C ase 6
Health Management Information
System for Integrated Delivery of
Public Health Services in Tamil Nadu—
A Success Story
Dr S Vijayakumar
The Health Management Information System (HMIS), Tamil Nadu, is the first centralised
web-based HMIS solution in a state covering 276 secondary-care hospitals, 1,539 primary
healthcare centres, to be expanded shortly to the 46 tertiary care institutions and 19 medical
colleges. Each hospital in the state has an independent Health Management System (HMS),
which is linked to the state-level HMIS. This makes real-time data available across 276
secondary care hospitals in 32 districts centrally. This data is used for planning healthcare,
managing drug inventory, and planning health initiatives at the state level. There are no
data entry operators employed in the whole project. The doctors themselves enter diagnosis,
order lab tests, and give prescriptions online for all out-patients. The system stands apart
in its comprehensiveness as it consolidates state-level data, links all health institutions, and
makes it possible to track individual health indices anywhere in the state through a unique
patient identification number.
 Introduction
The government of Tamil Nadu has pioneered many new approaches to enhance effective
access to quality health care at low financial cost. This article presents the experiences of
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113
the Tamil Nadu Health Systems Project, Department of Health and Family Welfare, in
the installation and operation of health management information system in the state.
 The Situation Before Introduction of HMIS
Prior to the introduction of Health Management Information System (HMIS) in the
state, the information generation and communication remained, by and large, manual
in nature. The problems were many. Following are some of the concerns/gaps in proper
health administration prior to the introduction of HMIS:
i. Inefficient delivery of health services: The delivery of health services in the hospital
was not efficient. Patients’ health could not be tracked, they were sometimes
prescribed medicines that were out of stock and there were gaps in the quality of
service.
ii. Lack of standardisation of health data: All hospital records were maintained manually,
which was time consuming and a lot of time was spent in retrieving records. More
funds were spent towards manual registers, which were difficult to maintain.
Lack of standardisation, incomplete data, and poor understanding of formats
were the major deterrents for healthcare practitioners. The data was provided for
ad hoc requirements and as per needs of various monitoring agencies and varied.
In-patients’ diagnosis was not being mapped to the International Classification of
Diseases (ICD)-10 that is recommended and followed worldwide.
iii. Costly maintenance of books: The government had been spending more funds in
procurement/printing of manual registers and storage of large volumes of books/
registers/records.
iv. Duplication of data entry, data retrieval, and reliable information: Same data
was being entered at various levels—for example, patient details were entered at
registration, nurses record, doctor record, etc. Reliability of the collated data could
not be ensured and reconciliation was difficult. Eighteen directorates under health
department required regular information. The number of copies of reports sent from
the institutions to district and state-level authorities was high—for example, almost
18 copies of each report were made and some of these reports had to be consolidated
at the district level for dispatch to state level for further consolidation. No records
were maintained at hospitals for outpatients prior to HMIS implementation.
v. No real-time data: For analysis of healthcare data, reliability of the data was
questionable. The ready availability of data for consolidation and manual collation,
etc., was prone to errors. Real-time data of transactions at the hospitals was
unavailable at the institutional, district, or state level for decision making. There
were no snapshot/dashboard views available to monitor the performance of the
hospitals, prior to the introduction of this system.
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vi. Poor equipment maintenance and drug supply chain management: No consolidated
equipment and drug inventory was available. Monitoring of equipment downtime,
drug stocks auto indent, drug stock accountability, and monitoring for drug expiry
dates were some of the other challenges the health system faced.
It was felt at various levels that there was a need for comprehensive and IT-enabled
information system to address these issues. The HMIS was therefore conceptualised to
realise this long-felt need of putting in place a system that helps in promoting evidencebased management of healthcare.
Given the above scenario and guided by the objective of improving the efficiency of
the healthcare system in Tamil Nadu by leveraging technology, rationalisation of some
processes, inputs, and reports has been affected. This has led to the removal of many
manual processes including manual tokens for drugs, lab request slips, indent forms,
etc., and automation of periodic reports on drug issues, indents, daily census, etc. This
has resulted in substantial saving of time for the end-users. It has reduced data entry
effort with direct export of required data to NRHM portal, and capture of patient data
for NCD programme for easier tracking and follow-up of patients.
