IMPLEMENTATION OF HOSPITAL INFORMATION SYSTEM in DDU, SHIMLA

Submitted by: Shruti Goel(PG/10/045)

HiSPindia PROFILE
HiSPindia is a not-for-profit NGO specializing since more than a decade in designing and implementing solutions in health informatics for the public health sector. It is a multi-disciplinary organization concentrating on the domains of public health and informatics. It works with a Vision to enable and coordinate a network of excellence in public health informatics, specializing in integrated health information architectures, with a geographical focus on South-East Asia. The organization has a strong commitment to free and open source technologies, and works with a global perspective of the Health Information Systems Programmes (HISP) network, coordinated by the University of Oslo, Norway, and is active in more than 20 countries in Africa and Asia. HiSPindia has a registered and head office in New Delhi, and project offices in Kerala, Himachal Pradesh, and Punjab. In India, it has worked in at least 90% of the states, and currently has a presence in about 20 states.

HIS team Team coordinator

Team Leader

Software Developers

Implementers

Hardware Supporters

We, as interns, were made a part of the Implementing Division of the HIS team at HISP.

HOSPITAL INFORMATION SYSTEM

What is HIS? Potential benefits Potential challenges

ABOUT DDU
Deen Dayal Upadhayay , commonly known as Rippon. It is a public hospital under the governance of Himachal Pradesh. It is the first district hospital of Himachal Pradesh where HIS is implemented by HiSPindia. It is the most established and functional government hospital. It is a 150 bedded hospital with all functionalities. Prime source of healthcare services in Shimla and neighbouring districts.

OpenMRS
The HIS developed by Society of Health Information Systems Programme (HiSPindia) and NHSRC is built on OpenMRS Open Medical Records System. It is community developed software which enables to design customized medical records without any programming knowledge. The principle of openMRS is that information should be stored in a easy to summarize & analyze form i.e. minimal use of free text & maximal use of coded text. It is a client server application which means it is designed to work in an environment where many clients computer access the same information on a server.

Contd

FEATURES Central concept dictionary: Security Privilege-based access Patient repository Unique identifiers per patient Data export Modular architecture Patient workflows Cohort management Patient merging Reporting tools

STEPS IN IMPLEMENTATION
Need Assessment for HIS in DDU Initiating the Process Procurement of Software/Hardware Support Module Implementing (a) Phase I (b) Phase II Training Session/Capacity Building for the End User Dry Run Going Live Process

1. NEED ASSESSMENT OF HIS IN DDU

The main important needs of DDU for HIS realized were To create records of the patients. Allow monitoring of the health care services Comprehensive, efficient and accurate administration of all services/functionalities Streamlining patient flow. Reducing paper work

2. INITIATING THE PROCESS (5 STEPS)

Demo of OpenMRS in Hospital The hospital authorities and end users of the software were given a detailed demonstration of OpenMRS.

Review of Existing Process

Requirements based in Review of Existing System Ways to gather information: Interviewing Focus group discussion Surveys Shadowing Sources of information: People Manuals System

Meeting on HIS implementation A proposal was compiled by the HISP team comprising of the requirements that the system would bear as well as the functionalities of system. The proposal was to be studied by the hospital team thoroughly.

Action Plan for HIS implementation The information gained was translated to the developers in order to enable them to customize and develop the software exactly the way it was desired by the hospital

3. PROCUREMENT OF HARDWARE & SOFTWARE

The creation of an intranet for information flow before the start of the implementation process. 26 HCL computers and HP laser jet printers were installed networked to a server running Linux Ubuntu 10.10. It is being shared on 10/100 mbps LAN connection. The application was installed on two servers: the first was used for testing and validation of different modules as well as for the training of users and the second hosted the production implementation of the HIS.

4. MODULE IMPLEMENTATION
The implementation was done on a modular-basis, following a set of priorities defined by the hospital put together for this purpose. Implemented in two phases Phase 1- Registration, Billing and Laboratory Phase 2- OPD, IPD, Inventory, Pharmacy, Blood bank

5. TRAINING SESSION/CAPACITY
BUILDING
Training objective Identification and assessment of training needs Basic requirements Training plan

Training plan
PHASE I training on computer basics PHASE II training on individual modules Doctors Nurses Pharmacist Inventory staff Post training - Competency Tests and Re- training.

6. DRY RUN
Testing
Aim - make sure that the system is working properly, to catch any bugs and report them. To avoid malfunctioning functionalities on site. At 3 levels
Simple Structured random Completely random

Hands on with end users

Hands on training was given to doctors, nurses, pharmacists, lab technicians etc to provide guidance and to supervise them to perform assigned tasks. Feedback from users is taken for any addition, customization or bug confronted by them.

7. GOING LIVE

CHALLENGES
Behavioural reluctance Vast manpower and different work timings Enormous patient load DDU s infrastructure Lack of well designed and well developed user manual. Development of new and stable version of modules.

LEARNINGS
HIS can be feasible in public hospital provided motivated infusion of understanding and hard work is there. Economic arguments no longer holds good as low cost open source tools adjustable by local teams are available. Importance of making hospital decision makers aware of efficient role of HIS is realized.

REFERENCES
www.hisp.org www.hispindia.org www.opemrs.org http://en.wikipedia.org/wiki/OpenMRS HIS- DDU manual by HISP A study on Determination of the success of a hospital's information system implementation by J.C. Sarivougioukas and A. Th. Vagelatos.