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IMPLEMENTATION OF

HOSPITAL INFORMATIONSYSTEM in DDU, SHIMLA

Submitted by:

Shruti Goel(PG/10/045)

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HHiiSPindia PROFILESPindia PROFILE

HiSPindia is a not-for-profit NGO specializing since more than a decade indesigning and implementing solutions in health informatics for the public

health sector. It is a multi-disciplinary organization concentrating on the

domains of public health and informatics.

It works with a Vision to enable and coordinate a network of excellence in

public health informatics, specializing in integrated health information

architectures, with a geographical focus on South-East Asia.

The organization has a strong commitment to free and open source

technologies, and works with a global perspective of the Health Information

Systems Programmes (HISP) network, coordinated by the University of

Oslo, Norway, and is active in more than 20 countries in Africa and Asia.

HiSPindia has a registered and head office in New Delhi, and project offices

in Kerala, Himachal Pradesh, and Punjab.

In India, it has worked in at least 90% of the states, and currently has a

presence in about 20 states.

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HIS team

SoftwareDevelopers

ImplementersHardwareSupporters

Team LeaderTeam

coordinator

We, as interns, were made a part of the Implementing

Division of the HIS team at HISP.

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HOSPITAL INFORMATION SYSTEMHOSPITAL INFORMATION SYSTEM

What is HIS?

Potential benefits

Potential challenges

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ABOUT DDUABOUT DDU

Deen Dayal Upadhayay , commonly known asRippon. It is a public hospital under the governanceof Himachal Pradesh.

It is the first district hospital of Himachal Pradeshwhere HIS is implemented by HiSPindia.

It is the most established and functional governmenthospital.

It is a 150 bedded hospital with all functionalities. Prime source of healthcare services in Shimla and

neighbouring districts.

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OpenMRSOpenMRS

The HIS developed by Society of Health Information SystemsProgramme (HiSPindia) and NHSRC is built on OpenMRS

Open Medical Records System.

It is community developed software which enables to design

customized medical records without any programmingknowledge.

The principle of openMRS is that information should be stored

in a easy to summarize & analyze form i.e. minimal use of free

text & maximal use of coded text.

It is a client server application which means it is designed to

work in an environment where many clients computer access

the same information on a server.

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Contd

FEATURES Central concept dictionary:

Security

Privilege-based access

Patient repository Unique identifiers per patient

Data export

Modular architecture

Patient workflows

Cohort management

Patient merging

Reporting tools

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STEPS IN IMPLEMENTATIONSTEPS IN IMPLEMENTATION

Need Assessment for HIS in DDU

Initiating the Process

Procurement of Software/Hardware Support

Module Implementing(a) Phase I

(b) Phase II

Training Session/Capacity Building for the End User

Dry Run

Going Live Process

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1. NEED ASSESSMENT OF HIS IN1. NEED ASSESSMENT OF HIS IN

DDUDDU

The main important needs of DDU for HIS realized

were-

To create records of the patients. Allow monitoring of the health care services

Comprehensive, efficient and accurate administration

of all services/functionalities

Streamlining patient flow.

Reducing paper work

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2. INITIATING THE PROCESS (52. INITIATING THE PROCESS (5

STEPS)STEPS)

Demo of OpenMRS in Hospital

The hospital authorities and end users of the software

were given a detailed demonstration of OpenMRS.

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Review of Existing Process

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Requirements based in Review of Existing System

Ways to gather information: Interviewing

Focus group discussion

Surveys Shadowing

Sources of information:

People

Manuals

System

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Meeting on HIS implementation

A proposal was compiled by the HISP team comprising ofthe requirements that the system would bear as well as the

functionalities of system. The proposal was to be studied by

the hospital team thoroughly.

Action Plan for HIS implementation

The information gained was translated to the developers inorder to enable them to customize and develop the software

exactly the way it was desired by the hospital

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3. PROCUREMENT OF3. PROCUREMENT OF

HARDWARE & SOFTWAREHARDWARE & SOFTWARE

The creation of an intranet for information flow before

the start of the implementation process.

26 HCL computers and HP laser jet printers wereinstalled networked to a server running Linux Ubuntu

10.10.

It is being shared on 10/100 mbps LAN connection.

The application was installed on two servers: the first

was used for testing and validation of different modules

as well as for the training of users and the second

hosted the production implementation of the HIS.

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4. MODULE IMPLEMENTATION4. MODULE IMPLEMENTATION

The implementation was done on a modular-basis,

following a set of priorities defined by the hospital

put together for this purpose.

Implemented in two phases

Phase 1- Registration, Billing and Laboratory

Phase 2- OPD, IPD, Inventory, Pharmacy, Bloodbank

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5. TRAINING SESSION/CAPACITY. TRAINING SESSION/CAPACITYBUILDINGBUILDING

Training objective

Identification and assessment of training needs

Basic requirements

Training plan

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Training plan

PHASE I training on computer basics

PHASE II training on individual modules

Doctors

Nurses

Pharmacist

Inventory staff

Post training - Competency Tests and Re- training.

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6. DRY RUN6. DRY RUN

Testing

Aim - make sure that the system is working properly,to catch any bugs and report them.

To avoid malfunctioning functionalities on site.

At 3 levels

Simple

Structured random

Completely random

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Hands on with end users

Hands on training was given to doctors, nurses, pharmacists,lab technicians etc to provide guidance and to supervise them

to perform assigned tasks.

Feedback from users is taken for any addition, customization

or bug confronted by them.

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7. GOING LIVE7. GOING LIVE

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Behavioural reluctance

Vast manpower and different work timings

Enormous patient load DDUs infrastructure

Lack of well designed and well developed user

manual. Development of new and stable version of

modules.

CHALLENGESCHALLENGES

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HIS can be feasible in public hospital providedmotivated infusion of understanding and hard

work is there.

Economic arguments no longer holds good aslow cost open source tools adjustable by local

teams are available.

Importance of making hospital decisionmakers aware of efficient role ofHIS is

realized.

LEARNINGSLEARNINGS

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www.hisp.org

www.hispindia.org

www.opemrs.org

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

HIS- DDU manual by HISP

A study on Determination of the success of a

hospital's information system implementation byJ.C. Sarivougioukas and A. Th. Vagelatos.

REFERENCESREFERENCES

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