REPORT ON EMPLOYEE HEALTH MANAGEMENT SYSTEM
SUMMER PLACEMENT IN HINDUSTAN PETROLEUM CORPORATION LIMITEDNEW DELHI
(SUBMITTED BY:Dr. AMRITA SINGHPGD HEALTH AND HOSPITAL MANAGEMENT IIHMR DELHIROLL NO. : EL- 2981-2K8)
( 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 TERMINALTraining Manager : SHRI KAMAL KUMAR )
MMMxm cmxnvNN
TABLE OF CONTENT
ACKNOWLEDGEMENT……………………………………………..……….5THE ORGANIZATION……………………………………………..…………6ORGANIZATION PROFILE...............................................................................7EXECUTIVE SUMMARY……………….…………………………..……………8INTRODUCTION…………………….………………………………..…………..9STUDY 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………………………………………………………………………51BIBLIOGRAPHY……………………………………………..……………….……73
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 TABLESTable 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
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.
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.
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.
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.
INTRODUCTION TO EHMS
Employees 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.
Study Objectives
· Evaluation of execution of EHMS in HPCL
· Ascertaining employee awareness of EHMS in HPCL
· 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.
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 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.
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.
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 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.
Sample size
For 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.
Employees are categorized into three segments:
1. Managerial Segment
2. Non-managerial Segment
3. Service assistant/labor 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:
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
3. Distribution of questionnaire/declaration forms
A 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 compiling
The 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
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.
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
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.
7. Analysis/inference
The data obtained was analyzed SPSS and Microsoft Excel was used to determine the awareness level regarding EHMS.
8. Recommendation
Recommendations were given for the outcome from the study.
9. Final presentation
Various 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.
A screenshot of the main website of Hindustan Petroleum Corporation Limited is taken.
This is the wellness portal for the employees.
After entering the wellness portal employees have to add their details for log in.
This screenshot tell about the online medical claim system in the organization.
This screenshot tell about the employee details and the general medical information considered.
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. 56-60
Figure 1.1 AGE DISTRIBUTION OF RESPONDENTS
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
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
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
Figure 1.4 MAJOR ADVANTAGES OF EHMS
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
Age and nature of work
Two type of job nature was being determined, Field and Table
Figure 1.6 AGE AND NATURE OF WORK
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
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. 25-30
ii. 31-35
iii. 36-40
iv. 41-45
v. 46-50
vi. 51-55
vii. 56-60
Frequency Table
Table 2.1 FREQUENCY TABLE OF AGE
AGE
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.
Table 2.2 FREQUENCY TABLE OF GENDER
GENDER
Frequency
Percent
Valid Percent
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 1-3lacs
ii. Rs 3-5lacs
iii. Rs5-7lacs
iv. Rs 7-10lacs
v. More than 10lacs
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
Total
2
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
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
NATURE * AWARENESS Crosstabulation
Count
AWARENESS
Total
1
NATURE
1
30
30
2
20
20
Total
50
50
Figure 2.2 BAR CHART OF NATURE OF JOB WITH AWARENESS
The age of the employees in this study was grouped into 7 headings:
1. 25-30 years
2. 31-35 years
3. 36-40 years
4. 41-45 years
5. 46-50 years
6. 51-55 years
7. 56-60 years
Table 2.4 AGE DISTRIBUTION OF THE EMPLOYEES
AGE
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
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.
Figure 2.3 AGE DISTRIBUTION
Table 2.5 MEASURING THE VITALS
VITALS
Frequency
Percent
Valid Percent
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
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.
