Essence of HMIS in Hospital Functioning

With huge investments being made in tertiary care, India’s health sector is expected to double in revenues to USD 280 billion by 2020; and this growth will be largely facilitated by IT.

Technology is pervasive for all sectors to function seamlessly. Recent evolution of technology in healthcare has improved the basic healthcare scenario in India and is now the driving force of the healthcare sector. It has led to improvements – changing the way healthcare organizations function to recent innovations and inventions in healthcare devices used to examine health of an individual. In recent times, with the increasing costs in healthcare industry, there is a need to organize the information that health professionals require. Today, every healthcare center demands a robust and effective hospital management information system (HMIS), a complete and cohesive information system designed to manage entire hospital operations to enhance the operational efficiency. The operations like medical, administrative, financial, legal, and other corresponding services can be easily managed by HMIS.

HMIS is now playing a crucial role in the Indian healthcare sector. With the burgeoning population and expanding number of critical diseases, one can now see various healthcare institutions rapidly expanding. A powerful HMIS enables small, medium, or big-sized hospitals as well as clinics to improve their effectiveness and quality of work. The entire activities of a hospital can be automated and ensure highly accurate flow of information between the departments. Such kinds of software systems help to make the workflow easier and convenient. Hospitals, healthcare groups, and medical practices have adapted to newer management structures and systems to curb spiraling costs. A number of large hospitals and healthcare providers have already shifted to a more integrated and comprehensive approach to excel in the clinical, operational, and financial spheres of the organization, while the smaller chains are finding ways to achieve collaborations for cost-effective access to resources. The quality of the HMIS data has improved over time, and some important information on improvements in equitable distribution of health infrastructure and coverage is now transparent.

The Government’s Role

The Manual on Health Statistics in India, published by the Ministry of Statistics and Program Implementation, lists multiple benefits that can be reaped from higher investments in HMIS including helping decision makers to detect and control emerging and endemic health problems, monitor progress toward health goals, and promote equity; empowering individuals and communities with timely and understandable health-related information, and drive improvements in quality of services; strengthening the evidence base for effective health policies, permitting evaluation of scale-up efforts, and enabling innovation through research and; improving governance, mobilizing new resources and ensuring accountability in the way they are used. An efficient national health information system facilitates transparent and evidence-based decision making which, in turn, leads to improvements in health outcomes.

Availability and use of regular, good quality health data is increasingly becoming a policy imperative. Health ministry is already at the forefront of incorporating the benefits of digital technology toward achieving the goals elucidated in National Health Policy (2017) which are synchronous with the Sustainable Development Goals (SDGs). Currently, around 200,000 health facilities across all districts are uploading facility wise data on a monthly basis directly on the HMIS web portal. HMIS was intended as a management information system to oversee the working of the National Health Mission (NHM). The mission is using a web-based HMIS to collect and collate data related to the health infrastructure to monitor its health programs and provide key inputs for policy formulation and interventions throughout the country. As part of NHM, health facilities capture data for HMIS about antenatal coverage, immunization coverage, delivery services, family planning coverage indicators, among other variables.

Computerization of district/sub-district hospitals and community health centers (CHCs) to implement the HMIS for creation of EHRs and online prescription is being undertaken in a phased manner with the purpose of better delivery of services to patients and improvement in efficiency of processes at hospitals/healthcare institutions. Financial support has been provided to Chandigarh, Himanchal Pradesh, Jammu and Kashmir, Jharkhand, Uttar Pradesh, Maharashtra, Meghalaya, Rajasthan, and Tamil Nadu during 2016. The Union Ministry has stated that 100 district hospitals in Uttar Pradesh will be on the e-hospitals platform very soon. All the 100 district hospitals will now receive the HMIS. The new digital system will help doctors see the medical history of the patients and all medical records online. The system will also introduce e-cash payment cards for the patients and will also let doctors check the availability of medicines before they prescribe a medicine.

Centre for Development of Advanced Computing (C-DAC) has also developed a unique concept of state-wide implementation of HMIS across various government hospitals ranging from super-specialty hospitals, medical college hospitals, and district hospitals to area hospitals. C-DAC’s HMIS has been deployed in more than 40 hospitals across India. C-DAC has developed various solutions in this area. These include e-Sushrut, e-Swasthya, Medical Document Semantic Analyzer, Megh Sushrut, ONCONET, Tejhas. MoHFW has introduced web-based name-based tracking system called mother and child tracking system (MCTS) across all the states and UTs to facilitate timely delivery of antenatal and postnatal care services to all the pregnant women and immunization to all the children.