 Introduction of IT in Public Health Systems
The expanding public health system makes administrative decisions complex. The
manually maintained communication systems pose many challenges to the administration
of health initiatives in the state. The international funding is increasingly used by the
health department for various projects that need an efficient information system. For
many years, the need was felt for a comprehensive information system that could address
the information needs of policy makers at all levels at a cheaper cost.
HMS at all the 276 Hospitals in 32 Districts
Hospital Management Systems (HMS) was deployed across the 276 secondary care
hospitals to streamline their functioning by automating processes and aiding proper
management of data. The services covered for hospitals as part of the HMS comprise 10
modules including Registration (outpatient, inpatient, casualty), Lab services, Pharmacy,
Stores, Wards, Blood Bank, Linen management, Diet, Biomedical Waste Management,
Equipment Inventory and Clinical Module covering patient Outpatient (OP) record,
In-patient (IP) record, Nurses notes, Operation notes, discharge summary, Ante Natal
Records (ANC) record, Natal & Post Natal record, Family welfare services, and Referral
services.
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State-Level Health Management
Information System
HMIS is implemented with the objective to serve
multiple users with a wide array of purposes that
can be summarised as the generation of information
to enable decision-makers at all levels of the
health system to identify problems and needs,
make evidence-based decisions on health policy
and allocate/utilise scarce resources optimally.
HMIS covers not only the clinical part of health
systems but also reporting on other aspects such
as administrative, personnel, ancillary services,
and programme management for a hospital. The
clinical records that are captured under the HMS
are automatically incorporated into the HMIS
Figure 1: Tamilnadu Health Systems
system, thereby avoiding the need to re-report the
Project
clinical data.
Further, HMIS aims to (i) promote the migration from paper-based to an electronic
health record information structure that would enable the health care providers and
beneficiaries easy access to information and health care respectively; (ii) ensure that
integration of institutional and personal health information and medical records are
managed effectively so as to ensure access to good health care; (iii) deliver measurable
cost and quality results from improved information management in health care; and (iv)
convert granular data to information for decision making.
The HMIS addresses the information needs at individual as well as health facility levels.
In the individual level data, the HMS captures the patient’s profile, healthcare needs,
and treatment, which serve as the basis for clinical decision making. Computerised
health care records provide the basis for continuum of care. This ensures minimisation
of manual data recording and easy retrieval of patient data. In the health facility
level data, it facilitates the capture of data at the point of care.
The HMIS is providing critical health data across the health chain for quick and
timely intervention by health directorates. The HMIS captures data from both aggregated
facility-level records and administrative sources such as drug procurement records,
enables healthcare managers to determine resource needs, guides purchasing and
distribution/deployment for drugs, equipment and supplies, manpower, etc.
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This has enabled institutions as well as the health administration to improve supply
chain management of essential drugs, build a robust equipment management system to
manage and monitor functioning of critical equipment and reduce down time through
systematic tracking.
The following services are covered as part of HMIS:
i. Online registration of outpatients and inpatients
ii. All out-patient services including doctors’ consultation, lab and pharmacy
services. Doctors’ services for outpatients including clinical findings, diagnosis,
prescriptions and lab requests entered online (real time)
iii. In-patient services including diet, linen management and discharge summary
iv. Blood bank and bio-medical waste management
v. Drug inventory
vi. Equipment management system
vii. Human resources management
viii. Health data reporting
 HMIS: Planning and Implementation Strategies
The HMIS was planned to be introduced in a phased manner and initiated by a pilot
project that was implemented in five secondary care hospitals during October 2008.
After the successful implementation of the pilot, the next phase of implementation was
carried out in five districts covering 38 hospitals from March 2009. Subsequently, in
Phase II, the HMIS component was implemented across all primary care and secondary
care institutions covering 276 hospitals and 1,600 Primary Health Centres (PHCs).
Figure 2: Registration of outpatients, Padmanabhapuram.
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Figure 3: Doctor consultation, Padmanabhapuram.
The HMS component covers all the 276 hospitals across all the districts in the state.
