HEALTH MANAGEMENT INFORMATION SYSTEM - TAMILNADU HEALTH SYSTEM PROJECT

HMIS, the flagship of the Tamil Nadu Health System Project was implemented in a phased manner, started as Pilot (during the year 2008), followed by Phase- I (during the year 2009), Phase-II (during the year 2010) and finally Phase III (2011).
Health Management Information System “HMIS” is a judicious combination of Information
Technology (IT) and Management Systems, to deliver improved evidence based health care to the public at large. Health Management Information System also provides information based support for the implementation of cutting-edge reforms by the Tami Nadu Health Systems Project. Apart from Primary Health Centers and Secondary Care Hospitals, this project is envisaged to include all the Tertiary Care Hospitals including the Medical Colleges.

1. Health Management Information System Tamil Nadu Health Systems Project Thiru.M.S.Shanmugam,I.A.S . Project Director “Health Service through ICT”

2. 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 Tertiary Care Population 7.21 Crores

3. HUDs-42 32 Revenue districts & 42 Health unit districts

4. 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

5. NRHM

6. 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 .

7. 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 Population 7.21 Crores (Census 2011) Area 130,058 sq.kms.   Vital Statistics

8. 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)

9. 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 HMS Automatic Incorporation of data at the Institutional level Clinical Information MIS

10. 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

11. Project Strategy 1 . ICT Initiatives 2. Policy Initiatives 3. Process Initiatives 4. Paradigm Shift

12. 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

13. 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 Periodic reviews & Follow up action taken Help desk set up Protocol established Central helpdesk for facilitation and co-ordination Equipment break down also monitored by HD IT coordinators placed in each district All infrastructure issues related activities Application support and training Form e-core team in individual hospitals and solve IT issues Three Server Administrators for Server Management

14. 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

15. 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

16. 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 INR 3.06 Cr INR 11.29 Cr INR 87.85 Cr Phase III- 47 Institutions under Directorate of Medical Education including 20 Medical Colleges + Tamil Nadu Dr.MGR Medical University INR 52.23 Cr August 2010 July 2011 Software development cost Rs:12.99 Cr DITC:Rs: 4.57 Cr Total Budget: Rs 172.15

17. 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

18. OP Registration

19. OP Consultation

20. Pharmacy

21. LABORATORY

22. Sense of Pride

23. 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

24. 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 --------------------------------------------------------------------------------------------------------------- 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) ----------------------------------------------------------------------------------------------------------------------- Future plans to interphase PIN with AADHAR(UID) Advantages of HMS

25. 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. ---------------------------------------------------------------------------------------------------------------------- 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

26. 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

27. 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 TNSDC HIPS - Host intrusion prevention system is provided for the application

28. Online usage statistics

29. OP Ticket Before After PIN & Reg details IN Diagnosis Findings Lab report Prescription M.O Name

30. 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

31. TNSWAN Connectivity Redundant VPNoBB Connectivity POP power issues Server Stabilization LAN within hospital UPS at POP & at hospital Recurrent IT infra issues Technical Constraints

32. 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 norms 5. Implementation follow up by TNHSP Regular 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 benchmark during implementation Levers of success

33. 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

34. 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

35. 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

36. 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 MANUAL Continued…..

37. 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…..

38. 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

39. 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

40. Thank you 43