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Medical & Health Information System In Indian Environment Experiences with Project Dhanwantari By Maj Gen (Dr) RK Bagga, AVSM (Retd.) Dr M V Krishnamurthy Dir UOL

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IT Enabling Technologies High speed Micro Processors - Affordable Massively Parallel Computer High Resolution Graphic Monitor High speed Data Networks-Visualisation AI and Expert System Robotics Multi Media & Virtual Reality 2G->3G->4G Mobile Revolution

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IT for Health Care Management Networking Internet Intranet Extranet Web Online Search Ocean of Information

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IT for Health Care Management Database Technology High Performance Database Servers Object-Oriented Databases Distributed Fault Tolerant Databases Data Ware Housing Data Mining Security and Privacy Grid/Cloud Computing

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IT in Medicine Typical Application Areas Computer Diagnosis AI/ES Genemapping Surgery Digital Visualisation Heart Modelling Education & Research MM & VR e-Learning

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IT in Medicine Typical Application Areas Rehabilitation of Handicapped Robotic Information System Patient Care Hospital Managements Telemedicine

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PRINCIPLES OF COMPUTER-ASSISTED SURGERY X Y Z CT - Computer Tomography MR - Magnetic resonance Generation of the Volume Model 3D View of the Operation area & the instruments position 3D Position measurement CT or MR Slices Preoperative scanning

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Childrens Hospital of Pittsburgh Presbyterian University Hospital School of Medicine; Neurological Surgery Eye & Ear HospitalMonteflore Hospital School of Medicine Anesthesiology Veterans Admn. Hospital Magee Womens Hospital School of Engineering Electrical Engineering Deptt. of CS MEDNET - LINKS REMOTE MEDICAL FACILITIES IN REAL TIME Real Time Monitoring - 1600 Brain Surgeries/year

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Virtual Reality Assisted Surgery Program (VRASP) Plan Compu ting system Comms Review/Rehearse Virtual image Surgeon-A Surgeon-B Conduct Surgery Patient World frame of reference

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MENU BAR TV PICTURE Patient Parameters - Graph Pulse Neuro Comn Temp ECGBP MEDNET SCREEN:- X WINDOW INTERFACE

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DHANWANTRI (1994-1996) A Computer based medical information system for military hospitals to facilitate patient care and hospital administration. Computer Centre, DRDL, Hyderabad MH, Secunderabad DEBEL, Bangalore A joint effort by

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Modules of Dhanwantri Phase-I Central Registration Medical Inspection Room(MI Room) Polyclinic Pathology Phase-II Medical Stores Dispensary Radiology Operation Theatre Wards

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Salient Features of Dhanwantri Focus on patient care rather than billing. Capturing of all the relevant information of a patient. Quick updation and retrieval of patients case history. Elimination/Minimisation of duplication of data. Simultaneous access of the database at several places by several users.

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Salient Features of Dhanwantri Automatic generation of various statistical/ summary reports, registers, slips etc. Immediate answers to several adhoc queries Quick accessing of medical data for research or any other purposes. Better management of hospital resources such as bed, wards, medical stores etc. Highly sophisticated user-friendly interface. Smooth transition from manual to computerised system.

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System Configuration Central Computer: Pentium server with 32 MB memory & 2 GB hard disk Standby Computer: PC 486 with 16MB memory & 2GB hard disk. Remote Stations: Terminals connected through port boxes & line drivers. Software: SCO UNIX Operating system & ORACLE 7 RDBMS (multiuser).

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Methodology Feasibility Study Formulating broad objective Economic & technical feasibility Submission of feasibility report Requirements Analysis Studying the existing manual system Study of forms, registers, reports, slips, etc. Meetings, Interviews, Presentations etc. Working out the Configuration Requirements Hardware, Software, Communiction Preparation of SRS Report & Review of SRS

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Methodology Preliminary Design Detailed Data Flow Analysis Data Modelling & Design Architectural Design (Structured Charts) User Interface Design Control Flow Analysis Preparation of PDR Review of PDR

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Methodology Detailed Design & Implementation Implementation in Oracle 7.0 Screens (Forms 3.0) Reports, Registers, Slips (Report Writer) Testing & Integration Function wise testing Integration with the Module Module wise testing System testing

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Methodology Installation Cabling Installation of HW Porting & testing of Dhanwantri User Training User level training System Administrator training

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Methodology Operational Support Overviewing Onsight Hardware/Software Problems User Feedback System & Database Administration Streamlining Startup/Shutdown Procedures Streamlining Backup/Archival Procedures Security

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Methodology Maintenance Correction of bugs Modifications New Requirements Remote Maintenance

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Dhanwantri Software 1. No of Modules 90 2. No of Tables 210 3. No of Forms 200 4. No of Reports 100

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Dhanwantri Project Team Software Development Scientists4 Staff8 Project trainees 12 Hardware & Networking Officers2 Staff3 Coordination with MH Officers2

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Dhanwantri Milestones Initiation of Project by SA to RM 2 Oct 94 Phase-I Requirement Analysis Dec 94 Preliminary Design Mar 95 Implementation Jul 95 Testing & Integration Sep 95 Hardware Installation & Cabling Oct 95 Software Inst. & User Training Oct 95 Launching by SA to RM 25 Nov 95 Revised Version 1.0 Apr 96 Revised Version 2.0 Aug 96

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Dhanwantri Milestones Phase-II Initiation of Project Apr 96 Requirement Analysis Jun 96 Preliminary Design Aug 96 Implementation Nov 96 Testing & Integration with Phase-I Dec 96 Installation at MH Dec 96 User training & feedbackunder progress Operational support from Oct 96 Hardware maintenance Software maintenance

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Experiences Development Phase Difficulties in Extracting/Specifying Requirements Design Difficulties Implementation Problems System Problems

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Experiences Operational Phase Resource Constraints Terminals, Printers, Stationary etc. Infrastructure Constraints Power, Communication etc. Cultural Change Lack of awareness Initial fear/apprehension Additional work load Need for Continuous Support

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Experiences Underestimation of Development Time and Effort Manpower Problems 10 Years ahead of Indian Government Scenario RR Hospital Delhi

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CONCLUSION & LESSONS It is must for India & Medical field Realistic plans/Projects in our context Affordable Infra-Structure-Must Safety-Critical System-Highly Reliable Info System for Medical Care-Available No Computer can replace man Maintenance of computerised System-Must Software cannot be taken for granted.

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? Any Questions

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Thank You