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REPORT ON EMPLOYEE HEALTH MANAGEMENT SYSTEM

SUMMER PLACEMENT IN HINDUSTAN PETROLEUM CORPORATION LIMITED

NEW DELHI

INTERNATIONAL INSTITUTE OF HEALTH MANAGEMENT RESEARCH (IIHMR) NEWDELHI

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SUBMITTED BY:

Dr. AMRITA SINGH

PGD HEALTH AND HOSPITAL MANAGEMENT

IIHMR DELHI


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Name of the Organization: Hindustan Petroleum Corporation Limited

Address : HPCL POL-Terminal, NH-8, Tikri Kalan, New Delhi-41

&

HPCL SHAKURBASTI INSTALATION

Duration of Training : APRIL 4th 2012 – JUNE 5th 2012.

Name of Project : EVALUATION OF EMPLOYEE HEALTH

MANAGEMENT SYSTEM

Department : TIKRI KALAN & SHAKURBASTI TERMINAL

Training Manager : SHRI KAMAL KUMAR


TABLE OF CONTENT

ACKNOWLEDGEMENT……………………………………………..……….5

THE ORGANIZATION……………………………………………..…………6

ORGANIZATION PROFILE...............................................................................7

EXECUTIVE SUMMARY……………….…………………………..……………8

INTRODUCTION…………………….………………………………..…………..9

STUDY OBJECTIVES……………..………..…………………………..……..…10

RATIONALE……..……………..…………………………………….….……….10

REVIEW OF LITERATURE…………..………………………..…….………….11

SAMPLE SIZE………………………………………..…………….…………..…16

METHODOLOGY…………………………………………………..……………….17

DETAILED STUDY OF EHMS AT HPCL………………………….…………..…22

ANALYSIS AND GENERAL FINDING………………………………..…………33

DISCUSSION…………………………………………………………………….....41

RECOMMENDATION…………………………………………………………..…48

LIMITATIONS……………………………………………………………………...48

CASE STUDY………………………………………………………………………51

BIBLIOGRAPHY……………………………………………..……………….……73


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LIST OF FIGURES

Figure 1.1 AGE DISTRIBUTION OF RESPONDENTSFigure 1.2 SATISFACTION WITH THE UPKEEP OF RECORDSFigure 1.3 MONITORING VITAL STATISTICSFigure 1.4 MAJOR ADVANTAGES OF EHMSFigure 1.5 AMOUNT OF HEALTH INSURANCEFigure 1.6 AGE AND NATURE OF WORKFigure 1.7 AGE AND AWARENESS OF EHMSFigure 2.1 BAR CHART OF NATURE OF JOB WITH INSURANCEFigure 2.2 BAR CHART OF NATURE OF JOB WITH AWARENESSFigure 2.3 AGE DISTRIBUTIONFigure 2.4 MEASURING THE VITALSFigure 3.1 HOURS SPENT OF INTERNETFigure 3.2 BAR DIAGRAM FOR COST-EFFECTIVENESSFigure 3.3 BAR DIAGRAM FOR SAVING TIME

LIST OF TABLES

Table 2.1 FREQUENCY TABLE OF AGETable 2.2 FREQUENCY TABLE OF GENDERTable 2.3 CROSS TABLULATION OF NATURE OF JOB AND INSURANCETable 2.4 CROSS TABULATION OF NATURE OF JOB AND AWARENESSTable 2.4 AGE DISTRIBUTION OF THE EMPLOYEESTable 2.5 MEASURING THE VITALSTable 3.1 NUMBER OF HOURS SPENT ON INTERNETTable 3.2 COST- EFFECTIVENESSTable 3.3 SAVING TIME


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ACKNOWLEDGEMENTS

I avail this opportunity to express my profound sense of sincere and deep

gratitude to those who have played an indispensable role in the accomplishment

of the project work given to me by providing their willing guidance and help.

Firstly, I express my sincere gratitude to Mr. Chhater Singh-Chief Manager,

HPCL-POL Terminal, Tikri-Kalan, New Delhi 110041 Delhi for allowing me to

carry out the project work in this Prestigious Organization and gain valuable

experience.

I am greatly indebted to Mr. Kamal Kumar Senior Installation Manager

Shakurbasti Terminal & Ms. Saroj Sharma Operations Officer for their support,

constant encouragement, consistent guidance and inspiration throughout the

project. Their constant interaction, expert guidance has helped me in learning

the whole system prevailing in the organization.

I am greatly indebted to Mr. A. K. Behra Manager Projects & Mr. Prabudh Jain

Project Engineer for their support, & consistent guidance throughout the project.

Their constant interaction & valuable suggestions helped me to complete this

project successfully.


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The Organization

HPCL is a Fortune 500 company having about 20% marketing share in India

and a strong market infrastructure throughout the country, company is one of

the major integrated oil refining and marketing companies in India. It is a Mega

Public Sector Undertaking (PSU) with Navaratna status.

Organization Profile

HPCL is a Fortune 500 company, with an annual turnover of Rs.

1,08,599 Crores and sales/income from operations of Rs 1,14,889

Crores (US$ 25,306 Millions) during FY 2009-10, having about 20%

Marketing share in India and a strong market infrastructure.

Consistent excellent performance has been made possible by highly

motivated workforce of over 11,360 employees working all over India

at its various refining and marketing locations.

I have taken up two marketing location to study the effectiveness of

health management system in HPCL & submitting my offering for

improvement in the system.


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I have taken up two marketing location to study the effectiveness of employee

health management system in HPCL & offering improvement in system.

1. Tikrikalan Terminal

2. Shakurbasti Terminal

Tikri Kalan terminal is under construction whereas the Shakurbasti Terminal is

an operative terminal. There are more than 100 permanent employee working

in these location.


