Summer Placement In
(April 4 - May 30, 2011)
IMPLEMENTATION OF HOSPITAL INFORMATION SYSTEM IN DEEN DAYAL UPADHAYAY HOSPITAL, SHIMLA
Shruti Goel PG/10/045
Post-graduate Programme in Hospital & Health Management, New Delhi 2010-12
International Institute of Health Management Research, New Delhi 2011
We wish to express our deep sense of gratitude to Prof Sundeep Sahay, President, HiSPindia for giving us great opportunity to do our Summer Training at HiSPindia, Shimla. We hereby express our deep gratitude towards Ms. Arunima S Mukherjee, Project-Lead Coordinator, HiSPindia, and Ms. Rashi Banta, Project-Lead Coordinator, HiSPindia, for their valuable guidance, support, interest, involvement, encouragement and advice. They inspired us greatly to work on this project. My sincere acknowledgement goes to Professor Indrajit Bhattacharya and Professor Anandhi Ramachandran for their kind assistance and support throughout our summer training. Finally, an honorable mention goes to our family and friends for their understanding and support in completing this project. Thank You
ABBREVIATIONS1. AIDS- Acquired Immuno-deficiency Syndrome 2. API- Application Programming Interface
3. BPL- Below Poverty Line4. DDU- Deen Dayal Upadhayay
5. DHIS- District Health Information System6. DOTS- Directly observed treatment shortcourse
7. HIS- Hospital Information System 8. HISP- Health Informatics Systems Programme9. HIV- Human Immuno-deficiency Virus 10. ICTC- Integrated Counselling and Testing Centre 11. IPD- In-patient Department 12. MLC- Medico-legal Cases 13. MRS- Medical Record System 14. MS- Medical Superintendent 15. OPD- Out-patient Department 16. RKS- Rogi Kalyan Samiti 17. RSBY- Rashtriya Suraksha Bima Yogna 18. SMO- Senior Medical Officer 19. TAT- Turn Around Time
TABLE OF CONTENTS1. HiSPindia Profile.7 2. Introduction..9 3. Operational Plan..11 3.1 Need Assessment for HIS.....11 3.2 Initiating the Process.12 3.2 (a) Demo of OpenMRS (HIS) in Hospital...12 3.2 (b) Review of Existing Process13 3.2 (c) Requirements Based on Review of Existing System.20 3.2 (d) Meeting on HIS implementation22 3.2 (e) Action Plan for HIS implementation..23 3.3 Procurement of Software/Hardware Support.23 3.4 Module Implementing24 3.5 Training Session/Capacity Building for the End User...46 3.5(a) Training Objective...46 3.5(b) Identification and Assessment of Training Need46 3.5(c) Basic Requirements.46 3.5 (d) Training Plan..47 3.6 Dry Run49 3.6 (a) Testing the Application for 10-15 days...49 3.6 (b) Hands on with End Users (nurses and doctors)...50 3.7 Going Live Process...50 4. Conclusion....51 5. References....53 4|Page
6. Case study....54 7. Annexure..60
ABSTRACTIntroduction Innovation in Healthcare Information Technology (IT) has fueled unprecedented gains in improving the medical field over the last 30 years. Today, IT companies with their healthcare verticals are an important engine to drive growth for hospitals getting automated. A Hospital Information System (HIS) is an integrated information system designed to manage the administrative, financial and clinical aspects of a hospital. HIS is vital tool in decision-making and plays a vital role in the success of any organization. Computerization and automation of the medical records and their documentation has resulted in efficient data management and exchange of information for the users. With the help of HIS, managers, clinicians and other healthcare workers can access the information without any delays or errors. Aim The primary aim is to establish an approach for implementing HIS (Hospital Information System) in Dean Dayal Upadhyay Hospital (Ripon), Shimla, which is already an established and functional government hospital. The approach should be such that it aligns to support the mission, vision, goals, objectives, and strategies of DDU. Objective Articulating and communicating the right vision and mission for HIS implementation project, committed involvement of the top management of a hospital and persistent training of the actual end users. Methodology 5|Page
The following practices, grouped into management processes, helps in the implementation of HIS in Hospitals:(1) Assessing the complete requirements of the Hospital and the end-users (2) Designing an existing flow and analyzing the gaps (3)Optimizing the workflow (4)Preparing the users by imparting high level training and capacity building (5)Transforming the system with live implementation, (6)Sustaining and providing support. Conclusion The implementation of HIS in DDU would result in the following (1) Reduced cost (2) Improve quality (3) Standardize Workflow (4) Better Management Control
