Nov-Dec 2006

E.HEALTH.NET: ICT AT GOVERNMENT HEALTH INSTITUTIONS : Ghan Shyam Bansal, Dr. Ravinder Goel, S. S. Duggal, Rahul Jain and Anil Aggarwal

During the past two decades, computers have revolutionised the way we live. The Information and Communication Technologies (ICT) are now part of every critical infrastructure, from telecommunication to banking to transportation. But usage of ICT and induction of e-Governance in health sector has remained very low as compared to other sectors, despite having a very high potential. The health sector, which is an important sector, should encourage ICT usage.

Keeping the above in mind, the NIC-Haryana State Centre and Directorate of Health Service, Haryana jointly initiated a mission mode project of e.Health.Net (ICT based health care system) during the beginning of the year 2003. The project mission was “To set up an efficient, effective, transparent and IT-enabled integrated system to provide the health care services to the people of Haryana so that their present position of health could be upgraded and uplifted”. Health Informatics is implemented to tone up the adminis-tration, facilitate accounting and enable effective management control. It also deals with collection, storage, retrieval, commu-nication and optimal use of health related data, information and knowledge base. Health Informatics was used in Haryana primarily with processing of data, information and knowledge in all aspects of healthcare.

Identification of areas for e-Governance applications

a. Public Centric Application includes Physical Disability Certification, Medical Certification, Birth and Death Certification, Blood Bank Compute-risation (Net/web based), User Fee Collection & Utilisation Monito-ring. The Hospital Computerisation includes Patient Registration, Admi-ssion, Discharge, Transfer, Bed Manage-ment, Wards Management Module, and Laboratory Information System and  Telemedicine, for utilising super-specialty healthcare in rural blocks.

b. Health Vital Statistics includes Medical certification of cause of death based on Form 4 and 4A, morbidity and mortality, Annual Administrative Report, disease prevalence – burden of disease based on ICD –X, performance indicators of health institution based on Form-D, monitoring implementation of Acts related to healthcare, Pre-Natal Diagnosis test-Prevention and control Act, Prevention of Food Adulteration Act, Employee Insurance Scheme drug procurement & distribution system, monitoring implementation of national and state health programme.

c. Office Automation Packages includes personnel information system for medico staff, budget utilisation monitoring system, payroll system, medical reimbursement system, court cases MIS, centralised file movement and tracking, dairy/dispatch.

d. Decision Support Systems includes Medicine Inventory Monitoring and Control System, Doctors Leave / tours Monitoring Information System, Health Infrastructure Monitoring and Evaluation System, Survey module.

e. IT awareness Activities like Basic IT training on office tools, exposure to latest happening in the field of health Informatics.
f. Other National/State Level Programmes like School Health, Blindness Control, RNTCP / DOTS, Mother and Child Health, Family Welfare, Control of Vector Borne Disease. In addition there is a requirement of interface with other third party / external application software in Health Department

Strategy adopted in Haryana
The e-Governance plan of the Health Department, amounting to Rs. 299.43 lacs was approved by the IT-PRISM (State level IT steering committee) in its 11th meeting held on 18 September 2003. The ICT infrastructure was created at State Head Quarter (HQ) and all districts at civil surgeon offices. To ensure the optimum utilization of ICT equipment, civil surgeons were advised to shift all the computers and computer manpower (irrespective of health programme/scheme under which computers and manpower were provided) to a common place. Internet/e-mail has been made functional in all the districts. All official communication has been put through cyber media (e-mail/Internet). Optimal uses of e-mail are being ensured.

Use of e-mail has been emphasized to save avoidable financial burden on the state exchequer.

District nodal officers have been designated who are responsible for overall implementation, supervision and monitoring and evaluation of the compute-risation. They are coordinating with the civil surgeon, district programme officers and the state headquarter for smooth implementation of ICT initiatives in their respective district. To increase the computer literacy, an extensive training programme has been started at the State HQ. Training is ongoing as per training calendar. In house service orientation training of the employees of the districts are being carried out at the district headquarter. The district nodal officers and data entry operators are asked to co-ordinate the training activities and ensure its speedy completion so as to bring complete computer literacy in the district and send monthly report to State HQ through e-mail. Over the past two years, the NIC-HRSC has developed and implemented e-Governance solutions for important key areas of health administration.

