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Functional Requirement of Integrated Health

Management Information System, U.P.

Design, development, piloting and program

management of Cloud based Information System

for the Directorate of Medical, Health & Family

Welfare, U.P.

Prepared by:

U.P. Health System Strengthening Project,

Training Block-2, SIHFW Campus, Opposite Eram Girls College,

Indira Nagar, Lucknow – 226016

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Index

S.No. Topic Page No.

1 Background of the Project 3

2 Directorate of Medical, Health & Family Welfare, U.P. 5

3 Proposed Integrated Information System 7

4 Applications to be implemented 9

5 Functional requirements at different facilities/offices 13

- Primary Health Centre 13

- Block Primary Health Centre/CHC 13

- District Hospitals 14

- CMO/Divisional Office 20

6 Cells of Directorate of Medical & Health, U.P. 25

7 Cells of Directorate of Family Welfare, U.P. 27

8 Performance Requirements 28

9 Annexure – 1: Department of Medical, Health and Family Welfare, UP –

Setup

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10 Annexure – 2: Current IT based Information System 31

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Background of the Project

Uttar Pradesh is the most populous (close to 200 million as per current estimates) state in India

with widespread poverty and illiteracy. Infant mortality rate, maternal mortality rate, and under 5

child mortality are one of the highest in the country. A very high incidence of avoidable morbidity

and mortality is indicative of the inherent inadequacy of available public health services and

their efficacy to deliver positive health outcomes. The fact that this situation continues despite

huge annual investments (to the tune of around 10000 crores) in the health sector in the state

underlines the need to strengthen the health systems further in a manner that makes them truly

efficient and effective in the delivery of public health services.

More than 70% of the total investment in the health sector reportedly goes in the payment of

salaries to the large workforce of doctors, nurses, and paramedics. But more than 80% of the

people, particularly in the rural areas, prefer to go to private health providers including faith

healers and quacks, instead of accessing public health facilities. This suggests that the public

health institutions do not enjoy the desired credibility and confidence of people. The public

health delivery system in that sense is still in some kind of a crisis of credibility. This calls for

radical re-thinking and re-organizing of the health systems in order to make the health services

more accessible and affordable to people.

Rationale

Uttar Pradesh Health Systems Strengthening Project (UPHSSP) is conceived as a strategic

initiative to enhance people’s access to quality health care services in the state of Uttar Pradesh

(UP). The project seeks to strengthen systems and institutions and their capacity to deliver

quality services further in a manner that makes them accessible to people in general and to the

poor in particular with a focus on women and un-served people in remote areas. The proposed

initiative is intended to build on the achievements of the UPHSDP Phase I project and

complement the on-going initiatives under National Rural Health Mission (NRHM).

NRHM and UPHSSP

National Rural Health Mission (NRHM), launched by Government of India (GOI) in 2005, aims at

a comprehensive re-vamping of the public health service delivery systems and services in the

rural areas across 18 high focus states including Uttar Pradesh. The stated goal of the NRHM is

to improve the availability of and access to quality basic health care, especially for people

residing in rural areas, the poor, women and children. The scope of the program is vast and

flexible enough to encompass almost all the conceivable aspects of public health service

delivery. The core strategies of NRHM include: increasing participation and ownership by the

community; improved management capacity; flexible financing; innovations in human resources

development for the health sector; and setting of standards and norms with monitoring.

UPHSSP

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UPHSSP is intended to complement NRHM by focusing on areas, which are either not being

directly or adequately addressed by it, but are of critical importance for creating an enabling

environment to pursue NRHM goals.

The Project Development Objective of UPHSSP (PDO) is to improve the efficiency, quality and

accountability of health services delivery in Uttar Pradesh by strengthening the State Health

Department’s management and systems capacity.

Uttar Pradesh Health Systems Strengthening Project (World Bank funded) has received a credit

of US $ 152 Million from the International Development Association (IDA)/World Bank. UPHSSP

is implementing a 5 years project to strengthen various functional cells, systems, hospitals and

other interventions in the Department of Medical Health and Family Welfare, Government of

Uttar Pradesh. Activities to be carried out in the Project are divided into two components as

given below:

S.No. Component Sub-component

1 Strengthening the Department of Health’s management and accountability systems

Building strategic planning functions in the Health Department

Improved use of data for program management Strengthening the use of financial information

Introducing and strengthening social accountability

2 Improve the Department of Health’s capacity to perform its quality assurance role and more effectively engage the private sector

Strengthening the institutional capacity for ensuring service quality and regulation

Improvement of quality of service delivery at public sector 40 hospitals

Contracting with private sector in order to improving quality of service delivery

Ensuring availability of the full complement of human resources

Under the Project, the Government is planning to strengthen the service delivery, systems &

processes through establishment of Data Resource Centre which will be the central repository

of data of the health sector of the State. As per Project Implementation Plan, application of

Information Technology is proposed in following activities:

Component Sub-component Main activity

Strengthening the Department of Health’s management and accountability systems

Improved use of data for program management

Improving use of Data for program management by Strengthening EDP Cell as Data Resource Centre

Introducing Health Geographical Information Systems (HGIS)

Strengthening Financial Management, Procurement, Supply Chain Management Systems in the Medical & Health Directorate

Strengthening Financial Management Systems in the Medical & Health Directorate

Strengthening CMSD for Procurement & Supply Chain Management

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Directorate of Medical & Health & Family Welfare, UP

Directorate of Medical & Health It is located in Swasthya Bhawan, Kaiserbagh, Lucknow. Cells at the Directorate of Medical & Health, UP are as given below:

S.No. Cell S.No. Cell

1 Medical Care 16 TB

2 CHC/PHC 17 Nursing

3 National Program 18 Karmik

4 Training 19 Eye

5 Planning & Budget 20 Leprosy

6 Public Health 21 Headquarter

7 Female 22 Periphery of Headquarter

8 Central Medicine Stores 23 Epidemic

9 Para-medical 24 Birth Death data

10 Electrical & Mechanical 25 Confidential

11 Transport 26 Finance Controller

12 Construction 27 Chief Audit Officer

13 Dental 28 RTI

14 Administration 29 EDP

15 Malaria 30 Monitoring

Directorate of Family Welfare, UP Directorate of Family Welfare is located at J.N. Raod, Lucknow. It is engaged in following activities:

1. Immunisation 2. Mother & Child Care 3. Family Welfare 4. Reproductive & Child Health Program.

National Programs National Programs include:

1. National Rural Health Mission (NRHM) 2. National Vector Borne Disease Control Programme (NVBDCP) 3. Integrated Disease Surveillance Programme (IDSP) 4. National Aids Control Programme (NACO) 5. National Leprosy Eradication Programme (NLEP) 6. National Programme for Control of Blindness (NPCB) 7. National Cancer Control Programme 8. National Mental Health Programme 9. National Diabetes Control Programme 10. National Iodine Deficiency Disorder Control Programme (NIDDCP) 11. Revised National Tuberculosis Control Programme (RNTCP) 12. Mother & Child Tracking System (MCTS)

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Monitoring of progress and reporting are done through portals provided under National Programs. Structure of Health Delivery System

For better administrative control, the entire State has been divided into 18 Divisional Offices and 75 Chief Medical Officers’ offices. At District level, there are Combined District Hospitals, District Hospital – Male and District Hospital – Female. There are 157 District level hospitals. There are 773 Community Health Centre (CHCs)/Block Primary Health Centres (BPHCs) and 3697 Primary Health Centres (PHCs). In addition, there are about 20621 Sub-centres. CHC/BPHCs cater to a population of 1,00,000 with 30 bed hospital. The Primary Health Centre has 4 beds in the Centre and caters to a population of 30,000. District Hospitals Summary No. of beds No. of hospitals No. of beds No. of hospitals No. of beds No. of hospitals

30 14 101-150 23 416 1

31-60 10 151-200 22 656 1

61-70 15 201-250 14 NA 8

71-90 4 251-300 6 TOTAL 157

91-100 34 301-351 5

List of Divisions is as given below:

S.No. Division District (Divisional HQs)

No. of Districts No. of District Hospitals

1 Chitrakootdham Banda 4 8

2 Jhansi Jhansi 3 6

3 Devipatan Gonda 4 7

4 Faizabad Faizabad 4(1) 8

5 Kanpur Kanpur Nagar 6 12

6 Lucknow Lucknow 6 20

7 Allahabad Allahabad 4 10

8 Azamgarh Azamgarh 3 5

9 Basti Basti 3 5

10 Gorakhpur Gorakhpur 4 6

11 Varanasi Varanasi 4 10

12 Vindhyanchal Mirzapur 3 4

13 Agra Agra 4 10

14 Aligarh Aligarh 3(1) 7

15 Bareilly Bareilly 4 8

16 Moradabad Moradabad 4(1) 9

17 Meerut Meerut 5(1) 11

18 Saharanpur Saharanpur 2(1) 4

TOTAL 70(5) 150

() indicates no. of district with no district hospital facility.

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Proposed Integrated Information System

The aim of the Integrated Information System is to provide better health services to citizens, improve efficiency for business and for its own staff by facilitating optimum utilization of resources and availability of information on services. Help employees to improve their efficiency and provide information to the top management for better decision making. Further, it would facilitate timely settlement of benefits to employees. The system will be process based. In the initial period of implementation, a mix of manual and process based system would be implemented with the aim of moving towards a process based system. Information Technology shall be used for conversion of manual processes to IT based processes in which data/records are to be stored, using user-friendly and simple systems with minimal changes as decided by the end-user in a definite time frame to be used by the end-user and are continuously improved and maintained by Data Resource Centre Cell. The end-user shall be empowered through suitable training programmes/refresher courses. The proposed system shall have following key features:

1. Information Technology to be a part of strategy: IT is part of the overall strategy of the Department to improve efficiency and effectiveness as well as to facilitate optimum utilization of resources. This strategy/policy will be reviewed periodically.

2. Information to Citizens: The availability of various facilities shall be displayed electronically in different hospitals including drugs & medicines, pathological tests, ambulances, wards and Operations Theatres. The Registration System at facilities will include name of the village and block, name of each patient and their social category (SC/ST, gender and BPL or not). VSHC/ Panchayats/ SHGs and the general public will be able to monitor the data.

3. The end-user has to be the owner of the sub-system: The end-user (officers & staff) of the Cell have to own the system. They should decide their requirements, suggest implementation plan and use. No computer operators shall be provided, except for the transition period.

4. Manual system of information to dis-continue: The manual system of keeping information will discontinue after successful parallel run. The system will be designed in a manner to facilitate working in case the IT based system is not available for sometime due to reasons beyond control. Reporting should be a by-product of the system implemented.

5. Custodian of IT assets: Information Technology assets require maintenance and custody, especially system software, application software and documentation. In view of the above, IT skilled manpower in Data Resource Centre (DRC) Cell is being deployed. This Cell will be primarily responsible for smooth running of Integrated Information System and act as an interface between the end-user and IT Application developer/system. Also ensures maintenance & upkeep of the proposed IT system (Integrated Information System). The application development or IT system development shall be outsourced to specialist organisations.