The HMIS is an online reporting system that comprises four modules, namely, Clinical,
Ancillary, National Programme Information, and Administrative Information System.
i. The clinical module comprises OP, IP census and details of maternal, child health,
immunisation details, family welfare services and disease-wise data of treatment
and cases, etc.
ii. The programme information module covers the national-and state-level programmes
like Blindness Control, Malaria, TB, Infectious diseases, School Health, etc.
iii. The ancillary module includes reporting forms for blood bank services, laboratory
services, stores/inventory details for drugs and other consumables, diet details, and
biomedical waste management.
iv. The administrative information system module contains finance-related forms for budget,
etc., and infrastructure related forms, including buildings, equipment, vehicles, etc.
This module also comprises establishment related forms for capture and reporting
details of all the health department personnel including transfers, training, leave,
etc.
The strategies adopted to bring about the transformation and smooth transition from
manual maintenance of records/register to a simple and efficient IT-enabled module are
listed below:
i. The project was conceptualised as a centralised web-based software solution to
minimise technology support and maintenance dependencies.
ii. The end-users across various institutions and offices were involved in finalising the
software requirement specifications, so that the entire application was customised
to suit the needs of 18 departments in the health sector. This helped to a greater
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Driving Process Change: Innovative e-Government Practices from India
Figure 4: Pharmacy–issue of medicines, Padmanabhapuram.
iii.
iv.
v.
vi.
vii.
viii.
ix
x
xi
xii
xiii.
extent in fulfilling the expectations of all stakeholders—a kind of motivation for
them to support its substance.
Use of open source software stack as it had a lower cost. At the same time, proper
support was ensured to overcome issues of using open source software.
Extremely simple, user-friendly screens designed and optimised for performance
by application provider to ensure end user ease of use.
Adequate training for the end-users at the institutional level, to ensure their full
participation and to increase their comfort level. The line department officers
visited each of the hospitals during the induction training programme that was
conducted over 3–4 weeks at each hospital.
Handholding during the initial roll out was helpful in addressing the resistance to
change from traditional practice.
Use the connectivity offered by Tamil Nadu State Wide Area Network (TNSWAN)
for a secure bandwidth for data transfer.
Provision of redundant connectivity using VPN over Broadband.
Co-location of the central servers at the State Data Centre to utilise the existing
investments by the state’s IT department
Issuance of necessary Government Orders (GO’s) to facilitate mandating the use
of online system as well as removal of manual systems
Around 5,000 hospital staff members have been trained and are using the online
system, which includes hospital staff from PHCs.
Appointment of trained skilled IT team to coordinate and troubleshoot problems
in IT infrastructure—one person in each district
Establishment of a central helpdesk to coordinate and follow up with vendors for
IT infrastructure installation, management and trouble shooting
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xiv. Continuous monitoring by the top management and periodic reviews of the
performance of the hospitals on HMS at the Directorate-level ensured that the
implementation was a success.
The other process initiatives include:
i. Stakeholder meetings
 Periodic reviews
 Follow-up on action points
ii. Help desk set up
 Central helpdesk
 Protocol established
iii. IT coordinator placed in each district
 Coordinate all infrastructure issues related activities
 Application support and training to end users as needed
iv. Basic computer skills training through TNeGA
v. Motivation to end users—written appreciation for good usage of online support—by
Project Director; Director of Medical Services
vi. Hospital/District level process
 Daily online usage monitoring
 e-nodal team set up at each hospital
 HMIS part of quality circle meeting agenda for review
Process Change
Guided by the objective of improving efficiencies at the global level and leveraging the
prolific presence of technology, rationalisation of some processes, inputs, and reports
have been done. This has led to removal of many manual processes including manual
tokens for drugs, lab request slips, indent forms, etc., and automation of periodic reports
on drug issues, indents, daily census, etc., resulting in substantial savings of time for
the end users. Grassroot level study of information requirements and processes has
facilitated the design of uniform and standardised input formats and processes. Common
uniform system of reporting will ease data comparison and performance monitoring
across institutions. Proactive Health programmes can now be tailored to meet local
challenges.
