharmacy Catering & Warehousing Management Laundry Medical Management equipment Pharmacy master data Maintenance Statistical analyses Mortuary Radiology Management Physical Geographical Doctor master data Facilities Police Reports
Information Figure Disease Immunisation License Systems Surveillance & Vaccination Management
3
Research Insurance claims
Technology component of eHealth Landscape
Stakeholders Personnel Registration of births Travellers data Financial data Patients data data data & deaths
Donors data Pregnancy records Pharmacy Blood bank Citizen data Facilities data data data National e-Health Vehicle data report
GIS KM data Security Other data National e-Health Training & Education conference
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Figure 3 brings out the technology Clinical Information Systems components of eHealth Landscape. It Administration Information Systems outlines the inputs and outputs of the Management Information Systems various eHealth Information Systems and the Portal Information System databases used by various modules that fall under the four broad categories of eHealth Information systems namely:
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3.1.1 eHealth Information System
CLINICAL INFORMATION SYSTEMS INFORMATION DISSEMINATION SYSTEMS
1 Provider Centric Components 1 Patient Registration 2 Consumer Centric Components 8 Pharmacy Management 3 Supplier Centric Components
2 Electronic Medical Record
9 Transportation Information Network ADMINISTRATIVE AND OTHER INFORMATION SYSTEMS Patient Admission , Bed & 3 Ward Management 1 Attendance Monitoring & 5 Financial Management Human Resource 10 Catering & Laundry Management System Inventory 2 Fixed Assets Mgmt 6 Management 4 Scheduling & Appointment
Physical Facilities 3 Medical Equipment 7 11 Mortuary Management Maintenance Management
Registry License 5 Nursing Care 4 8 Management Management 12 Immunization & Vaccination
MANAGEMENT DECISION-MAKING SYSTEMS 6 Disease Surveillance 2 Geographical Information System 13 Radiology Management 1 Data Warehousing
7 Laboratory and Blood Bank 3 Budgeting Management
Figure 4 eHealth Information System 20 | P a g e He@lth 2015
3.2 PROCESS MEASURES This eBusiness plan looks at the technology should be determined by Documented standard development of eHealth in healthcare the services and hence services operating procedures sector in a holistic fashion. The provided by a stakeholder of are required for process solution framework would consider healthcare sector in Mauritius should driven clinical systems. the People, Process and Technology be at the core of entire technology measures to achieve the eHealth solutions. On the technology front objectives. If a task is being executed the systems required for on a repetitive basis then there must Documented standard operating clinical management procedures are required for process exist a standard process for doing it. need to seamlessly driven clinical systems and on the This process needs to be captured technology front the various systems integrate to maintain a and documented so as to move required for clinical management smooth information flow towards a process driven approach. need to seamlessly integrate with amongst various Once the process is formalized then each other so as to maintain a departments and comes in the technology to facilitate smooth information flow amongst divisions. the process. In this age of services various departments and divisions oriented architecture (SOA)
3.3 PEOPLE
National e-Health Advisory Committee
Advisory & Coordination • Plan • Prepare • Measure • Improve • Advise
Project Management Office Outsourced/Insourced Developers Virtuous Project Circle of Project Management e-health Development Operations Evolution • Procure • Manage • Validate • Operate • Implement • Maintain
Technology Expertise Operational Expertise Domain Expertise
Figure 5 eHealth- Institutional Structure for Implementation 21 | P a g e He@lth 2015
Figure 5 brings out the organizational the eHealth project owners and the The institutional triad for eHealth development which top-level body. The project comprises the following broad management group performs the framework functions. day-to-day project management and recommended for monitoring and coordination of the He@lth 2015 is a three- ADVISORY AND COORDINATION, activities being undertaken. tier one comprising the which is ideally done by an apex level Wherever required and when three large functional multi-stakeholder body that performs competencies exist, this group must the functions of planning, advising, also advise the stakeholders on the areas of Advisory and monitoring and coordinating the initiatives being undertaken. Coordination, Project activities of the multiple stakeholders Management and that constitute/ represent the health OUTSOURCED/ INSOURCED PROJECT Outsourced/Insourced sector. This body also ensures that DEVELOPERS, which comprises the System Development there is a buy-in of the initiatives people who are in charge of the efforts. being pursued among the policy development of the eHealth systems makers too. proposed, their implementation, operationalisation and maintenance. PROJECT MANAGEMENT, which is Typically, this group would be actually a middle-level group of working through two wings- one, who professionals that is entrusted with are the actual system developers, the day-to-day project management packaged or custom-built, and two, of the initiatives being undertaken. those who take over for the These functions will be This group also doubles up as the operationalisation, support and performed respectively, “always available” bridge between maintenance of the systems that have by the National eHealth Committee, the Project Management Office and individual Committees National and/or taskforces E-Health acting in unison with Committee eHealth system developers.
