Integrated Hospital Management System
Content
IHMS, 2007-2009 Integrated Hospital Management Systems I. Initiative: I. a. Location and its Inhabitants: Integrated Health Management System – is a unique venture for the country undertaken in Dadra and Nagar Haveli. The Union Territory with an area of 491sq.km has forty percent of the area covered by forest and has 2,20,490 inhabitants. Adivasis form a prominent part of the local population accounting for 79 percent of the total inhabitants. The initiation and later implementation of the Integrated Health Management has evolved taking into consideration the demographic details of the area as: a) A large percentage of the population (over 80%) live in rural setting and are a vulnerable section as it is difficult for any rural population to access quality care - a reality across India. b) Illiteracy hinders preventive health management measures and follow up care. The illiteracy rate of the population at Dadra and Nagar Haveli is 40%, and is higher among women at 57%. This makes it necessary to have treatment services that are people centric. c) The health care infrastructure indicates a lacuna both as human resource and infrastructure. There is a shortfall of 12 Sub-centers and one health center as human resources the shortage is far more with 35 multipurpose workers at the health center and sub-centers, six health assistants. At community centers there is scarcity of specialized staff such as an obstetrician and gynecologist, physician, pediatrician and other specialists. I.a.1. The Institute carrying out the Project: Shri. Vinoba Bhave Civil Hospital, at Dadra and Nagar Haveli, began its journey of addressing health care concerns of the poor, in 1952 as Cottage Hospital. It was given its present name in 1999. Today, it can house 161 patients and ensure provision of specialized medical care. The comprehensive nature of the health care services provided is indicated by the various departments embedded within the Shri. Vinoba Bhave Civil Hospital, they include Surgery (inclusive of Nuero, Plastic, and Reconstruction Surgery); Medicine; Paedicatrics, Obstetrics and Gynecology, Orthopaedics,
1 Shri. Vinoba Bhave Civil Hospital, Dadra and Nagar Haveli
IHMS, 2007-2009 Opthalmology, Pathology; Radiology and Imaging (inclusive of Spiral CT Scan), Telemedicine, ENT, Public Health, Dentistry, Physiotherapy, Accident Prevention cum Trauma and Emergency Services, Dermatology, Psychiatry, a Central Medical Store and Pharmacy; Dietetics, a Medical Record Department, Central Sterile and Supplies Division, Mortuary and Post Mortem Section, Ambulance Services, Security and House Keeping. I.a.2. Local Relevance (or reasons) of present project At both the national and the international level health is an important aspect to ensuring that social capital is empowered and utilized. The National Family Health Survey carried out under the aegis of the Government of India indicated that the accessibility and availability of health care was important to ensure health status of a community and that coverage by health facilities was central to positive change. An adverse impact of limited health coverage across India is seen in the fact that 65% percent of Indian households seek health care from the private medical sector and only one-third use the public medical sector. Common reasons for not using health care facilities of the public sector, is the poor quality of services and non-availability of a nearby facility. It is in this context the present program gains relevance for it addresses realities that hinder effective health care for rural populations. Some of the reasons for initiating the program at the hospital are: • Shri. Vinoba Bhave Civil Hospital is the only Specialty Hospital for medical care here and it caters to the entire population of Dadra and Nagar Haveli besides people from some areas on the borders of Maharashtra and Gujarat. • With a lack of adequate infrastructure as health facilities offering quality health services accessible to the local population; the only practical option was to facilitate a participatory, multi-stakeholder intervention bringing health care services to the people. The service is flexible, timely and precise in addressing individual health care needs by additionally provision of specialized medical care when required.
Period and Duration It is by taking into consideration the local reality of health care concerns that the Shri. Vinoba Bhave Civil Hospital undertook a holistic integrated health management system for those seeking the services of the institute. After a pilot
2 Shri. Vinoba Bhave Civil Hospital, Dadra and Nagar Haveli
IHMS, 2007-2009 intervention for a period of one year, the actual program has been in place and running successfully during the period 2007-2009. II. Purpose and Priorities of the Initiative
Overall Goal or Purpose: To address the health care needs of children by providing timely specialized health care service that is holistic, easy to access, multi-disciplinary and functions within an environment conducive to sustain participatory and flexible out reach work. Priorities or Objectives of the Initiative: Overall Objective: To facilitate a participatory environment conducive to a positive attitude towards health; strengthens early preventive measures, offers quality and timely health care services, especially for the poor. Specific Objectives: a) Facilitating quality integrated health services along with provision of relevant referral care and follow up. b) Creating a positive attitude towards a healthy life style through awareness programs . I. Strategies adopted/mode of transformation with details of role of various Stakeholders.