 Role of Top Management in Planning
and Implementation of HMIS
The role of top management has been critical to the success of HMIS implementation.
Certain responsibilities included:
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i. Set project expectations: In the planning stage, the Government of Tamil Nadu and
the team of HMIS carried out an analysis of the project and developed a strategic
plan to accelerate implementation by ensuring participatory consultation with key
management teams.
ii. Set the cultural tone for systemic change for the project: For instance, for
project-related activity, e-mail communication was made mandatory and paper
communication was banned. A helpline was set up to help and ensure seamless
usage of IT. At the behest of the Director of Medical and Rural Health Services
facilitated by TNHSP, the state government has supported this project by way
of issuing government orders (GO) for doing away with manual registers and
making full use of HMIS application. This has been an important policy decision
and a significant step in change management. The GO also advised the audit
department on the auditing process.
iii. Lead the vendor management process: An accelerated vendor selection process
was developed that followed the state’s transparency guidelines. During the
roll out of the project, the nominee played a very important role as a catalyst in
bringing multiple vendors and other stakeholders together for periodic review
of the progress in implementation of the HMIS to address bottlenecks across the
table. The sheer size and spread of the infrastructure was daunting, given the
stringent timelines involving procurement, installation, commission of over 15,000
desktops, connectivity, power back-up through UPS, 500 printers and installation
of LAN at each hospital as well as the setting up of the server at the data centre
that called for strong programme implementation and monitoring capabilities.
This was ably demonstrated by constant reviews and quick decisions to address
bottlenecks.
There was continuous motivation of the health administrators for change
management on the one hand and addressing vendor-specific issues during the
reviews on the other. HMIS involved multiple vendors in the combined periodic
reviews that helped in addressing gaps and in speeding up the processes.
iv. Lead communication efforts (with physicians and nurses): The project actively
engaged with physicians and other clinicians to design and implement HMIS. The
author ensured in his capacity as Special Secretary, Health the involvement and
support of the top management from the 18 health directorates, which was critical
in the successful acceptance and deployment of the IT application.
v. Human capital development (critical for change management): It was felt that
physician leadership is a critical success factor for health information technology
initiatives. Dialogue was also initiated with reputed academic Institutions (Tata
Institute of Social Science (TISS)/National Institute of Engineering (NIE)) to assess
further training needs of the health professionals. The author has been able to
design the training programmes for public health professionals to provide them
opportunities for higher level of learning and motivation. He also ensured that
basic computer training was given to all the hospital staff with the help of Tamil
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Nadu e-Governance Agency (TNeGA). The doctors themselves use the system to
enter diagnosis, order lab tests and give prescriptions online for all outpatients.
No data entry operators were deployed and the end-users were empowered for
on-line usage. As a result, manual records are not maintained any longer. Around
8,000 hospital staff members have been trained and are using the on-line system.
Apart from the health professionals, a pool of IT-skilled professionals was created
to assist and handle IT-related issues both at the hospitals and at the HQs for server
management. All these initiatives were carefully streamlined into the mainstream
health administration to ensure continuity of support.
vi. Create HMIS implementation plans and training modules: The project published
guidelines covering many facets of HMIS/HMS practices. Many of the guidelines
are aligned with the national priorities of building the capacity of information
management and sharing at various levels. For example, the HMIS Manual/practice
guideline ‘Core Data Sets for the Physician Practice Electronic Health Record’
clearly indicates the nominee’s commitment in understanding the importance of
core data sets and insisted discipline across all levels in adhering to the manuals.
These guidelines provided domain-specific best-practice principles for health care
professionals to succeed in the transition to an electronic healthcare environment.
vii. Adoption of health information standards for inter-operability of health
information: The author promoted the introduction and use of standards (such
as ICD-10, standardised drug/lab codes) and this transition brings tremendous
benefits in patient management in the long run.