• The RCH portal (upgraded version of MCTS) has been designed for early identification and tracking of the individual beneficiary throughout the reproductive lifecycle; and to promote and support the reproductive, maternal, new-born, and child health (RMNCH) schemes/program delivery and reporting. This portal will facilitate all the stakeholders with readily available information at one place
• To improve the data quality, MoHFW has also introduced a tablet-based application, called ANMOL (Auxiliary Nurse Midwives On Line), for RCH application. ANMOL enables ANMs to enter and update data for beneficiaries of their jurisdiction. This ensures more prompt entry and updation of data as well as improves the data quality since the data is entered at source (by providers of health services themselves)
• An online data entry portal (www.cbhi.nic.in) is used for reporting of certain communicable and non-communicable diseases from district and/or state/UT levels in co-ordination with Directorate of Health Services (DHS)/State Bureau of Health Intelligence (SBHI) of respective state/UTs. Revised National Tuberculosis Control Programme (RNTCP) is using a web-based reporting system called Nikshay and is periodically validated

Overcoming Challenges

Under-reporting of deaths of mothers and infants in the HMIS, the weaknesses of HMIS are well-researched and acknowledged by the government itself. Studies have suggested rationalization of registers and reports by discarding those with poor managerial value and amalgamating those with duplication, thus saving resources and easing staff burden. Apart from under-reporting of deaths and lack of coverage of the private sector, the HMIS system does not provide information on the exposed population, thus making it impossible to calculate different indicators. To inform evidence-based decision making, HMIS in the country will have to improve tremendously, with a focus on integration of existing infrastructure like the Integrated Disease Surveillance Programme (IDSP) and on collection of data from the private sector.

The large government-funded health insurance schemes can be used as a means to hasten the progress in regulation of private medical institutions and to ensure a regular flow of information from the private sector, which remains a blind spot even in the case of notifiable diseases. It might take time for the HMIS to stabilize and provide quality data that will prove useful in understanding the magnitude and trend of inequality in service utilization across time, space, and population subgroups. However, a highly efficient HMIS is indispensable for any functional public health system. Tamil Nadu’s transition in 10 years into paperless health system and what Punjab is trying to achieve can offer some policy insights. The launch of the GIS-enabled HMIS application in May 2016 was a step in the right direction.

Latest research from Haryana shows that HMIS records for RMNC services at sub-center level in the state were satisfactory in terms of completeness. At the same time, there were quality concerns in the form of significant differences in terms of reported and evaluated coverage of services. The quality of HMIS needs to be improved to make it relevant for public health program planning and research. Often, multiplicity of initiatives prevents a holistic health systems approach, leads to duplication and redundancies, and makes coordinated delivery difficult as observed in the 12th plan document. Various initiatives announced by the health as well as the women and child development ministries can be mapped in a way that there is a comprehensive set of indicators aiding in both the assessment of the system and the tracking of progress. This should be followed by efforts in consolidation and rationalization of existing systems.

Global Market

The global hospital information systems (HIS) market size was valued at USD 16.45 billion in 2017 and is projected to grow at a CAGR of 11.4 percent from 2018 to 2025, predicts Grand View Research. The market is expected to witness significant growth on account of rapid increase in the adoption of these systems for efficient management of hospital operations. The rising demand for efficient management of large volume of data generated and its availability for medical practitioners as and when required is one of the key drivers for the expansion of the market.

Moreover, due to the growing significance of efficient workflow, streamlining of operations, and better storage, management, and distribution of patient data and imaging results, as well as better healthcare delivery and outcomes, there is a growing demand for such IT solutions. The rapid technological advent along with supportive government policies and initiatives are also key contributors to the expansion of the market. Across the globe, health systems have invested significantly in installation of EHR technology and upgradation of IT in health, but only the EHR system no longer serves to be adequate with the rapidly changing healthcare landscape.

The cloud-based technology segment is anticipated to continue the dominance over the next 8 years with a CAGR of 11.8 percent. The key factors driving the widespread use of cloud systems include cost considerations, data storage capacity, and remote access to information. The cloud-based technology is gaining momentum due to numerous security lapses in the web-based and on premise systems. Web-based technology is expected to be the second fastest growing delivery mode growing at a CAGR of over 11 percent. The use of web-based systems has significantly reduced the operational hassles encountered due to processing large volumes of data.

The software segment held a majority of the share in the past. The high demand for advanced software and digitalization of hospitals and technological developments such as eHealth platforms, web-based software, remote monitoring tools, portal technologies, and others are contributing to the large share of the segment. Furthermore, the services segment is projected to be the fastest growing segment during the forecast period with a CAGR of 11.7 percent. The rising requirement for collaboration platforms, implementation of various health information software, and implementation of EHR systems is expected to boost the segment growth.

North America is the largest market for these systems and the government initiatives in the region accelerate the adoption of information technology in healthcare. Furthermore, the local presence of large players with focus on development of advanced IT solutions, successful implementation of EHRs in the region, and high deployment of robust IT infrastructure can be attributed to the large share of the region.

Asia-Pacific is projected to be the fastest growing market with a CAGR of 11.7 percent. The emerging economies, such as India and China, are the most lucrative markets due to the rising elderly population, increasing patient pool, and improving healthcare facilities. The increasing awareness about these systems and their growing importance coupled with the supportive government programs and policies is projected to boost the growth. Rapid adoption of digitization in healthcare by the emerging economies is also contributing to the growth.

