Februaury 2011

BYTE OF THE PIE

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HMIS harnesses the power of information to bring quickest corrective action on ground for fighting any challenge in public health.

By Dhirendra Pratap Singh

Improving health conditions in rural areas has always been the biggest challenge in India. With an enormous land area spread across a staggering 3.28 million sq. km. and having nearly 70 percent of its teeming billion living in rural areas, providing equitable and efficient health services is surely a herculean task by any scale of measure.

Not only does it require a huge funding base, but it also involves massive operations in terms of mobilising materials, medicines, human resources and physical infrastructure, required to deliver and administer health services. At the centre of all these lies an essential element—’information’


“HMIS enhances information integrity, optimises workflow and allows easy patient data recovery and storage consolidation”

Dr TBS Buxi
Chairman
North Healthcare Diagnostics 

Flow of information and management of resources is critical for the success of any programme. Understandably, this is even more pronounced, when it entails the issue of public health. Starting right from policy makers, to programme managers, to implementers and even for field health workers, information is a critical resource in understanding challenges, identifying gap areas and ensuring efficient implementation of the programme.

The goal of HMIS is to put data for action at the local level. To make this happen, we need data, analytical capabilities and authority to use this analysis for action on ground

 Even up till recently, health data collected at village level took some few months to reach authorities at the Centre. With manual and semi-automated systems in place, it was almost impossible to receive information in a short time. This resulted in delayed response time for authorities and a high rate of data redundancy in the system. In turn, this led to create lacunae in public health planning by way of creating difficulty in forecasting the accurate need for service provisioning, emergency preparedness and even resource mobilisation.

NRHM

In a project as crucial as the National Rural Health Mission, inefficiency of any form, not only escalates costs but often proves critical in terms of human life and health conditions. Since public health has a direct bearing on national productivity and consumption, it makes sense to plug all holes to bring efficiency in a project which will invest as much as INR 12,050 crores/INR 120.5 billion in the current fiscal, with scope for higher allocation in successive years till 2012.

Keeping this in mind, for NRHM health statistics information Ministry of Health and Family Welfare, Government of India in technical collaboration with iBilt Technologies launched HMIS (Hospital Management Information System) portal www.nrhm-mis.nic.in. Built to serve as a one-stop-site for the entire NRHM programme, the portal combines an array of cutting edge technologies that render superior data analytics, robust data warehousing and sharp business intelligence tools, which can allow decision makers to generate more frequent periodic reports and closely monitor the status of the health sector.

Pravin Srivastav
Ministry of Health and Family Welfare, Govt. of India

“The cutting-edge analytical tools of HMIS portal helps consolidate data from different sources and facilitate timely action”

Pravin Srivastava, Ministry of Health and Family Welfare, Govt. of India says, “The biggest strength of HMIS system lies in its ability to bring apparently disparate data sets and spatially distributed resources on one single platform. This has been achieved to the extent of even integrating the financial reporting system within the health information system. Getting both physical and financial information on the same portal is in itself quite unique and remarkable.”

Case of Maharashtra

Similarly, realising the challenges of dealing with providing healthcare services to a huge population, Government of Maharashtra decided to use ICT as a tool to enhance their ability to deal with this complex delivery model. Through this project, the entire patient registration and front office management of out and in patients and casualty services was outsourced with an objective of reducing patient waiting time and bringing more professionalism and better patient experience when they approach government hospitals.

A model of “Outsourced Service Delivery” was adopted on a monthly payable basis for seven years, wherein the Government absolved themselves of making huge upfront investments thus making the project more affordable. The project became operational since October 2008.

Dr TBS Buxi, Chairman and Managing Director, North Healthcare Diagnostics Pvt Ltd sharing his views on the benefits of HMIS in healthcare delivery said, “Dissemination of information to all relevant areas and yet maintaining the privacy of the patient record is paramount. HMIS allows interpretive information to the clinicians and interdisciplinary interactions for quick management of the patient with intelligent life cycle management of the clinical information. PACS is being used for instant transfer of images to important interfaces such as the Intensive Care Units and Operation Theatres for enabling the healthcare professionals to collaborate seamlessly across multiple sites, platforms and specialities for timely, quality patient care.”

He adds, “Interactions and discussions between different authorities of various fields of practice are possible across the globe. Comprehensive policies can be monitored easily with efficient and accurate interactions with the finance, engineering and dietetics departments. Pharmacy monitoring for drug usages and interactions becomes more effective. HMIS enhances information integrity, reduces duplication of entries, propagates paperless working, optimises workflow andallows easy patient data recovery and storage consolidation.”

Substantial Change

The achievements of HMIS project in medical and drugs department, Maharashtra are commendable. Unique Health ID generated by HMIS has been issued to approximately 25 Lakh patients that have come to the 4 hospitals which have gone live since Oct 2008. Patient waiting time at the various registration counters have been brought down from 45 min to 10 min even in peak hours.  Automatic generation of cash collection and inventory reports has improved efficiency and reduced scope for malpractices and pilferages.

The NRHM portal is also going to bring a paradigm shift in terms of overall program management and administration. Commenting on this, Ashok Tiwari, Chairman & Managing Director, iBilt Technologies says, “The NRHM portal is going to bring a substantial change in the management and operation of the entire program. It’ll provide health administrators with immense power to analyse field data like never before; monitor progress at every step of the work; and improve success levels and outcomes of program implementation.”

The ultimate goal of HMIS is to put data for action at the local level. However, to make this happen, firstly we need data, secondly we need analytical capabilities, and thirdly we need the authority to use this analysis for action on ground. This calls for a huge amount of mindset change that has to go in for making people capable of making their own decisions. However, it is not at all easy to put this in practice.

“We are used to filling forms, collecting data and then forgetting all about it. But we need to stop forgetting and start using the data. The cutting-edge analytical tools of this HMIS portal will help consolidate data from different sources and facilitate timely action. It also requires talking to institutions, creating capacity by training and sensitising people who have never before thought about using data in such a way,” says Praveen.

Dr Sundeep Sahay, Advisor, National Health Systems Resource Centre said, “Right now the usage is very limited and only a few states are making use of the data available. A change in mindset is required which can actually come through long term education and training and capacity building programs.”

The usage can be increased by training, capacity building, providing better tools so that people can easily look at drafts, charts, maps. People are only used to sending information up the hierarchy but they don’t really use it for themselves and for their local actions.

The idea is that, in the long-run, data collected at ground level can be made readily available for quick and immediate decision making at the local level. Traditionally, data collected at the local level bear no ownership among local people. Typically, the time lag for data to reach decision makers at higher levels; their subsequent aggregation and analysis into meaningful interpretations; and finally, execution of corrective action on ground is often too long, cumbersome and in many instances, not effective. On the contrary, if local people are empowered to recognise the ownership of their data and are made capable of taking immediate action for potential threats, the benefits will be much better.

This will lead to actual realisation of objectives of data-for-action. However, it’ll be a considerable time before able to create requisite capacities at local level and realise the true potential. The efforts have just begun.

This is a model that can work for healthcare providers having large volume of patients with varied geographical spread.  Investment of the limited available funds could be directed in the model that is working on this project so that more and more state governments can afford ICT implementation.

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