 Salient Features of HMIS
The salient features of HMIS have been listed below:
i. Transparency and stakeholder participation: The implementation of HMIS involved
multiple stakeholders including IT infrastructure vendors. Vendors provided
hardware, infrastructure, furniture, training, civil work, networking, connectivity,
data centre hosting, etc. The other health department stakeholders include the
Director of Medical and Rural Health Services, Director of Public Health, Tamil
Nadu Medical Services Corporation, ELCOT, etc. In order to effectively implement
the project, it was critical that the different stakeholders be actively involved in
the processes during the implementation phase. During progress review, the issues
were immediately addressed across the table as all the stakeholders involved in the
implementation of HMIS were part of the reviews.
The end users across various institutions and offices were called upon for
finalising the software requirement specifications, so that the entire application
was customised to suit the needs of each and every department. Extremely simple,
user-friendly screens were designed by application provider to ensure end-user’s
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ease and optimised performance. The customisation was made based on the
requirements of the end-user; for example, the medical officer at the hospital could
customise drug combinations for general illness so that during consultation, he/she
could prescribe the drug with one click.
Stakeholder participation in all stages of the project was the major reason for the least
resistance in the IT implementation in the project. Involvement and participation of all
stakeholders including the end users is ample proof of the openness and transparency
prevailing in the implementation of the IT-enabled healthcare administration.
ii. Innovative and replicable: The HMIS is based on unique identifiers for each hospital,
patient, and institutional user. This provides for patient referral across the health
chain. HMIS is an idea that has been designed to improve the process and services
in the health system by using information technology. The project uses a centralised
server model instead of a client server model, which enables inter-hospital retrieval
of patient data. This web-enabled system, built on open source software, captures
real time clinical data of patients from 276 hospitals across all districts of Tamil
Nadu. While TCS provides the software solution support, the connectivity is
provided by Electronics Corporation of Tamil Nadu using a 2 mbps dedicated
leased line at every hospital. Thereby, this system was successfully deployed across
all hospitals, independent of the volume of patients handled by them. The simplicity
of the interface enables the use of the application directly by the end-users. The
centralised web-based solution developed using open source technologies addresses
issues like costs associated with vendor lock-in for proprietary databases, etc. The
end-user systems work on Linux Operating system that has also proved to be
cost-effective, keeping them free from virus as well as savings on cost of procurement
of antivirus software as is required for other OS till date. The use of open source
software has led to significant reduction in cost of procurement even of Server
Hardware as many standard proprietary databases are highly resource hungry and
will disproportionately increase the cost of ownership by increasing the hardware
requirements and license fee for each installation including high maintenance
costs.
The design caters for possible pain-points that could arise at operational level due
to factors like remote location of the hospital, lack of trained manpower at hospital,
operational exigencies, etc. The solution is driven by low cost of support, ease of
deployment, training, etc. HMIS data entry formats are fully standardised and provide
for uniformity in reporting and data consolidation. Data input and collection in forms
includes the data requirements for National Rural Health Mission (NRHM) and other
reporting needs at state and central level. Integration and inclusion of programme
initiatives like NRHM and NCD as part of the application design has brought in several
benefits. It has also provided the health administration with required reporting facility.
Health Management Information System 
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 Results
The following is the outcome expected from and delivered by the initiative:
i. Evidence-based planning, financing, research, and policy formulation is ensured.
ii. Workflow at all 276 secondary care hospitals has been standardised and
streamlined.
iii. The demographic details and clinical records of 1,48,51,390 patients are available
in the database and can be retrieved on demand across all government hospitals
in the state. Real-time records are available from all secondary care hospitals.
iv. 62 per cent of the patients bring back the Patient Identification Number (PIN) to
the hospital during subsequent visits. They have realised that they need to bring
only the PIN and need not carry all previous records with them.
v. Doctors in all the hospitals have been trained and are comfortable with the online
system for documenting clinical findings and prescriptions.
vi. Management of drug inventory and equipment inventory has improved. Moreover,
a large section of the manpower used in the process of data compilation and
reporting is now available for other essential medical services.
vii. Unique PIN.
viii. Unique institution codes across all government hospitals and offices.
ix. Unique employee numbers/user names and passwords – for access to system.
x. Standardisation through reuse of drug codes (from central procurement agency)
and treasury codes for finance-related information.
xi. Uniform reporting platform across all state government health facilities with
standardised reporting formats across all institutions for better data consolidation,
comparison, and analysis.
xii. Facility to link patient’s record with UID, once it is made operational by Government
of India.
xiii. Auto integration with national-level data pool.
xiv. Lab test results are being given to the patient with test report reference values.
xv. The final diagnosis is linked to International Classification of Disease Code-10.
