Bringing Change Case Study of Implementation of Hospital Information System (HIS) at Post Graduate Institute Of Medica

1. Bringing ChangeCase Study of Implementation of Hospital Information System (HIS) at Post Graduate Institute Of Medical Education &Research, Chandigarh

2. Mandate: PGIMER Act 1967 Provide high quality patient care Attain self sufficiency in PG Medical Education,meet country’s need for highly qualified medical teachersin all medical / surgical fields Provide educational facilities for training of personnel in all important branches of health activity Undertake basic community based research

3. PGIMER at a Glance

4. Patient Care Services Infrastructure • 1978 bedded hospital which includes • Five Private Wards having 98 rooms • Ultra modern diagnostic facilities. Well-established super specialties in • Cardiology,Neurology,Gastroenterology,Hematology • Endocrinology, Nephrology, Pulmonary Medicine, • Nuclear Medicine, Radiotherapy, • Cardiothoracic Vascular, Urology, Plastic Surgery, • Neurosurgery, Pediatric Surgery.

5. OPD-Patients19,19,136 (2012)

7. Background • Efforts for hospital computerisation was started in 1999. • Work of Computerization Project was initiated in PGIMER for the deployment of Information Technology Infrastructure to improve Patient Care/Medical Services, Academic understanding, Medical Education Standards and Research activities in the field of Medical Science, improving patient care by reducing turnaround time of the patients. • PGIMER envisaged to procure state-of-the-art IT infrastructure to host custom developed Hospital Information System (HIS) • The project was finally awarded on Turnkey basis to M/s C-DAC Noida at the cost of Rs. 21.70 crore (including for years ACMC charges of Rs.1.97 crore) our of Plant Grant in March, 2007

8. Objectives of Computerisation Project Improvement in efficiency and reduction in time & cost of all the functions pertaining to the Hospital. Facilitating quality patient-care by centralizing patient related information. Improved patient management through online availability of patient data, test reports, interdisciplinary consultations More efficient treatment planning, leading to savings to patients/PGI. Online appointments. Cost saving by improving inventory management Internet/E-mail Facility across the campus Human Resource Management – Personnel information, Vacancy status etc. Accounts - Financial Accounting, Payroll, Fee collection w.r.t. hospital services

9. Salient Features of HIS • Web Based • Three-Tire Application software Compliance with • Health Level (HL)-7 standards, • Digital Imaging & Communication in Medicine (DICOM) Standards • WHO’s International Classification of Diseases ICD 10 • Picture Archiving and Communication System (PACS) ready • Technology - Web Services using XML switches based on Java 2 Platform • Interfaces for enabling mobile devices as well as remote access devices • Biometric • Bar code • Medical and Lab Equipment

10. HIS Modules

11. Challenges Faced • Slow pace of implementation • Poor or no involvement of end user • Delayed response in customisation by the implementing agency • Various bottlenecks in every module • Lab tests were not given individual charges • Non entering poor free, VVIP patients etc in the module • Non-availability of qualified manpower by the Implementing Agency • The Resistance to Change

12. Sources of Resistance to Change • Ignorance: a failure to understand the situation or the problem • Mistrust: motives for change are considered suspicious • Disbelief: a feeling that the way forward will not work • “Power-Cut”: a fear that sources of influence and control will be eroded.

13. THE CHANGE EQUATION: A + B + C + D must be > EFACTORS NECESSARY FOR EFFECTIVE CHANGE AThe individual, group or organisation level of dissatisfaction with the status quo B A clear and shared picture of a better future - how things could be C The capacity of individuals, groups and the organisation to change (orientation, competence and skill) D Acceptable and “do-able” first action steps E The cost (financial, time, “aggro”) of making the change to individuals, groups and the organisation.

14. Breaking the Resistance Resisting individuals and/or groups were identified Cause of resistance identified Computer illiterate IT will make them redundant Peer pressure to resists change Beliefs and values do they had Already doing excellently without IT HIS failed in Other hospitals Importance of Existing power and authority might diluted Their need and interests identified

15. Strategies Adopted • Communication Strategy • General functions /operations of HIS were communicated • Key befits of HIS were communicated through interactive sessions. • Impact of HIS on people ,process and technology • Influencing user attitude • Employee related modules were first implemented e.g. Salary slip and Service Book Record • Individual and group leaders were involved their suggestions were incorporated in the system • HIS was customizing to make it user friendly • Hands-on training was organized

16. Problem Solving • Implementing agency was asked to provided the reports for monitoring of the project • Database was got de-normalized in order to generate reports • Dashboards are prepared for the Director HODs etc. • Aggressive monitoring of project and the implementing agency and motivation of end users was undertaken

17. What has been accomplished?

18. Campus wide LAN & WAN Connectivity

19. Innovation • Parameterized Dashboards • Process re-engineering of Registration • Token system. • Bar coded lab samples. • Provision for Machine Interface to lab investigation module • Innovative design of HIS software to reduce data entry efforts and errors. • Integration with MSDG (Mobile Service Delivery Gateway) and email