Application software packages developed and implemented

  •  Drug Inventory Monitoring and Control System
  •  Clinical Laboratory Management System
  •  Personnel Management & Information System
  •  Leave & Tour Monitoring System
  •  Health Infrastructure Monitoring & Evaluation System
  •  Budget Utilization & Management System
  •  Monitoring of Ambulances usage
  •  Burden of Disease based on ICD-10
  •  Institute Performance Monitoring System based on Form –D
  •  Annual Administrative Report Generation System.
  •   (URL Website of the department
  •  Hospital Registration and User Charges Module
  •  Implementation of Integrated Disease Surveillance Programme
  •  Medical Officer’s Counseling Software
  •  Recruitment Software for Medical Officer and Nurses

Application software development approach

  • Low cost technology solution adopted in software development.
  • Tailor made modular approach adopted for software development under NIC-HrSC’s supervision.
  • Emphasis on taking modules keeping in mind monitoring aspect in first phase and few public centric applications like clinical lab computerisation, central registration and pharmacy store in health care institution
  • Distributed processing emphasized and data updating through low cost e-mail solution.
  • All application softwares developed by NIC-HrSC
  • Substantial amount spent on creation of facilities at HQ & field.
  • Bottom- Up approach adopted for software development & data collection.
  • Data collected is analysed, elevated and feed back is provided to all concern

“Real Challenge is not the hardware or software but data collection from field &  analysis and its utilisation  for corrective  decision. ”

Overview of e.Health.Net applications in Haryana

Med-Centre of Haryana is an integrated software project for capturing utilisation of medicine inventory data and analysing consumption pattern of various medicine location wise to moni-tor disease occurrence pattern, pilferage and any other exception in the functio-ning of health institutions. Reports generated at various levels act as helping tools for multipurpose analysis and inferences, in order to provide affordable health care to common man by monitoring the flow of medicines. Med-Centre capture the medicine data for 316 medicines under 23 various categories from 619 health institutions. (54 general hospitals, 74 CHC, 401 PHC and 89 others health institutions) The software captures opening balance, re-ceipt issued and closing balance of the medicine of pharmacy of the institute. Presently data entry is done at Civil Sur-geon Offices, which is transmitted to HQ every month (using e-mail). At HQ,  data is consolidated and various statisti-cal and analytical report are generated.

Doctor’s Tour/Leave MIS: In order to reduce the habitual absenteeism of doctors in rural areas, a system was developed wherein every doctor was to intimate his leave/tour/court case/ attendance, etc. in advance to civil surgeon concerned. This was entered in the system at district’s civil surgeon’s office and transmitted to HQ on a daily basis, which is then compared with the doctor wise reports, generated from field records randomly.
Burden of Death based International Code for Disease (ICD-10): This system module is implemented in State Bureau of Health Intelligence (SBHI) and reports for the year 2003 has been generated using this software. This software has been developed for completion of MIS report for medical certificate for cause of death (form 4 & 4A). The system also helps in generation of ‘Cause of Death’ booklet automatically using data captured and elaborate analysis reports are also generated through software. The implementation of system has reduced the burden of manual compilation of this statistics, which used to take months, resulting in delay in publication of ‘Cause of Death’ booklet. Over the years, the implementation of system shall help analysis of data year wise and location wise through ICD-10 diseases classification and several other parameters.

Performance Monitoring of Health Institution: This system module is implemented in State Bureau of Health Intelligence (SBHI) and reports for year 2004 has been started generating using this software. Software has been developed to compile and process form-D which has statistics pertaining to indoor and outdoor deaths at each health institution due to various diseases (based on ICD-10). Various analyses can be done which otherwise were a tedious job.

Doctor’s Personnel Information System: The system has been developed to build database of all the doctors posted in Haryana. The system captures qualification, specialty, place of posting, and date of posting and other general parameters of the doctors like ACR/complaints/charge sheets if any. The system is used for rational posting of doctors based on their qualification and availability of post at that location. The system also generates gradation list of doctors. It helps the section in handling transfer/ACR and disciplinary cases in efficient functioning.

