Kasturba Hospital at Sevagram has now grown into a nearly 1000- bed teaching hospital. Like all public and teaching hospitals, our hospital is also fairly busy. Take for instance, the health-related events that the hospital generates on a typical Monday. Over a 24-hour period, close to 1700 patients access the outpatient care in the hospital, hospital pharmacies deal with 1800 prescriptions, 140 patients seek admission to the hospital wards, 14 patients undergo major surgeries, 12 babies are delivered, and 20 units of blood are transfused. In addition, 270 patients undergo radiography, 60 ultrasound examinations, 14 computed tomography, and seven patients have a magnetic resonance imaging scan. The laboratories report 750 biochemical tests, 470 complete blood counts, 100 serologic tests, 20 cytology samples and 15 biopsy specimens.
A decade ago, these activities required tonnes of papers- full of illegible prescriptions, indecipherable numbers difficult-to-make-out handwritten notes. The information had all the drawbacks associated with paper-based system: it took time, efforts and manpower to enter and store the data, and huge inputs notwithstanding, the information was neither accurate nor precise and always rank the risk of being lost.
In 2004, two electronic-savvy faculty members from the department of Medicine and the staff of hospital computer section decided that the time was ripe to replace paper- intensive processes with electronic ones. They wanted to create a hospital information system at MGIMS that makes it possible to get the right information, at the right time, at the right place, to the right people, in a right format.
The Ministry of Information Technology, Government of India, funded this concept and asked Center for Development of Advanced Computing (CDAC), Noida to design a system that fulfilled the MGIMS electronic wish list. Over a two-year period, dozens of system analysts, programmers, code writers, code testers, and implementers from C DAC descended at MGIMS, met and discussed the needs of each section of the hospital, worked closely with the newly developed HIS department. They defined the input, designed the processes and created an output. Two years later, they produced a system, MGIMS is justifiably proud of.
Virtually every area of hospital operations is now computer-supported. The hospital uses the HIS to store and process health information and data about patients. As of now, the HIS has built 21 modules that are used by 150 faculty, 120 residents, 60 interns, 250 nurses, scores of clerks, laboratory technicians, pharmacists, dieticians and administrators. Spread over the entire campus- thanks to a WiFi connectivity, doctors now use over 350 desktops, countless mobile phones, iPads and laptops across the hospital to access the data- anytime, anywhere on campus.
HIS application is a Web based application; it runs on Linux servers. Optimized for different browsers including Safari, Chrome, Mozilla, IE etc, the system allows faculty, residents, interns, nurses, pharmacists, laboratory technicians, administrators, student section of the dean office, the central store, and finance department to transact all their requirements electronically.
Registration, Admission, Discharge, Transfer (RADT) Module
Managing the entire patient care workflow has never been easier. At the registration desk, the system captures patient demographic information and assigns them a unique 12-digit ID. The module is also used for generating annual health assurance cards, bed tracking and discharge, the Registration, Admission, Discharge, Transfer (RADT) system manages the necessary administrative procedures for both inpatient and outpatient visits, including applying policies, managing waiting lists, and assigning wards, units and beds.
The system is fully integrated with ward systems and automatically generates an accurate census at the stroke of midnight- statistics on occupancy, admissions, transfers, and discharges.
We offer a unique health assurance scheme which greatly facilitates the access to an affordable health care. Close to 65,000 families avail themselves of this facility and a quarter million individuals in and around villages and towns around Sevagram register themselves every year for the unique feature Kasturba Hospital is associated with. The Health Assurance modules helps the hospital acquire, store and use this information and helps the billing section to bill the patients according to the category they belong to.
Queue Management System
An electronic queue management system ensures that all outpatients in the respective OPDs are assigned a number and enter the doctors chambers according to the queue number generated by the system. This system has also helped the institute to do a time motion analysis to assess how much time patients are spending at each counter after they are registered in the hospital.
A unique feature of the system is electronic desk- extensively used by residents, interns, consultants for tracking the inpatient information. This module helps the doctors to track all the patients in their unit and department, order laboratory tests, view test results- arranged chronologically, order drugs electronically, enter operating room notes, generate a discharge summary, review past visits, test results and admissions and print the discharge summary.
With a few mouse clicks, doctors can quickly and simultaneously view diagnoses, treatment histories, test results, and medication histories. The HIS includes a fully integrated computerized electronic discharge card that allows clinicians prepare discharge summaries electronically. The system captures information on patient demography, all laboratory tests, operating room notes, and in-hospital management. Laboratory results and diagnostic images are electronically reported and linked to the patient.
The HIS provides a platform to support nursing related activities within the hospital setting including assigning a bed, tracking the patient, medication administration, maintaining stocks, and billing the services used by the patient.