III. a. Overall Strategy: To create a human resource at the community and institutional level for facilitating and sustaining participatory and quality health care service for the local population. III.a.1. Specific Strategies undertaken at Institutional Level: Trained Human Resource: The holistic approach of the program requires trained human resource working at different levels of the project. Professionals and Para-Professionals of the institute were trained to offer relevant services facilitating the implementation of the Integrated Hospital Management System. To ensure the availability of quality care specialized medical and paramedical staff was appointed by the health institute. Whenever the need arose, additional support as specialized medical care was provided to patients through telemedicine by networking with health institutions and health professionals from Mumbai.
3
Shri. Vinoba Bhave Civil Hospital, Dadra and Nagar Haveli
IHMS, 2007-2009 Telemedicine: To tackle the scarcity of specialized services in Dadra and Nagar Haveli camps were held for poor or needy patients with experts from Mumbai (Nanavati Hospital, Jaslok Hospital and Tata Memorial Hospital) providing care. It was a close interaction that led to the thought of initiating the development and implementation of Telemedicine as an essentially required option. In the telemedicine process a two-way video conference is held over a local network with the combined skills of doctors sharpening the process of diagnosis, treatment and follow up. Cardiac care requiring very skilled input is one area that has overtly benefited of telemedicine. Often the telemedicine conferencing involves the diagnosis of a disease or ailment and the prescription of appropriate treatment inclusive of any surgery. In the case of ‘open surgery’ the infrastructure of Shri. Vinoba Bhave Civil Hospital is used for pre and post operative care when specialized operations are done from Mumbai. In addition to health care the telemedicine service is used to upgrade the skills of professionals within Shri.Vinoba Bhave Civil Hospital. Health professionals have been trained through programs on common pediatric problems, surgery and surgery related aspects, cardiology, cardiothoracic surgery, oncology, diabetology and endocrinology, respiratory medicine, neuron surgery, management of asthma and dialysis treatment of end stage-Kidney disease. Integrated Hospital Management System and Creation of Data Base • Integrated Hospital Management System (IHMS) addresses needs in all areas of the institute, streamlining operations, enhancing administrative control, improving responses to patient needs and cost control. • IHMS has been developed in an environment that ensures portability and connectivity of the management systems to run on virtually all standard hardware platforms, with stringent data security and easy recovery in case of system failure. • The package facilitates intervention through its precision and focus on time management. • Being user friendly its value is easily recognized by anyone introduced to the system and helps facilitate its implementation elsewhere. Factors that make it adaptable and user friendly are a user friendly design, ease of customization, a modular structure ensuring that the software addresses
4
Shri. Vinoba Bhave Civil Hospital, Dadra and Nagar Haveli
IHMS, 2007-2009 different functional needs of the health care institute. It is easy to install with a graphical user interface, a highly secure user authentication of modules and voice tutors for the entire software operations. III. Outcome i.e. Impact/benefits resulting from the Project, for example:
Time Management and Sharpening Focus of Health Care: Within the health care system, time plays a crucial role beginning with the time taken for the admission process and the time taken to access previous health care history. This aspect is taken care of by the Integrated Health Management Systems. The interaction with the patient starts with the provision of a unique patient ID card, with a registration number for later referencing patient history through the online database. Subsequently the provision of OPD or IPD services, as required, is facilitated by modules that address patient specific and administrative needs; to illustrate the process a case example of OPD care is given. After registration the patient goes to OPD section with his/her Registration card. The medical specialist enters all the details of the patient online in the OPD Module. Investigations such as hematology, biochemistry, x-ray, sonography, and color Doppler etc are ordered online. The laboratory reports are later available directly on the IHMS database. X-Ray, USG and CT-Scans are made available on its Picture Archiving and Communication System (PACS) within 30 seconds along with a digitized report. Through the IHMS the doctor can view all past records on the database sitting at his desk and compare it with recent ones. Other modules developed for implementing the IHMS and ensuring quality services are: • the Casualty Management Module (details on medico legal aspects included), • the Doctor’s Appointment Module (doctor’s inpatient and out patient appointments are tracked), • Operation Theatre Scheduling Module (facilitates convenient booking), the Radiology Module (facilitates keeping track of X-ray films, scheduling and reporting of X-ray requests, results, linked with billing module and statistical analysis of graphical data based on doctor/ unit and type of X-ray film utilization versus wastage control is possible for better administration), • Medical Research Module (records of special tests such as T3, T4, TSH, HIV, Hepatitis, FSH etc, are maintained),
5
Shri. Vinoba Bhave Civil Hospital, Dadra and Nagar Haveli