Figure E-Health Status Report 6
Project Project Institutional Framewor Management Coordinate and Support Taskforce Office
k
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been developed. Whereas, usually its activities. This would also cover Three large the first one is outsourced, the knowledge of any emerging competency areas for second one could also be done by the developments in the sphere of operationalisation of healthcare bodies themselves, once eHealth elsewhere. the necessary handholding has been 2. TECHNOLOGY EXPERTISE or the He@lth 2015 are (a) provided and knowledge transferred. competency required to address all Domain Expertise, or This will not only cut down on costs, the requirements from a knowledge of the but it will also increase ownership and technology perspective, including health sector activities, address any domain competencies within its scope, hardware, (b) Technology required at the same time. software, networking and the like. Expertise, or 3. OPERATIONAL EXPERTISE, or the COMPETENCIES REQUIRED competencies required to manage knowledge of the Three kinds of competencies are the day to day activities of the technologies deployed required to perform the functions national eHealth system with for eHealth, and (c) described above. multiple stakeholders, resource Operational Expertise, 1. DOMAIN EXPERTISE, or the constraints, budgetary limitations, or the day-to-day awareness and the functional and handling the non-technology project management knowledge of the health sector and risks that emerge along the way. required to ensure 3.3.1 INSTITUTIONAL FRAMEWORK FOR EHEALTH IMPLEMENTATION sustained adoption and Figure 6 brings out the main elements implemented. For example, if a use of eHealth by of the institutional framework solution needs to be implemented at stakeholders. required for the implementation of the Transport Division, then the the eHealth strategy. project taskforce/committee will comprise representatives from the The National eHealth Committee be division while the ProMO will oversee the body responsible for the the implementation. “Advisory and Coordination” functions. The ProMO will be responsible for getting eHealth solutions developed For project management functions, a by outsourced contractor. The ProMO Project Management Office would be will be responsible for all support and formed to be a dedicated team maintenance activities on eHealth. responsible for the implementation of the eHealth initiatives. Therefore, while the ProMO will take charge of all development and For operational functions, all projects implementation activities, the identified as part of this strategy will committees/taskforces will be have committees and taskforces responsible for operationalising the responsible for its implementation. solutions in the user departments. These will be or represent the actual organisation where the actual Figure 7 represents the complete eHealth solution is being institutional constitution.
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NATIONAL E-HEALTH COMMITTEE
Independent Programme INDEPENDENT Managers are a PROJECT PROGRAMME MANAGEMENT OFFICE method being used MANAGERS to ensure that project E-HEALTH PORTAL MANAGEMENT STAFF management activities do not •Constitution of the ProMO will take some time, the Independent Programme Managers(IPM) have been suffer for want of a suggested as a stop-gap arrangement to ensure that ready group of delay in implementation is minimised. •IPM to undertake necessary handholding people within the arrangements to ensure smooth transition to sector to facilitate ProMo the implementation •Project Committees and Task forces to take overall PROJECT COMMITTEES AND/OR TASKFORCES process. They would responsibility of projects and constituted by the 1 2 3 4 5 6 7 8 9 10 11 12 NeHC as one of the first things in its also bring in the implementation agenda •Work on the portal development will most likely PROJECT COMMITTEES AND/OR TASKFORCE WILL BE required levels of need to get outsourced to portal development THE PROJECT OWNER expertise, specialists, however, operating the portal on a independence and continual basis could be taken up internally since this will necessarily involve substantial and neutrality into the continual consultations with stakeholders. vendor selection • At the time of constitution of the Project process. Committees and taskforces, it should be borne in Health Sector Unit as Outsourced/Insourced mind that representation from the IPM/ProMO be relevant for the System Implementers as necessarily included into it, though the task different Projects relevant
force/committee would best be chaired by a The Complete eHealth Institutional Framework Institutional eHealth Complete The
7 representative from a health sector organisation.