20. Registration Module • Centrally generated unique identification No.(CR.NO) to the patient • Patient demography once entered is accessed across different speciality • OPD/Emergency Patient statistics available on real-time basis. • Unique identifier can be used for different services Billing , Lab services ,patient tracking

21. Registration Module (Figures)

22. E-Recruitment (Facts) • Online submission of Application • Fee Collection Online/Bank Challan • Online generation of Admit Card • Reduction in discrepancies • Transparency • Recruitment process in 6 months in contrast to manual process from 1.5 to 2 years

23. E-Recruitment (Figures)

24. Lab Information System(Lab Module) • Online ordering of lab investigations from Clinical Information System(IPD/OPD Desk). • Direct uploading of lab results into database by providing machine interface with HIS for such equipment as auto-analyzer. • Viewing of lab results textual & Graphical • Results can be viewed over range of dates for one test or range of tests • Correlation of test results and treatment can be studied • Abnormal results/readings can be highlighted/alerted • Around 1000-1500 samples are collected and processed on daily basis

25. Inpatient Module(Facts and figures) • Map view of wards available for bed allocation • Patient movement(admission/transfer/ discharge across service areas) • Tracking of patient on real-time basis • Nursing Staff is offloaded from preparing manual statistics of Admission/Discharge/Deaths • Daily 250 admissions and 225 discharges through system.

26. Online Inventory System • Master data of Store/Pharmacy items entered in system • Effortless indent generation • Online indents are being generated from 300 locations • Alerts of inventory level lower than specific limit. • Enables timely replenishment of inventory

27. Payroll System • Salary preparation and disbursement of salary, pension , GPF ,allowance and arrears • 6200 in service employees and 2000 pensioners are beneficiary • Salary slip generation and printing from anywhere in the institute • Service record can be viewed from anywhere in the institute.

28. Who is beneficiary & How ?

29. Patient centric Services enhancements • Demographic details of patient captured in electronic format helps to generate card for other specialties/OPDs instantly. • Capturing of information at one place is being used across different functional areas such as OPD , lab, Billing , Admission etc reduces errors and chances of inconsistent data. • Patient information gets updated during course of the treatment starting from registration, OPD desk , investigation , Diagnosis, treatment/admission. Patient Medical record can be maintained as separate episode for separate specialty. • Admitted patient can be tracked based on parameters such as Name, Cr. No etc. • Online registration and recording of the case history and diagnosis of old and new patient will reduce queuing taking place in OPD. • Patient information available in electronic format provides crucial inputs for research work for faculty, doctors and researchers. • Important details & statistics of patients help in analysis of disease pattern and effective diagnosis. • Online availability of the clinical investigation reports reduce the turnaround time of patient and helps early diagnosis and decision making by clinician.

30. Patient centric Services enhancements(continue) • Accessibility to schedules of OPDs, doctors and important resources such as Operation theatres at reception and query terminal saves patients time. • Online availability of teaching material enables faculty to access and deliver lectures through multimedia instruments in the Institute. • Online information about diseases and medicines improves quality of care and patient treatment. • Application software has built in decision support and analytical processing capabilities which will facilitate to take immediate decision. • The data once entered in the HIS helps in building a Decision Support System and thus policy making can be improved • Fast and reliable information storage, querying and retrieval. Retrieval could be either for generation of reports based on demographics, gender, and age or for research & library classification.

31. Enhancement in Decision Support System: • Maintenance of historical data of patients and statistical analysis of the various diseases pattern in the region can help Central Government in taking policy decisions of better health care. • Online maintenance inventory of medicines, surgical items, hospital gases and other vital and essential items with defined reorder level. Alerts are generated to take decision for replenish the inventory. • Alerts are generated for treating doctors about abnormal and out of range reports of the patients for taking decision for corrective action. • Electronic Dashboard for executive level decision support .

32. Accessibility & User Convenience • The HIS is web enabled , browser based application can accessed and used on electronic device capable of running internet browser. • SOPs have been defined for the critical tasks and intensive training to the employees is being imparted on routine basis • Help Desk has been setup for 24 X 7 for HIS related services and support. • Role based access to all users. Limited access to functionality to particular employee depending on his/her level and role in the workflow. • HIS system is capable of Connecting people, processes and data in real time basis across the hospital on a single platform. • Patient’s number of visits to lab report delivery counter has reduced. • Customized Clinical templates to capture data according to each Department, Laboratory etc

33. What is in pipeline ? • Integration of HIS with PACS • Dual Monitors for registration for checking and correcting data entry before final printing. • Opiton to web-based pre-registration of patients by entering demographic detail in system through internet reducing waiting time, chances of errors. • RFID tags in tracking of equipment(e.g ventilators, portable USG/X-ray machines etc.), inventory management • All service areas OPD/Wards Wi-Fi enabled starting with New OPD.

34. Thank you