IHMS, 2007-2009 • Communication Module (makes it possible to extend the reach and range of the existing facilities to the outside world by linking up to the internet, with intranet and email facilities). • Daily admissions and discharge details are available, • Physiotherapy Module (records of inpatient and out patient with details of the exercises), • Dental Module (records maintained of inpatient and outpatient services along with details of appointments), • Diet Module (diet requirement of patients are taken care of and instruction given to the Kitchen), • Laboratory Module (investigations ordered online from OPD, Casualty and IPD are reflected in this module and results made available to the concerned medical specialists on their desktop), • Hospital Information Management System (contains strong and secure database of the hospital around 2,20,000 records are available online), • Pharmacy Module (in addition to keeping track of medicines dispensed it facilitates preventing over dose indicates drug to drug interactions and avoids complications in patient care), • Medical Store Module, • System Administration Module, • Medical Store Module, • Roster Module and Billing Module. Utilization of Services for Health Care: The presence of the Integrated Hospital Management System facilitated Child Care and other forms of health services at Shri. Vinoba Bhave Civil Hospital. The possibility of timely, relevant and quality care ensured the local population utilizing the services and resulted in an improvement of the general health status of the community.
6
Shri. Vinoba Bhave Civil Hospital, Dadra and Nagar Haveli
IHMS, 2007-2009 Table No:1. Utilization of Health Care Service at Shri. Vinoba Bhave Civil Hospital Year 2007 2008 2009 2010 OPD 355358 378405 382493 398661 IPD 15076 17364 19762 21519 Surgical 2928 3595 3900 3670 Cataract Delivery Operation 131 2316 272 2367 240 2485 286 2479
As result of Integrated Health Management Systems it has been possible to document the services provided during the period (2007-2010). An improved quality service more in tune with the needs of clients facilitated Shri.Vinoba Bhave Health Institute cater to increasingly more individuals in a relevant and systematic manner. IV. Highlight Features of the Initiative Transparency and Stake holder participation: The success of the Integrated Hospital Management Systems depends on the participatory involvement of the patient, community and the networked professional institutions. Multi-stakeholder participation necessitates transparency at all stages. Yet, at the same time measures are put in place to ensure that rights of individuals seeking care are not abused but protected especially in the case of those seeking care for communicable diseases that lead to marginalization and discrimination. Innovativeness of the initiative and scope for replication: This first of its kind initiative for the country is a flexible and simplified process calling for limited additional resources for dissemination or replication. Increased efficiency of processes and effectiveness of outcome: The factor that increased the efficiency of the Integrated Health Management System is its participatory approach, with easily accessible secure database. A linkage to institutions outside the Union Territory through Telemedicine and the up-gradation of professional skills in the institute increased the efficiency of the intervention. The effectiveness of the intervention is indicated by the participation of multiple stakeholders, the identification of different ailments among children and adults, the provision of OPD and IPD care with special needs of patients being addressed. The verifiable database of individuals and
7
Shri. Vinoba Bhave Civil Hospital, Dadra and Nagar Haveli
IHMS, 2007-2009 school children treated is in itself an indication of effectiveness of the program. Display of leadership /Team work by nominee(s) The program is the outcome of the team work of multi disciplinary professionals having come together with a shared vision, of giving local people in Dadra and Nagar Haveli a healthy life. The Integrated Health Management System was initiated by Dr.V.K.Das, Medical Superintendent, Shri.Vinoba Bhave Civil Hospital who gave a definitive shape to the Health Program Plan and designed the training program for ensuring successful implementation of the health initiative. Successful implementation of the program requires the operations to be carried in a systematic and timely manner, Mrs. Payal Thakker, a Bio Medical Engineer at Shri. Vinoba Bhave Civil Hospital took initiative to implement the entire program from the installation, migration of database to implementation and training for an ensured smooth functioning by overseeing the process at user and server end. Sustainability of the initiative: The initiative is sustainable as it is utilizes existing allocations in an optimal manner safeguarding the future human resource of the Union Territory - the local social capital. The initiative falls largely under existing programs for Health and Social Development and programs focusing on strengthening e-governance and the National Rural Health Mission (NRHM). Besides, the issue of sustainability is seen from the perspective of cost management and the environment friendly approach (reduced dependence on paper documentation) all of which are seen as measures beneficial to the nation. To elaborate on some cost management instances: wastage of material used (such as X-ray films) avoidance of trauma of patients suffering adverse reaction because of nonavailability of earlier patient history reduction in time taken to access the individual’s health data the possibility of acquiring information on the likelihood of adverse reactions between drugs thereby avoiding health complications and associated costs identifying and accessing relevant professional skills for further diagnosis and treatment; as through telemedicine.