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Executive Summary

Health promotion programs have been in place within the employer sector since

the mid-1980s. Historically, the primary focus for health plans has been quality

medical services delivery with the hope of reducing costs. More recently, the

role of the health plan has been enhanced with the addition of health

management tools and programs. In general, the scientific evidence favors the

multidisciplinary care coordination model as most appropriate and effective

within the health plan environment. Multidisciplinary programs show

documented improvements in clinical outcomes and cost savings through

reduced hospitalizations. These EHM programs are defined as: health

promotion, self-care, disease management, and case management programs.

Thats why companies have jumped on the health and wellness wave,

understanding that keeping their employees healthy helps their bottom-line. In

HPCL like organization, employees are well inclined and predetermined. The

company members are often prepared about their health. Employees were cent

percent aware and very keen regarding their health. Organization provides more

than Rs 10 lacs of insurance to their employees who are working in field and Rs

7-10 lacs of insurance to those who work on tables.


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http://www.allbusiness.com/management/4102150-1.html



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INTRODUCTION TO EHMSEmployees are the most important element of every business. Their

contributions play a significant role in determining the success of any

organization. The contravention within an administration is to promote a culture

that promotes a high-performing workplace.

Maintaining healthy employee in an organization is a pre-requisite for

organizational success. Healthy employees are required for high productivity

and human satisfaction. Employee health depends upon healthy and safe work

environment, cent percent involvement and commitment of all employees,

incentives for employee motivation, and effective communication system in the

organization. Healthy employees lead to more efficient, motivated and

productive employees which further lead to increase in sales level.

Successful companies realize the positive results realized from proven health

promotion and wellness strategies motivate employees to become better

healthcare decision makers, effectively reducing benefit money spent.

That’s why companies have jumped on the health and wellness wave,

understanding that keeping their employees healthy helps their bottom-line.

These days, it’s an oddity if an employer hasn’t encouraged participation in

a wellness program, encouraged employees to eat less trans-fat, eat more whole

foods, exercise thirty minutes a day, take time for relaxation, etc.

Websites like http://www.ehms.com provides online solution and management

of the health records. Hence even employees are getting more conscious and

updated regarding their health and inscribed themselves in various activities.


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http://www.ehms.com/

http://www.thedailymind.com/stress/100-ways-to-relax-unwind-and-loosen-up/

http://www.mayoclinic.com/health/aerobic-exercise/EP00002

http://en.wikipedia.org/wiki/Whole_foods

http://en.wikipedia.org/wiki/Whole_foods

http://www.americanheart.org/presenter.jhtml?identifier=3046430

http://health-insurance.suite101.com/article.cfm/workplace_wellness_programs

http://www.allbusiness.com/management/4102150-1.html


Study Objectives

è Evaluation of execution of EHMS in HPCL

è Ascertaining employee awareness of EHMS in HPCL

è Creating orientation of employees towards effective EHMS in HPCL

Rationale

This study fundamentally aims to examine the EHMS in HPCL at two

locations where the system had been already implemented. This study

also includes company medical policies and benefits, health promotion,

wellness and fitness programs, industrial safety.

Also, the understanding and sustainability of an integrated health system

is as well included in the study. If employees aren't aware of their

employers' programs and how to participate, health behaviors won't

change. This is a traditional problem with how employee health and

wellness has historically been done.


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Review of Literature

I. Financial Impact of Employee Health Management Programs:

Studies were published after 2004. The delimiter of excluding articles

published before 2005 is derived from our observation that relevant

review articles and EHM related studies prior to this date were an

amalgam of worksite wellness or disease prevention-oriented programs.

The EHM programs evaluated in more recent studies have expanded to

include targeted disease management programs that have been integrated

with traditional worksite wellness offerings.

II. A review on systematic reviews of employee

health information system studies:

The purpose of this review is to consolidate existing evidence from

published systematic reviews on

employee health information system (EHIS) evaluation studies to inform

EHIS practice and research. Fifty reviews published during 1994-2008

were selected for meta-level synthesis. These reviews covered five areas:

medication management, preventive care, health conditions, data quality,

and care process/outcome. After reconciliation for duplicates, 1276 EHIS

studies were arrived at as the non-overlapping corpus. On the basis of a

subset of 287 controlled EHIS studies, there is some evidence for


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improved quality of care, but in varying degrees across topic areas. For

instance, 31/43 (72%) controlled EHIS studies had positive results using

preventive care reminders, mostly through guideline adherence such as

immunization and health screening.

III. Healthcare professionals' organizational barriers

to health information technologies:

This systematic literature review was carried out during December 2009

and January 2010. Additional on-going reviews of updates through

automated system alerts took place up until this paper was submitted. A

total of thirty-one sources were searched including nine software

platforms/databases, fifteen specialized websites/targeted databases,

Google Scholar, ISI Science Citation Index and five journals hand-

searched.

Results: The study covers seventy-nine articles on organizational barriers

to ICT adoption by healthcare professionals. These are categorized under

five main headings - (I) Structure of healthcare organizations; (II) Tasks;

(III) People policies; (IV) Incentives; and (V) Information and decision

processes. A total of ten subcategories are also identified. By adopting an

organizational management approach, some recommendations to remove

organizational management barriers are made.


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IV. Health Resource Information System for Health (HRIS):

The attainment of the health-related Millennium Development Goals

relies on countries having adequate numbers of wellness resources

for health and their appropriate distribution, global understanding of

the systems used to generate information for monitoring health resources

stock and flows, known as human resources information systems for

health (HRIS), is minimal. While HRIS are increasingly recognized as

integral to health system performance assessment,

baseline information regarding their scope and capability around the

world has been limited. We conducted are view of the

available literature on HRIS implementation processes in order to draw

this baseline.

