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Medical Education & Drugs Department

Government of Maharashtra

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Implementation of Healthcare & Academics Management &

Information System in

Government Medical Colleges & its Attached hospitals in Maharashtra

HMIS Project

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ObjectiveImplementation of e-Governance policy decision of the

State Government in Government Medical College & its

attached Hospitals in Maharashtra

Improvement in Delivery of Health Care and Medical

Education by using powerful HMIS Software of

International standard and Quality Hardware

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Project Scope

Hospital + Medical College

Hospital

Central Server-NASIK

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Benefits• Unique Health ID

• EMR Electronic Medical Record• Time Saving

• International Standards

• Better Utilization of Available Resources

• Avoidance of Pilferages

• Business Intelligence Reports

• Instant Availability of Administrative Data

Savings

Clinical Trials & Research

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Benefits Institute & GovernmentAll Institutes Interconnectivity, Centralized Data ,Uniformity

Inventory Management - Prevention of Pilferages

Availability & analysis of Administrative Data

Generation of income through Clinical

Trials and Research

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Innovative Model

• Build Own Operate & Refresh (BOOR) Model

• Service Contract

• No Upfront Payment to the Service Provider

• Monthly Payments linked to the Service Provided as per Service Level Agreements (SLAs)

• Zero Risk to the Government

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Architecture

• Distributed

– LAN – At Each Institute

– WAN – Connecting To Central Data Repository (CSRC)

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Initial Project Cost

• Rs. 180 crore

• Rs. 150 crores - Fixed Charges - From

Plan Budget

• Rs. 30 crores (approx.) - Transaction

Charges - From Hospital PLA - @ Rs.

6.60/Transaction

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Transactions

• OPD Registration

• IPD Registration

• Students Registration

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Expected Changes Registration

Present ScenarioScenario After HMIS

Implementation

New Registration number every time

One single unique Health ID throughout Life

Long Queues for Registration - New/Old

Reduction in waiting time for Registration as no need to enter the data again

Registration Counters -OPD/Casualty manned by

GoM

All Registration Counters -manned by Service provider

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Expected Changes OPD -Doctors Consultation

Present ScenarioNo Computerization

• Doctors unaware of the Waiting Patients

• No availability of Past Record

• No statistical analysis possible for OPD Clinical

Data • Laboratory Investigations

and Prescription of Medicines - on Paper.

• Separate Forms needs to be filled

• Such facility is not available

Scenario After HMIS Implementation

• Computerization in all OPDs• Waiting Patients List available on Computer screen

• Instant availability of Past Record

• All types of statistical analysis possible on OPD

Data• Investigation & Prescription of Medicines- e-Prescription

• With click of the Mouse - on Computer

• Each Department can customize the their OPD

screens as per their favorite list of Symptoms, Probable Diagnosis, Investigations,

Medicines etc.

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Expected Changes OPD - Doctors Consultation contd...

Present Scenario Scenario After HMIS Implementation

On Paper

Lab Results are manually carried by the

Patients.

Availability of Bed,

Scheduling for Investigation or

Operation is difficult

as no data of other concerned departments

available in the manual set-up

Instant availability of the Lab Results

Instant availability of X-Ray, C.T. Scan, MRI, Sonography on the ComputerTime saving for the Departments to

handover the Reports and Patients to carry them

Doctor can access these Reports from any terminal in the Hospital

IPD Admission, Operation scheduling, Special Investigation scheduling - Possible

at OPD

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Possible Generation of IncomeRegistration

Area Present Scenario Possibility

Registration

Rs. 5Rs. 10

(Transaction Charge payable to Service Provider - Rs 6.60)

Validity - 7 Days Validity - 1 Day

No charges from -Prisoners &

Samples for Testing

Charge of Rs. 10 to be introduced

No Charge if attends of referred to other

OPD

Rs 10 to be charged if he wants to attend other OPD

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Possible Generation of IncomePharmacy

Area Present Scenario Possibility

Pharmacy

All Medicines - Free

Actual Charges (may be 5% less than MRP)

BPL - Free - certain Medicines only.

Pharmacy Store can be started in all Institute

Profit Margin is 20-200%

JJ ScenarioAbout 8 crore spent on Medicines

OPD -1.5 croreIPD - 6.5 crore

Free MedicinesBMC - only 20 medicines GoM - About 90 medicines

Restriction on Free MedicinesPossibility of saving 40-60% of

spending

Generation of Income from the Pharmacy Store

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Possible Income GenerationAdvertisement

Charging for using the HMIS Data for any analytical purpose (to authorized persons only) as per the prevailing policy for the use of the DataAdvertisement:On the back side of the OPD Number CardOn the computer screen - scrolling/pop up advertisementIn the Waiting AreaOn Medicine PacketsAt any other possible area

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Possible Generation of IncomeClinical Trials/Contract Research

India - Preferred destination for outsourcing due to:

Largest pool of variety of patients.

Specialty Hospital Beds - 7 Lakh

269 Medical Colleges.

Low cost - 50-60% cheaper than in US

English speaking personnel

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Present Status

• Pilot Phase – at Grant Medical College

& Sir JJ Hospital Complete

• Pune, Nagpur & Aurangabad - Ready

for Trial

• St. George, G.T. & Cama –

Implementation started

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Project Governance

• Steering Committee

• Project Coordinator

• State Level Project

Implementation Committee

• Project Implementation Committee

(PIC) at Each Location

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Challenges

• Customization

• Mindset of the Users

• Old Equipments

• Top Down Governance

• Old Infrastructure

• Lack of Flexibility & Freedom in Implementation

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Challenges

Use of the HMIS Data for Analysis and Policy MakingLegal Issues in relation to EMR confidentialityRTI ActOLD Equipments - like X-Ray, Biochemistry Machines not compatible to HMISData Entry into the system

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Challenges

• Complexity of the Processes

• Multiple GR – Sometimes Conflicting

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Increase in Project Cost

• Learning from the Pilot Phase

• Less No of Nodes/Terminal (Computer)

• Cabinet Approved Additional Rs. 93 crore

for receiving the services for the Nodes

& Printers for 19 Institutes for 7 years

(Feb 09)

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Timelines

• 27th Feb 09 - Cabinet Approved for

Additional 93 crores for Nodes

• Nov 2010- Implementation of Roll-Out

Locations

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Ray of Hope

• No State Government in India has done what GOM has done

• Its Matter of Time and Benefits are assured

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International ScenarioUSA• US President Obama's big idea: Digital health records: Computerize all Health Records Within Five Years.

• Only about 8% of the US 5,000 hospitals and 17% of its 8 Lakh Physicians currently use the kind of Common Computerized Record-keeping Systems that Obamaenvisions for the Whole Nation.

• Expected Cost at least $75 Billion to $100 Billion (Rs.1.5 - 2 Lakh crores) over the Ten Years they think the Hospitals would need to Implement.

• On February 17, 2009 President Obama Signed the Stimulus Bill into Law. In the Bill, Obama allocated

• $19 Billion Dollars (Rs. 38,000 Thousand

Crore) to Electronic Health Records program.

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Stakeholder

State Government

Larsen & Toubro Limited - Technical

Advisor

Hewlett Packard - HP - Prime Contractor

Amrita Technologies - HMIS Software

Provider

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For the details contact

Dr. Sanjay Bijwe M.D.

Officer on Special Duty

Medical Education & Drugs

Mantralaya Mumbai -400032

Tel.91-22-22828715

Mobile:91-9821138798

Thank You

Nivedita Golatkar

Special Project Officer

Department of Information

technology

Mantralaya Mumbai-400032

Mobile:9323293206