6. System is implemented in a definite time frame: The system should be implemented in a definite time frame and in phases. Each phase getting completed in six months from the date of start of the phase.

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7. Simple system with minimal changes: Change and complexity are difficult to implement. It is prudent to implement a simple system with minimal changes in implementation as the change to Information Technology itself is a big change.

8. Application Software prior to deployment of hardware: A complete User Acceptance Plan (UAT) to be developed and software should be developed and tested prior to rolling out application in the field. Feedback shall be taken from end users regularly, necessary action shall be taken and informed to concern staff.

9. Rigorous and refresher training: The training to users has to be rigorous and should be repeated to gain the acceptance of system by the end user.

10. Employee beneficial systems to be implemented: For better acceptance of the IT system, systems will be implemented which directly benefit employees. A few of them include:

a. Medical re-imbursement: to reduce this cycle from 1-3 months b. Pay-slips to employees, Income tax calculation tool, etc. c. ACR received information d. Leave records

Resources of the Department Main resources of the Department are:

1. Facilities, i.e., District Hospitals, Community Health Centres/Block Primary Health Centres, Primary Health Centres and Sub-Centres. Number of patients are highest in District Hospitals and lowest at Sub-Centres. No. of Out Patients are about 1500-2000 per day in District Hospitals with working beds of about 200.

2. Pathology labs in District hospitals and CHCs 3. Pharmacy drug stores in CMO and District Hospitals. A typical District hospital issues on

an average 100 drugs/ medicines per day to sub-stores (Wards, OPD, OT, Emergency, etc.), 200 receipts of drugs/medicines in a year from Rate Contract and 50 receipts of Local Purchase in a year.

4. Operation Theatres 5. Blood Banks 6. Medical Officers deployed all across the State at Headquarter, Divisional Offices, CMO

Offices, District Hospitals, CHCs and PHCs. There is a sanctioned strength of 15000 Medical Officers. Para-medical staff has a sanctioned strength of 37,700. There are other Class IV employees.

7. Infrastructure and Equipment in terms of X-ray machines, Ultrasound machines, CT scan, ambulances, etc.

8. Annual Budget of the Department

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Applications to be implemented

S.No. Application Volume of data

1. Health Management

Information System

Monthly Progress Report from CMOs, District Hospitals, CHC/

BPHCs, PHCs;

2. Health Geographical

Information System

Demographical details– 0.1 million revenue villages, 52,028

Gram Panchayats, 820 Blocks, 75 districts and 18 divisions;

Marking of different type of Health facilities; Periodic data from

MIS

3. Personnel Information

System

80,000 employees; 12 payroll transactions per annum; 24

other transactions per annum

4. Central Medicine

Stores Department

Rate Contracts – 50 in a year; A District Hospital issues 100

drugs/medicines/items to Sub-stores per day, 200 receipts

against Rate Contracts in a year and 50 receipts against Local

Purchase in a year; Chief Medical Officer receives one indent

per month from CHC/BPHC or PHC in a month and delivers

once or twice in a month

5. Hospital Information

System (in District

Hospitals only)

Patient Index: 10% population of the State using urban public

health facilities; no. of OPD patients per day varies from 1000

– 6000 per District Hospital; No. of X-rays per annum – 1.5

million; No. of USG per annum – 0.5 million; no. of pathology

tests per annum – 10 million; No. of surgeries per annum: 0.5

million; IPD: 19,941 beds with 100% BOR.

6. Financial Management

System

Drawing Disbursing Officer – salary bills, travel bills and

contingency bills; 350 Drawing Disbursing Officers.

7. Tele-medicine District Hospitals shall be connected to Nodal Centres to

provide Tele-medicine.

8. Tele-radiology District Hospitals shall be connected to Nodal Centres to

provide Tele-radiology.

9. Beneficiary Tracking

system using handheld

devices

A web based application shall be developed for tracking

beneficiaries using handheld devices

The Department has planned to implement an Integrated Information System for better and integrated utilization of these resources, covering the following: a. Health Management Information System

CMOs and CMS of District Hospitals are sending reports on prescribed formats to the Directorate. The List of formats is given in Annexure-8. HMIS is to be developed based on the existing reports. The data being captured in National Programs is not to be captured again. Data entered in National Programs shall be downloaded and additional reports may be prepared.

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CHCs/BPHCs and PHCs shall send their periodic reports to respective CMOs in tailor made software either through internet or physical transfer of computer file. These will be consolidated at CMO offices. This will include Dash Boards and analytical reports. Base Data and Intermediate reports It is not possible to implement the system at once all across the State and in all types of facilities and offices of the Directorate. For a few applications and locations, data shall be captured from base transactions right from the beginning. At this point of time, data shall be recorded from intermediate reports for other locations. With the success of implementation, other locations and applications shall be included in using the system and providing data from base transactions.

b. Health Geographical Information System

Health Geographical Information System is to be primarily used for visual display of information and resource planning. It will have demographic details of villages, panchayats, Blocks, District, Division and State. Various facilities like Sub-Centres, PHCs, CHC/BPHC, District Hospitals, CMO Offices and Divisional Offices shall be mapped. This data is by and large static and to be used for planning new facilities. In addition, the resource availability in terms of manpower (sanctioned/posted), Specilisation-wise doctors, equipment available/functional, performance indicators shall be displayed using data collected from Health Management Information System. Later on, private sector health facilities shall also be mapped.

c. Hospital Information System

The district hospitals shall be taken in phases for implementation of Hospital Information System. The focus shall be on patient registration for OPD and IPD, Drugs distribution, Pathology Labs, Wards and use of Operation Theatre. Suitable displays may be made in hospitals for people to know the availability of bed in wards, Operation Theatre, drugs/ medicines, status of equipment, pathology tests available, etc.

d. Personnel Information System

Transactions of Personnel Information System shall be done at CMO, CMS, Divisional Offices and at headquarter. All transactions related to personnel shall be recorded through this system only. For this purpose, all draft notesheets and orders shall be printed through this system. Once the drafts are approved by the competent authority, the approval shall be posted in the system and final orders shall be printed by the system. Once the posting is done, then the data can not be changed. There will also be provision for final orders prepared manually and then posted in the system. Reports can be generated at any point of time by authorized users. System Integrator shall study the existing system and shall be responsible for upgrade of the existing system or development of a new system.