Results: Ninety-five articles with relevant HRIS information were

reviewed, mostly from the grey literature, which comprised 84 % of all

documents. The articles represented 63 national HRIS and two regionally

integrated systems. Whereas a high percentage of countries reported the

capability to generate workforce supply and deployment data,

few systems were documented as being used for HRH planning and

decision-making. Of the systems examined, only 23 % explicitly stated

they collect data on workforce attrition. The majority of countries

experiencing crisis levels of HRH shortages (56 %) did not report data

on health worker qualifications or professional credentialing as part of

their HRIS.


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V. Impacts of e-health on the outcomes of care in low- and middle-

income countries: where do we go from here?

E-health encompasses a diverse set of informatics tools that have been

designed to improve public health and health care. Little information is

available on the impacts of e-health programmes, particularly in low- and

middle-income countries. We therefore conducted a scoping review of the

published and non-published literature to identify data on the effects of e-

health on health outcomes and costs. The emphasis was on the

identification of unanswered questions for future research, particularly on

topics relevant to low- and middle-income countries. Although e-

health tools supporting clinical practice have growing penetration

globally, there is more evidence of benefits for tools that support clinical

decisions and laboratory information systems than for those that support

picture archiving and communication systems.

Community information systems for disease surveillance have been

implemented successfully in several low- and middle-income countries.

Although information on outcomes is generally lacking, a large project in

Brazil has documented notable impacts on health-system efficiency.

Meta-analyses and rigorous trials have documented the benefits of text

messaging for improving outcomes such as patients' self-care. Automated

telephone monitoring and self-care support calls have been shown to

improve some outcomes of chronic disease management, such as


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glycaemia and blood pressure control, in low- and middle-income

countries. Although large programmes for e-health implementation and

research are being conducted in many low- and middle-income countries,

more information on the impacts of e-health on outcomes and costs in

these settings is still needed.

VI. Do employee health management programs work?

Current peer review literature clearly documents the economic return and

Return-on-Investment (ROI) for employee health management (EHM)

programs. These EHM programs are defined as: health promotion, self-

care, disease management, and case management programs. The

evaluation literature for the sub-set of health promotion and disease

management programs is examined in this article for specific evidence of

the level of economic return in medical benefit cost reduction or

avoidance. The article identifies the methodological challenges associated

with determination of economic return for EHM programs and

summarizes the findings from 23 articles that included 120 peer review

study results. The article identifies the average ROI and percent health

plan cost impact to be expected for both types of EHM programs, the

expected time period for its occurrence, and caveats related to its

measurement.


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Sample sizeFor the base line study, two locations of HPCL were chosen. First being the Tikrikalan Terminal at tikri border New Delhi and other being the Shakurbasti Terminal in New Delhi.

Calculation of the sample size:

ss =Z 2 * (p) * (1-p)

c 2

Where:

Z = Z value (confidence level) p = percentage picking a choice, expressed as decimal c = confidence interval, expressed as decimal

In my research study I considered:

Confidence level as 95%,

Confidence interval as 10 and,

Percentage of 50,

Hence the sample size is 50.


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METHODLOGY

Departmental/ sectionalwise orientation

Orientation of administrators for EHMS

Distribution of the questionnaire

Forms collection

Data compiling

Detailed study of EHMS at HPCL

Analysis/inference

Recommendation

Final Presentation


Employees are categorized into three segments:

1. Managerial Segment

2. Non-managerial Segment

3. Service assistant/labor Segment


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Managerial Segment

Non-managerial Segment

Service Assistant Segment


Methodology

1. Departmental/section wise orientation towards the EHMS:

I have covered study and analysis of two locations which covered Tikri kalan

and Shakurbasti Terminal thus departments like production, project, human

resource, operation, finance, information technology, etc were informed.

2. Orientation of administrators for EHMS

A Power Point presentation was made abbreviating about Health, Information

Technology and EHMS. A detailed presentation was carried out for the

employees signifying the importance of EHMS in the organization and its

benefits for maintaining a healthy workforce and general betterment of the

employees. Response of the employees was encouraging in general but few

were enquiring on the general concept of health management in other

organizations.

Presentation on EHMS and its effective implementation in the organization

Few key points of the presentation are given below:


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BENEFITS of EMHS

Benefits to Physicians:

Reduced overhead costs due to streamlined efficiencies

Billing claims are checked prior to submission to reduce rejections and

errors

Browser-based means anytime, anywhere access (Office, Nursing Home,

or home)

Access through any device (handheld, tablet, laptop, desktop)

Electronic/Paperless Employee Health Record

Benefits to Office Staff

Minimal time to enter patient information and easy retrieval of patient

information

Billing has never been easier

Provide patient information at the click of a button

Privacy and Security of the patient's personal information is ensured

Lower healthcare cost trends


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3. Distribution of questionnaire/declaration formsA questionnaire on State of Employee Health Management System

(EHMS) was circulated among the employees and was asked to fill-up

the questionnaire form for scrutiny.

Sample of the declaration form is attached in last of the report.

4. Forms collection

The filled up forms were collected and inputs were assembled for further

analysis of the data.

5. Data compilingThe opinion regarding EHMS was arranged and transferred to SPSS and

Microsoft Excel for the further analysis.

6. Detailed study of EHMS at HPCL

a. Periodical medical examination

b. Health portal

c. Occupational health centers

d. Physicians and pharmacist

e. Personal safety

f. Employee training-training conducted on safety

g. Medical insurance of all employees through NIAC- limits


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Detailed study of EHMS at HPCL:

a. Periodical medical examination:

Yearly health check-up for hazardous locations like terminals, depots,

LPG plant, etc. for all employees, once in three years in non-hazardous

locations like Head offices Zonal office & Regional Office. Compulsory

annual examination of employees of more than 50 years of age.

b. Health portal:

Maintaining of health records like ECG reports, blood-sugar, lipid profile

report of all the employees on the portal. The report can be viewed/access

by the employees as and when required using their employee id and

password. Thus the information is safe protected.

c. Occupational health centers:

An occupational health centers with trained physicians and pharmacist is

available in all the factory locations of HPCL. The employees can

undergo free of cost consultation from the physician.

d. Physician and pharmacist:

Weekly visit of the general physician and check up of the employees and

consultation if required.