8 Shri. Vinoba Bhave Civil Hospital, Dadra and Nagar Haveli
IHMS, 2007-2009
Integrated Hospital Management System of Shri Vinoba Bhave Civil Hospital Shri Vinoba Bhave Civil Hospital has developed a fully functional Integrated Hospital Management System (‘IHMS’) which covers all the requirements of a modern health care institution. 'HMS' is a fully integrated hospital management solution that caters to the clinical, administrative and financial needs of the hospital. Integrated Hospital Management System (IHMS) is a generic application, which addresses all the major functional areas of hospitals. It also help the top management for taking critical decisions and monitor the performance of various departments. HMS provides the benefits of streamlined operations, enhanced administration control, improved response to patient care, cost control and improved profitability. It generates various MIS and statistical reports which give information on common diseases prevalent in certain areas, the catchments areas of the hospital, Hospital statistics in terms of inpatients, outpatients, diagnostic services, surgeries etc. Gives cost analysis of each department/ward as an individual cost-center. One area of direct savings to the hospital is its ability to control the inventory of drugs and other items including tracking of slow and fast moving items and effective utilization of resources. The system provides comprehensive data security to prevent unauthorized user access. The package has been developed on the latest database system technology with central database storage and multi-user environment. S.N Module Innovative 1 Front Office- Reception, Registration & OP Billing Scheduling for Doctor Consultation/Procedures. Bed Booking Tentative admission/discharges with color coded graphic displays
9
Shri. Vinoba Bhave Civil Hospital, Dadra and Nagar Haveli
IHMS, 2007-2009 2 Registration Laminated unique bar-coded registration number with photograph containing patients’ finger print details in database. Innovative OPD Waiting List LED Queue Maintenance Maintaining Drug Allergies of the Patient and adverse drug reaction notifications. Provision for Credit Card Interface Maintains the entire patient details therapy wise Centralized Admission and discharge. Worklist can be seens and differentiated according to the priorities defined based on wards like ICU, NICU etc. with highlighted color codes. Unique Barcoded Lab Number Generation: to keep track of samples Integration with Laboratory Machines Online Laboratory Reports Integration with Picture Archiving and Communication System (PACS) Maintains Electronic Patient Folder for each patient. Scheduling OT and maintain OT Inventory online Provision for Medi-claim management in future Maintaining record of all the engineering services of the hospital. Internal Communication system to reduce the communication gap between the staff Flexibility to customize reports as per the requirements of the top level management. Provision to display general information of patients ward wise on kiosk based system or LED TV
S.N 3
Module Doctor’s Module
4 5 6 7
OPD Billing Physiotherapy Admission Discharge Transfer (ADT) Phlebotomy
8 9 10 11 12 13 14 15 16
Laboratory & Microbiology Radiology Module Ward OT Claim Management Bio-Medical Engineering Communication Module Report Designer Enquiry
10 Shri. Vinoba Bhave Civil Hospital, Dadra and Nagar Haveli
IHMS, 2007-2009 17 18 Basic Backup Management Automatic scheduling of back up in main database server and mirror server. High End database storage Provision to push and pull from storage management devices. Maintains logs of backup activity Module Master & User Management Innovative Flexibility to change the masters as per the changing needs of the hospital. Role Based security Model: Assigning rights to the users as per the roles played in the hospital. IP Billing Auto Bill Calculation with receipt adjustments. MIS Reports Accounts As per the procedures followed in the UT Administration. It has options to maintain the accounts for all the different heads running under Shri Vinoba Bhave Civil Hospital like RKS, NRHM etc. Integration with 6 Pay Software Material Management EOQ, reorder level, ABC & VED analysis Stock register as per the rules of the UT Administration. Recruitment Management Record of all the employees who are applying for job in organization. This module also allow to apply online. Personnel Management Records of all the employees of the hospital Attendance and Leave Integration with Finger Print attendance. Management Training Module Planning the Training of the employees. Payroll Management Maintaining the payroll of all the employees. Employee Separation Maintaining exit interview of all employees Diet Daily diet schedule from IPD Central Sterile Supply Records of all sterilization procedures. department Laundry Maintaining all the records of linen SMS Module Provision to send lab reports and other details to Specialists and Medical Officer
S.N 19
20 21
22 23 24 25 26 27 28 29 30 31 32
11 Shri. Vinoba Bhave Civil Hospital, Dadra and Nagar Haveli
IHMS, 2007-2009 33 Integration with Telemedicine Maintains patient folder.
