TN e-Health �as a �Healing Hand �to �Patients

1. TN e-Health
as a
Healing Hand
to
Patients
1
Dr. P. Sunil Gavaskar M.B., B.S., D.A.,
Medical Officer –
Health Management Information System
Tamil Nadu Health System Project

2. Three Tier Health Care delivery
in Tamil Nadu
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3. 32 Revenue districts &
42 Health unit districts
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4. Health Management Information Systems
(HMIS)
HMIS developed by Tamil Nadu Health Systems Project for:-
267 secondary care hospitals
20 Medical College (MIS along with CMS –college management system) & 49 hospitals
1614 Primary Health Centres
One Medical University (UAS –University Automation System)
Conceptualized to provide real time critical health data
126 Crores project funded by world bank (reimbursement loan)
IT infrastructure provided for Govt. hospitals with centralized servers and TNSWAN Connectivity for web
based application

Ten thousand users and one lac patients are cycled in the system daily
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5. Project Strategy
Project Rationale
Policy Initiatives
Process Initiatives
Paradigm Shift
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6. HMIS –Project Rationale
No real time dataavailable to monitor the performance of the hospital
Evidence based program managementwas a challenge
Undue delaysin receipt of data
Retrieval of old manual records was ineffective & time consuming.
Drug & equipment inventory - maintenance and tracking of warranty/AMC- more
cumbersome
Lack of standard names and codes
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7. HMIS -Policy Initiatives
Issue of government orders for:-
Implementation, Sustainability & Usage
Fixing of responsibilityon the end users
Budgetary provisionsfor maintenance & support
Removal of Manual records
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 helpdesk at the directorate
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8. HMIS -Process Initiatives
For Software requirement specifications(SRS) thorough study of the entire health system and its process
were studied
Extensive trainingsessions were conducted for various categories
Stakeholders meetings
Weekly reviews & Follow up action taken
Help desk set up
Protocol established -Escalation matrix followed
Central helpdesk for facilitation and co-ordination
IT coordinators placed in each district
All infrastructure issues related activities
Application support and training
Form e-core teamin individual hospitals and solve IT issues

Three Server Administratorsfor Server Management
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9. HMIS -Paradigm Shift
Automation of work flowprocess at the hospitals
Manual Registers/Records are partly removed from hospitals
Real Time monitoringof hospitals performances
Electronic Medical records
Standardization of health systemsand processes
Computer skill development among the hospital staff
Online maintenance of drug inventory/equipment inventory
No data entry operators-involvement of regular staff
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10. Implementation overview
Pilot -5
hospitals
Phase I –HMS in
36 hospitals across
5 districts
Phase II –HMS in 222 secondary care
hospitals
+
HMIS in 1613 PHCs fully online
Phase III- 49 Institutions under
Directorate of Medical Education
including 20 Medical Colleges
+
TN Dr. MGR Medical University
INR 8 Crores
INR 2.8 Crores
INR 87 Crores
INR 45 Crores
Dec,
2008
Nov,
2009
Aug,
2011
2013
Software development
cost 9.69 crores
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11. Two Components of HMIS
Hospital Management System-(HMS) &
Management Information System-(MIS)
HMS MIS
Clinical Information
Automatic Incorporation of data
at the Institutional level
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12. 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
The Modules are unique for the type of users
These modules are regarded as patient management information system
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13. Advantages of HMS
For Patients
Unique Patient identification number (PIN)
On next visit, no registration queue
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 and he record is readily
available for review
For Doctors
Saves a lot of time
Drugs/Lab investigations can be grouped
into packages (Treatment Kits) for
prescription.
Can view previous clinical reports on line
Repetition of previous prescription with a
single click –useful in Chronic diseases
In certain cases doctor can follow
Standard treatment guidelines (Master
data)
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14. Advantages of HMS
For Pharmacist
Drug stocks are updated upon each drug
issue
He can monitor expiry dates and batch
numberof each drug.
The Warranty / AMC of equipment can be
easily tracked.
Transparency and accountability in managing
drugs, equipment stocks.
Interface with TNMSC software for online
indenting.
Hospital can view the stock position of the
warehouse & vice versa
For Nurses
Saves a lot of time- need not maintain too many
registers
Diet, drugs & linen -indenting can be done from wards
Ward inventory made easy, Drugs expiry dates
monitored
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
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15. 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
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16. Registration Screen
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17. Treatment Kit
Lab Test
Medication
Diagnosis
Kit name
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18. Standard Treatment Guidelines
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19. Stock View Screen
19