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e. Personal safety:

Emergency medical kit with all essential medicines, stretcher, Personal

Protective Equipments (PPE) like safety belt, safety shoes, helmet,

goggles, hand gloves, oxygen cylinders, etc. are available at all time for

use in case of any emergency.

f. Employee training-training conducted on safety:

Initiative on employee training on health and safety are carried out from

time to time an example of first aid training imparted at Shakurbasti

Terminal on First Aid by National Safety Circle is attached below


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g. Medical insurance:

Medical insurance is through New India Assurance Company Ltd.

Nominal monthly contribution is given by the employees and employees

and their dependents are covered under this scheme. Employees can avail

medical benefits up to Rs 7 lack yearly per family member and Rs 15 lack

per family member for life time depending upon their eligibility.


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7. Analysis/inferenceThe data obtained was analyzed SPSS and Microsoft Excel was used to

determine the awareness level regarding EHMS.

8. RecommendationRecommendations were given for the outcome from the study.

9. Final presentationVarious dept. like safety, M&R, Purchase etc are there in these terminals.

Orientation towards EHMS was provided to all employees in these

departments and the employees were asked to attend the Presentation on

EHMS.

The general feedback from the employees in various sections was

positive and encouraging.


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A screenshot of the main website of Hindustan Petroleum Corporation Limited is taken.


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This is the wellness portal for the employees.


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After entering the wellness portal employees have to add their details for log in.


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This screenshot tell about the online medical claim system in the organization.


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This screenshot tell about the employee details and the general medical information considered.


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ANALYSIS AND GENERAL FINIDINGS

Age Distribution

There had been a wide range of age in the location. Study consists of division

into

a. 25-30

b. 31-35

c. 36-40

d. 41-45

e. 45-50

f. 51-55

g. 56-60Figure 1.1 AGE DISTRIBUTION OF RESPONDENTS

12%

16%

10%

24%

20%

14%

4%

Age Distribution

25-3031-3536-4041-4546-5051-5556-60


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Satisfaction with the upkeep of medical records

96% of the sample said ‘YES’ they were satisfied with their upkeep of

medical records.

Whereas only 4% of them were unsatisfied with their track of medical

records.

Figure 1.2 SATISFACTION WITH THE UPKEEP OF RECORDS

YES NO0

10

20

30

40

50

60

Satisfaction with the upkeep of records

Series1


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Monitoring medical vital statistics

86% of them said they keep healthy track record of their vital statistics.

And, 14% said they don’t keep a track of their vital statistics.

Figure 1.3 MONITORING VITAL STATISTICS

YES

NO

05

1015202530354045

Series1 7

Monitoring medical vital statistics

Axis Title


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Major advantages of EHMS

Six options were given to the employees to choose the advantages for the

EHMS.

a. Will save time

b. Reduce cost of care

c. Improve quality

d. Reduce errors in lab

e. Reduce errors in medication

f. Others (specify)

Majority i.e 33% of the employees said that it reduces errors in

medication.

27% said that it reduce errors in lab.

20% stated that it will improve the quality

13% stated that it reduces the cost of care

While 7% said that EHMS will save time


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Figure 1.4 MAJOR ADVANTAGES OF EHMS

7%

13%

20%

27%

33%

Major Advantages

12345


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Amount of health insurance

In this section five alternatives were given to the employees to opt for

their health insurance.

a. Rs 1-3 lacs

b. Rs 3-5 lacs

c. Rs 5-7 lacs

d. Rs 7-10 lacs

e. More than 10 lacs

48% of the employees have more than lack rupees insurance

30% of the employees have Rs 7-10 lacs rupees insurance

20% of the employees have Rs 5-7 lacs rupees insurance

Only 2% of them have Rs 3-5 lacs rupees insurance

Figure 1.5 AMOUNT OF HEALTH INSURANCE

1 2 3 4 5

0

5

10

15

20

25

AMOUNT OF HEALTH INSURANCE

Series1Series2

Axis Title

Axis Title


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Age and nature of work

Two type of job nature was being determined, Field and Table

Figure 1.6 AGE AND NATURE OF WORK

25-30 31-35 36-40 41-45 46-50 51-55 55-600

1

2

3

4

5

6

7

8

4 4

3

7 7

3

22

4

2

5

3

4

0

FIELD TABLE


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Age and awareness of EHMS

Cent percent awareness regarding EHMS within the employees was found

of every age group.

Figure 1.7 AGE AND AWARENESS OF EHMS

12%

16%

10%

24%

20%

14%4%

12%

16%

10%

24%

20%

14%

4%

AGE AND AWARENESS OF EHMS

25-3031-3536-4041-4546-5051-5556-60


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Discussion

The rationale of this study was to evaluate the EHMS in HPCL and to detect the awareness of the employees for the same.

Employees in HPCL have a broad age distribution and in this study they are sorted into seven groups:

i. 25-30ii. 31-35iii. 36-40iv. 41-45v. 46-50vi. 51-55vii. 56-60

Frequency Table

Table 2.1 FREQUENCY TABLE OF AGEAGE

Frequency Percent Valid Percent

Cumulative

Percent

Valid 1 6 12.0 12.0 12.0

2 8 16.0 16.0 28.0

3 5 10.0 10.0 38.0

4 12 24.0 24.0 62.0

5 10 20.0 20.0 82.0

6 7 14.0 14.0 96.0

7 2 4.0 4.0 100.0

Total 50 100.0 100.0

The result says that maximum group of employees belong to the 4th group i.e. 41-45 years of age group. Next group which has the most number of employees is 46-50 years.


