The HMIS project was implemented in Maharashtra under the eGovernance policy decision to improve standards of healthcare delivery and medical education. Dr. Sanjay Bijwe, Project Director & Officer-on-Special-Duty, in an interview with eHealth, provides insight into the major project highlights.
Dr Sanjay Bijwe
Project Director & Officer on Special Duty (HMIS Project)
Medical Education & Drugs Department
Government of Maharashtra
How was the RFP for HMIS project raised? On what basis was the vendor selected?
RFP of this project is now like a bible for many state governments and different organizations. A unique aspect of this is the penalty clause on the government for late payment, which gave a lot of confidence to the vendors.
We incorporated all the healthcare standards while creating the RFP, taking guidelines from the standards laid by the Ministry of IT. We allowed consortium of three partners to bring out a well balanced RFP.
We decided that it should be a working software, which can be customized according to our needs. We also wanted it to have the healthcare standards like HL7, DICOM. While deciding on the software, fifty percent weightage was given to the capability of the vendor to implement the project, financial capabilities and other technical capacities and fifty percent weightage was given to the type of software. We decided on a fixed and variable model where the company will get a fixed amount every month against the service providers. The plan was to have distributed architecture, which is not dependent on connectivity and is only within the institutions and LAN. Thus, the hospital is self sufficient and the data is stored in a centralized location.
Out of the five responses we received, HP and Amrita as a consortium were the ones to qualify. We used certain tools available on the internet to check the compliance of the software. A committee under the finance secretary was also formed, led by Dr. Deepak Phatak, to verify the cost of the project.
For us, HP is the single point of contact and its their responsibility to implement, while Amrita is their sub-contract partner.
The entire funding for the project has been done by the Department of Health and Family Welfare.
What is the current status of the project?
The total time period allotted for the project is eight years, out of which the first year is pilot. Once the pilot is successful, implementation will take place at all 19 locations over the next two years. During this period, three institutions will go online every four months. In the remaining five years all these institutions will start functioning. The project started on January 3, 2007 and went live only on October 18th, 2008 because of certain difficulties. Thereafter, the project will be online for the next seven years.
As of now, the Nagpur, Pune, Aurangabad and Mumbai institutions have gone live, except for JJ Hospital, Mumbai. Implementation process is being carried out at other six locations. The delay is because of some unfortunate circumstances. One of the major problem is that the financial model is very complex in the government and whatever is available in the system needs to be customised properly. So, unless everything is integrated the cycle remains incomplete.
Further, our detailed guidelines are also ready. The beauty of the system is that a lot of pilferages can be saved and I am confident that the cost of this project will come out from saving these pilferages. Being in the last lap of completing the project, we want to issue the guidelines once the finance module is complete.
Who will take the onus of the project after this eight year span is over?
Indeed, we have included this point in the contract. In the 6th year, that is two years prior to the end of the project, the process of what happens after that will start. If we are satisfied with the services of HP, we will give the project to them. If they dont want to continue we will float another RFP and will continue either with the current software or take another one.
We have taken enough precautions to ensure that all data and generated EMR could be easily transferred to the new platform or database.
What were the challenges faced for implementation of this project?
The challenges are tremendous and customization was one of the major ones. Many people from IT do not understand the health domain, while many doctors are not aware of international standards. There is absolutely no standardisation for clinical pathways and I am still trying to find out if there are any international set of best practices available. There has to be business process re-engineering to change all medical processes and the main challenge is to have standardization.
Another challenge is to align IT with clinical process and make the process simple.
Guidelines on usage also need to be issued for the benefit of people who are using it. For instance, a unique ID will be generated for every individual, who is visiting any of these 19 locations. It was a very tough task to create this kind of a unique ID. The problem is that biometric identification also needs to be incorporated in that. In all government hospitals the OPDs are extremely crowded and there is hardly any time for verification of the details provided by the patient. If the unique ID is not developed, the whole purpose of the project will be defeated. So, there has to be a biometric ID but there needs to be a simpler process for creating that.
Computerisation of the OPD is the biggest challenge. There are other challenges in the wards as well. While doctors are on rounds, nurses write down the details in a register. For computerisation of this process, either there should be computer on wheels (COWs) or PDAs. So we need to have something like this but the cost factors also need to be kept in mind.
What are the benefits of this project?
Benefits of the project are mind boggling because the fundamental framework is very solid and robust. Because of this, procurement becomes simple and in an instant you will know the requirement of all colleges. The next step would be to analyse the data that will be made available through data mining. The beauty of our model is that there is no issue of any instrument or technology getting obsolete.
The vendors were told to make the HMIS available 99 percent of the time. All desktops and hardware are provided by them and in case of any break down, replacement has to be made within one hour, else a penalty will be charged. This makes it necessary for the vendors to keep their engineers and spare parts at all locations. In case of queries raised, the response should be available within 3 seconds. The time period for an image to be received is 10 seconds. We have also deployed various tools at different locations to constantly record, measure and report the time taken for these processes.
This makes the functioning of the project very efficient and has proven to be beneficial overall