12 Shri. Vinoba Bhave Civil Hospital, Dadra and Nagar Haveli
1 Shri. Vinoba Bhave Civil Hospital, Dadra and Nagar Haveli
IHMS, 2007-2009 Opthalmology, Pathology; Radiology and Imaging (inclusive of Spiral CT Scan), Telemedicine, ENT, Public Health, Dentistry, Physiotherapy, Accident Prevention cum Trauma and Emergency Services, Dermatology, Psychiatry, a Central Medical Store and Pharmacy; Dietetics, a Medical Record Department, Central Sterile and Supplies Division, Mortuary and Post Mortem Section, Ambulance Services, Security and House Keeping. I.a.2. Local Relevance (or reasons) of present project At both the national and the international level health is an important aspect to ensuring that social capital is empowered and utilized. The National Family Health Survey carried out under the aegis of the Government of India indicated that the accessibility and availability of health care was important to ensure health status of a community and that coverage by health facilities was central to positive change. An adverse impact of limited health coverage across India is seen in the fact that 65% percent of Indian households seek health care from the private medical sector and only one-third use the public medical sector. Common reasons for not using health care facilities of the public sector, is the poor quality of services and non-availability of a nearby facility. It is in this context the present program gains relevance for it addresses realities that hinder effective health care for rural populations. Some of the reasons for initiating the program at the hospital are: • Shri. Vinoba Bhave Civil Hospital is the only Specialty Hospital for medical care here and it caters to the entire population of Dadra and Nagar Haveli besides people from some areas on the borders of Maharashtra and Gujarat. • With a lack of adequate infrastructure as health facilities offering quality health services accessible to the local population; the only practical option was to facilitate a participatory, multi-stakeholder intervention bringing health care services to the people. The service is flexible, timely and precise in addressing individual health care needs by additionally provision of specialized medical care when required.
Period and Duration It is by taking into consideration the local reality of health care concerns that the Shri. Vinoba Bhave Civil Hospital undertook a holistic integrated health management system for those seeking the services of the institute. After a pilot
2 Shri. Vinoba Bhave Civil Hospital, Dadra and Nagar Haveli
IHMS, 2007-2009 intervention for a period of one year, the actual program has been in place and running successfully during the period 2007-2009. II. Purpose and Priorities of the Initiative
Overall Goal or Purpose: To address the health care needs of children by providing timely specialized health care service that is holistic, easy to access, multi-disciplinary and functions within an environment conducive to sustain participatory and flexible out reach work. Priorities or Objectives of the Initiative: Overall Objective: To facilitate a participatory environment conducive to a positive attitude towards health; strengthens early preventive measures, offers quality and timely health care services, especially for the poor. Specific Objectives: a) Facilitating quality integrated health services along with provision of relevant referral care and follow up. b) Creating a positive attitude towards a healthy life style through awareness programs . I. Strategies adopted/mode of transformation with details of role of various Stakeholders.
III. a. Overall Strategy: To create a human resource at the community and institutional level for facilitating and sustaining participatory and quality health care service for the local population. III.a.1. Specific Strategies undertaken at Institutional Level: Trained Human Resource: The holistic approach of the program requires trained human resource working at different levels of the project. Professionals and Para-Professionals of the institute were trained to offer relevant services facilitating the implementation of the Integrated Hospital Management System. To ensure the availability of quality care specialized medical and paramedical staff was appointed by the health institute. Whenever the need arose, additional support as specialized medical care was provided to patients through telemedicine by networking with health institutions and health professionals from Mumbai.