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Table 2.2 FREQUENCY TABLE OF GENDERGENDER


Cumulative

Percent

Valid 1 46 92.0 92.0 92.0

2 4 8.0 8.0 100.0

Total 50 100.0 100.0

Gender percentage in HPCL is very extensive. 92% of the candidates of the study were male and only 8% of the candidates were female.The study has been divided into two types of nature of job. 1st is being the field and 2nd being the table job. With regard to insurance, the study is sorted into

i. Rs 1-3lacsii. Rs 3-5lacsiii. Rs5-7lacsiv. Rs 7-10lacsv. More than 10lacs


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Case Processing Summary

Cases

Valid Missing Total

N Percent N Percent N Percent

NATURE * INSURANCE 50 100.0% 0 .0% 50 100.0%


Table 2.3 CROSS TABLULATION OF NATURE OF JOB AND INSURANCE

NATURE * INSURANCE Crosstabulation

Count

INSURANCE

Total2 3 4 5

NATURE 1 0 1 7 22 30

2 1 9 8 2 20

Total 1 10 15 24 50

The outcome of the study came like 60% of the employees have field type of work and 40% have table work. 73.3% of the employees having field nature of job are having more than 10 lacs of insurance and 23% of the employees are having insurance between 7-10 lacs. While 45% of the employees having table nature of job are having 3-5 lacs of insurance and 40% of the employees are having insurance between 5-7 lacs.

Figure 2.1 BAR CHART OF NATURE OF JOB WITH INSURANCE


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This study also found that there is cent percent awareness regarding the EHMS. 100% of awareness is present in the employees with field as well as table type nature of job.

Table 2.4 CROSS TABULATION OF NATURE OF JOB AND AWARENESS

Figure 2.2 BAR CHART OF NATURE OF JOB WITH AWARENESS


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NATURE * AWARENESS Crosstabulation

Count

AWARENESS

Total1

NATURE 1 30 30

2 20 20

Total 50 50


The age of the employees in this study was grouped into 7 headings:

1. 25-30 years2. 31-35 years3. 36-40 years4. 41-45 years5. 46-50 years6. 51-55 years7. 56-60 years

Table 2.4 AGE DISTRIBUTION OF THE EMPLOYEESAGE


Cumulative

Percent

Valid 1 6 12.0 12.0 12.0

2 8 16.0 16.0 28.0

3 5 10.0 10.0 38.0

4 12 24.0 24.0 62.0

5 10 20.0 20.0 82.0

6 7 14.0 14.0 96.0

7 2 4.0 4.0 100.0

Total 50 100.0 100.0

Maximum employees with 24% belong to the 4th group i.e. between 41-45 years

of age. Next with 20%, employees belong to the 5th group i.e. 46-50 years.

Employees within 31-35 years of age constitute 16% and 51-55 years of age

group constitute 14%. 12% of the employees belong to 25-30 years of age group

and only 4% form the 7th group i.e. 56-60 years.


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Figure 2.3 AGE DISTRIBUTION

Table 2.5 MEASURING THE VITALS

VITALS


Cumulative

Percent

Valid 1 43 86.0 86.0 86.0

2 7 14.0 14.0 100.0

Total 50 100.0 100.0


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Figure 2.4 MEASURING THE VITALS

This study also let out the result regarding the measurement of the vitals. 86%

of the employees measured their vitals regularly while 14% of the employees

said they didn’t measure their vitals so regularly.


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Recommendations

Conversion of health record into personal health record

Achievability of uniform online communication

Coverage for the non-management employee

Better link data/information to resource allocation

Visiting Doctors should be more trained for EHMS

The employee health data should be easily communicable to the

incorporated hospitals

Limitation

Limited access to the non-managerial staff

Limited access about the data

Sample of the questionnaire is attached to the next page:


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Survey: EMPLOYEES HEALTH MANAGEMENT SYSTEM

Purpose and Scope

The objective of administering this questionnaire is to write a Whitepaper on State of Employee Health Management System (EHMS) through the collection and analysis of the views and inputs from the key stakeholders. A major strength of this whitepaper lies in the ability to display the challenges and opportunity in EHMS and ways for better health management and to transform the Healthcare in the HPCL with the use of Information Technology

By: Dr. Amrita Singh (Student of IIHMR)

1.0General

1.1 Name of the Respondent

1.2 Address

City

Contact numbers (with STD Code)

Email

1.3Age

1.4Gender

1,5Nature of job(Table/Field )

Signature of the Interviewers:(Note: please leave this blank if self executed)


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2.0 Maintenance of Electronic Health Record

2.1 Are you aware of Employee Health Management System

1. Yes2. No

2.2 Do you monitor your medical vital statistics periodically?

1. Yes 2. No

2.3 Are you satisfied with the upkeep of your physical health Records?

1. Yes 2. No

2.4 If no? Would you like to maintain your regular health records in electronic Information System?

1. Yes 2. No

2.5 If yes what has been the major advantages? a. Will saves timeb. Reduce cost of carec. Improve qualityd. Reduce errors in labe. Reduce errors in medicationf. Others (specify)

2.6 Do you believe that “ What health records get measured , gets improved”

1. Yes2. No

2.7 Would you like to monitor regular health records and maintain in EHMS?

1. Yes2. No

2.8 If No, Why?

3.0 Information on Health Insurance3.1 Do you understand the importance of Health

Insurance?1. Yes2. No

3.2 How many health insurance policies have your enrolled?

3. 20124. 2011 2. 2010 3. 2009 4. 2008

3.3 What is the amount insured for health insurance in your family

1. Rs. 1 – 3 lacs2. Rs.3 – 5 lacs3. Rs.5 – 7 lacs4. Rs.7 – 10 lacs5. More than 10 lacs

3.4 Do you think that Healthcare Insurance groups can leverage on IT to reduce the cost of healthcare?

1. Yes 2. No

3.5 Any further recommendation for the betterment of the system..


51


CASE STUDY

TELEMEDICINE IN DENTAL HEALTHCARE


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INTRODUCTIONTelemedicine is the use of telecommunication and information technologies in

order to provide clinical health care at a distance. It helps eliminate distance

barriers and can improve access to medical services that would often not be

consistently available in distant rural communities. It is also used to save lives

in critical care and emergency situations.