Due to greater opportunities in both developed and developing countries, companies are undertaking strategic initiatives such as M&A and collaborations for development of novel innovative solutions and expansion of operations for increased global presence. Prominent players include GE Healthcare, Cerner Corporation, Carestream Health, Siemens Healthineers, Philips Healthcare, Merge Healthcare (IBM), McKesson Corporation, NextGen Healthcare, and Allscripts.

The Road Ahead

The National Health Policy 2017 has suggested that a national digital health authority will be responsible for developing common standards, notifying them, and ensuring that there is buy-in from stakeholders, including for the private sector that remains mostly outside the purview of the national health information system. To overcome this binding constraint, a National Health Resource Repository is currently being rolled out. Given the complexity of the systems and the multiple stakeholders involved, there is a need for making the datasets behind policy decisions transparent for democratic decision-making. The digital architecture needs to be made more inclusive and universally adoptable so that even if different stakeholders build components individually, these are built consistently and uniformly across the overall system. The new health information infrastructure will also have to find ways of overcoming the inter-sectoral, inter-ministerial, and inter-organizational incoherence.

Information systems at hospitals present a balkanized picture. Although a host of applications capture patient data at different points of contact, an integrated picture of the patient is missing. India has not fully tapped into the potential that information technology offers to integrate the health information systems in the country. Complete implementation of HMIS would prove invaluable in data collection for predicting disease burden and local health needs, rapid data collection for outbreak, early warning, and response to a disease. Information technology has great potential toward improvement of delivery of healthcare services. India is committed to reforms in health service delivery using IT under Digital India program. With huge investments being made in tertiary care, India’s health sector is expected to double in revenues to USD 280 billion by 2020; and this growth will be largely facilitated by IT.

Industry Speak

Technological Advancements and Emerging Trends on HMIS

Technology has turned the tables in the healthcare industry in India. It is quite evident that the private sector has been adopting healthcare technology like never before to provide efficient and affordable healthcare services. IT solutions have become an integral part of patient care, management information system (MIS), and process management in hospitals. 10 years down the line and there will be immense growth in the health insurance sector. This growth will be driven by efficient systems that facilitate greater storage and retrieval of information. Healthcare service providers see this as a result of the pressure to ingest technology to modernize infrastructure.

Wearable technology has been on the rise since the last couple of years. It will continue to grow in the next 5 years. The growth is further encouraged with the increase in the use of cloud computing and wireless technologies. These technologies will improve accessibility and provide solutions for manpower shortage. By 2020, there will be an increased deployment of telemedicine, hospital information systems, teleradiology, hospital MISs, electronic medical records, online etc. The healthcare sector will be imbibing cloud computing in a significant way in the next 5 years. Cloud-based solutions are cost-effective and make remote monitoring possible. This will further enhance patient care.

Healthcare service providers also have an inclination toward healthcare automation because of the benefits it offers such as easy accessibility, fewer errors, faster response during emergencies, and patient convenience. In order to improve their efficiencies, hospitals are opting for process automation for workforce management, billing, administration, finance, patient records, and pharmacies. However, it is important to note that greater technology adoption will not be very smooth and it will have its fair share of challenges. One such major challenge is IT budget for Indian hospitals. It does not exceed 10 percent of the revenues they earn. This can be a hurdle as technology adoption can be expensive.

Jaiho Shanthi Bhandari
CMD and Founder,
Pressbury Solutions Private Limited

Second Opinion

Role of AI in Healthcare

Technology is changing every industry in significant ways. No one can dispute technology’s ability to enable us all to live longer, healthier lives. From surgical robots to smart hospitals, the digital transformation is revolutionizing patient care in new and exciting ways. That is not all. National health expenditures in India accounted for 8–10 percent of the country’s total GDP. It is predicted that the digital revolution can save in spending money in the sector, especially in the area of chronic diseases. Clearly there is value – human and financial – in bringing new technology to the healthcare market.

There are several high-value applications for artificial intelligence (AI) in healthcare. Challenges with underlying data sources and new ethical concerns have emerged as significant factors driving adoption. In healthcare, which is in the midst of an industry transformation and a digitalization of key aspects of patient engagement and care management, the roles of data, analytics, and AI are central to the organizational mission. However, it is easy to get caught up in one aspect or another when extolling the role of AI, while ignoring the near-term potential as well as the limitations of the technology.

How can AI play a role in healthcare today? There are three ways in which AI can impact a business today. Upwards, meaning that AI can take on intelligent capabilities that enable a higher level of interaction with humans; downwards, implying an ability to reduce costs; and outwards, which is to take AI to the edges of our computing infrastructure. With the emergence of cheap computing and storage infrastructure, AI technologies help manage vast arrays of servers and networking equipment, detecting and remediating the most common problems without human intervention. Purpose-built hardware with inbuilt AI capabilities are becoming the norm in high-volume and time-sensitive operations that require running machine learning algorithms on large data sets and doing it at low costs at the end point and sending it back to a backend system can save lives by reducing the time involved in alerting caregivers to medical emergencies.

Dr Swapana Mitra
Group Chief Coordinator-Quality Control and Nursing Superintendent,
Metro Hospital & Research Institute