Health Management Information System (HMIS) for Independent Private Hospitals and Clinics in Uganda (Private-for-Profit Hospitals and Clinics)
BACKGROUND
Flow
of data from private hospitals and health clinics to the Ministry of Health and
Other Partners has been poor and management and utilization of HMIS has been inadequate. Majority of the reporting health
units are government owned and PNFP faith-based hospitals implying that PFP or
independent private health units are sometimes not represented and yet they
have a significant role in healthcare delivery. Most Health workers do not
appreciate the importance of HMIS. Based on that situation, there is need to
establish a sector-based centralized HMIS for the PFP private health sub sector
in Uganda which will be recognized and harmonized with the central government
(MOH) HMIS System.
The Healthcare Environment in Uganda

Public Hospitals
Non-Profit Private Private-for-Profit (PFP)
Health Sector
Health Sector
The
Uganda National Association of Private
Hospitals (UNAPH) has identified quality health services and the efficiency of private
hospitals as key contributors for building trust and confidence for the general hospitals in the hearts of Ugandan citizens. In order to be able to take
prompt decisions
at appropriate
times required a holistic view of the functioning
of all hospitals and clinics which mandated integrated information system deployment across the hospital processes.
help the administrators
to have
better monitoring
and control of
the functioning
of hospitals across the country using decision support
indicators but also assist the doctors and medical staff to improve health services with readily reference patient data, work flow enabled less-paper process and parameterized
alarms and triggers during patient treatment cycle.
HMIS enables
monitoring
pre-defined health indicators and the
embedded exception reporting facilitates decision making by the hospital management and
state level administrators for policy and strategic decisions.
HMIS will enable provision
of better care to patients by automating all the major
functional areas of the hospitals & the entire private
hospital sector. HMIS will
go live in all private hospitals and
clinics in the country.
A.
PROJECT CONCEPTUALIZATION
HMIS project was conceptualized by the department of monitoring
and quality assurance to ensure the quality health care by IT application in
such
a manner so
has to
provide standard
clinical
& diagnostic protocol tools ,
hospital management tools and
integration of management information at the national
level so as to
ensure online review & monitoring.
This is aimed at management of vital patient records, analysis of the critical health related data so as to provide an updated planning & policy tool towards provision of quality health services.
B.
PROJECT VISION, STAKEHOLDERS, OBJECTIVES AND SERVICES
•VISION
Access to Quality health care services for all by providing improved patient care through effective clinical and administrative
processes Technology with the help of
Information Communication
• STAKEHOLDERS
1.
Citizens (Patients & their relatives)
2.
Private Hospitals and
private clinics
3.
Department of Quality Assurance, Clinical Services, Medical Education & Research
4.
Science & Technology department,
5.
Total Solution Provider (Magezi
Solutions Ltd.)
• OBJECTIVES
1.
To provide access to quality health care.
2.
To create Electronic medical records.
3.
To improve clinical & diagnostic services.
4.
To provide early alerts on disease trends & Cause of deaths as per International codes for Disease surveillance and rapid action.
5.
To get integrated national level holistic view of the resource utilization.
6.
To monitor
identified indicators and to get comparison of efficiency and performance among private
hospitals and clinics.
7.
To provide evidence based effective and responsive hospital management.
8.
To provide tools
for
effective health policy making & planning.
• SERVICES
The various services provided through HMIS are as follows:
• PATIENT CARE SERVICES
1.
Registration
2.
Wards
3.
Pharmacy
4.
Billing
5.
Patient Education
6.
Information Kiosk
7.
Nursing Care
• CLINICAL SERVICES
i.
Clinical/EMR (Gynecology, Ophthalmic, Orthopedic, ENT, Gastro Medicine, General Medicine, Nephrology, Pediatric, Surgery, Urology, Skin etc…)
ii.
Laboratory (Pathology, Microbiology, Bio - Chemistry, Radiology)
iii.
Blood Bank
iv.
Imaging
• HOSPITAL ADMINISTRATION
1.
Hospital Admin
2.
Human Resource
3.
Payroll
4.
Financial Accounting
5.
Stores/Inventory
6.
Purchase
7.
Complaints & Redresses
8.
Transportation
9.
MIS Reports
10. EIS Reports
• ANCILLARY SERVICES
i.
National Programs
ii.
Linen Management
iii.
Equipment Maintenance
iv.
Resource Scheduling
v.
Special Camp & Training
vi.
Bio Medical Waste
vii.
Application Security
C. NECESSITY/NEEDS
• HMIS PROJECT
WAS NECESSITATED FOR THE FOLLOWING REASONS:
·
Difficulty in integration of patient records
and
hospital activities affected quality of health care services adversely.
·
Difficulty in getting Real time information regarding the outbreak of epidemics.
·
Need for an integrated tool for timely monitoring of services.
·
Lack of timely information resulting in inefficient utilization of resource.
·
Adoption of Quality standards for processes for diseases, Death causes etc.
·
Necessity for effective tool for health policy making.
• PROJECT PLAN
1.
Need assessment and system study.
2.
Requirements of process re-engineering.
3.
Technical Architecture
4.
Capacity building
5.
Pilot & Complete Rollout
6. REQUIREMENTS OF PROCESS RE-ENGINEERING AND LEGAL FRAMEWORK
·
Process of registration re-engineered so as to form the basis for e-database, workflow and work list.