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e. Central Medicines Stores Department

Central Drug Stores Department transactions shall take place at Headquarter, CMO and CMS offices. The Headquarter is involved in entering into Rate Contract for different medicines, drugs, surgical items and equipment. These Rate Contracts are communicated to Field Offices, i.e. Divisional Offices, CMOs and District Hospitals. These facilities/offices send indent to companies which have Rate Contract. Supplies are made by these companies at Main Stores of these indenting offices/facilities. After receipt of material, bills are processed and sent to Accounts for payment. The inventory of items is maintained and issued to CHC/BPHC or PHC by CMO and sub-stores/units at the District Hospital. The system shall have provision for inter-hospital medicine transfer. These Offices/Facilities have provision to procure 10% of their requirements through Local Purchase as well.

f. Financial Management System

The Financial Management System is to be implemented at the Drawing Disbursement Officer (DDO) level. The DDO maintains all books of accounts as prescribed by the Financial Handbook. At present, the bills are made manually and presented to Treasuries for payment. Directorate of Treasuries has already implemented a computer based payment system. Budget allocation software is already in use at the Headquarter. For budget control purpose, at present, expenditure data is brought from the Directorate of Financial Statistics at Headquarter. The salary bill is to be integrated with the Personnel Information System.

g. Dashboard for monitoring

This will provide a high level overview of health services in the State and display real time graphical display of Key Performance Indicators (KPIs) to the Management team or Decision Makers. Dashboards should be developed with drill-down feature to provide tiers of performance data for each level of Department such as Directorate/District/Block/Hospitals. The dashboard should provide an overview of all health programs including communicable diseases, maternal health, integrated disease surveillance, leprosy, etc. and provide performance for each program. The dashboard will draw on data from the beneficiary system, wherever available.

h. Use of handheld/mobile devices to track beneficiaries

Web based tool accessible through handheld/mobile devices to enter patient details and information on service delivery at health facility to feed information to Hospital Information System.

i. Tele-medicine & Tele-radiology

District hospitals shall be connected to Nodal Centres to provide Tele-medicine and Tele-radiology.

These systems are linked with each other and require an integrated approach to save on cost and time. The data can be viewed by different Sections of the Government, DG office, Different Cells at headquarter, Divisional Offices, CMO offices and CMS offices.

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Applications to run at Different types of Facilities/Offices are as given below:

S.No. Facility Type/Office No. of

locations

Application/s

1. Primary Health Centre

/NPHC

3697 - SMS on few parameters – daily

- on-line entry of monthly progress report

(this can be entered by PHC using existing

IT resources or at CHC/BPHC/CMO)

2. Community Health Centre/

Block Primary Health

Centre

773 - SMS on few parameters – daily

- on-line entry of monthly progress report

(this can be entered by CHC/BPHC using

existing IT resources or at CMO)

3. Chief Medical Officer 75 - Health Management Information System

- Personnel Information System

- Central Medicine Stores Department

- Financial Management System

- Health Geographical Information System

- Equipment Maintenance System

4. District Hospital 157 - Hospital Information System

- Health Management Information System





- Tele-medicine

- Tele-radiology

5. Divisional Offices 18 - Health Management Information System





6. Directorate of M&H and FW 2 - Health Management Information System





7. NRHM 1 - Health Management Information System





The System should comply with proposed Meta Data & Data Standards and EMR/EHR

standards of Ministry of Family Welfare & Health, Govt. of India.

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Functional requirements at different facilities/offices

Primary Health Centre


S.No. Section Event Form/Report

1. Hospital Mobile registration Two mobile numbers shall be registered for sending SMS/IVRS – MOIC and Pharmacist

At the beginning of Day – for previous day/night

SMS/IVRS indicating few performance parameters like No. of OPD, no. of IPD, No. of tests, any shortage of drug, Doctor absent, Other employees absent

Monthly Progress Reports MPR as prescribed by the Directorate for PHC

Health Report Card

Community Health Centre/Block Primary Health Centre



1. Hospital Mobile registration Two mobile numbers shall be registered for sending SMS/IVRS – MS and Pharmacist

At the beginning of Day – for previous day/night

SMS/IVRS indicating few performance parameters like No. of OPD, no. of IPD, No. of tests, No. of surgeries, No. of Deliveries, any shortage of drug, No. of doctors absent, No. of other employees absent

Monthly Progress Reports MPR as prescribed by the Directorate for CHC/BPHC

Health Report Card

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District Hospital

- Hospital Information System – should comply with proposed EMR/EHR standards of Ministry

of Family Welfare & Health, Govt. of India






- Tele-medicine

- Tele-radiology


1. Patient Registration New patient in OPD – first time Patient details – Registration no., Patient name, Age, Gender, Caste, BPL no., Mobile no., Disease, Address, Registration Fee, Token no., Speciality to be visited; should comply with proposed EMR/EHR standards of MOHFW, GoI

Subsequent patient visit in OPD – within 15 days of prescription

Patient OPD registration and Token no.