Figure Figure
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4. Recommended Technology Systems
Technology systems recommended fall in four broad areas Clinical Information Systems; Administrative Information Systems; Portal Information Systems; and Management Information Systems.
4.1 Clinical Information Systems Systems for better clinical management whenever a diagnosis is made or follow up systems are essentially those that bring done or the patient gets treated. about seamless continuity of care to patients among different healthcare SCHEDULING & APPOINTMENT facility. These systems are strongly clinical Based on the details of discomfort provided in their content and revolve around the by the patient at Patients Registration, he / patients’ record, and are supported by such she is scheduled or allotted an other systems like the pharmacy, disease appointment with concerned medical surveillance, radiotherapy and practitioner. Scheduling is done in such a appointments and scheduling. The manner so as to reduce the practitioners’ following modules are proposed. idle time in the healthcare unit.
PATIENT REGISTRATION PATIENT ADMISSION, BED AND WARD This is the first point of contact of the MANAGEMENT patients with the healthcare unit. The An inpatient is required to be admitted in patient or an accompanying person the healthcare unit. Bed and Ward registers the patient by providing the Management is the allocation and particulars of the patient. provision of wards and beds in a hospital where beds in specialist wards are a scarce ELECTRONIC MEDICAL RECORD resource. It is done in a manner to ensure Based on the information provided at the maximum bed / ward occupancy rates. Patient Registration, an Electronic Medical Record is generated which is a single file NURSING CARE that moves with the patient within and Once an inpatient is admitted, \ medical outside the healthcare unit (if required). care is ensured by nursing officer by This medical record is appended to recording vitals and ensuring the timely
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medication of the patient as prescribed by CATERING & LAUNDRY MANAGEMENT the medical practitioner. Catering and Laundry forms an integral part of Clinical Systems as the diet and hygiene LABORATORY & BLOOD BANK of a patient are controlled as per the MANAGEMENT prescription of the medical practitioner. A patient needs to undergo various tests in This system is directly linked to Bed & Ward a pathology lab as prescribed by the Management. medical practitioner. Once the patient has undergone these tests reports pertaining to TRANSPORTATION SERVICES these tests is sent by the pathology In case of emergency or some other acute laboratory to the medical practitioner. The cases, Ambulance services are provided by Blood bank is linked to the Laboratory and healthcare unit. This service needs to be its services are availed if blood is required centralised to ensure maximum occupancy by a patient. On the other hand a donor and minimum idle time of Ambulances and can register him / her and donate blood to drivers. the blood bank. HEALTH & DISEASE SURVEILLANCE PHARMACY MANAGEMENT This module is meant track the visitors to The medicines that are prescribed by a Mauritius for the diseases with which they medical practitioner are supplied by the visit Mauritius and whether the required Pharmacy in the healthcare unit. This processes have been followed as Pharmacy has a direct link to the Central recommended. Supply Division (Administration) as well which replenishes the stock at the IMMUNIZATION & VACCINATION Pharmacy. This module manages the administration of immunisation and vaccination to the MORTUARY MANAGEMENT citizens of Mauritius. If an inpatient passes away or a person is brought dead then he / she is sent to the RADIOLOGY MANAGEMENT mortuary in the healthcare unit. This Radiology is the specialty directing medical mortuary unit has linkages with Ministry of imaging technologies to diagnose and Social Security (for e.g. pension related), sometimes treat diseases. It has direct links Local government (for e.g. cremation), to Bed & Ward Management and also with Ministry of Interior (for e.g. police cases) the Laboratory & Blood Bank Management. and Ministry of Civil Status (for e.g. death registration).
