March 2010

“IT is the only facilitator for health services in the government sector”

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The health department is a constituent unit of Municipal Corporation of Delhi (MCD), providing holistic healthcare facilities to the population residing in the geographical territory under MCD. In the recent past, the department has undergone large-scale IT implementation for enhancing the delivery of healthcare services. Two of the IT projects of MCD have received national awards and one project has been appreciated by the UNICEF.

Dr. R C Patnaik, CMO (HI), Municipal Corporation of Delhi, who heads the Health Informatics Department, has played a pioneering role in IT application in the Health Department. e-HEALTH traces the recent initiatives of the health department under MCD through deployment of IT.

Dr. R C Patnaik
Chief Medical Offi cer
Municipal Corporation of Delhi

Please tell us about MCD’s initiatives towards health sector reforms and improvement of existing healthcare facilities.

MCD is responsible for providing civic services to almost 98 percent of the population of Delhi covering around 97 percent of the geographic area of Delhi. One of components of the civic services provided by MCD is comprehensive healthcare comprising of preventive, curative, promotive, and rehabilitative components. In addition to this, the health department under MCD, also focuses on medical education, training and research.

Almost 30 percent of Delhi’s population depends on the curative health services provided by MCD. However, in addition, MCD organizes an entire spectrum of public health services for Delhi. To provide qualitative healthcare the department has been divided into two wings— the public health wing and and the hospital administration wing. The health department of MCD realized the importance of information technology in improving operational effi ciency and started its efforts to computerise all activities of healthcare delivery systems covering both public health as well as hospital administration, which encompasses medical care, mother and child welfare, TB control programme, school health services, disease
surveillance, registration of births and deaths, and the like.

The department has tried to improve operational effi ciency of the constituent units. To start with, a complete solution for registration of births and deaths was developed along with renewal of health trade license incorporated with other municipal services. Computerisation of MCD hospitals and hospital information system (HIS) has been taken up separately.

The health department under MCD is doing a large-scale IT implementation for modernising its hospitals. What is the scope and size of this initiative?

Over the years, the health trends have undergone a transformation with increase in patients’ expectations. However, budgetary constraints, manpower shortage and frequent changes in political and legislative policies impede the health services offered by us. The number and socio-economic status of patients availing healthcare facilities in MCD institutions can not be compared with private sector institutions. Also the work load on medical and paramedical staff is increasing
constantly, thereby affecting the quality.

To overcome this, MCD decided to implement IT application reforms in a substantial way. MCD realised that IT is the only facilitator and a lot of issues can be resolved through IT implementation. There is no R&D in MCD, but MCD has created some new concepts during IT implementation, which have been appreciated at the national level.

In 2003, MCD kicked off its fi rst project, for registration of births and deaths. The volume of registration was so high that the number of people engaged were not able to handle the work. Nearly 50 percent of the posts are still lying vacant. The
citizens were dissatisfi ed because of a delayed response and diffi culties in issuing certifi cates since all the work was being managed manually. But all these problems were resolved with the deployment of IT in hospitals. A centralised registration system was introduced and nearly 400 hospitals under the MCD area were linked with each other. A scheme called OLIR was for online registration of births and deaths. All linked hospitals were provided with user ids and passwords through which births and deaths could be registered online by the hospital. Apart from this, MCD opened registration centres in various cremation grounds and setup IT workstations in 12 zones under 12 registrars. These centres were equipped with desktops, broadband services, which aided in data entry for domestic events. Through this process, MCD was able to cut down on the time required for registration issuing of birth and death certifi cates. Moreover, facility for submitting online application through payment gateways was introduced. MCD is the fi rst agency in India to introduce such systems and this project was well appreciated and awarded for outstanding performance by the RGI in 2004.

The second major project is the HIS project. In a major move aimed to revolutionise the delivery of medical care, MCD initiated computerisation of six major hospitals . An agreement was signed with Wipro HealthCare  IT Limited on 14th October 2004 to computerise the six hospitals in a phased manner. There were 33 modules in the package. Of the six hospitals, Swami Dayanand Hospital (230 bed general hospital) was selected as pilot for customization and implementation of software and HIS was commissioned in October 2005.

MCD decided to begin a pilot project in one of the hospitals and replicated the same in others. In addition to the installation of LAN and procurement of servers and other hardware, civil and electrical work was done separately. New concepts such as patient registration scheme were implemented in which patients coming to hospitals were being registered for lifetime and were given a laminated card with a unique UHID. With this system in place it is easy to store all information of the patients on record and easy to retrieve on demands of the patients. The major benefits achieved were standardisation and patient satisfaction. Subsequently, electronic patient folder (EPF) module was implemented where all the records of the patients of all six hospitals were uploaded to a central server in a batch processing. This allows the physicians of any hospital to access patient records when patients are being referred to any of these hospitals.

This project was awarded in the e-India conference held at Hyderabad in August 2009.

