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Health Management Information System Implemented in Government Hospitals of Tamil Nadu

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Health Management Information System Implemented in Government Hospitals of Tamil Nadu International Journal of Scientific & Engineering Research, Volume 4, Issue 10, October-2013 282 ISSN 2229-5518 Health Management Information System implemented in Government Hospitals of Tamil Nadu Natarajan.S,Panchanathan.V,Pankaj Kumar Bansal* Abstract -The HMIS or the Health Management Information System is an online portal through which medical professionals and the support staff in medical establishments can maintain crucial information about the patients. Ever since the creation of government health centres and public health services, there has been a great gap created between the decision makers and the implementers. This gap has been due to the lack of processes when it comes to processing the information and the lack of feedback upon sub-functional but existing systems. One of the many initiatives to bridge this gap has been the implementation of the HMIS system in every major public hospital, rural health centre and primary health centres across the state. Index Terms - HMIS, HMS, Inpatient, Outpatient, Pharmacy, Staff, Tamil Nadu Health Systems Project *Natarajan.S-Additional Director of Medical Services (Administration),Dr.N.Panchanathan – Professor & Head of Department, Annamalai University ,PankajKumarBansal IAS-Special Secretary to Government, Health & Family Welfare & Project Director ,Tamilnadu Health System Project —————————— —————————— INTRODUCTION system (3) CMS....College Management System (4) UAS......University Automation System “A next generation MIS, that is powerful, flexible In the pilot phase, Government Hospitals in and easy to use has been designed and developed to deliver Tambaram, Sriperumbudur in Kancheepuram district, real conceivable benefits to hospitals.” “Hospitals need to Sholingur in Vellore district, and Padmanabhapuram, decide how services could beIJSER delivered more effectively to Colachel in Kanyakumari district were identified. reduce costs, improve quality and extend reach.” Under Phase I, Hospital Management System Tamilnadu Health Systems Project (TNHSP) is (HMS) was implemented in five districts viz. Theni, being implemented since 2005 by the Government of Kanyakumari, Dharmapuri, Krishnagiri and Pudukottai Tamilnadu with World Bank soft loan for several programs districts comprising of thirty six hospitals. Phase II is an to improve the health delivery systems. One of the key extension of this work across the state for 222 hospitals. areas was the introduction of Hospital Management Currently HMS & MIS is functional in 267 Secondary Care Information System (HMIS) a flagship programme of hospitals, MIS in all the 1613 PHCs. TNHSP, to be implemented in three phases after a Phase III is a comprehensive project involving successful Pilot phase. “Access to the right information and Govt Tertiary care hospitals and implementation of a automation of complex tasks and work flow is the key University Automation System for Tamilnadu Dr.MGR focus of the HMIS, enabling freeing the staff to spend more Medical University with a College Management System. 47 time on caring for patients and extending the reach of institutions under Directorate of Medical Education services. HMIS has four components (1) HMS....Hospital including 17 Medical Colleges will also be in the stream Management System (2)MIS.....Management Information (shown in Fig.1). IJSER © 2013 http://www.ijser.org International Journal of Scientific & Engineering Research, Volume 4, Issue 10, October-2013 283 ISSN 2229-5518 August 2010 INR 87 crores INR INR 8 Phase II – HMS in 222 2.8 Crores secondary care hospitals crores + HMIS in 1613 PHC’s fully Dec Nov online 2008 2009 INR 21 Pilot -5 Crores hospitals Phase I – HMS in 36 hospitals across 5 districts Phase III- 47 Institutions under Directorate of Medical Education including 17 Medical Colleges + July Software 2011 Tamil Nadu Dr.MGR Medical development cost University 9.69 cores Fig. 1 Implementation Overview OBJECTIVES hospitals, Proper maintenance of Equipment Inventory, monitoring of Equipment downtime, Drug stocks auto Even though there have been multiple attempts at indent, drug stock accountability and monitoring for the quantifying the effectiveness of management systems, there drug expiry dates were some of the challenges, that we had have not been much research on the bench marks that have to overcome. been achieved in the medical system today. This paper By identifying key features which can be taken as a attempts to look at the benchmarksIJSER that have been achieved benchmark for the performance of the HMIS system, we and provide a clear understanding of the pain points of the attempt to measure the impact of this system on the system that