Subsequent patient visit in OPD – after 15 days of prescription

Patient OPD registration and Token no./ Registration Fee

Deposit of Registration Fee User Charges Register

Deposit of User Charges in Bank Updation of User Charges Register – Monthly

Patient demography

On-line OPD patient registration SMS/e-mail confirmation to patient

2. OPD Consultation by Doctor Symptoms, Diagnosis, Lab Tests, Medication, Advice, Forwarded to other doctor

Prescription screen to be of single page – symptoms, diagnosis, investigations, advice

Update Doctor’s Patient Register

Details of OPD Chambers List of OPD Chambers

Standard OPD Duty Roster List of doctors in OPD

Token to patient Token display at OPD Chamber

Change of doctor in OPD – on leave, court case, other pre-occupation, etc.

List of doctors in OPD on day

OPD chamber-wise patients attended in OPD

3. Lab Investigation Sample given by patient Investigation report to patient

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Sample Id to be generated which is linked with the patient

Investigation to be done gets activated only when the charges are paid

Deposit of Fee; No fee for BPL Patient; no. of investigations are free

Entry in Investigation Register

Lab tests conducted for BPL families

Updation of Investigation-wise charges;

List of charges;

4. Cash Counter Cash deposited by patients for Lab tests and In-patient services

Cash Receipt

Cash deposit to Accounts Cash Deposit

5. Drug Distribution Prescription by patient Collection of medicines from stock as per prescription

List of Medicines generally prescribed & available in Stores

Handing over of medicines to patients

Updation of Drug Distribution Sheet

Medicine distribution Register–Patient Registration no., Medicine, Quantity

Medicines distributed to BPL patients

Medicines Receipt from Main Pharmacy Stores

Challan

Updation of Stock Ledger

End of Day Updation of Stock Ledger

Medicine Return to Main Store Challan


6. Operation Theatre Scheduling of Operation Updation of OT Register

Operation Updation of Operation details –Operation(Major/minor), patient, anesthetist, surgeon, Time start, time complete

Surgical operations conducted for BPL patients

7. In patient Patient admission – Admission Time & Actual bed occupancy Time

Patient details

Daily Patient admission

Admission Time Variance Report

Patient Discharge – Discharge Discharge summary

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Time & Actual time of leaving

Morning Statement with Bed Occupancy Ratio

Discharge Time Variance Report

Provision of Floor Bed

In patient treated from BPL families

Medico-Legal Register

Dog Bite Register

Wards & Beds details

Non-functional ward/bed Updation of non-functional wards/beds

Functional ward/bed Updation of ward/bed coming functional

Daily Summary of Bed Occupancy

Web based availability of bed

Discharge summary updation on Central server

Uploading of Discharge Summary on Central Server

8. Main Pharmacy Stores

Sub-stores identification List of sub-stores

Rate Contract from CMSD Rate Contract Details

List of Suppliers of RC Purchase

List of Suppliers of Local Purchase

Medicine requisition Report – 3 months stock

Purchase of medicines/surgical items/ instruments

Purchase Order to Supplier

Receipt of Medicines/surgical items/instruments of RC items

Updation of Medicine Stock Ledger/Instrument Stock Book

Updation of Drug Expiry Register

Medicine indents from sub-stores Indent Register – Sub-stores

Issue to sub-stores Daily updation of Stock Ledger

Petty Issue Daily updation of Stock Ledger

Reversal of issue Daily updation of Stock Ledger

Medicine Return to Supplier Goods Return Note; Updation of Stock Ledger

Medicines/surgical items consumption analysis

Bills from Supplier Updation of Bill Register

Payment to Supplier Updation of Bill Register

Medicine transfer to other Updation of Stock Ledger

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hospital

Discarding Expired Medicines Updation of Stock Ledger

Age-analysis of drugs/ surgical items

Purchase Order for Local Purchase

Purchase Order

Receipt of Medicines/surgical items from Local Purchase

Updation of Local Purchase Stock Ledger

Issue of Medicines/surgical items from Local Purchase



Purchase Committee Meeting Purchase Committee Meeting Minutes’ Register

Stock verification Stock verification report

Local Purchase Register

RC Purchase Register

9. Accounts Section Paybill Register

Casual Bill Register

P.O.L. Register

Telephone Register

T.A. Bill Register

11c Register

Pay & Allowance Register

Advance Control Register

Income Tax Deduction at Source

G.P.F. Advance

G.P.F. Ledger

Treasury Bill Register

Cash Book

Cheque Register

Cash Receipt Register

Pay slip to employee

Form 16 to employee

Audit observation & compliance Register

10. Establishment Joining of doctor/staff Updation of joining

Joining/relieving details to Treasury

SMS alert to concerned employee/Reporting Officer on joining/relieving as well as not on joining/relieving

Relieving of doctor/staff Updation of relieving

Request for Long leave Updation of Long leave

Promotion/resignation/retiring Updation of promotion/ resignation/retiring

Request for Earned Leave Updation of Earned Leave

Medical Claim Re-imbursement Claim approval

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Training Updation of training course undergone

Retirement benefits

Employees retiring in next xx months

Foreign travel Updation of foreign travel

Two children increment Updation of increment

ACR received List of ACRs not received

Sanctioned posts for each facility/ Office

Sanctioned vs Actual (each position) on employees/ doctors

List of positions for which employees are more than the sanctioned strength

List of positions for which employees are less than the sanctioned strength

Change of address/mobile Updation of current residential address/mobile

Employees posted in District Jail, Police Hospital, NOIDA, etc.