4.2 Administrative Information Systems All administrative processes including but also with other clinical information financial should be integrated using systems. Typically these systems will be technology in such a manner so that they those that are not clinical in their content communicate not only amongst themselves like file tracking systems in the ministry,
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license management systems, asset the movement of files and other management systems, equipment communication received in the ministry. management systems, personnel information systems and financial FIXED ASSET MANAGEMENT SYSTEM management systems. This module would involve management of the information related to inventory in FINANCIAL MANAGEMENT SYSTEM MoHQL, that is, the fixed assets that are This module would cater to the complete present and are owned by the MoHQL. requirements related to the financial information needs of the MoHQL, including MEDICAL EQUIPMENT MAINTENANCE the budgetary allocation, the expenditure MANAGEMENT made, the bills processed and the like. This module would capture all details related to the maintenance of medical HUMAN RESOURCES MANAGEMENT equipment in the MoHQL. This module takes care of information related to complete human resources in PHYSICAL FACILITIES MANAGEMENT MoHQL, which would cover the skillsets This module would cater to the available in the ministry, the capability management of physical facilities present building requirements for the same, their and owned by the MoHQL and would compensation structure, remuneration include such assets as buildings etc. processing and the like. LICENSE MANAGEMENT SYSTEM INVENTORY MANAGEMENT Selling of food items in Mauritius requires This module would involve management of acquiring a license from the MoHQL under the information related to inventory in which to undertake such activities in MoHQL, that is, the movable assets other Mauritius. This module would take care of than those of drugs and medicines. all the informational requirements pertaining to the same. REGISTRY MANAGEMENT SYSTEM This would be largely based on document management system that will help track
4.3 Portal Information Systems User centricity of information administrative information systems. As dissemination in healthcare sector is of such, there also needs to be a single-point utmost importance. The information reference for all healthcare related provided to the various stakeholders information in Mauritius. The national through information dissemination needs eHealth portal is expected to fulfill this to be latest and up-do-date and at the requirement. same time in-sync with other clinical and
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HEALTHCARE PROVIDER CENTRIC units, pharmacies and other drugs and INFORMATION AND SERVICES equipments suppliers; at a generic level This comprises information and services this would also include other suppliers of typically required and used by healthcare non-medical equipments. providers including doctors, nurses, paramedical staff and the like. HEALTHCARE USER AND CONSUMER CENTRIC INFORMATION AND SERVICES HEALTHCARE SUPPLIER CENTRIC This consists of information and services INFORMATION AND SERVICES typically required by healthcare users and This includes information and services consumers like patients, buyers, typically required by healthcare suppliers government bodies and the like including medical supply-oriented business
4.4 Management Information Systems Once all the systems for clinical, DATA WAREHOUSE SYSTEMS administration and information This comprises the set of information and dissemination are in place and there is a services that are related to decision- smooth flow if information amongst these support where many variables need to be systems, the management decision making taken into account towards deriving trends would be made easy. Specialised decision- and other statistical analyses aimed at support systems capable of inferring trends facilitating decision-making at the MoHQL.. and doing such other statistical analyses as may required for policy formulation is conceptualized for the purpose.
BUDGETING This includes the set of information and services that are related to decision-making on budgetary requisitions, allocations, expenditure, monitoring and evaluation of the same and informing future decision- making based on past trends.
GEOGRAPHICAL INFORMATION SYSTEMS This consists of the set of information systems that work as a significant aid to decision-making as described above, that will work as a visualizing and query tool towards facilitating multi-dimensional decision-making as described above.