3
Shri. Vinoba Bhave Civil Hospital, Dadra and Nagar Haveli
IHMS, 2007-2009 Telemedicine: To tackle the scarcity of specialized services in Dadra and Nagar Haveli camps were held for poor or needy patients with experts from Mumbai (Nanavati Hospital, Jaslok Hospital and Tata Memorial Hospital) providing care. It was a close interaction that led to the thought of initiating the development and implementation of Telemedicine as an essentially required option. In the telemedicine process a two-way video conference is held over a local network with the combined skills of doctors sharpening the process of diagnosis, treatment and follow up. Cardiac care requiring very skilled input is one area that has overtly benefited of telemedicine. Often the telemedicine conferencing involves the diagnosis of a disease or ailment and the prescription of appropriate treatment inclusive of any surgery. In the case of ‘open surgery’ the infrastructure of Shri. Vinoba Bhave Civil Hospital is used for pre and post operative care when specialized operations are done from Mumbai. In addition to health care the telemedicine service is used to upgrade the skills of professionals within Shri.Vinoba Bhave Civil Hospital. Health professionals have been trained through programs on common pediatric problems, surgery and surgery related aspects, cardiology, cardiothoracic surgery, oncology, diabetology and endocrinology, respiratory medicine, neuron surgery, management of asthma and dialysis treatment of end stage-Kidney disease. Integrated Hospital Management System and Creation of Data Base • Integrated Hospital Management System (IHMS) addresses needs in all areas of the institute, streamlining operations, enhancing administrative control, improving responses to patient needs and cost control. • IHMS has been developed in an environment that ensures portability and connectivity of the management systems to run on virtually all standard hardware platforms, with stringent data security and easy recovery in case of system failure. • The package facilitates intervention through its precision and focus on time management. • Being user friendly its value is easily recognized by anyone introduced to the system and helps facilitate its implementation elsewhere. Factors that make it adaptable and user friendly are a user friendly design, ease of customization, a modular structure ensuring that the software addresses
4
Shri. Vinoba Bhave Civil Hospital, Dadra and Nagar Haveli
IHMS, 2007-2009 different functional needs of the health care institute. It is easy to install with a graphical user interface, a highly secure user authentication of modules and voice tutors for the entire software operations. III. Outcome i.e. Impact/benefits resulting from the Project, for example:
Time Management and Sharpening Focus of Health Care: Within the health care system, time plays a crucial role beginning with the time taken for the admission process and the time taken to access previous health care history. This aspect is taken care of by the Integrated Health Management Systems. The interaction with the patient starts with the provision of a unique patient ID card, with a registration number for later referencing patient history through the online database. Subsequently the provision of OPD or IPD services, as required, is facilitated by modules that address patient specific and administrative needs; to illustrate the process a case example of OPD care is given. After registration the patient goes to OPD section with his/her Registration card. The medical specialist enters all the details of the patient online in the OPD Module. Investigations such as hematology, biochemistry, x-ray, sonography, and color Doppler etc are ordered online. The laboratory reports are later available directly on the IHMS database. X-Ray, USG and CT-Scans are made available on its Picture Archiving and Communication System (PACS) within 30 seconds along with a digitized report. Through the IHMS the doctor can view all past records on the database sitting at his desk and compare it with recent ones. Other modules developed for implementing the IHMS and ensuring quality services are: • the Casualty Management Module (details on medico legal aspects included), • the Doctor’s Appointment Module (doctor’s inpatient and out patient appointments are tracked), • Operation Theatre Scheduling Module (facilitates convenient booking), the Radiology Module (facilitates keeping track of X-ray films, scheduling and reporting of X-ray requests, results, linked with billing module and statistical analysis of graphical data based on doctor/ unit and type of X-ray film utilization versus wastage control is possible for better administration), • Medical Research Module (records of special tests such as T3, T4, TSH, HIV, Hepatitis, FSH etc, are maintained),
5
Shri. Vinoba Bhave Civil Hospital, Dadra and Nagar Haveli
IHMS, 2007-2009 • Communication Module (makes it possible to extend the reach and range of the existing facilities to the outside world by linking up to the internet, with intranet and email facilities). • Daily admissions and discharge details are available, • Physiotherapy Module (records of inpatient and out patient with details of the exercises), • Dental Module (records maintained of inpatient and outpatient services along with details of appointments), • Diet Module (diet requirement of patients are taken care of and instruction given to the Kitchen), • Laboratory Module (investigations ordered online from OPD, Casualty and IPD are reflected in this module and results made available to the concerned medical specialists on their desktop), • Hospital Information Management System (contains strong and secure database of the hospital around 2,20,000 records are available online), • Pharmacy Module (in addition to keeping track of medicines dispensed it facilitates preventing over dose indicates drug to drug interactions and avoids complications in patient care), • Medical Store Module, • System Administration Module, • Medical Store Module, • Roster Module and Billing Module. Utilization of Services for Health Care: The presence of the Integrated Hospital Management System facilitated Child Care and other forms of health services at Shri. Vinoba Bhave Civil Hospital. The possibility of timely, relevant and quality care ensured the local population utilizing the services and resulted in an improvement of the general health status of the community.