Employees working in facilities/Offices other than of Directorate

Initiation of disciplinary action Updation of Employee record

Conclusion of disciplinary action Updation of Employee record

Caste change List of employees who have changed Caste

Marital status change List of employees whose marital status had changed

Request for NOC for Passport NOC for Passport

Updation of Passport information List of employees having passport

11. MIS Section MIS preparation MIS

Health Report Card

12. HelpDesk To provide information asked by a Patient

Information on resources

Information display Information on medicines

Information on doctors

Information on wards occupancy

User charges for Lab tests & in-patient facilities

13. Patient Complaint Registering of complaint from patient

Patient control Register

Complaint redressed Updation of Patient Control Register

Summary of complaints & redressal

14. Equipment Maintenance

Purchase of Equipment Equipment Details, including Warranty

Fault & Repair of Equipment Details of fault, repair and

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costs

Annual Maintenance Contract AMC details

Monthly utilization Utilisation in terms of tests, km, hours run

List of equipment not in use – age-analysis

15. Day-end Operations

Uploading of data on Central Server

Day-end Reports – Daily performance reports

16. Switch over to and from Manual system

If the system fails, then provision to continue operations manually and resumption, once the system comes to normal operations

Operating procedures

The District Hospital shall have a Local Area Network. It is a business critical system. There

shall be a provision for uploading of discharge summary of in-patients as well as MIS related

parameters at the Central Server.

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CMO/Divisional Office







1. Main Pharmacy Stores

CHC/BPHC and PHC identification

List of sub-stores


Setting up of Re-order level Medicine/Surgical items requisition Report – 3 months stock

Purchase of medicines/surgical items

Purchase Order to Supplier

Receipt of Medicines/surgical items of RC items


Updation of Drug Expiry Register

Medicine indents from CHC/BPHC and PHC

Indents Register Updation

Issue to CHC/BPHC and PHC; Daily updation of Stock Ledger; Updation of Indents Register; Delivery Challan

Medicine Return from CHC/ BPHC and PHC

Daily updation of Stock Ledger

Medicine Return to Supplier Goods Return Note; Updation of Stock Ledger

Bills from Supplier Updation of Bill Register

Payment to Supplier Updation of Bill Register

Medicine transfer to other hospital/CMO


Discarding Expired Medicines Updation of Stock Ledger

Medicines/surgical items consumption analysis

Age-analysis of drugs/ surgical items

Purchase Order for Local Purchase

Purchase Order

Receipt of Medicines/items from Local Purchase


Issue of Medicines/items from Local Purchase



Purchase Committee Meeting Purchase Committee Meeting Minutes’ Register

Stock verification Stock verification report

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Local Purchase Register

RC Purchase Register

2. Accounts Section Paybill Register

Casual Bill Register

P.O.L. Register

Telephone Register

T.A. Bill Register

11c Register

Pay & Allowance Register

Advance Control Register

Income Tax Deduction at Source

G.P.F. Advance

G.P.F. Ledger

Treasury Bill Register

Cash Book

Cheque Register

Cash Receipt Register

Pay slip to employee

Form 16 to employee

Audit observation & compliance Register

3. Establishment Joining of doctor/staff Updation of joining

Joining/relieving details to Treasury

SMS alert to concerned employee/Reporting Officer on joining/relieving as well as not on joining/relieving

Relieving of doctor/staff Updation of relieving

Request for Earned Leave Updation of Earned Leave

Request for Long leave Updation of Long leave

Duty for court evidence of doctors Court Evidence occupation Report

Promotion/resignation/retiring Updation of promotion/ resignation/retiring

Transfer of employee other than doctor

Transfer Order

Medical Claim Re-imbursement Claim approval

Training Updation of training course undergone

Retirement benefits

Employees retiring in next xx months

Two children increment Updation of increment

Foreign travel Updation of foreign travel

ACR received List of ACRs not received

Sanctioned posts for each facility/ Office

Sanctioned vs Actual (each position) on employees/

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doctors

List of positions for which employees are more than the sanctioned strength

List of positions for which employees are less than the sanctioned strength

Change of address/mobile Updation of current residential address/mobile

Employees posted in District Jail, Police Hospital, NOIDA, etc.

Employees working in facilities/Offices other than of Directorate

Initiation of disciplinary action Updation of Employee record

Conclusion of disciplinary action Updation of Employee record

Caste change List of employees who have changed Caste

Marital status change List of employees whose marital status had changed

Request for NOC for Passport NOC for Passport

4. MIS Section Monthly Progress Report from CHC/BPHC and PHC

Monthly Progress Report

Progress of National/Other Programme

- NRHM - RSBY - EMTS - NVBDC - MCTS - RTBCP - NBCP - NLEP - NACO - IDSP - Family Welfare - 20 point program - UIP & CHP - Dr.R.M.L.S.G.Y

National/Other Programme Reports

Progress of Construction projects Construction projects progress Reports

Status of infrastructure, Vehicles and Equipment

Infrastructure, Equipment & Vehicle Maintenance Reports

SMS on few parameters from CHC/ BPHC and PHC

Daily Progress Report (OPD/ IPD/Operations/Deliveries/ Tests conducted/any shortage of drug/doctors absent/staff absent)

Health Report Card

Block-wise Village-wise coverage of CHC/BPHC, PHC and Sub-

Block-wise Village-wise coverage of CHC/BPHC,

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Centres PHC & Sub-Centres & population