Telemedicine may be as simple as two health professionals discussing a case

over the telephone, or as complex as using satellite technology and video-

conferencing equipment to conduct a real-time consultation between medical

specialists in two different countries. Telemedicine generally refers to the use of

communications and information technologies for the delivery of clinical care.

Care at a distance (also called ''in absentia'' care), is an old practice which was

often conducted via post. There has been a long and successful history of in

absentia health care which, thanks to modern communication technology, has

evolved into what we know as modern telemedicine.

Telemedicine is employed in various segments of healthcare like

i. Telenursing

ii. Telepharmacy

iii. Telecardiology

iv. Telepsychiatry

v. Teledentistry

vi. Teleradiology

vii. Telepathology


53

http://en.wikipedia.org/wiki/Emergency_medicine

http://en.wikipedia.org/wiki/Trauma_(medicine)

http://en.wikipedia.org/wiki/Health_care

http://en.wikipedia.org/wiki/Information_technology

http://en.wikipedia.org/wiki/Telecommunication


STUDY OBJECTIVE

Review on the use of telemedicine in dental healthcare

Review of Literature

According to a study on Teledentistry-assisted, affiliated practice for dental

hygienists: an innovative oral health workforce model found that The 2010 U.S.

Patient Protection and Affordable Care Act (PPACA) calls for training

programs to develop mid-level dental health care providers to work in areas

with underserved populations. In 2004, legislation was passed in Arizona

allowing qualified dental hygienists to enter into an affiliated practice

relationship with a dentist to provide oral health care services for underserved

populations without general or direct supervision in public health settings. In

response, the Northern Arizona University (NAU) Dental Hygiene Department

developed a teledentistry-assisted, affiliated practice dental hygiene model that

places a dental hygienist in the role of the mid-level practitioner as part of a

digitally linked oral health care team. Utilizing current technologies, affiliated

practice dental hygienists can digitally acquire and transmit diagnostic data to a

distant dentist for triage, diagnosis, and patient referral in addition to providing

preventive services permitted within the dental hygiene scope of practice.

Another study on Reliability of Telemedicine Examination was conducted and

found that For ophthalmology, physical therapy, and cardiac auscultation,

91.2% of the conventional findings and 86.5% of the telemedicine findings

were identical or similar to the criterion standard. The kappa coefficient on

matched-pair analysis was 0.66. For pulmonary auscultation and reading of INTERNATIONAL INSTITUTE OF HEALTH MANAGEMENT RESEARCH (IIHMR) NEWDELHI

54


chest films with a telemedicine camera and monitor, abnormalities were

suppressed at default settings but subsequently revealed with extensive

manipulation of system settings. For tracings and images, both conventional and

telemedicine findings showed 92% reliability, with a kappa coefficient of 0.87.

On the basis of these observations and the methods used, reliability varied with

the type of examination, clinician experience with telemedicine, and participant

knowledge of system limitations. Clinicians without experience or knowledge

of system limitations missed findings of clinical importance. Improvements in

equipment since the clinics were conducted in 1994 may have resolved some of

these problems. Our findings raise doubts about the reliability of occasional

telemedicine consultations by clinicians inexperienced in the technology.

Also a study is done on the challenge to delivering oral health services in rural

America through teledentistry. It stated that rural populations have lower dental

care utilization, higher rates of dental caries, lower rates of insurance, higher

rates of poverty, less water fluoridation, fewer dentists per population, and

greater distances to travel to access care than urban populations. Improving the

oral health of rural populations requires practical and flexible approaches to

expand and better distribute the rural oral health workforce, including

approaches tailored to remote areas. Solutions that involve mass

prevention/public health interventions include increasing water fluoridation,

providing timely oral health education, caries risk assessment and referral,

preventive services, and offering behavioral interventions such as smoking and

tobacco cessation programs. Solutions that train more providers prepared to

work in rural areas include recruiting students from rural areas, training students

in rural locations, and providing loan repayment and scholarships. Increasing

the flexibility and capacity of the oral health workforce for rural areas could be INTERNATIONAL INSTITUTE OF HEALTH MANAGEMENT RESEARCH (IIHMR) NEWDELHI

55


achieved by creating new roles for and new types of providers. Solutions that

overcome distance barriers include mobile clinics and telehealth technology.

Rural areas need flexibility and resources to develop innovative solutions that

meet their specific needs. Prevention needs to be at the front line of rural oral

health care, with systematic approaches that cross health professions and health

sectors.

According to one more study done on The Use of the Teledentistry for Dental

Science Information . The findings of the survey include that a majority of the

dental teachers and students (73.7%) under study have their own personal

computers or laptops; A majority of the respondents (70.8%) access the Internet

from the college or workplace, while 19.3% also access from home; and, 42.6%

of the respondents use the Internet and electronic resources for finding

health/dental sciences information, followed by patient care with 26.5%

responses.

One more study on Teledentistry in General Dentistry was conducted and the

authors successfully screened 1,039 of 1,159 randomly sampled U.S. general

dentists in active practice (89.6% response rate). Two hundred fifty-six (24.6%)

respondents had computers at chair side and thus were eligible for this study.

