HP_HMIS Project_GoM_2014

HEALTHCARE & ACADEMICS MANAGEMENT INFORMATION

SYSTEM (HMIS)

An IT solution for Hospital Operations which improves patient services outcomes through end-to-end IT outsourcing

An initiative of Maharashtra Education And Drugs Department (MEDD)

Introduction – MEDD HMIS Project

Medical Education and Drugs Department drew a comprehensive solution for IT enabled services to encompass the operations of 14 Government Medical Colleges and 19 teaching Hospitals by implementation of an Hospital Management Information System for the purpose of education, training, research and patient care related activities at the State Government run Hospitals and Medical colleges in Maharashtra

The Service Provider, Hewlett Packard India Sales Pvt Ltd, to create IT Infrastructure, conduct the Patient Registration Processes (Front office) for Outpatient & Inpatient as an Outsourced function and manage the Created IT infrastructure

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Salient Features & IT Architecture

HMIS Project Details

HMIS Salient Features

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HMIS Modules are fully Integrated Radiology Information System, Laboratory Information System, Electronic

Medical Record, Inventory control and finance modules are accessed as one application from Anywhere in the Hospital / Department

HMIS Modules are Patient centric All Modules are configured, accessed based on patient work flow

Integrated and standardized Workflow The HMIS system workflow is customized to meet requirements of

Government Hospitals Decision Support system

Unified online reports on Patient information for supporting the Dean / HoD’s to make decisions faster and provide better medical care to patients

Uniform access to HMIS modules Simple Internet Browser based user-interface for all modules of application

Technical Architecture5

Technical Solution Architecture Objectives6

Simplicity: Reduce Complexity, Open Standards, lower cost and minimum resource requirement

Modularity: Ability to change one component of the environment without affecting other components

Integration: IT infrastructure components must be integrated through a uniform set of relationship that is defined by the Business, easy to understand, manage and modify

Standardization: Identifies how things work (processes), how they work together and makes the knowledge available for maximum benefits

Redundancy: The application is installed in two application servers which give a redundancy feature enabling to give 100% availability of the HMIS application to all users.

The Central Site: All the sites under the scope of the project can be connected to the central site through WAN. This gives an option to the patient to visit any hospital without bothering to carry all his files with him/her.

Repository of patient Data: The local server stores all the patient data including investigation reports, CT/MRI scans etc. This capacity management is such that the patient data will be available for viewing for a long duration of years.

End user System: The best configuration of systems is made available to the users for application navigation and seamless viewing of radiology images. Thin clients occupies less space as compared to desktops and completely portable. For new implementations the thin clients are being replaced by Desktops as the efficiency of displaying radiology images increases on a desktop.

Technical Solution Architecture Objectives Contd

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HMIS Work Flow

HMIS

Doctor Consultatio

n

Pharmacy

Laboratory

Radiology

Nursing

Store Manageme

nt

Billing

Patient Registration

Patient coming to Hospital

Patient going Home

Manual Vs Automated Process.

Benefits of HMIS Project

HMIS Project – Benefits

Benefits to Patients A unique patient ID for Life long as MRD number No loss of patient data including X-ray, CT, MRI images and

accessible from any locations Reduction in the waiting time at registration and consultation

since all demographic details of the patient are captured for life long

Speedy access to investigation reports since they are available online leading to early diagnosis

Patients do not have to go MRD section / Record room to draw their old records prior to consulting the doctor

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Benefits to Patients…contd. Below poverty line / senior citizen “exempt” process simplified

through central data – no moving from one counter to another Prescriptions are available online to the pharmacist even before the

patients reach pharmacy counter – quick disposal Online prescriptions reduce medication error Reduced chances of specimen mismatch through unique MRD

number link improving the accuracy of patient’s investigation report.

On admission bed allocation is dynamic saving lot of time Simplified Patient transfer system through online bed transfer Patient data integrity and accuracy maintained - saved cannot be

modified or erased

HMIS Project – Benefits12

Benefits to Doctors / Nurses and Administrative staff Availability of Electronic Medical Record for recall at any point, from

anywhere within the network The process of diagnosis and treatment has been hastened -

availability of patients past history, diagnostic study reports and ‘quick prescription’ etc…

Proper medical audit through audit trail Patient referral/second opinions simplified through online referral Doctors can do consultation from anywhere, anytime within the

network Cash collection process within Hospital - simplified and transparent. Automatic generation of cash collection and inventory reports -

improved efficiency and reduces scope for malpractices and pilferages.