HiSPindia is a not-for-profit NGO specializing since more than a decade in designing and implementing solutions in health informatics for the public health sector in Indian states, and also recently in Bangladesh and Sri Lanka. It is not a solely technology focused organization, but a multi-disciplinary organization concentrating on the domains of public health and informatics. The organization has a strong commitment to free and open source technologies, and works with a global perspective of the Health Information Systems Programmes (HISP) network, coordinated by the University of Oslo, Norway, and is active in more than 20 countries in Africa and Asia. HiSPindia has a registered and head office in New Delhi, and project offices in Kerala, Himachal Pradesh, and Punjab. The team members are intensively travelling to different parts of the country to provide technical support services. 1.1 VISION To enable and coordinate a network of excellence in public health informatics, specializing in integrated health information architectures, with a geographical focus on South-East Asia. 1.2 HISTORY In 1999, an informal group of idealists got together to start a project in a primary health centre in the remote villages of Kuppam, Chittoor district in Andhra Pradesh. These efforts were 7|Page
supported by the University of Oslo, Norway, and had initial partnerships with IIM Bangalore and ASCI Hyderabad. During the first five years, it remained focused on Andhra Pradesh and carried out implementations of the first version of the DHIS software application. From 2005, it started to work in the State of Kerala first in one facility and by 2008 all the facilities were reporting data in the DHIS2. The DHIS2, which is a global standard today for facility reporting, took birth in a clinic in Kerala in 2006. The achievements in Kerala prompted the state of Gujarat first, and then Jharkhand and Madhya Pradesh to initiate DHIS2 implementations. This led to collaboration in 2008 at the national level with National Health Systems Resource Centre (NHSRC) to provide technical support on DHIS2 nationally. About 25 states took up DHIS2 in 2008. Today, HISP has gained international recognition, and has also been invited to provide technical support in Bangladesh, Sri Lanka, Rwanda, and Philippines. 1.3 GEOGRAPHICAL COVERAGE With a 30 team members, HISP has a strong national and global coverage of work. In India, it has worked in at least 90% of the states, and currently has a presence in about 20 states. Internationally, HiSPindia has worked in Bangladesh and Sri Lanka, and on an individual basis, experts have contributed to Global HISP activities in various countries including Vietnam, Tanzania, Zanzibar, Ethiopia, Mozambique, South Africa, and those in West Africa.
2. INTRODUCTIONOver the last few decades, medical sciences have significant progress leading to improvements in the modes of investigations, therapeutic activities and surgical procedures. This has enhanced the need to have authentic and accurate medical records of the patients. Health Information System (HIS) is one of the most promising applications of Information Technology (IT) in the Health Care Sector. The aim of HIS is to use a network of computers to collect, process and retrieve patient care and administrative information from various departments for all hospital activities. It also helps in decision-making for developing comprehensive health care policies.
2.1 CONTEXT AND CONCEPT The HIS comprises of an electronic patient record which forms the core of the system and links it to all other departments in the hospital where every department can be viewed baas an information-processing agency. Present health Information system reveals that the existing system at DDU Hospital requires up-gradation to meet the requirements of the managers and the clinicians. The management at DDU feels HIS assists in decision making, and medical audit. It is also felt that the existing HIS resulted in longer time for OPD consultation and delay in investigation results.
2.2 ADVANTAGES OF HOSPITAL INFORMATION SYSTEM HIS is based on the exemplar of a centralized information system designed for quick delivery of operational and administrative information.
The administration can actively use HIS for monitoring and controlling the quality of patient care. Helps in providing improved clinical outcomes and better diagnosis and care to the patients. The administrative and supply chain modules improve productivity and efficiency, driving down costs and waste. Assesses the performance of the medical staff; in keeping track on how hospitals resources are being put to use. Gathering data for short term and long term decisions. Prompt and reliable information storage, querying and retrieval. A data warehouse of such records can be utilized for statistical requirements and for research.
Improved monitoring of drug usage, and study of effectiveness.
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1. OPERATIONAL PLANThe