6
Shri. Vinoba Bhave Civil Hospital, Dadra and Nagar Haveli
IHMS, 2007-2009 Table No:1. Utilization of Health Care Service at Shri. Vinoba Bhave Civil Hospital Year 2007 2008 2009 2010 OPD 355358 378405 382493 398661 IPD 15076 17364 19762 21519 Surgical 2928 3595 3900 3670 Cataract Delivery Operation 131 2316 272 2367 240 2485 286 2479
As result of Integrated Health Management Systems it has been possible to document the services provided during the period (2007-2010). An improved quality service more in tune with the needs of clients facilitated Shri.Vinoba Bhave Health Institute cater to increasingly more individuals in a relevant and systematic manner. IV. Highlight Features of the Initiative Transparency and Stake holder participation: The success of the Integrated Hospital Management Systems depends on the participatory involvement of the patient, community and the networked professional institutions. Multi-stakeholder participation necessitates transparency at all stages. Yet, at the same time measures are put in place to ensure that rights of individuals seeking care are not abused but protected especially in the case of those seeking care for communicable diseases that lead to marginalization and discrimination. Innovativeness of the initiative and scope for replication: This first of its kind initiative for the country is a flexible and simplified process calling for limited additional resources for dissemination or replication. Increased efficiency of processes and effectiveness of outcome: The factor that increased the efficiency of the Integrated Health Management System is its participatory approach, with easily accessible secure database. A linkage to institutions outside the Union Territory through Telemedicine and the up-gradation of professional skills in the institute increased the efficiency of the intervention. The effectiveness of the intervention is indicated by the participation of multiple stakeholders, the identification of different ailments among children and adults, the provision of OPD and IPD care with special needs of patients being addressed. The verifiable database of individuals and
7
Shri. Vinoba Bhave Civil Hospital, Dadra and Nagar Haveli
IHMS, 2007-2009 school children treated is in itself an indication of effectiveness of the program. Display of leadership /Team work by nominee(s) The program is the outcome of the team work of multi disciplinary professionals having come together with a shared vision, of giving local people in Dadra and Nagar Haveli a healthy life. The Integrated Health Management System was initiated by Dr.V.K.Das, Medical Superintendent, Shri.Vinoba Bhave Civil Hospital who gave a definitive shape to the Health Program Plan and designed the training program for ensuring successful implementation of the health initiative. Successful implementation of the program requires the operations to be carried in a systematic and timely manner, Mrs. Payal Thakker, a Bio Medical Engineer at Shri. Vinoba Bhave Civil Hospital took initiative to implement the entire program from the installation, migration of database to implementation and training for an ensured smooth functioning by overseeing the process at user and server end. Sustainability of the initiative: The initiative is sustainable as it is utilizes existing allocations in an optimal manner safeguarding the future human resource of the Union Territory - the local social capital. The initiative falls largely under existing programs for Health and Social Development and programs focusing on strengthening e-governance and the National Rural Health Mission (NRHM). Besides, the issue of sustainability is seen from the perspective of cost management and the environment friendly approach (reduced dependence on paper documentation) all of which are seen as measures beneficial to the nation. To elaborate on some cost management instances: wastage of material used (such as X-ray films) avoidance of trauma of patients suffering adverse reaction because of nonavailability of earlier patient history reduction in time taken to access the individual’s health data the possibility of acquiring information on the likelihood of adverse reactions between drugs thereby avoiding health complications and associated costs identifying and accessing relevant professional skills for further diagnosis and treatment; as through telemedicine.