Facilities with OT without any Major/Minor Surgery in a month

Facilities with OT having no Anesthetist or Surgeon

Facilities with Gynecologist having no Anesthetist or vice versa

Surgeons posted in Facilities without OT

5. Legal Cases New Legal Case details Entry of Legal Case

Progress of hearing Updation of due date of hearing

Updation of brief of hearing/ status

List of legal cases pending in different courts

List of cases due for hearing in xx days

List of cases with no updation of hearing details

Judgement – Interim Order List of cases with Interim Orders

Judgement – Final Order List of cases with Final Orders

Category-wise list of cases – Service Matter, Payment, Policy, Others

Compliance made List of cases which require compliance in xx days

List of cases where compliances have been made

List and details of Standing Counsels

Scanning & retention of Judgement

Retrieval of judgement of a case

6. Health GIS Display of performance indicators

Population density wise spatial analysis of facilities

Specialisation wise spatial analysis of doctors

Infrastructure/Equipment wise spatial analysis

Equipment and technician wise spatial analysis

Gap analysis of resources

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Consumption/Stock of drugs, medicines and items

Epidemic analysis

Connectivity of facilities

7. Equipment Maintenance

Purchase of Equipment Equipment Details, including Warranty

Fault & Repair of Equipment Details of fault, repair and costs

Annual Maintenance Contract AMC details

Monthly utilization Utilisation in terms of tests, km, hours run

List of equipment not in use – age-analysis

The entire data shall reside on the Central server.

25

Cells of Directorate of Medical & Health, U.P.

Cells in the Directorate are as given below:

S.No. Cell Function

1 Administration looks after Establishment (Human Resources) related issues of Level 4 and above Officers like salary, pension & gratuity, complaint, legal, leave applications, leave encashment, GPF, foreign travel & passport, benefits at the time of retirement, interest on gratuity, one increment for officer with two children, etc. 2000-2500 officers are at Level 4 and above.

2 AES/Epidemic Acute Encephalitis Syndrome/Epidemic reporting

3 Birth & Death

4 Central Medicine Stores Department (CMSD)

Carries out activities for Rate Contract of medicines, drugs, instruments, equipment and other items for Directorate as well as all Field Offices. Rate Contract is generally for a duration of one year. This Cell does not purchase any medicines. It does not maintain any stocks except to items received from Govt. of India. There are two Joint Directors for medicines, two for instruments and one for General Administration.

5 CHC/PHC looks after the establishment of Community Health Centres (CHC) / Block Primary Health Centres (BPHC) and Primary Health Centres (PHCs/NPHCs) in the Directorate. This includes creation of posts in CHCs/BPHCs/PHCs/NPHCs, budget proposal, norms for CHC/BPHC/NPHC and monitoring of operations in CHC/ BPHC/ NPHC.

6 Chief Audit Officer

7 Confidential To maintain Annual Confidential Records of L1, L2 and L3 Officers.

8 Construction looks after the construction of facilities and offices in the Directorate. Projects are awarded to different Agencies. The Cell receives progress report from these Agencies and consolidates. One Assistant Engineer is posted in each Division and 1 Junior Engineer is posted in each District. They are responsible for maintenance work, quality control, verification of work and reporting the progress to the Directorate.

9 Co-ordination To co-ordinate between the State Government and different Cells in the Directorate. Chief Minister’s as well as public representatives references received in the Directorate are marked to various Cells. It receives about 10 letters per day.

10 Control Room

11 Dental

12 EDP/Computer To maintain the Establishment records of Doctors on PIS system developed by NIC; generates reports for Karmik Cell and Administration Cell related to doctors. There are about 90,000 records in the database including doctors, paramedical

26

staff and other staff. This data needs to be cleansed to handle retired/expired/absconding employees. As the data is basic, other relevant fields are to be appended with each record. P1 data was not made available by all facilities/offices and needs to be updated/ augmented.

13 Electric & Mechanical Involved in maintenance of equipment and vehicle. For equipment, CMO/CMS is authorized to approve maintenance upto Rs.20,000. For maintenance above Rs.20,000, technical sanction is required and budget is issues for the same. For annual maintenance of equipment, budget is allotted to Field Offices. At headquarter, inventory of equipment available and its status (condemnable, functional, shut down) in field offices is not available. For vehicle repair, CMO/CMS has power upto Rs.10,000, Additional Director upto Rs.15,000 and Director General upto Rs.25,000. For repair above Rs.25,000, approval from Transport Commissioner is required. For Electrical repair, Technical Sanction is required above Rs.10,000. There is an Electrician in each hospital to maintain generator as well. Details of equipment in each hospital should be available in this Cell. The establishment function of drivers is handled at Headquarter. Against sanctioned strength of 2181 drivers, only 1759 drivers are in position.

14 Eye

15 Female

16 Finance Controller Involved in budget preparation, allotment and control. Demand is received from Field Offices through letters for budget planning.

17 Headquarter

18 Headquarter periphery

19 Health

20 Karmik looks after Establishment (Human Resources) related issues of Level 1 to Level 3 Officers like salary, pension & gratuity, complaint, legal, leave applications, leave encashment, GPF, foreign travel & passport, benefits at the time of retirement, interest on gratuity, one increment for officer with two children, etc. 9000 officers are at Level 1, 2 and 3.

21 Legal

22 Leprosy

23 Malaria

24 Medical Care

27

25 Monitoring To collect data from Field Offices periodically as well as on ad hoc basis, consolidate and present; To send directions to Field Offices on behalf of DG M&H on email

26 National Programs

27 NPPCD

28 Paramedical looks after Establishment (Human Resources) related issues of Para-medical class 3 and class 4 staff like salary, pension & gratuity, complaint, legal, leave applications, leave encashment, GPF, foreign travel & passport, benefits at the time of retirement, interest on gratuity, one increment for staff with two children, etc. Applications from staff are received and handled. File of each employee are maintained at District level as well as Directorate. At Directorate, the distribution of work is in six clerks – LT, Pharmacist, Chief Pharmacists, Dark Room Assistant, Others like Physiotherapist and Dispatch.