existed earlier. With the growth and prevalence existing issues. The project has been conceptualized as a of information technology, a detailed look into how the centralized web based software solution to minimize issues have been managed and resolved is presented in this technology support and maintenance dependencies. Hassle paper. The HMIS Solution architecture has been designed free connectivity through Tamil Nadu State Wide Area for scalability and long term sustainability. After several Network (TNSWAN) , which is a 2 Mbps dedicated leased iterations of requirements, uniformity and standardization line terminating at each hospital level. of input formats were finalized and resulted in significant Broadband Connectivity of 2 Mbps connectivity has level of changes. Common uniform system of reporting will also been setup at all hospitals as a redundant connection. provide for ease of data comparison and performance We have also established Automatic switch over from monitoring across institutions. TNSWAN to broadband and vise-a-versa during times when either one of them fails. A centralized web server METHODOLOGY which houses the entire database placed at a fully equipped All the hospital records were being maintained Data center. TNHSP in coordination with Tamil Nadu manually, which meant more time consuming and even Electricity Board has ensured that there are no power cuts more time utilised for retrieving records. Spending more during the Outpatient hours of the hospitals. We have also funds towards procurement of manual registers, supplied UPS with 2 hours back up to all the hospitals in Duplication of records of the patients, unreliability of the case of a power failure. collected data, lack of monitoring the performance of the ANALYSIS BASED ON DATA of the Health and Family Welfare departments, 268 The state of Tamil Nadu has been segregated into institutions have been identified to be connected through 32 districts for effective administration and in these 32 the centralised HMIS system (shown in Fig.2). districts the Government of Tamil Nadu under the auspices IJSER © 2013 http://www.ijser.org International Journal of Scientific & Engineering Research, Volume 4, Issue 10, October-2013 284 ISSN 2229-5518 Hospitals covered under HMS HMIS HELP DESK AT HEAD QUARTERS – HQRS 30 ESTABLISHED BY TNHSP FOR SOFTWARE &OTHER IT Taluk Hospitals 156 INFRASTRUCTURE CLARIFICATIONS REQUIRED BY THE Non Taluk Hospitals 75 END USER Women and Children Hospital 7 The concept of help desk is to guide and provide every single end user with all the relevant information that they are looking for. This toll free number can be reached Fig.2 by end user 24X7 and they can get their help and guidelines from the helpdesk IT coordinators and Medical For the purposes of this paper, the data collected Officers.CUG number for the helpdesk is obtained and all from these 268 institutions are analysed and the end users can get connected to helpdesk for their IT infra effectiveness of the HMIS system in terms of transparency issues. An exclusive software helpdesk with SW and efficiency is presented. One of the main sources of professionals are also available at headquarters for information that is generated by the system is the reports answering all queries related to application. This is that are available to the various senior officials. These executed by application stakeholder M/s Tata Consultancy officials in turn can use the data for making decisions and Services. recommendations to the government aimed at making the overall health system more effective. AMC REPORTS: The AMC (Application Maintenance Cost) reports TRAINING AND ORIENTATION – are the feedback and suggestions on the software that is HANDHOLDING being implemented by the TNHSP. It gives a detailed To improve the performance and functionality of report about the usage of the software and modifications the HMIS system, the supposed users are trained by experts required for field usage. These reports helps us estimate the on everyday basis. Every mode of input and the various costing and longevity of each set up, which in turn helps us nuances of using the system will be shown screen by screen decide the monetary allocation for each district. and case by case. These systems require regular maintenance and servicing for proper functioning of the system. These IT Co- HOSPITAL PERFORMANCE DATA ordinators would be available at every institution and The HMS comparative performances for the years would be the caretaker of hardware like Computer, 2012 (July – June) and 2013 (July – June) on various Monitor, UPS etc. Also they monitor the Primary and parameters are displayed below as a comparative Secondary Connectivity providedIJSER by TNSWAN & BSNL. statement. On analysing these data we can find out that They regularly interact with hospital staff; resolve the there is a remarkable improvement
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