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4.5 Prioritisation Among Interventions eHealth implementation is recommended approach success necessarily comes much to be taken up in phases (or stages) later. described here as “Phases”. Phase One and Phase Two from Jan 2011 to 2015 will PHASE I CLINICAL & ADMINISTRATIVE constitute the complete implementation SYSTEM IMPLEMENTATION spectrum for eHealth systems in Mauritius. Implementation plan for clinical system & administrative module which will include: This approach will yield the following Patient Registration benefits Electronic Medical Record not all ICT initiatives that have been Patient Administration, Bed & Ward identified are equally important; taking Management them up in phases will ensure that the Scheduling and Appointment ones that are most important are taken Nursing care up first, benefits and gains from them are Disease Surveillance visible faster which, in turn, will impart Laboratory and Blood Bank Management added impetus to the subsequent stages Pharmacy Management of implementation that are more Attendance Monitoring complex. Transport Information Network with manpower resources and budgetary Catering & Laundry allocations being limited the phased approach will ensure that not only is the PHASE II CLINICAL & ADMINISTRATIVE manpower suitably focused to SYSTEM IMPLEMENTATION concentrate smaller chunks of work, but Implementation plan for clinical and also that the limited budgetary allocations administrative system which will include: are better utilized. Mortuary Management Doing the implementation in stages will Immunization & Vaccination also mean that if some mistakes become Radiology Management apparent in the early stages of Fixed Assets Management implementation, these can not only be Medical Equipment Maintenance corrected but also that subsequent Data Warehousing initiatives in later stages of the implementation stand to gain from these early mistakes. Doing everything all at once will deny agencies this advantage. a staged implementation ensures that parts of the implementation are taken, and successfully accomplished before moving on to the next stages. As such, stakeholders do not have to wait for a long time to see the “low hanging fruits” or the early successes. In an all-at-once
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Data Warehousing LOW 2014 IDS modules Management Decision- CIS modules making Systems AOIS modules Fixed Assets Management MDS modules GIS Licence Management Medical Equipment Budgeting
maintenance Physical Facilities Management Administrative and Other Radiology Operational Information Management Systems
Disease Surveillance Registry Financial Management Management Human Resource The complete suite of Management Laboratory & Blood Transportation Services Inventory applications for eHealth will be Bank Management Management Attendance FEASIBILITY Immunisation & implemented in two phases Pharmacy Monitoring Vaccination Patient Management with the first one lasting till Registration Clinical Information Systems 2014 and covering modules as Scheduling & Mortuary Management described in the figure on the Electronic Medical Appointments Record Supplier centric Portal left. components Provider centric Portal Catering & Laundry components Management Information Dissemination Systems Modules fall in all four genres Patient Admission, Bed & Ward Management Consumer centric Web of information systems that Portal Jan 2011 Nursing care have been described above.
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He@lth 2015 5. The eHealth Action Plan Table 3 eHealth Action Plan 2011 2012 2013 2014 NAME OF THE INITIATIVE Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Constitution of the National eHealth Committee Constitution of the eHAP Project Management Office Finalisation of the First Year Action Plan for the eHAP (PROJECT ONE) Independent Programme Managers for eHealth Implementation (PROJECT TWO) Communication Initiatives of the eHAP (PROJECT THREE) National eHealth Interoperability and Security Framework (PROJECT FOUR) Health Services Comprehensive Process Manual (PROJECT FIVE) National eHealth Portal (PROJECT SIX) eHealth System Implementation Phase I (PROJECT SEVEN) eHealth System Implementation Phase II Operationalisation of the eHealth System
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32 | P a g e He@lth 2015 6. Conclusion
The importance of the National eHealth strategy is enormous. Its successful implementation will decisively influence the uptake and adoption of ICT in the health sector. A failure to implement the same may also do irreparable damage.
Today, as we take stock of the current state realities, it increasingly emerges how ineffective piecemeal efforts can be. Failure to define an overarching national level strategy, in which the different ICT components must belong, robs initiatives any sectoral ownership and leaves them at the hands of individual organisations. This national level eHealth strategy with almost a sector-wide participation and ownership is an effort to fill this gap. Stakeholders stand to benefit through participation in this endeavor through win-win relationships.
At the same time, definition of this strategy has, perhaps for the first time, afforded the opportunity to look at ICT issues in the health sector in their totality. Interventions have been outlined not only in the technology dimensions, but also in other areas including those of processes, organisational and institutional capacity building, and awareness dimensions. The treatment is holistic and the approach step-by-step. Think Big, Start Small and Scale Fast has been the influencing mantra.
For the implementation, though, it must be said that getting the complete and combined buy-in of all participating stakeholders may yet prove difficult to obtain. In light of this, the greatest possible participation needs to be built without unduly compromising the pace of implementation. Successful implementation will automatically co-opt those of them that do not make it in the initial stages. Another temptation that must be resisted at all costs is possibility of the plan being implemented only in parts. Components of the action plan are too tightly knitted together to allow that.
Implementation would also engender its own set of problems and issues, anticipating all of which is difficult at this stage. Implementers will need to be fully prepared for such emerging realities and armed with corrective measures required to address them. The plan, therefore, is evolutionary, as against revolutionary, and necessarily requires that the emerging situation be periodically visited as soon and as frequently as it may be affordable to discover emerging glitches, iron them out and identify new approaches that need to be followed
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For more details please contact
Mr Sanjay Sobee Assistant Secretary Ministry of Health and Quality of Life, Republic of Mauritius Phone: +2302542191 Email: [email protected]
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