Health Management Information System (HMIS) for Independent Private Hospitals and Clinics in Uganda

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.

The Health Management Information System (HMIS) has been envisaged to not only 

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:­

·       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:

1. Selected an IT partner, who had required expertise and total solutions with proven track record.
2. ready-to-deploy HMIS framework application earlier, therefore having proven record and experience about functional as well as technical know-how
3. Identification of private hospital as teaching and health centers for pilot sites
4. 250+ users from across the roles and hospitals
5. interviewed, observations documented and Proof- of-Concept replayed to these users prior to their approving for roll-out to other hospitals.
6. 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.
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• •   PROJECT MANAGEMENT TEAMS
  
  
  i.                      Project Management: Additional Director, Civil Surgeon at respective hospitals and representatives from solution provider
  ii.                     Project Policy level: Commissioner, UNAPH Staff, Additional Director
  iii.                   Change Management: Commissioner, Civil Surgeon and Medical Superintendent, IT Committee that includes HoDs of different medical specialties
  
  
  
  
  •    EVALUATION AND MEASUREMENT
  
  
  The Stakeholder Need Assessment will be done by taking structured user feedback survey based on following parameters:
  
  
  1. Quality of Deliverables
  2. ii.   Project Management
  3. Post-implementation support
  4. Documentations v.   Responsiveness vi.   Communication vii.   Infrastructure
  5. Security & Confidentiality
  
  
  
  
  The Service levels Agreement [SLA] have been defined for the implementing partner.
  
  

  Sr. No.	SLA Measure	Description
  1	Issue                 Response Time/Acknowledgement	All  cases  from  case  open  time  tosupport team acknowledgement time
  2	Issue Resolution Time	All cases from case open time to case close  time.  SLA provided  for system support cases
  3	Age of Issue	Current  open  cases  from  case  open time. SLA provided for system support cases
  4	Backlog of issue	Current  open  cases  by  rolling  four weeks total volume

  
  
  
  
  
  
  11.  ISSUES AND THEIR SOLUTIONS
  
  
  
  
  A.  LESSONS LEARNT - CRITICAL SUCCESS FACTORS, FAILURE FACTORS
  
  
  •    CRITICAL SUCCESS FACTORS
  
  
  a.                   Customization
  b.                  User Convenience
  c.                   Uniform & Integrated System
  d.                  Adequate Security & Authentication provisions v.   Change Management
  e.                   Ongoing Training & Support
  
  
  
  
  •                                FAILURE FACTORS
  i.  N/A
  
  
  REPLICATION IN OTHER COUNTRIES
  The 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 RESULTS
  
  
  A.  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 2013-14
  
  
  Almost all private hospitals and clinics will go on system by 2014.
  
  
  
  
  C.  FUTURE PLANS FOR READERS SEEKING MORE INFORMATION ON PROJECT
  
  
  The future plans for HMIS are as follows:
  
  
  i.                      Integration of HMIS with private hospitals
  ii.                     National Health Resource Center for health services