HMIS Project_GGMC Sir JJH_2014

HEALTHCARE & ACADEMICS MANAGEMENT INFORMATION SYSTEM

GMC & Sir JJ Hospital, MumbaiAn “e- Governance” Initiative by Medical Education and Drugs Department

An “e- Governance” Initiative by Medical Education and Drugs Department

GGMC & Sir JJ Hospital, Mumbai

IntroductionHMIS Project

MEDD HMIS Project – Snapshot 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

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

HP incurs all Capital investments upfront and Government of Maharashtra pays back to HP on a monthly payment basis.

MEDD HMIS Project at GGMC and Sir JJ Hospital, Mumbai

GGMC and Sir JJ Hospital, Mumbai was shortlisted as the Pilot location for the prestigious MEDD HMIS project

The Central Server Repository Data Center for storing the patient data across all 19 hospitals is located in this institute

The project went live on 18th Oct 2008

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Primary Objectives – MEDD HMIS Project To create Unique Health ID for the Patients visiting State

Government run Hospitals which will be used as permanent MRD number for the patient

Reduction in the waiting time for Patients at registration counter

Making all patient data including X-ray, CT, MRI images and diagnostic reports available to the Clinician on screen

Make Patient data available in Electronic format for easy Management of Hospitals and Patient Care services

To bring transparency and clinical audit trail facility in Patient Data Management

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Primary Objectives – MEDD HMIS Project

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

To create MIS reports / Statistical Information at all levels Medical Research and Data Mining with patient data

captured across all 19 Hospitals in digital format To create a central repository of Patient records for the State

and accessibility to these records from any of these Hospitals

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Features and AchievementsHMIS Project

HMIS Salient Features – Broad Perspective

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 he 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 application9

HMIS Salient Features - Nutshell Unique Health ID for Patients

Easy tracking of medical history of patients, thereby assisting speedy and error-free care

Reduction in the waiting time for Patients at registration counter HP-provided skilled operators at counters to

ensure quick registration of service requests All patient data incl. X-ray/CT/MRI

images, diagnostic reports on screen Cost savings on film for hospital and ease of

use for patients Patient data available in Electronic

format, across locations Ready availability of data across state, Data

impervious to damage as with paper

Audit Trail facility Plugs loopholes and pilferage, bringing

accountability and transparency in transactions

Rich MIS Up to date statistical reports to assist

administration Medical Research and Data Mining

features Analysis of patient data across state to assist

in better, pro-active and preventive healthcare

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HMIS Project Achievements Waiting time at registration counter reduced by 88%

Reduced from 55 minutes to under 7 minutes Unique Health ID issued to 15, 56, 720 patients till date

Unified medical history of patients Reduced time to commence treatment

Totally 42, 63, 837 patients have been registered from HMIS since Oct 2008

Increase in revenue due to increased transparency at registration and billing counters Registrations Revenue increased by about 82% Diagnostic Services Revenue increased by more than 400%

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HMIS Project Achievements…..Contd Patient EMR and administrative reports available to authorized

users instantly Instant access to data, reducing non-clinical process time

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 through

batch processing Demographic details of more than 15 Lakh Unique patients

available Data mining / Research can assist enhancement of preventive

healthcare in MEDD owned hospitals

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HMIS Project Achievements…..Contd 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 at Sir JJ

Hospital

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StatisticsHMIS Project

OPD Registrations Statistics15

The OPD Registration has been on the increasing trend since Go-Live of HMIS project

Data collated till May 2014

IPD Admissions Statistics16

The IPD Admissions has been on the increasing trend since Go-Live of HMIS project


Free & Repeat Patients Statistics – Loyalty Index

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The number of repeated patients are on an increasing trend emphasizing their trust on the patient care management.

* Data collated till May 2014

Senior Citizens Visiting Sir JJ Hospital18

Senior Citizens visiting Sir JJ Hospital has been increasing every year


Surgeries – Major & Minor19

Major and Minor Surgeries Details of Sir JJ Hospital has been increasing every year


Service Department Statistics - Orders Processed

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The processing capacity of the service departments has been increasing since 2008 depicting increase of revenue through investigations

Data collated till May2014

Revenue Growth provided by HMIS Registrations Revenue at Sir JJH,

before HMIS implementation was Rs 2,52,417 and after HMIS implementation it is Rs 4,94,070 in May 2014 i.e. an increase of about 82%

Diagnostic Services Revenue at Sir JJH, before HMIS implementation was Rs 9,12,587 whereas after implementation it has sprung to Rs 47, 02, 086 in May 2014 i.e. an increase of over 400%.

