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,

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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

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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.

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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

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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),

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• 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.

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Table No:1. Utilization of Health Care Service at Shri. Vinoba

Bhave Civil Hospital

Year OPD IPD Surgical Cataract Delivery

Operation
2007 355358 15076 2928 131 2316
2008 378405 17364 3595 272 2367
2009 382493 19762 3900 240 2485
2010 398661 21519 3670 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

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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 non-
availability 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.

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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, Scheduling for Doctor

Registration & OP Billing Consultation/Procedures.

Bed Booking
Tentative admission/discharges with color
coded graphic displays

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2 Registration Laminated unique bar-coded registration

number with photograph containing
patients’ finger print details in database.

Module Innovative
S.N
3 Doctor’s Module OPD Waiting List
LED Queue Maintenance
Maintaining Drug Allergies of the Patient
and adverse drug reaction notifications.
4 OPD Billing Provision for Credit Card Interface
5 Physiotherapy Maintains the entire patient details therapy
wise
6 Admission Discharge Centralized Admission and discharge.
Transfer (ADT)
7 Phlebotomy 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
8 Laboratory & Integration with Laboratory Machines
Microbiology Online Laboratory Reports
9 Radiology Module Integration with Picture Archiving and
Communication System (PACS)
10 Ward Maintains Electronic Patient Folder for each
patient.
11 OT Scheduling OT and maintain OT Inventory
online
12 Claim Management Provision for Medi-claim management in
future
13 Bio-Medical Engineering Maintaining record of all the engineering
services of the hospital.
14 Communication Module Internal Communication system to reduce
the communication gap between the staff
15 Report Designer Flexibility to customize reports as per the
requirements of the top level management.
16 Enquiry Provision to display general information of
patients ward wise on kiosk based system or
LED TV

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17 Basic Backup Management Automatic scheduling of back up in main

database server and mirror server.

18 High End database storage Provision to push and pull from storage
management devices.
Maintains logs of backup activity

S.N Module Innovative

19 Master & User Flexibility to change the masters as per the
Management changing needs of the hospital.
Role Based security Model: Assigning rights
to the users as per the roles played in the
hospital.
20 IP Billing Auto Bill Calculation with receipt
adjustments.
MIS Reports
21 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
22 Material Management EOQ, reorder level, ABC & VED analysis
Stock register as per the rules of the UT
Administration.
23 Recruitment Management Record of all the employees who are
applying for job in organization.
This module also allow to apply online.
24 Personnel Management Records of all the employees of the hospital
25 Attendance and Leave Integration with Finger Print attendance.
Management
26 Training Module Planning the Training of the employees.
27 Payroll Management Maintaining the payroll of all the employees.
28 Employee Separation Maintaining exit interview of all employees
29 Diet Daily diet schedule from IPD
30 Central Sterile Supply Records of all sterilization procedures.
department
31 Laundry Maintaining all the records of linen
32 SMS Module Provision to send lab reports and other
details to Specialists and Medical Officer

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33 Integration with Maintains patient folder.

Telemedicine

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