technology to improve patient satisfaction and quality of care in public healthcare facilities of Haryana State Health Systems Resource Centre Haryana Dr Sonia Trikha Director Health Services ID: 1043743
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1. e-Upchaar: Leveraging information technology to improve patient satisfaction and quality of care in public healthcare facilities of HaryanaState Health Systems Resource Centre, HaryanaDr Sonia TrikhaDirector Health ServicesED, SHSRC, Haryana
2. Public Healthcare: Challenges2Overcrowding at the facilities - poor patient satisfactionAbsence of reliable processes, compromising PSGsCompromised inventory control leading to stock-outs, eventually increasing OOPERetrieval of medical records time consuming, reliability and authenticity of data?
3. Project background3Hospital Management Information System (HMIS), ‘e-Upchaar’ initiated by Government of Haryana in 2014Project being implemented by State Health Systems Resource Centre, HaryanaStakeholders: Departments of Health, Medical Education & Research and AYUSHSKG AC KurukshetraBPS MC Khanpur KalanSHK MC Mewat PGIMS Rohtak
4. Objectives4Availability of EMR for every registered patient across 56 facilities(MCs & DHs) Transparency and availability of information related to hospital servicesReduction in waiting time through efficient queue managementOptimal utilization of infrastructure, equipment, facilities, HR, drugs & consumablesSimplification and automation of manual processes
5. Objectives (contd…)5100% service availability to all patientsReal-time reporting, efficient analytics and decision supportEfficient grievance redressal mechanismIntegration with external applications, programs and schemes
6. e-Upchaar Modules6
7. OP Touch Points, Activities and KPIs7
8. Registration module8Designated registration counters Token system for better queue managementUHID for patient identification Easy monitoring of patient waiting times
9. Doctors’ Module9User Friendly screens Capturing diagnosis Ordering investigations Prescribing medicinesViewing diagnostic reports
10. Doctors’ ModuleView of patient queue (on Doctor’s screen)Favourites/Tick list featureThe doctor can mark the patient as seen, send a patient for cross referral, order investigations (lab & radiology) and also view the patient’s EMR from this screen.The regularly used diagnosis can be added to the Favourite list by an individual doctor. All the diagnoses are mapped to the ICD 10 classification of diseases.
11. … Past Practice
12. Diagnostic Modules12Laboratory ModuleUnique Barcode for each collected sampleIntegration of Lab equipment with the applicationReduction in the lab errors and sample re-dos‘Out of range’ values highlighted Alerts for critical valuesRadiology ModuleIntegration of radiology equipment with the applicationX-ray images are available on the doctors’ screen for view & decision makingCost saving due to discontinuation of printing of x-ray films
13. Integration of e-Upchaar with PACS13
14. Pharmacy Module14Availability of online Prescription (part of EMR) for medicine dispensing Automatic linkage with the store inventory Alerts for stock outs, expiry etc.
15. IP Touch Points, Activities and KPIs15
16. IPD Module16Capturing the diagnosis, investigations and the hospital course of treatmentSurgical procedures (including OT notes, Anaesthesia details)Discharge summaries automatically populated with the course of events post admission
17. Sterile linen and instruments transported in linen/instrument trolleys
18. Digitisation of patient record18Patient record captured in the form of Electronic Medical Record (EMR) against each patient ID. Available for review and evaluation by the doctors.It includes:Patient diagnosis which is mapped to ICD 10 classificationDiagnostic reportsMedicines dispensed/issuedSurgery details (if any)Discharge details
19. Store & Sub Store ModuleMapping of available drugsDispensing of drugs through the pharmacy/store moduleAnalysis of consumption patterns for fixing reorder levels for drugsAlerts for Stock outsNear expiry drugsExpired drugsTransparency related to stock availabilityReduction in wastage due to Expiry Reduction in pilferage of drugsImproved decision making
20. Benefits of implementing e-Upchaar 20UHID generation, Aadhaar linkage, facilitation through registration countersIn-patient identification through ID bands reducing medication errorsToken system in OPD, ER and diagnostics to reduce patient waitingManual records replaced with lean systemReduced waiting times Quality patient careClinical effectiveness through standardized treatment protocolsAutomation of laboratory and radiology servicesSystem alerts in pharmacy and stores for stock-outs and near expiryElectronic Health Record for all registered patientsOnline laboratory reportsMonitoring of pre-defined health indicatorsImproved patient outcomesCapturing of patient feedback through ‘Mera Aspataal’Improved patient satisfaction levelsStructureProcessOutcome
21. Cost effectiveness 2124,20,700
22. Laboratory errors and re-dos being analysed by the laboratory staff
23. Impact analysis23Services/FacilitiesIn Manual SystemThrough e-UpchaarPatient Registration4-5 mins per new patient once the patient reaches the counter1 min per new patientFollow Up visit with UHID3-4 mins per patient[In practice, a new card is issued to revisiting patients]30 secs per patientBilling & Cash Collection2-4 hours per patient3-5 MinutesDiagnostic report availability1 - 2 daysSame day in most casesInventory ControlPoor & lengthy system of managementReduction in wastage with alerts for near expiry and expired stockBlood BankNo track of blood stock, information on available blood groups etc.Manual tracking of blood bag expiry dateManual Tracking of blood collected during blood campsIncrease in blood utilizationWastage Avoided Centralized Blood Inventory InformationCare Planning by PhysiciansCare Planning is event based and time consumingEMR of a patient helps physician in better care planning and monitoring. Follow up is easier.
24. Overview of implementation24
25. New Developments25Central dashboardHRMSKey performance indicators (KPIs)http://117.252.5.248:8092/dashboard/dashboardLanding.jsp http://117.252.5.249:9093/#/Login
26. Training of the usersShift from manual data recording to a more transparent systemInadequate manpowerManpower constraintsIssues with data validationDelayed construction activitiesOperational issuesDifferential price master across facilitiesLack of transparency related to servicesStandardization of processesInteroperability issues with external applicationIntegration with external applicationsChallengesChange management
27. The way forward..27Web portal and mobile applicationExpanding to the remaining healthcare facilities (Approximately 670): New RFP in the process of finalizationAdvanced analytics for decision making at thestate levelData Mining for research studies/publications
28. 28Thanks