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:
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)
1.0
General
1.1
Name of the Respondent
1.2
Address
City
Contact numbers (with STD Code)
1.3
Age
1.4
Gender
1,5
Nature of job
(Table/Field )
Signature of the Interviewers:
(Note: please leave this blank if self executed)
2.0
Maintenance of Electronic Health Record
2.1
Are you aware of Employee Health Management System
1. Yes
2. 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 time
b. Reduce cost of care
c. Improve quality
d. Reduce errors in lab
e. Reduce errors in medication
f. Others (specify)
2.6
Do you believe that “ What health records get measured , gets improved”
1. Yes
2. No
2.7
Would you like to monitor regular health records and maintain in EHMS?
1. Yes
2. No
2.8
If No, Why?
3.0
Information on Health Insurance
3.1
Do you understand the importance of Health Insurance?
1. Yes
2. No
3.2
How many health insurance policies have your enrolled?
3. 2012
4. 2011
2. 2010
3. 2009
4. 2008
3.3
What is the amount insured for health insurance in your family
1. Rs. 1 – 3 lacs
2. Rs.3 – 5 lacs
3. Rs.5 – 7 lacs
4. Rs.7 – 10 lacs
5. 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..
CASE STUDY
TELEMEDICINE IN DENTAL HEALTHCARE
INTRODUCTION
Telemedicine 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
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 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 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 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.
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 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. 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.
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. Computers
ii. Multimedia devices
iii. Scanners
iv. Security devices
v. 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.
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.
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.
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.
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.
Results
Time spent on internet
Time spent on the internet is categorized into three sections.
i. 1-3 hrs
ii. 3-5 hrs
iii. 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 INTERNET
HOURS
Frequency
Percent
Valid Percent
Cumulative 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
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- EFFECTIVENESS
COSTEFFECTIVE
Frequency
Percent
Valid Percent
Cumulative Percent
Valid
1
12
80.0
80.0
80.0
2
3
20.0
20.0
100.0
Total
15
100.0
100.0
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 TIME
SAVINGTIME
Frequency
Percent
Valid Percent
Cumulative Percent
Valid
1
13
86.7
86.7
86.7
2
2
13.3
13.3
100.0
Total
15
100.0
100.0
Figure 3.3 BAR DIAGRAM FOR SAVING TIME
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....
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.
Bibliography
1. www.hindustanpetroleum.com
2. www.hindustanpetroleum.com/En/ui/CSRPolicy.aspx
3. www.iihmrdelhi.org
4. www.ehms.com
5. www.wikipedia.org
6. www.google.com
7. www.palisolutions.com/EHMSBrochure
8. www.staywellhealthmanagement.com
9. www.healthmanagementsystem.net
10. www.workforcehealthcare.co.za
11. http://www.ijmijournal.com
12. http://www.jstor.org
13. www.ibm.com/ibmresponsibilty/employeewellbeigns.html
14. www.employeewellnessusa.com
15. www.dentsu.com
16. http://www.globalmed.com/products/telemedicine-carts.php
17. www.wikipedia.com
18. www.jispcd.org
19. www. jamia.bmj.com
20. www.online.liebertpub.com
21. www.digitalcommons.unl.edu
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
METHODLOGY
Final Presentation
Managerial Segment
Non-managerial Segment
Service Assistant Segment
SCOPE OF TELEDENTISTRY
REQUIREMENTS
BASIS
CURRENT EVIDENCE FOR TELEDENTISTRY
ETHICAL AND LEGAL ISSUE
Age Distribution
25-3031-3536-4041-4546-5051-5556-60685121072
Satisfaction with the upkeep of records
YESNO482
Monitoring medical vital statistics
YESNO437
Major Advantages
123452134192123
AMOUNT OF HEALTH INSURANCE
1234501101524FIELD25-3031-3536-4041-4546-5051-5555-604437732TABLE25-3031-3536-4041-4546-5051-5555-602425340
AGE AND AWARENESS OF EHMS
25-3031-3536-4041-4546-5051-5556-6068512107225-3031-3536-4041-4546-5051-5556-60685121072
INTERNATIONAL INSTITUTE OF HEALTH MANAGEMENT RESEARCH (IIHMR) NEWDELHI
5