HMIS Project – Benefits13

HMIS Project – BenefitsBenefits to Doctors / Nurses and Administrative

staff…..Contd. Inventory management – efficient, transparent – less

chances of pilferage Easy for hospital administrators – supervise from their desk

through the computerized system. The seamless availability of patient data on Central Server

helps the doctor in conduct of Medical Research and Data Mining.

Doctor’s while performing surgery are able to accurately view the required images in various dimensions, thus helping him in performing precise surgeries.

Medical errors are reduced since repetitive writing work is eliminated through this automated process.

Computerized Nursing documentation – simplifies documentation for Nurses

Nurses have more time available - Repetitive manual writing eliminated

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Benefits to Service Departments (Labs & Radiology) On line viewing of LAB & Radiology investigations LIS - Interfacing of Lab Equipments with HMIS –

Direct Result entry in Reports saving time Avoids error due to manual data entry

PACS - Interfacing of Imaging Modalities with HMIS – No need to process films No need to carry and preserve the films – Any image

can be viewed at any time for diagnostic/comparison purpose

Clinically critical cases’ images can be used for academic purpose

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Benefits to Medical Store & Pharmacist

Avoids error due to misinterpretation of Drugs

Receives alerts on near Expiry stock & Low stock level

On line Indent Request/Issue for speedy delivery

Hassle free inventory management

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HMIS Project – BenefitsBenefits to Hospital Administration All MIS & Statistics on a single click. For Example -

Total OPD/IPD & Casualty patients visiting to Hospital (Consultation Reort)

Total Free/Repeat Patients OPD & IPD revenue Drugs ordered and Dispensed Investigation ordered and Processed Statics of Surgeries Bed transfer Indent reports Inventory reports ETC…..

Helps in taking quick decisions and action in case of emergency /shoot up of any communicable disease

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Achievements & Benefits

HMIS Project

Achievements & Benefits provided by HMIS

Creating Unique Health ID for the Patients visiting State Government run Hospitals which will be used as permanent MRD number for the patient From October, 2008 to Sept 2014, over 62 Lakh patients

were provided computerized registration or the unique health ID at the 11 Go live hospitals.

These patient records are audited and certified by the HMIS Project implementation committee and Dean of the institute on monthly basis.

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Reduction in the waiting time for Patients at registration counter During the manual registration being done by hospital

clerks only 3 to 4 registration counters were available but after introducing HMIS system number of counter increased to 14 – 16 depending on the volume of the patients.

The average waiting time at counters has been reduced to about 7 minutes from about 55 minutes prior to implementation of HMIS project.

Thus the waiting time at registration counters has been reduced by nearly 90%.

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Making all patient data including X-ray, CT, MRI images and diagnostic reports available to the Clinician on screen CT / MR scans are available online for a patient to access care from

any terminal on the HMIS network. These scans are stored digitally, hence no loss of images and are as

part of EMR. After computerization the X ray films are made available through

HMIS system and soft copy of the X-Ray film is available on the computer screens of all doctors, hence there is a huge potential of cost saving on Film procurement, Developing / processing of films and Storage of films.

The Old films / images are stored as soft copy in the HMIS servers for recall at any future date. Therefore patient need not go around collecting Films to get doctor consultation thus saving time for both Patient and consulting doctor

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Make Patient data available in Electronic format for easy Management of Hospitals and Patient Care services The patient and his relatives, are spared the burden of having to

maintain accurately filed medical history and having to carry such files around the hospital. The Laboratory reports, X-ray images, prescribed drugs and

previous doctor’s consultation is readily available from HMIS system.

The patient’s EMR is instantly available to the doctor hence reducing non-clinical process time. Since the EMR contains historic data and other information, it

helps the doctor in avoiding medication errors. The EMR is a digital record, and is impervious to damage by time

and weather as with paper records.

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HMIS has been practically assimilated in the working routine at these hospitals. Increase in number of patients registered is about 55%, indicating massive

reduction in number of unregistered patients. HMIS handles over 85% of all transactions at these hospitals.

Better transparency in inventory audits and accounting procedures Prescriptions and medicine dispensing from within HMIS is about 95%. At pharmacy, the printout given by the doctor facilitates the process because it

contains the MRD number. Since it’s a print out and not handwritten, legibility increases, thus increasing

accuracy in medicines dispensed. Based on the medicines outflow, the inventory is automatically updated. This

also helps in stock replenishment. The possibility of pilferage is reduced because each medicine is now accounted

for in the HMIS system.