Our third project was LIBRE (Linking Births Records & Immunisation Records). This was aimed at reducing the duplicities in data entry or data utilisation. This project focussed on generating an immunisation card on the basis of the data collected in birth record of a child where most of the fi elds of these two records are identical. This project also received funds and appreciation from the UNICEF. This has been implemented in 32 maternity homes. Besides training in IT application, MCD also focused on digitisation of records. This has been effectively implemented in maintaining birth and death records.

Please provide an overview of the projects that are currently in the pipeline.

The main projects, which are currently in the pipeline and will be implemented shortly include the Mother and Child Welfare Information System (MCWIS), TBTRAM (TB patient tracing and monitoring system), which will integrate DOTS management system, integrated dots management system (IDMS), School Health Card and Disease surveillance system.

The MCWIS has been hosted and staff are doing the UAT. In this, all major activities undertaken like ANC, PNC, family planning and well baby clinics, etc., will be streamlined through IT application. MCD will be linking ANC registration to
birth registration in order to track abortions undertaken to fi nd out female foeticides. NRHM reporting system is a module in this project which will help ANMs to devote more time for clinical work rather than compiling reports manually. There is a plan to go live, with this project from the 1st of April 2010.

The next project in the pipeline is the IDMS project. On the basis of the experience gained from the inventory management module of HIS, the project has been out-lined. MCD is catering to four different systems under medicine including Allopathy, Unani, Ayurved and Homoeopathy. The project will provide web-based solution to mange and monitor all processes of procurement and distribution of medicines, reagents, surgical items, etc. The modules will be ordering (EOQ), ABC/VED analysis, monitoring the expiry dates, maintaining the suppliers profi le, etc. This will help the administrators to make effective utilization of the allocated budget.

Another system on which MCD is working right now, but still hasn’t designed is the TB tracking system. This system will be able to track defaulters, who are under DOTS therapy but do not return to take subsequent doses after getting the symptomatic relief leading to MDR. Considering the constant increase in the number of TB patients, and lack of manpower, the defaulters can only be tracked with the help of IT application. MCD is also planning to do a project for school health. There are 1800 schools under control of MCD and nearly 9 lakh children are studying in these schools. There is a separate wing in health department called School Health Services, which organises curative and preventive healthcare for school children. In order to implement qualitative care, MCD has planned to utilise IT for a solution. The due diligence for the application has been completed. MCD will focus on introducing a health card for individual students and follow this as long as they are enrolled in MCD schools. Having a project on registration of birth and immunisation, MCD in all likelihood can come up with a database of birth, immunisation and health of school children.

For public health, MCD wants to do a project on disease surveillance. As per the DMC act, there are 9 notifi able diseases like tuberculosis, cholera, measles, polio, meningitis, plague and dangerous disease like AIDS and dengue which are a perpetual threat to Delhi. To keep a track of these diseases, IT implementation is essential at a macro level. Under the disease surveillance system, the hospital where a patient is being diagnosed in any of these diseases may communicate to the Zonal Public Health Administrator (DHO), who can organise preventive/remedial measures in the locality to cut down on the spread of these diseases in the community, thereby reducing the chances of epidemic. Currently, there are separate programmes running such as malaria control programme and cholera control programme. So the aim is to club all these programmes together under the disease surveillance project.

What is the estimated investment for all these projects?

The health department is a part of the MCD and the investments are made by MCD. Only for the HIS project, health department spent an amount of Rs. 174 lakh for procuring and customising the product. In addition, separate investments were made for procurement of hardware, LAN and for maintenance and manpower. Registration of births and deaths was developed as a part of MCD project and part of LIBRE was funded by the UNICEF. However, IT department  is in the process of developing other projects, so the accurate estimate of investment cannot be provided as of now.

What is your view regarding the support of technology partners and solution vendors for various projects?

Wipro is our IT partner in the HIS project. The birth and death registration project was done in collaboration with ECIL, who did a CSB project for the entire MCD. Now MCD has selected Tech Mahindra for the e-governance project. Tech Mahindra will develop IT applications for all departments and will integrate all these applications. MCD has proposed this e-governance initiative to harness the power of ICT platform for its vision as “a socially committed, technology driven, professionally managed and forward looking organisation”.

What are your measures to quantify the benefits? 

There are signifi cant and observed benefi ts in the areas where IT applications have already been deployed. Through IT  implementation, we are able to manage the shortage of manpower, subsequently balancing it with the increasing number of patients. Most of the processes have been managed effi ciently where the citizens are being benefi ted. IT also has helped in making different reports like statistical reports and MIS reports which are benefi cial for the health administrators. The most important factor is that all the projects are being sustained and credit goes to the entire staff that uses these.

Overall, IT implementation in health sector under control of government will bring about a total reform in organizing health facilities and services, which benefi t the citizens as well as administrators. The projected benefi ts are to provide single window services to citizens on any time, anywhere basis (through the internet), increase the effi ciency and productivity of health units, enhance monitoring and transparency, develop a single and integrated view of health information system across all units and provide timely and reliable management information relating to health administration for effective decision making.

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