·
Templatized Clinical treatment protocols.
·
Diagnostic process simplified through single sample collection.
·
Administrative formats are standardized to cut down on repetitive work which resulted in saving of time for administrative staff, doctors and nurses.
·
Online Stock management: procurement and issue of medicines, consumables, and other
housekeeping materials is re-engineered so as to identify the fast moving items.
·
Convergence of standardized Biomedical Waste Management, Death causes, standards compliance & Codification of Diseases with HMIS.
·
Provision of number of financial, technical, managerial and policy tools to help take right decisions at right time.
·
Integrated management of inpatient through linking surgeries, nursing
care, ward management, laboratory,
radiology and blood bank.
·
HRD management through allocation of work list, workflow resulted in to optimum resource utilization through tracking breakdown and maintenance of equipments and effective usage of ambulance services.
7.
TECHNOLOGY ARCHITECTURE
HMIS will be developed on .NET technology with SQL Server as backend. The Technology architecture for HMIS project is as follows:Â
· Tier 1 (Presentation
Logic):
Includes simple
controls
and
user input validation
·
Tier
2
(Application
Server):
Includes business processes logic and the data access
·
Tier 3 (Data Server): Provides business Data
PROJECT MANAGEMENT STRUCTURE
- National Level
- Central Monitoring committee reviews implementation fortnightly.
- Technical committees to suggest and approve individual modules.
- Field visits by management team to ensure implementation as per schedule.
- Hospital Level
- Technical team to provide onsite support and coordinate rollout.
- Continuous monitoring by Civil Surgeons and Hospital administrators.
10. IMPLEMENTATION
A.
STRATEGY FOR PILOT TO ROLL OUT
The strategy adopted for implementation of HMIS project has been as follows:
- Selected an IT partner, who had required expertise and total solutions with proven track record.
- ready-to-deploy HMIS framework application earlier, therefore having proven record and experience about functional as well as technical know-how
- Identification of private hospital as teaching and health centers for pilot sites
- 250+ users from across the roles and hospitals
- interviewed, observations documented and Proof- of-Concept replayed to these users prior to their approving for roll-out to other hospitals.
- On site hand holding team, regular reviews by task committee members for ensuring progress and change management
B. CAPACITY BUILDING:
GOVERNANCE STRUCTURE, PROJECT MANAGEMENT TEAMS,
EXIT MANAGEMENT TEAM, CHANGE MANAGEMENT AND TRAINING
- UNAPH has put lot of emphasis on capacity building for successful implementation of HMIS project.
- Detailed manual for every module will be prepared and issued to all private hospitals and clinics.
- All the users will be provided with the basic computer training along with the HMIS specific training and hands on training.
- Hand holding to all the users will be provided through a technical team of total solution provider and concerned hospital.
- Periodical orientation and refresher training will be imparted to all the users.
-
• PROJECT MANAGEMENT TEAMSi. Project Management: Additional Director, Civil Surgeon at respective hospitals and representatives from solution providerii. Project Policy level: Commissioner, UNAPH Staff, Additional Directoriii. Change Management: Commissioner, Civil Surgeon and Medical Superintendent, IT Committee that includes HoDs of different medical specialties• EVALUATION AND MEASUREMENTThe Stakeholder Need Assessment will be done by taking structured user feedback survey based on following parameters:
- Quality of Deliverables
- ii. Project Management
- Post-implementation support
- Documentations v. Responsiveness vi. Communication vii. Infrastructure
- Security & Confidentiality
The Service levels Agreement [SLA] have been defined for the implementing partner.Sr. No.SLA MeasureDescription1Issue ResponseTime/AcknowledgementAll cases from case open time tosupport team acknowledgement time2Issue Resolution TimeAll cases from case open time to caseclose time. SLA provided for system support cases3Age of IssueCurrent open cases from case opentime. SLA provided for system support cases4Backlog of issueCurrent open cases by rolling fourweeks total volume11. ISSUES AND THEIR SOLUTIONSA. LESSONS LEARNT - CRITICAL SUCCESS FACTORS, FAILURE FACTORS• CRITICAL SUCCESS FACTORSa. Customizationb. User Conveniencec. Uniform & Integrated Systemd. Adequate Security & Authentication provisions v. Change Managemente. Ongoing Training & Support• FAILURE FACTORSi. N/AREPLICATION IN OTHER COUNTRIESThe HMIS project can be easily replicated in other countries with little customization.C. ROAD AHEAD- Touch screen kiosk for health promotion and prevention.
- SMS alerts to Staff
- RFID / Smart card for capturing patient and doctor’s data.
- Bar Code for Patient Identification and even for other items.
- Biometrics for Employees Attendance System as well as for retrieving the Patients data.
- Online Appointments
- Tele Medicine
- CME – Continued Medical Education
12. STATUS AND RESULTSA. PRESENT STATUS- HMIS will go live to all private Hospitals and clinics
- All operators of private hospitals and clinics will be provided training
B. SPECIFIC ACHIEVEMENTS DURING THE YEAR 2013-14Almost all private hospitals and clinics will go on system by 2014.C. FUTURE PLANS FOR READERS SEEKING MORE INFORMATION ON PROJECTThe future plans for HMIS are as follows:i. Integration of HMIS with private hospitalsii. National Health Resource Center for health services
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