Disability Certificate Issuance System: This system has been developed to calculate and generate percentage of disability of physicaly handicapped candidate. The process captures various medical parameters based on medical examination of candidate and automatically calculate and generates certificate, using the guidelines and provision of Disability Act, Government of India. This has brought transparency in the medical examination and handicap certificate generation.

Website (http://haryanahealth. The website gives insight of Health Department and also gives details of health schemes and programmes running in the state. The institute helps public in location of health institutions and facilities available in the state for primary, secondary and tertiary healthcare. Various policies and Acts related to health are available, along with downloadable forms. Geographical location of the health institutions is also available on the website. In order to bring transparency, charge rates of various tests are also made available on website.

Clinical Laboratory Information System: A phased approach has been adopted for the computerisation of hospital. In the first phase, lab reports were computerised. The reports give value of patient parameter along with normal range of tests for which report is generated. The system is implemented in all laboratories of general hospital. The system also helps in generating MIS reports, for status of various tests conducted, which are generated at the end of day, monthly and yearly basis. These are helpful for doctors and civil surgeons for inference purpose.

Medical Bills Reimbursement-Processing System: This system is developed to automate the processing of medical reimbursement claims for indoor/outdoor treatment of Govern-ment employees and their dependents. The system captures charges claimed for medicine, room rent, consultation, injection and processes the same by using preferred admissible changes for the same. This helps in reduction in processing time of bills and also ensures transparency and uniformity in the process. The system has been given for implementation in all the departments of Government of Haryana.

GIS Mapping of Health Institutes: Introduction of GIS for monitoring various schemes and programme of health using GIS has been initiated. Presently the Health Institute (50 GH, 410 PHC and 2345 Sub-Center) has been mapped. This shall be linked with parameter data (health indicators), which will be used for planning & monitoring.

Budget Monitoring System: This system captures expenditure and receipt under various heads, from all the locations of health department. The reports generated help in monitoring expenditure increase under various heads against allocation under that head. This helps in proper utilisation and monitoring of funds available with department. It also helps in reconci-liation process with the treasury.

Monitoring of National Health Programmes: Software has been developed for compilation of progress reports, receipt from field location at head office and generated under various National Health Programmes. The programme for which module has been developed are:- School Health Care Programme, Family Welfare, Mother and Child Programme and  monitoring under Prevention of Food Adulteration Act. The analysis report is monitored by health administration.

Results achieved/anticipated
The implementation of Medicine Inven-tory Monitoring and Control System and Doctors’ Attendance Monitoring System has reduced the absenteeism, resulting in increase in availability of doctors. The implementation of the system has helped in monitoring distribution, availability and consumption details of medicines supplied for public in all health institution of Haryana. Software captures the medicine data for 332 medicines under 23 different categories from 618 health institutions (54 general hospitals, 74 CHCs, 410 PHCs and 89 others health institutions) in all the 20 districts of Haryana.  The system helps in efficiently managing inventory function, distribution of medicine from central store, using parameters like minimum buffer stock (reorder level), OPD inflow, population covered and consumption pattern. The medicine consumption data helps in monitoring the efficiency of the functions of OPD. Exception figures in reports are used to check the malfunction like pilferage or non-functioning of

OPD in a particular institution. Implemen-tation of the system in all the districts of Haryana has resulted in checking the pilferage of medicines, increase in availability of medicine at government health institutions, increase in attendance of patients/doctors in health institutions and optimal utilisation of medicine.

The implementation of Disability Certificate Issuance system has brought transparency in the medical examination and handicap certificate generation.  Clinical Laboratory Information System has helped in generating MIS reports, for status of various tests conducted, which are generated at the end of day, monthly and yearly basis. These are helpful for doctors and civil surgeons for inference purpose. Various charge rates of different tests have been made available on the health website. There has been a signifi-cant reduction in patient waiting time.

The implementation of e.Health.Net has also resulted in capturing of error free data at source and its availability at State Headquarter for planning better health care system for masses. The e.Health.Net system works on low-end ICT resources and e-mail based data transfer from district HQ to state HQ.

The e.Health.Net is a generic e-Governance solution for health sector, which can be replicated in any state /Union Territory (UT) health department. The NIC Centers are functioning in each state and district, therefore the transferability of the solution is easy across all States and UTs in India.

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