20. Injection OP Screen
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21. Lab result Screen
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22. Online Usage Statistics
up to Aug, 2013
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23. Online Usage Statistics
for Aug, 2013
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24. OP Registration
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25. OP Consultation
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26. Pharmacy
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27. Laboratory
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28. The Ultimate Goal
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29. OP Ticket
Before After
PIN & Reg.
details
Diagnosis
Findings
Lab Report
Prescription
M.O. Name
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30. HMS -TNMSC Online Indent
It facilitates the drug supply management system
The indent raised by the hospital chief pharmacist, after online approval by the CMO, will be visible in
the HMS -TNMSC Online indent screen for warehouse.
The Warehouse Pharmacist will down load the indent file & upload the same in TNMSC warehouse
application software.
After the warehouse process the indent the Outward Goods Register (OGR) file will be downloaded
from the TNMSC software and uploaded in the HMS -TNMSC online indent software.
The Pharmacist has to Physically verify the quantity in OGR and supplied quantity and accept the
indent.
The Batch number & Expiry date of drugs will be auto- updated as entered in the OGR generated from
the TNMSC software –avoids time consuming indented drug details in the software.
In future both the software are planned to be integrated so that the indents from hospitals through
HMS can directly flow in & out of TNMSC software
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31. HMS -TNMSC Online Indent Screen for
Warehouse
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32. Online Indents view in Warehouse
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33. Online Indents view in Warehouse
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34. 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
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35. MIS –Data Entry Form
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36. MIS Report
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37. MIS –Personal Module
All details in SR will be digitised (DPH SR updationis complete & their personal module is live)
Updationof old data will be done by the application developer after getting the details from
respective Directorate in Excel format.
When the modules are made live individual hospital has to update their staff details daily on a
regular basis
SR entry to be made online.
Most of the proceedings will be generated from the MIS-Personal module
The respective directorate will have the vacancy position online and can be used for appointments
/ transfer counselling.
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38. MIS –Personal Module
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39. Forms in Personal Module of MIS
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40. Employee Detail Entry Page
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41. Sample SR Entries
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42. Sample SR Reports
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43. Mini SR Report
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44. Sample Proceeding generated through MIS
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45. HMIS (HMS/MIS) Application Software
GoTNowner of the application
Developed by Tata Consultancy Services
Centralized web based application on open source platform
J2EE (Java 2 enterprise edition)
PostgreSQL data base
Glass fish Application Server
Solaris Operating System
Follows industry standard-three tier architectureviz.
(Presentation, Business logic and Data layer)
SUSE Linux OS at the end user level-user friendly screens
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46. HMIS Server Architecture (Current)
Web
Servers
App Servers
Database Server
Backup Server
Report Server
NAS
Tape Library
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47. Connectivity
Primary–TNSWAN
Point of Presence (POP) –District & Taluk
2 Mbps
Certain locations TalukPOPs are bypassed to improve connectivity
Redundant –VPNoBB
Initially 512 kbps
As per the load of the hospitals enhanced to 1 or 2 Mbps
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48. Hurdles –But Still Running
Lack of co ordination among various vendors(no single vendor for IT infra)
Mapping existing process and rationalization of input forms for standardization
Damage caused by local factors–Construction , Drainage work etc.
Power crisisand poor backup from UPS
Mind-setand Involvement of the hospital staff
Change Management and Total system transformation
Disruption of connectivity
Delay in server stabilisation
Lack of basic computer knowledge
Safe custody of HMIS supplies (hardware)
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49. Levers of success
Strong ownership and support from Top Health Administration
Communication to hospitals –by State authorities
Supporting Government orders
Mandating usage of Online system
End users trained to use system
No data entry support
Procurement Policy
TNMSC &ELCOT-as per norms
Implementation follow up by TNHSP
Regular stake holders meeting to discuss various issues and resolve the issues
Utilizing State Investments in establishing the Infrastructure
World Bank’s periodical monitoring and review helps to attain the benchmark during
implementation
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50. Various Directorates of H&FW Dept.
using HMIS
Directorate of Public Health
Directorate of Medical & Rural Health Service
Directorate of Medical Education &

National Rural Health Mission/TN
Once SHDRC is established HMIS will be extended to remaining directorates
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51. State Health Data Resource Centre
(SHDRC)- in progress
Huge volume of Data collected through HMIS has to be analysed, 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 17 verticals reporting health data)
To utilise the data and convert them into information and knowledge to improve the health
outcomes in the state through performance, policy evaluation and enhancement

Contribution from ICMR / NRHM / WB apart from State Govt. funds
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52. SHDRC: Goals
Purpose Driven Data Monitoring
for Evidence Based Decisions
Preventive Action
Corrective Action
Epidemic Response
Resource Planning
Performance Management
Policy Analysis
Health System Research
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53. Future Plans
HMS
Linking PIN to Adhaar(UID) Card
Integrating HMS & TNMSC for fully automated online indent system
Incorporating Picture Archiving & Communication System (PACS) in HMS
Collection of Private Medical institution’s clinical data through MIS for comprehensive health
data analysis in SHDRC
Appointment system for speciality investigations like CT- Scan, MRI-Scan, Angiography etc.
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54. 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 –Nihilente-governance awards 2011-12

National e-Governance award-Gold 2011- 12 under category ”exemplary reuse of ICT based solutions”
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55. Other IT Initiatives of TN
Health Management Information System (HMIS)
Hospital Management System (HMS)
Management Information System (MIS)
(Software developed by TCS)
College Management System (CMS)
(Software developed by TCS)
Pregnancy &Infant Cohort Monitoring and Evaluation (PICME / MCTS)
(Software developed by NIC)
Dr. MuthulakshmiReddy Maternal Benefit Scheme (MRMBS)
(Software developed by NIC)
Chief Minister Comprehensive Health Insurance Scheme (CMCHIS)
(Software developed by s/w vendor identified by UIIC)
State Health Data Resource Centre (SHDRC)

Central Repository for all 17 vertical departments under H &FW
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56. Websites of TN e-Health Projects
Application Software Website
HMS www.tnhmis.org/tnhsphms/
MIS www.tnhmis.org/hmis/
TNMSCOnline Indent (Warehouse) www.tnhmis.org/tnmsc
CMS www.tnhmis.com/tnmgrmucms_v3
College Website Website registrationin progress
NRHM
www.nrhm-mis.nic.in
www.tamilnadu.nhsrc-hmis.org
PICME www.picme.tn.nic.in
MRMBS www.mrmbs.tn.nic.in
CMCHIS www.cmchistn.com/
SHDRC In Progress
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57. Lives are precious, Handle them with (e-)care
Thank You
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