(Note: The revision of rates has also contributed to the steep increase in revenue)

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415.24

%82.54

%

Research Details22

PublicationsYEAR 2008 2009 2010 2011 2012 2013Total 10 29 36 36 51 57

219

Paper/Poster Presented

On going

Research

Year 2008 2009 20102011

2012

2013 2014

Total 6 43 34 51 55 61 76250

BenefitsHMIS Project

HMIS Project – BenefitsBenefits 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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HMIS Project – BenefitsBenefits 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

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HMIS Project – BenefitsBenefits 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.

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HMIS Project – Benefits27

Benefits 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


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


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


Benefits to MRD (Record) Department All medical records (Normal as well as MLC) can be

preserved for very long time – no space constraint Easy to retrieve any case records All Statistics on a single click – No need to prepare manual

reports and statistical reports


Benefits 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

ChallengesHMIS Project

Challenge 1: Huge Patient Volume33

Over 5, 00,000 Patients visit OPD and over 45,000 admissions in Large hospitals (Large hospitals - having bed capacity over 1000 Beds) in a year, due to the patient rush in Out patient department the key challenge was to develop the system in such a manner that it’s a single operation screen for all patient care activities that consultant will work upon

Solution: Single window for Patient Service Customized Template designed for case notes to capture details seamlessly Ready made templates of signs and symptoms for common diseases thus managing

70% to 80% of patient work load

Challenge 2: Non standard maintenance of Data

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There are no universal standards to record or to keep medical Data. The availability of accurate and exhaustive master data as the data was available in bits and pieces.

Solution Requirement gathering of the workflow across state government hospitals

to standardize the templates Scrutiny of past records / Circulars /Notices / GR’s issued for capturing

relevant data fed into HMIS system This master data was put forth for user acceptance and other statutory

approvals as per government norms Standardized data formats developed with consultative approach involving

all Stakeholders

Challenge 3: Management of Change35

This was the most challenging piece in the hospital as the users were more comfortable using paper and pen for doing patient care related activities and they were to be migrated from Paper based system to On line system which due to lack of time was difficult. Also setting up right expectations from the management and users in the hospital on the effort required for internalizing this Programme was a difficult task.

Solution: Structured manner of implementation encompassing - 24 X 7 Training Facility User Acquaintance program Executive Training Program Creation of Core team Class room Training of users Handholding of User’s in real Time Environment Creating Departmental Champions Refresher training

Challenge 4: Inconsistency in Capturing Data

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Designing user friendly interfaces in HMIS as each user has his own way of looking at patients and then capturing data for creating EMR

Solution: Preparation of standardized Templates Creation of Detailed Standard operating procedures for all modules

of HMIS to bring consistency and accuracy in the HMIS implementation

Challenge 5: Outdated Equipments37

Interfacing OLD Equipments - like X-Ray, Biochemistry Machines not compatible to current day HMIS

Solution Detailed study of the equipments available in various diagnostic centers Developing a composite application was developed for reading both

ASTM and Non ASTM compatible data so as to integrate with the existing HMIS application

Challenge 6: Lack of IT knowledge38

Lack of any IT related module in Medical course(MBBS/BAMS/BHMS)

Solution New Joinee induction programme for junior most consultants and

Nursing staff includes HMIS Orientation and Training

Challenge 7: Infrastructure rollout39

Right infrastructure in terms of right sizing, the servers and PCs, LAN design, equipment security etc, this typically was a key point at most of the government hospitals are hosted out of old stone buildings / structures in which setting infrastructure is difficult due to its build and where most of the route diagrams / floor layout blue prints are not available

Solution Detailed existing workflow study was conducted in each of the hospitals location to

understand the Geographical scope of HMIS users within the campus based on which Computers in ratio of 1-1 (One Doctor – One computer) Installed latest Blade servers to ensure processing speed of the data is always high. All Servers of Application and Database are configured in High Availability mode

with Network switches in auto failover mode Rigorous discussion with hospital authorities was done and based on the previous

experience of making infrastructure ready, some key assumptions were made to design and execute LAN infrastructure piece. Once all the infra readiness work was completed the route diagrams were submitted to hospital authorities for future reference and record purposes

Thank You

HEALTHCARE & ACADEMICS MANAGEMENT INFORMATION SYSTEM FOR GGMC & SIR JJ HOSPITAL, MUMBAI

Healthcare

HMIS Project_GGMC Sir JJH_2014