8 Shri. Vinoba Bhave Civil Hospital, Dadra and Nagar Haveli
IHMS, 2007-2009
Integrated Hospital Management System of Shri Vinoba Bhave Civil Hospital Shri Vinoba Bhave Civil Hospital has developed a fully functional Integrated Hospital Management System (‘IHMS’) which covers all the requirements of a modern health care institution. 'HMS' is a fully integrated hospital management solution that caters to the clinical, administrative and financial needs of the hospital. Integrated Hospital Management System (IHMS) is a generic application, which addresses all the major functional areas of hospitals. It also help the top management for taking critical decisions and monitor the performance of various departments. HMS provides the benefits of streamlined operations, enhanced administration control, improved response to patient care, cost control and improved profitability. It generates various MIS and statistical reports which give information on common diseases prevalent in certain areas, the catchments areas of the hospital, Hospital statistics in terms of inpatients, outpatients, diagnostic services, surgeries etc. Gives cost analysis of each department/ward as an individual cost-center. One area of direct savings to the hospital is its ability to control the inventory of drugs and other items including tracking of slow and fast moving items and effective utilization of resources. The system provides comprehensive data security to prevent unauthorized user access. The package has been developed on the latest database system technology with central database storage and multi-user environment. S.N Module Innovative 1 Front Office- Reception, Registration & OP Billing Scheduling for Doctor Consultation/Procedures. Bed Booking Tentative admission/discharges with color coded graphic displays
9
Shri. Vinoba Bhave Civil Hospital, Dadra and Nagar Haveli
IHMS, 2007-2009 2 Registration Laminated unique bar-coded registration number with photograph containing patients’ finger print details in database. Innovative OPD Waiting List LED Queue Maintenance Maintaining Drug Allergies of the Patient and adverse drug reaction notifications. Provision for Credit Card Interface Maintains the entire patient details therapy wise Centralized Admission and discharge. Worklist can be seens and differentiated according to the priorities defined based on wards like ICU, NICU etc. with highlighted color codes. Unique Barcoded Lab Number Generation: to keep track of samples Integration with Laboratory Machines Online Laboratory Reports Integration with Picture Archiving and Communication System (PACS) Maintains Electronic Patient Folder for each patient. Scheduling OT and maintain OT Inventory online Provision for Medi-claim management in future Maintaining record of all the engineering services of the hospital. Internal Communication system to reduce the communication gap between the staff Flexibility to customize reports as per the requirements of the top level management. Provision to display general information of patients ward wise on kiosk based system or LED TV
S.N 3
Module Doctor’s Module
4 5 6 7
OPD Billing Physiotherapy Admission Discharge Transfer (ADT) Phlebotomy
8 9 10 11 12 13 14 15 16
Laboratory & Microbiology Radiology Module Ward OT Claim Management Bio-Medical Engineering Communication Module Report Designer Enquiry
10 Shri. Vinoba Bhave Civil Hospital, Dadra and Nagar Haveli
IHMS, 2007-2009 17 18 Basic Backup Management Automatic scheduling of back up in main database server and mirror server. High End database storage Provision to push and pull from storage management devices. Maintains logs of backup activity Module Master & User Management Innovative Flexibility to change the masters as per the changing needs of the hospital. Role Based security Model: Assigning rights to the users as per the roles played in the hospital. IP Billing Auto Bill Calculation with receipt adjustments. MIS Reports Accounts As per the procedures followed in the UT Administration. It has options to maintain the accounts for all the different heads running under Shri Vinoba Bhave Civil Hospital like RKS, NRHM etc. Integration with 6 Pay Software Material Management EOQ, reorder level, ABC & VED analysis Stock register as per the rules of the UT Administration. Recruitment Management Record of all the employees who are applying for job in organization. This module also allow to apply online. Personnel Management Records of all the employees of the hospital Attendance and Leave Integration with Finger Print attendance. Management Training Module Planning the Training of the employees. Payroll Management Maintaining the payroll of all the employees. Employee Separation Maintaining exit interview of all employees Diet Daily diet schedule from IPD Central Sterile Supply Records of all sterilization procedures. department Laundry Maintaining all the records of linen SMS Module Provision to send lab reports and other details to Specialists and Medical Officer
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11 Shri. Vinoba Bhave Civil Hospital, Dadra and Nagar Haveli
IHMS, 2007-2009 33 Integration with Telemedicine Maintains patient folder.
12 Shri. Vinoba Bhave Civil Hospital, Dadra and Nagar Haveli