29 Planning & Budget involved in monitoring of construction, 5 years plan, annual plan, Integrated Action Plan & Flagship Program being run in three districts, Mirzapur, Sonebhadra and Chandauli, Special packages like Bundelkhand and monthly reports on National Programs. These reports are forwarded to the State Govt.

30 Radiology

31 Records

32 RTI

33 SHI

34 Stores

35 TB

36 Training

37 Transport

Cells of Directorate of Family Welfare, U.P.

S.No. Cell Function

1 Administration

2 Immunisation

3 Mother & Child Care

4 Family Welfare

5 Reproductive & Child Health Program

6 Construction

7 Finance

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Performance Requirements

The system has to ensure availability of information to various stakeholders, from Government

to citizen through Directorate, Additional Directors, Chief Medical Officers, Chief Medical

Superintendants, MS, MOIC, Officers and employees of Directorates.

The system shall facilitate implementation of process based system with report generation as a

by-product.

The System Integrator has to design and develop the system to facilitate the following:

S.No. Location Users per location

No. of locations

1. State Govt. 24 1

2. Directorate of Medical & Health 150 1

3. Directorate of Family Welfare 35 1

4. NRHM, UP 20 1

5. Additional Directors 10 18

6. Chief Medical Officers 20 75

7. District Hospitals – bed capacity varies from 30 to 646

25 157

8. Optional – District Hospitals – On-line OPD Prescription – Maximum no. of OPD Chambers are 35

25 157

9. CHC/BPHC – Monthly Progress Report and Daily performance on IVRS/SMS

1 773

10. PHC – Monthly Progress Report and Daily performance on IVRS/SMS

1 3692

Volume of transactions:

S.No. Parameter Value

1 Number of employees 80,000

2 Number of doctors in District Hospitals 3,500

3 Average number of OPD patients per day in District Hospitals 1,50,000

4 Average number of patients to which drugs distributed per day

in District Hospitals

1,50,000

5 Average number of Lab tests conducted every day in District

Hospitals

15,000

6 No. of beds in District Hospitals 19,941

7 Average Bed Occupancy Rate in District Hospitals 100%

8 Average number of Surgeries per day in District Hospitals 2,000

Growth in number of transactions in facilities can be estimated to grow at 20% per annum.

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Following applications shall reside on Central server:

1. Health Management Information System (including Legal information System,

Equipment Maintenance System)

2. Health Geographical Information System

3. Personnel Information System

4. Central Medicine Stores Department

5. Financial Management System

6. Discharge summary of Inpatients.

Hospital Information Management System shall be operational at District Hospitals on Local

area Network. There would be provision for uploading of daily HMIS parameters and Discharge

Summary of Inpatients at the End of the Day.

Block Primary Health Centres/Community Health Centres and Primary Health Centres shall

enter Monthly Progress Report on Central Server. In addition, these facilities shall send their

daily performance on few parameters using IVRS/SMS.

Personnel Information System, Central Medicine Stores Department, Financial Management

System and Hospital Information Management System shall be process based system.

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Annexure-1

Department of Medical, Health and Family Welfare, UP – Setup

Lucknow Secretariat } } Lucknow } 1.Tulsi Ganga Complex } 2. J.N.Road } 3. Swasthya Bhawan } . …. } Divisions Districts

Block

Area with population of 30,000

Village

State

Government

DG, M&H

Cell 1 Cell 2 Cell n

NRHM

Chief

Medical

Officer

District

Hospital

Block Primary

Health Centre

Primary Health

Centre

Sub Centre

DG, FW

AD

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Annexure-2

Current IT based Information System

Location Current IT based Information System

Directorate – Finance Budget Control System Developed by: NIC Environment: Web based Operating System: Local host Database: MS SQL Server Front-end: .Net

Directorate – Administration & Karmik

Personnel Information System (PIS) to maintain transfer/posting details of doctors Developed by: NIC Environment: Web based Hosted at: NIC Data Centre Database: MS SQL Server Front-end: .Net End-user: EDP Cell updates for Administration, Karmik and Para-medical Cell The system has records of 90,000 employees

Directorate – National Programs

Reporting systems of different National Programs

Directorate – All sections Desktops provided in all Cells for wordprocessing, Spreadsheet and email

Additional Director (Divisional Office)

a. Uses PIS software for joining and relieving of doctors b. Desktops used for wordprocessing, spreadsheet and email of progress reports; primarily for MIS reports

Chief Medical Officer (at District)

a. Uses PIS software for joining and relieving of doctors b. Medicine inventory software developed by NIC c. Desktops used for wordprocessing, spreadsheet and email of progress reports; primarily for MIS reports

Chief Medical Superintendent (at District Hospital)

a. Uses PIS software for joining and relieving of doctors b. Medicine inventory software developed by NIC c. Few District Hospitals have Patient Registration System d. Rashtriya Swasthya Bima Yojana (RSBY) e. Desktops used for wordprocessing, spreadsheet and email of progress reports; primarily for MIS reports f. Laboratories may also have computer associated with the equipment

Community Health Centre (CHC) / Block Primary Health Centre (BPHC)

a. Desktop used for wordprocessing, spreadsheet and email of progress reports; b. HMIS application of NRHM c. RSBY d. JSY

Primary Health Centre (PHC) a. Desktop used for wordprocessing, spreadsheet and email of progress reports; b. HMIS application of NRHM c. RSBY d. JSY

functional requirement of integrated health …uphealth.up.nic.in/pdf/functional requirement.pdf ·...

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