The authors successfully interviewed 102 respondents (39.8%). Clinical

information associated with administration and billing, such as appointments

and treatment plans, was stored predominantly on the computer; other

information, such as the medical history and progress notes, primarily resided

on paper. Nineteen respondents, or 1.8% of all general dentists, were

completely paperless. Auxiliary personnel, such as dental assistants and

hygienists, entered most data. Respondents adopted clinical computing to

improve office efficiency and operations, support diagnosis and treatment, and INTERNATIONAL INSTITUTE OF HEALTH MANAGEMENT RESEARCH (IIHMR) NEWDELHI

56

http://digitalcommons.unl.edu/cgi/viewcontent.cgi?article=1214&context=libphilprac

http://digitalcommons.unl.edu/cgi/viewcontent.cgi?article=1214&context=libphilprac


enhance patient communication and perception. Barriers included insufficient

operational reliability, program limitations, a steep learning curve, cost, and

infection control issues.

METHODOLOGY

This case study is basically based on the primary as well as secondary data. The

primary data collected was on the criteria of the scope of teledentistry,

requirements regarding the teledentistry, basis of teledentistry, current evidence

for teledentistry and the ethical and legal issues regarding the same. Also, a

questionnaire was prepared to know about the teledentistry perception.


57



58

SCOPE OF TELEDENTISTRY

REQUIREMENTS

BASIS

CURRENT EVIDENCE FOR TELEDENTISTRY

ETHICAL AND LEGAL ISSUE


TELECONSULTATION

Teleconsultation through teledentistry can take place in either of the following

ways - "Real-Time Consultation" and "Store-and Forward Method". Real-Time

Consultation involves a videoconference in which dental professionals and their

patients, at different locations, may see, hear, and communicate with one

another. Store-and-Forward Method involves the exchange of clinical

information and static images collected and stored by the dental practitioner,

who forwards them for consultation and treatment planning. Dentists can share

patient information, radiographs, graphical representations of periodontal and


59


hard tissues, therapies applied lab results, tests, remarks, photographs, and other

information transportable through multiple providers.

SCOPE OF TELEDENTISTRY

Teledentistry has the ability to improve access to oral health care, improve the

delivery of oral healthcare and lower its costs. It also has the potential to

eliminate the disparities in oral healthcare between rural and urban

communities. Teledentistry may turn out to be the cheapest, as well as the

fastest, way to bridge the rural-urban health divide. Taking into account the

huge strides in the field of information and communication technology,

teledentistry can help to bring specialized healthcare to the remotest corners of

the world. Telemedical services were helpful for cases related to dental trauma

and provided valuable support where a specialty dentist was not available.

Teledentistry permitted distant, cost-effective specialist dental consultations in

rural areas.

If the projections on the shortages of dentists in the next decade come to pass,

teledentistry will be important not only for rural areas but also for our urban and

suburban populations. Inter-professional communications will improve

dentistry's integration into the larger healthcare delivery system. The use of

teledentistry for specialist consultations, diagnosis, treatment planning and

coordination, and continuity of care will provide aspects of decision support and

facilitate a sharing of the contextual knowledge of the patient among dentists.


60


Second opinions, pre-authorization and other insurance requirements will be

met almost instantaneously online, with the use of real images of dental

problems rather than tooth charts and written descriptions. Teledentistry will

also provide an opportunity to supplement traditional teaching methods in

dental education, and provide new opportunities for dental students and dentists.

BASIS OF TELEDENTISTRY

Internet is the basis of modern systems of teledentistry, being up-to-date and

fast, and able to transport large amounts of data. All new systems of

teledentistry are Internet-based, as well as all kinds of distant consultation.

Information and communication technologies used in conjunction with Internet

have become a central part of academic life in colleges and campuses. Internet-

based teledentistry education enables students to choose themselves the place,

time, and mode of learning. In continued professional dental education, modern

Internet systems also offer on-line video-conferencing, broadcasting operations

and treatments, and on-line training courses. In continued professional dental

education, modern Internet systems also offer on-line video-conferencing,

broadcasting operations and treatments, and on-line training courses.


61


REQUIREMENTS

For most dental applications, store-and-forward technology provides excellent

results without excessive costs for equipment or connectivity.

Telemedicine equipment can broadly be divided into the following components:

Information Technology (IT) hardware Connectivity Hardware Video conferencing hardware Medical Hardware

IT Hardware

i. Computersii. Multimedia devices

iii. Scannersiv. Security devicesv. Daughter boards

vi. Hand held devices

Connectivity Hardware

i. Modems ii. VSATS, routers

iii. Switches

Video Conferencing Hardware

Full screen TV, plasma TV or Projection TV, live two way audio and video conferencing.

Medical Hardware

This would comprise all the clinical instrumentation that would be attached to the Telemedicine system to capture data from the patient.


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63


CURRENT EVIDENCE FOR TELEDENTISTRY

a. Role in Oral Medicine and Diagnosis:

The use of teledentistry in oral medicine in a community dental service is being

successfully proved using a prototype teledentistry system. Distant diagnosis is

an effective alternative in the diagnosis of oral lesions using transmission of

digital images by email. Summerfelt FF reported a teledentistry-assisted,

affiliated practice dental hygiene model developed by the Northern Arizona

University Dental Hygiene Department that allowed dental hygienists to

provide oral healthcare to underserved populations by digitally linking up with a

distant oral health team.

b. Role in Oral and Maxillofacial Surgery

The diagnostic assessment of the clinical diagnosis of impacted or semi-

impacted third molars assisted by the telemedicine approach was equal to the

real-time assessment of clinical diagnosis. According to Rollert MK et al.,

telemedicine consultations, in adequately assessing patients for dentoalveolar

surgery with general anaesthesia and nasotracheal intubation, are as reliable as

those conducted by traditional methods and that telecommunication is an

efficient and cost-effective mechanism to provide pre-operative evaluation in

situations in which patient transport is difficult or costly.