We introduced RIS/ PACS in the hospital in 2011. The RIS/PACS is a seamlessly combined Radiology Information System (RIS) and Picture Archiving and Communication System (PACS) that has been integrated with the Hospital Information System. With RIS/PACS, radiologists use a single software application to manipulate study images and access the entire patient medical record. The workstation interface has been optimized for radiologist workflow, including support for predefined templates, an intuitive report editor, and voice-recognition and dictation capabilities. Multi-resource appointment scheduling, image distribution, and patient billing are also included.
Laboratory Information System
The Laboratory Information System fully integrated with other modules allows doctors to order laboratory tests electronically, and laboratory technicians to accept the samples, run the tests, and enter the test results electronically. The consultants electronically validate the test results and doctors can access the validated tests at the point of care in different settings- OPDs, wards and operating rooms. Automated integration software for lab analyzers (e.g. electronic cell counters) allows test results to be captured directly in the system. Thus, the turnaround time for biochemical tests has been reduced to 2 hours leading to improved clinical outcomes and increased efficiency.
With over close to 20 major surgeries performed in the hospital each day, the operating rooms require a quality surgical management system. The HIS operating theater module delivers maximum efficiency of operating room resources, staff, and materials through scheduling, utilization, and peri-operative management tools. We have also designed a module that permits the OT nurses to electronically order all drugs, sutures, and accessories required for an operation electronically.
Blood Bank Management System is a solution that was designed for MGIMS to store, process, retrieve and analyze information concerned with the administrative, inventory management, and clinical aspects of providing services within a blood bank. Every year, close to 4500 blood bags are issued to the different sections of the hospital, using this module.
Clinical Forensic Medicine Unit (CFMU) Module
Taking into consideration the poor quality of medico-legal reports which act as a deceptive factor during judiciary trials, in 2012, we established Maharashtra's first Clinical Forensic Medicine Unit (CFMU) at the department of forensic medicine.
Started with a purpose to bring an efficient medico-legal system, this unit is incorporated to work hand-in-hand with the emergency centre and all medico-legal cases are handled under direct supervision of experts from the department.
The judiciary had passed strictures on the illegible handwriting of medicos on the legal reports as it was impossible to decipher them. To overcome this constraint, MGIMS has also developed forensic medical software which generates printed and organized reports. The module has complete data of patients and ensures that not even a minute detail is skipped.
Medical Record Department
The Medical Records Department is responsible for maintaining medical records in a standardized and professional manner in order to protect patient confidentiality while allowing adequate access to providers in order to promote quality patient care. All discharge diagnoses are coded by a pair of trained medical record personnel. They assign ICD 10 code to each discharge diagnosis and generate reports that helps administrators understand the prevalence of diseases. The code set allows more than 14,400 different codes and permits to assess the burden of diseases in the communities that they are serving. Also information on notifiable infectious diseases, births, and deaths is collected and sent to the state public health agencies.
In addition to automating the routine workflow of hospital pharmacy, HIS provides tools for bar coded prescriptions. The e-prescriptions generated at the point of care helps increase patient safety by decreasing the risk of patients receiving the wrong medication. The HIS also deals with the purchase, inventory management and distribution of various drugs, sutures and surgical items to outpatient pharmacy, inpatient pharmacy, wards and operating rooms in the entire hospital. The system ensures that the pharmacies are well-stocked. We have created transparency, better monitoring and complete control over the drug distribution in the hospital.
iPads at the Point of Care
We introduced iPads at the point of care in 2013. We realized that our patient care is becoming very data driven. Although the electronic system had eased our access to data, the data were still housed in computers. Doctors are always on the move, and clinical medicine can never be practiced behind a desk. We, therefore felt that critical data also needs to be mobile. Thus, we needed a system that allowed providers to be at the bedside to make these decisions and yet still be able to access the data.
We procured iPads for the residents and willing faculty, and asked them to use the iPads at the patient’s bedside. We commissioned a Bangalore based leading app application agency to specially develop an app for MGIMS which could help doctor enter, store, retrieve and act on the information where it matters most- at the point of care.
When doctors-in-training at the hospital were given iPads to use on their rounds, they found that using the device helped them be more efficient at ordering tests and procedures for their patients. They also felt that earlier they couldn’t spend a lot of time at the bedside because they're tied to the computer. The iPads allowed residents to see patients' electronic health records, to contact the hospital laboratory or other departments if they needed tests done and to show patients their own x-rays and other test results, as well as access medical journals. https://www.youtube.com/watch?v=glxjwIijONI
Accounts and Payroll
The HIS provides general ledger, accounts payable, accounts receivable, fixed asset, and cash management solutions enabling a current, consolidated, and fast view of the financial status of the organization at any point in time. Payments received from patients, and payments paid to vendors, salaries are electronically generated, tuition and hostel fees now take an electronic route and all transactions can be tracked and easily posted to the General Ledger system to reflect their effect on accounts and financial reports.
To sum up, the real time HIS streamlines the treatment flow of patients and also empowers the hospital's workforce to perform their duties effectively and efficiently and providing benefits to both the recipients and the providers of healthcare.