The system can be easily replicated in any other state as most of the reporting
indicators are compliant with the Government of India (GoI) reporting formats.
Processes and Effectiveness of Outcomes
The solution has been designed in such a way that the system automatically incorporates
data at the institutional level with clinical data from HMS and auto populates the HMIS
reporting fields, thereby minimising considerable amount of effort in terms of reporting
and consolidation.
HMIS is a solution that encompasses technology, procedures and people with a focus
on providing timely and accurate information to manage at the operational level and aid
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Driving Process Change: Innovative e-Government Practices from India
decision making at the policy level. This solution aims to increase process and quality
outcomes and decrease inefficiencies and costs. This would help control administration
costs and maximise efficiencies of available resources. The huge cost involved in the
procurement of records and registers are now being curtailed and a more cost-effective
system is put in place.
This project was cost effective when compared to other similar projects of this size
and scale. This was possible because of various reasons—use of open source software,
rationalisation of hardware/equipments, no additional manpower for data entry, capacity
creation within the hospital, increased productivity and centralised system curtailing
costs of maintenance at the hospital level.
Review of hospital performance has become easier as the CMO can view staff
performance and distribution of patients among the medical officers, pharmacist, lab
technician, and nurses. Institutions’ performance review and monitoring are possible
as it has been built as a part of HMIS that can give a snapshot view of the capacity of
the hospital and utilisation of services. Out-patient (OP) and In-patient (IP) statistics,
rationalisation of manpower, etc., is possible with HMIS.
The system is open and is capable of being linked with larger systems when
there is such a need. All these characters make these initiatives capable of creating
transformational effect in the health sector and the initiatives have the potential to be
sustainable, scalable and replicable.
 Impact of HMIS
HMIS has brought about a significant reduction in the time taken for delivery of services
and the time spent by a patient in the hospital. The patients who are already registered
do not have to wait in long queues every time they visit the hospital as was the practice
before the introduction of HMS. The patients can now go directly to the respective OP
department to meet the doctor. The doctor is able to retrieve the patient’s records using
the unique patient number and enter the details. Doctors can view all previous history
of the patient including treatment, medication and investigations done.
Table 1: Impact of HMIS
Indicator
Before HMIS
After HMIS
Citizens
Waiting time in the queue
Every visit at the OP registration Spends about 15 minutes
counter approximately 30 minutes during the first visit, on
subsequent
visits
does
not have to go to the OP
registration counter
(Contd.)
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(Contd.)
Collection of lab results
Where the patients were asked to The patient can collect the
come back to meet the doctor for results the next day itself.
follow up visits after 3 days, the
patient had to come back to the
lab to collect the results the next
day and on the third day for the
follow up visit
Medical Officers
Time spent on writing Separate tokens written for drugs, Pre-designed packages for
prescriptions and lab orders
lab orders and treatment
prescription and lab requests
help doctor complete it with
few clicks
Review of patient history Patients had to bring their old
during the visit
records during the visit for the
doctor to review. No documents at
the hospital regarding treatment
given to the outpatients at the
hospital level
Consolidation of diagnosis
All records available on
the computer—doctors can
view entire patient record—
better patient management.
Patients need to bring the
PIN number only.
No data available on OP treatment Diagnosis and prescription
pattern
pattern available
Nurse
Day-end
statistics
consolidation
of 1 hour for injections for OP alone
Drug indenting for IP cases
5 minutes
20–30 minutes
5 minutes
3 hours
10 minutes
15 minutes
5 minutes
2 hours every day
5 minutes every day
2 days
15 minutes
4–5 hours
15 minutes
Census report
1 day
10 minutes
Stock report for stores
2 days
30 minutes
Diagnosis-wise report
3 hours
5 minutes
Drug inventory
Diet/linen indenting
Pharmacist
Consolidation of
stock issue report
day-end
Indenting drugs and reporting
at the end of the month
Stock check for expiry
Report preparation
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The HMIS has brought about significant impact in the delivery of health services to
the citizens. The doctors find the system very useful for patient care. The availability
of data helps them in observing trends. The doctors, for example, get online alerts for
drugs that are not available in the hospital pharmacy, or if the patient is currently on
medication prescribed by any other doctor in the system and in general, keeping track
of the patient history. The nursing staff finds the system useful for preparing reports,
inventory management, diet orders, etc. The patients can now visit any secondary
care hospital in the state with the Patient Identification Number (PIN) and his/her case
records can be accessed by the treating physician.