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c. Role in Endodontics

Remote dentists can identify root canal orifices based on images of

endodontically accessed teeth. Teledentistry based on the Internet as a

telecommunication medium can be successfully utilized in the diagnosis of

periapical lesions of the front teeth, reducing the costs associated with distant

visits and making urgent help available. And there was no statistical difference

existed between the ability of evaluators to identify periapical bone lesions

using conventional radiographs on a view box and their ability to interpret the

same images transmitted on a monitor screen by a video teleconferencing

system.

d. Role in Orthodontics

Interceptive orthodontic treatments provided by sufficiently prepared general

dentists and supervised remotely by orthodontic specialists through teledentistry

are a viable approach to reducing the severity of malocclusions in

disadvantaged children when referral to an orthodontist is not feasible. Also,

general dental practitioners generally supported a teledentistry system to screen

new patient orthodontic referrals. Patients were referred through a "store and

forward" teledentistry link and were later evaluated clinically, to assess whether

the same decision to accept the referral was made. It was seen that clinician

agreement for screening and accepting orthodontic referrals based on clinical

photographs was comparable to that reported for clinical decision making.


65


e. Role in Pediatric and Preventive Dentistry

Teledentistry is as good as visual/tactile examinations for dental caries

screening in young children. It offers a potentially efficient means of screening

high-risk preschool children for signs of early childhood caries. The intraoral

camera is a feasible and potentially cost-effective alternative to a visual oral

examination for caries screening, especially early childhood caries, in preschool

children attending childcare centres.

f. Role in Periodontics:

The Web-based teledentistry consultation system developed for dental clinics

showed that referrals to oral surgery, prosthodontics and periodontics had the

highest number of consults. The use of videoconferencing for diagnosis and

treatment planning for patients requiring prosthetic or oral rehabilitation

treatment and stated that video-consultation in dentistry has the potential to

increase the total number of dental specialist services in sparsely populated

areas.


66


ETHICAL AND LEGAL ISSUES

Concerns about the confidentiality of dental information arise from the transfer

of medical histories and records as well as from general security issues of

electronic information stored in computers. The practitioners of teledentistry

should take utmost care to ensure that patient privacy is not compromised by

unauthorized entities. However, patients should be made aware that their

information is to be transmitted electronically and the possibility exists that the

information will be intercepted, despite maximum efforts to maintain security.

Concerns also may arise about the proper method of informing patients of the

potential transmission of their data. Informed consent in teledentistry should

cover everything that exists in a standard, traditional consent form. The patient

should be informed of the inherent risk of improper diagnosis and/or treatment

due to failure of the technology involved.

In teledentistry practice, medico legal and copyright issues also have to be

considered. These problems arise primarily due to a lack of well-defined

standards. Currently, there is no method to ensure quality, safety, efficiency, or

effectiveness of information or its exchange. There are privacy and security

issues as well as remuneration, fiscal and taxation issues associated with

electronic commerce. Many of the legal issues, such as licensure, jurisdiction,

and malpractice, have not yet been definitively decided by legislative or judicial

branches of various governments. Inspite of this, information on teledentistry

licensure does not appear to be readily available today.


67


ResultsTime spent on internet

Time spent on the internet is categorized into three sections.

i. 1-3 hrsii. 3-5 hrsiii. More than 5 hrs

Approximately 67% of the sample size spent between 1-3 hours per day on the computer and Internet. Overall, the majority of the participants were positive towards teledentistry, stating that teledentistry has a potential and has to be integrated into current dental services.

Table 3.1 NUMBER OF HOURS SPENT ON INTERNETHOURS

Frequency Percent Valid PercentCumulative Percent

Valid 1 10 66.7 66.7 66.7

2 4 26.7 26.7 93.3

3 1 6.7 6.7 100.0

Total 15 100.0 100.0


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Figure 3.1 HOURS SPENT OF INTERNET

Cost Effectiveness

The responses of the participants show that the majority of the participants thought teledentistry would be cost-effective.

Table 3.2 COST- EFFECTIVENESSCOSTEFFECTIVE


Valid 1 12 80.0 80.0 80.0

2 3 20.0 20.0 100.0

Total 15 100.0 100.0


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Figure 3.2 BAR DIAGRAM FOR COST-EFFECTIVENESS

80% of the sample thought teledentistry will be very cost effective. And 20% thought that it will not be that cost effective.

Time Consumption

86.7 % have anticipated that teledentistry would save time. While 23.3% of the sample didn’t agree on it.

Table 3.3 SAVING TIMESAVINGTIME


Valid 1 13 86.7 86.7 86.7

2 2 13.3 13.3 100.0

Total 15 100.0 100.0


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Figure 3.3 BAR DIAGRAM FOR SAVING TIME


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Sample of the Questionnaire

Demographic

Name:

Age:

Sex:

Years of Experience:

Active area in dentistry:

Computer and Internet Use:

Computer and Internet Use for Health Related Purposes:

Teledentistry perception

1) A telehealth assistant can provide me a good understanding of the patient’s oral health problem over the Internet

2) Teledentistry can violate the patient’s privacy

3) Teledentistry is a convenient form of oral health care delivery

4) Teledentistry can reduce costs for the dental practices.

5) Teledentistry makes it easier for me to contact the patient

6) Further recommendations....


72


CONCLUSION

With all the technological developments taking place in the field of

teledentistry, practitioners may eventually link up to virtual dental health clinics

and an entirely new era of dentistry can be created. The future might also see

distant telemedical control of robotized instruments in situations with long-term

unavailability of dental care, e.g., during space flights, on transoceanic ships,

and in various rural areas. The results achieved so far are very encouraging,

setting the road signs for future investigations. However, a number of things

have to be addressed before teledentistry can rise to its peak. Further studies

involving greater number of participants will be required to validate the various

aspects of teledental applications.


73


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