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Creating MIS reports / Statistical Information at all levels a statistical report of Hospital bulletin is available for information purposes

Medical Research and Data Mining with patient data captured across all 19 Hospitals in digital format and create a central repository of Patient records for the State and accessibility to these records from any of these Hospitals

Currently Patient data of each implemented location is stored locally in the hospital, the internet connectivity between the eleven (11) implemented locations and Central site is in progress. Once the connectivity is established all the patient records across these hospitals will be accessed seamlessly.

In all, more than 150 Lakh records which includes New and follow-up patients is available a mouse click. As per the deans of the institutes research papers submitted by doctors and staff have increased because of the convenience in tracking patient medical history.

Similarly the turnaround time to address challenges has come down drastically. For example, during the Mumbai blasts, the hospital was able to put up a list of patients admitted within a span of 1 hour for the convenience of relatives of patients.

Medical errors are reduced since repetitive writing work is eliminated through this automated process

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The following chart proves the successful implementation and assimilation of the HMIS project in all the four locations, as well as continued growth in its usage in hospital operations.

Currently approximately 80% to 85 % of patients are given some kind of services like Radiology, Laboratory, EMR, Indoor etc through HMIS system.


To plug Loop holes for pilferage and bring accountability, transparency and audit trail in all transactions

Registrations Revenue of All Site, before HMIS implementation was approx Rs 20 lakh and after HMIS implementation it is around Rs 28.5 lakh/Month i.e. an increase of 42%

Diagnostic Services Revenue of all site, before HMIS implementation was approx Rs 32.9 lakh whereas after implementation there is an increase of over 175%.

Note: The registration and investigation charges have increased since Feb 2010.

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Scalability

HMIS Project

HMIS Project – Scalability & Road Map

Introduction of Patient Smart Card Reduce patient’s waiting time further from 7 Minutes to

approximately 4 Minutes or lesser Reduce non-clinical process time for doctors Reduction of errors while entering the patient unique ID number

during Drug dispensing, Sample collection and EMR generation.

Hospital Mobility Solution Medical Computer Crash Cart specially designed to carry Medicine's,

IV’s , Equipment's along with wire less computer backed up with sufficient UPS power to complete the rounds by Doctors & Nurses.

Enables the doctors to view CT , MRI & X-Ray at the patient Bed Side to deliver care at Patient Bed Side real-time

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HMIS Statistics

HMIS Project Details

HMIS Statistics

Unique Health ID issued to more than 62 lakh patients Demographic details and photograph of every patient Reduced time to commence treatment

Waiting time at registration counter reduced by 88% Reduced from 55 minutes to under 7 minutes

1.54 Cr patients registered from HMIS across all computerized MEDD hospitals since Oct 2008

Increase in revenue at registration and billing counters Registrations Revenue increased by about 42% Diagnostic Services Revenue increased by more than 175%

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HMIS Statistics…Contd

Patient prescriptions and dispensing of medicines through HMIS is about 98 % (2 % of Patients go out of the queue ) Better transparency in inventory audits and accounting procedures

Central repository of patient records Accessibility to EMR from any MEDD computerized Hospital

Increase in number of patients registered is about 75% Computerized registration has helped curb number of unregistered

patients HMIS handles over 90% of transactions

Proves successful user acceptance of computerization in MEDD Hospitals

Film-less Radiology Information System Potential savings on film, in addition to ease of use for the users

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Patient Registration in OPD – All Locations

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Data collated till Sept 14

The Patient Registration in OPD has been on the increasing trend (< 75%) since Go-Live of HMIS project ( Data for 2008 is for 5 months, Data for 2014 is for 9 Months. )

Patient Admissions Statistics – All Locations

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The Patient Admissions has been on the increasing trend since Go-Live of HMIS project ( Data for 2008 is for 5 months )

Data collated till Sept 2014

Registration Cash Collection – All Locations

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Data collated till Sept’2014

The PLA has seen a positive revenue increase due to increase in Registration Cash Collection in all HMIS implemented institutions

Thank You

HEALTHCARE & ACADEMICS MANAGEMENT INFORMATION SYSTEM FOR MEDD

HP_HMIS Project_GoM_2014

Healthcare

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