i. Real time data is available for closer monitoring and decision making on staff
deployment, utilisation of resources, etc. This can be used to understand the trends
and patterns accurately.
ii. The time spent on consolidating the monthly reports has come down drastically. The
consolidated reports are available readily. With HMIS, each administrative unit can
view the reports online; this has helped do away with the system where monthly
consolidated reports were required to be sent to several agencies.
iii. Reporting compliance by institutions is easier. Defaulters are closely tracked and
held accountable during review meetings.
iv. Validation of data elements at the time of data entry has significantly improved the
accuracy of data reported. Missing data elements and report tracking is also made
easier through online system.
v. Institutional Performance Report and identified periodic reporting forms currently
at 100 per cent compliance due to close monitoring and follow up by the health
administrators.
vi. Periodic and monthly reports that are to be sent to NRHM are directly exported
from HMIS online; there is no consolidation or data entry.
vii. Manpower rationalisation based on performance, utilisation, etc., is possible. For
instance, work load of the medical officers can be calculated.
Figure 5: Total Registration of patients 2010–2012.
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One of the important measurable outcomes of HMIS is based on the observation that
around 60 per cent of the registered patients bring back the PIN (Patient Identification
Number) during their subsequent visits, which shows high patient compliance with this
system.
The HMIS has significantly contributed to the simplification of processes that were
hitherto very cumbersome and time consuming. The discharge summary is autopopulated and ready at the time of discharge. Most importantly, a printed discharge
summary (that is readable!) is ready at the time of discharge of the patient. The patient
does not have not to wait or come back to collect the discharge summary. Another
example of improved efficiency and process simplification is that in-patients’ diet can be
ordered over the system by the ward in-charge for all inpatients based on their dietary
requirement. Before introduction of this system, the diet staff had to go to each ward
and collect the diet request forms. HMIS has done away with manual system of drug
indenting. The staff nurse in-charge of the ward places the orders over the system.
 State Health Data Resource Centre (SHDRC)
The SHDRC is planned as a comprehensive repository of health information across all
directorates and departments integrated in a single platform. IT enablement of hospitals
in Tamil Nadu’s districts creates an accurate real time database that can be used as a basis
of timely information for drawing up health-related policies and budgets by the state
bureau. The data gives insights such as the main ailments in the state, most common
drugs prescribed, lab usage pattern, district-wise health indicators, etc. This initiative
strives to strengthen the patient and hospital databases such that they ably support the
strategic management of health system of the state. Easy access to epidemiological data
about individual patients enables proactive and efficient management of communicable
and non-communicable diseases. This is very effective and result-oriented during
the eventuality of an epidemic. Early intervention and swift response by the health
directorates, guided by accurate information would aid in handling emergencies and
such other situations.
 Towards Sustainability
The HMIS has demonstrated the integration of departments in providing cost-effective
and sustainable IT solution to public health services. To ensure sustainability, policy-level
steps were initiated through the health department. The budget (recurring expenditure)
needed to run this project is factored in during the annual budgeting of the respective
directorates. The state IT department maintains the hardware/software through its
Annual Technical Support plan. A major portion of the cost for network connectivity is
assured as the project depends on the state IT infrastructure and TNSWAN for hosting
and connectivity. The central servers are co-located at the State Data Centre (managed
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Driving Process Change: Innovative e-Government Practices from India
by the IT Department). This ensures sustainability of HMIS at least cost. This also serves
as a model for other departments of the state government to make better use of existing
IT infrastructure of the government.
Figure 6: Pictorial representation of the HMS and HMIS.