“8th National Biennial Conference on Medical Informatics 2012”

Objectified Assessment of
Rheumatoid Arthritis (RA) in Real-
Time as an Aid for Treat-to-Target
(T2T) Treatment Strategy
Prof. A. N. Malaviya,
MD, FRCP (Lond.), M-ACR, FAMS, FNASc
Ex- HOD Medicine and Chief of Clinical Immunology & Rheumatology, AIIMS
Consultant Rheumatologist, ISIC Superspeciality Hospital, New Delhi

Dr. S. B. Gogia,
MS (Surgery), Consultant Surgeon,
Past President IAMI

Rheumatoid disease
• A systemic multiorgan disease where the
brunt of the disease is on the joints in the
extremities
• It is an autoimmune where the body’s own
defence system attacks the body itself.
• The disease has genetic basis.
• What is (are) the trigger(s) for these genes to
start attacking the body remain to be
discovered (smoking is one of them)

Pathogenesis well characterised

Imbalanced production of cytokines with
excess of proinflammatory cytokines the
main one being tumour necrosis factor – α
(TNF-α)

Dramatic advances in the treatment of
RA
• Disease modifying drugs (DMARDs)
• Biological response modifiers (Biologics)
• Which drug; at what stage of the disease;
what dose and routes:
– Monotherapy
– Combination therapy
– Strategy for their use

RA treatment
From being
“There is not much that can be done, patient
would die”
It has now become a
“Treatable condition where patients can lead a
normal life”
With dramatic advances in drug treatment of this
disease

RA can now be compared to
diabetes, hypertension and other
chronic diseases
They can be well controlled
With almost a normal life span with good
quality of life
Don’t worry about ‘cure’ –
Although ~ 20% go in drug-free remission

Basic treatment strategy for these
diseases
• Keep the disease under ‘tight control’
– Keep Hb-A1C < 6 (by proper close follow-up and
regular blood testing) in diabetes
– Keep BP <140/90 (will need to be adjusted for
younger people) in patients with hypertension
• This approach of treatment is called ‘treat-to-
target’ (T2T)
• How do we know what is the target in RA? There
are so many domains in the disease, very unlike
diabetes or hypertension!

RA has multiple domains
• Pain in the joints
• Swelling in the joints
• Poor ‘general health’ due to disease
• Poor ‘function’ due to joint involvement
• Inflammation in the body
All this needs to be measured
How do we obtain a number that represents
DISEASE ACTIVITY ON THAT DAY?

Composite indices
• Disease activity index (44 joints) – DAS44
– With erythrocyte sedimentation rate (ESR)
– With C-reactive protein (CRP)
• Disease activity index (28 joints) – DAS28
• Clinical Disease activity index – CDAI
• Simplified Disease activity index – SDAI

RA disease assessment using DAS28
• DAS28 = 0.56 * sqrt(tender28) + 0.28 *
sqrt(swollen28) + 0.70 * ln(ESR) + 0.014 * GH
• < 2.6 = Remission
• < 3.2 = Low disease activity
• < 5.1 = Moderate disease activity
• > 5.1 = High disease activity

RA assessment using CDAI and SDAI
• SDAI = (28TJC) + (28SJC) + MDGA + PtGA + CRP*
– Remission = <3.3
– Low disease activity = >3.3 to <11
– Moderate disease activity = >11 to <26
– High disease activity = >26

• CDAI = (28TJC) + (28SJC) + MDGA + PtGA*
– Remission ≤2.8
– Low disease activity = >2.8 to ≤10
– Moderate disease activity = >10 to ≤22
– High disease activity = >22

Assessment of RA
• At each patient visit to the clinic we must know the
status of disease activity to keep it under tight control
i.e.:
• In ‘remission’
Or at least
• In ‘low disease state’
Therefore:
• It becomes mandatory to have DAS28 or CDAI or SDAI
at each visit
To be able to adjust the drugs / drug dosages
To keep the disease under ‘tight control’

Remember the formulae?
• DAS28 = 0.56 * sqrt(tender28) + 0.28 *
sqrt(swollen28) + 0.70 * ln(ESR) + 0.014 * GH
• SDAI = (28TJC) + (28SJC) + MDGA + PtGA +
CRP*
• CDAI = (28TJC) + (28SJC) + MDGA + PtGA*
• Can you imagine doing the calculations and
finding out whether the patient is in:
– Remission, low disease state or not?

Gadgets are needed
• Pre-programmed calculators
• On-line DAS calculators (now available)
• Why not have an EMR that would help:
– Permanent record of patient’s medical record
including medical history, examination findings,
laboratory test records
– Sequential assessment details
– Make drug prescriptions as well!
That is the question Dr. Gogia asked us
(rheumatologists) when he saw us struggling for
the use of ‘T2T’ approach for our RA patients

Development of rheumatology-specific
EMR
• Two of us worked closely
• Understanding each other’s way of working
• Work-flow of a rheumatology clinic was
understood by Dr. Gogia
• ‘Objectified assessment methodology’ as
discussed including all the composite indices for
the assessment of disease activity and their
formulae, cut-off points etc.
• Final EMR (~ 2 ½ years in development) ready for
use

Front sheet of the medical record

Final appearance of the face-sheet
now

Prescription handed over to the
patient

Summary
• Rheumatology-EMR has the following
advantages:
– Quick and objectified assessment for guiding
treatment
– Clearly stated disease status
– Neat prescription with detailed instructions
– Appointment, tests before the next visit
– Many other benefits: more patients in the same
time period, data-mining easy for research

Significance Of An Appropriate
Change Management Strategy In
Successful Implementation Of A
Health Management Information
System
Dr. Aman Rana (IIHMR, Delhi)
&
Dr. Anandhi Ramachandran (IIHMR, Delhi)

HEALTH CARE INFORMATION SYSTEM
• Corporate Social Responsibility
• Benefits: for management- Workforce: an asset
- track of health status
-underlying occupational hazard
-success of any health intervention
-medi-claims easy
Employees:
-sense of security
-all information at one place
-reduced medical negligence

STUDY BACKGROUND:
• Location
A notable public organization,
EMPLOYEE HEALTH MANAGEMENT
SYSTEMS (EHMS) : Unsuccessful for past 2
years

OBJECTIVES
• To understand the Knowledge and Attitude of
the Employees towards EHMS
• To ascertain the reasons for failure of EHMS
adoption in the organization
• To put forth an operational framework for
successful adoption of EHMS
• To evaluate the success of the interventions
implemented
• To provide a suitable recommendations for
future continuous adoption of EHMS

METHODOLOGY
• STUDY TYPE: Quantitative
• SAMPLE SIZE: 353 employees
• SAMPLING: Convenience Sampling
• DATA UTILIZED: Primary and Secondary data
• TOOLS USED: Questionnaires, Focus Group
Discussions and Personal Interviews

PRE INTERVENTION STATUS:
• Out of the 353 employees:
• 5 = somewhat correct awareness of EHMS ( All
Admin.)
• 12= filled up self declarations
• No one had filled up the detailed periodic health
record.
• 85 = had some where heard of EHMS but had no clear
idea of what it is.
• 251 = people had never heard of EHMS.

• In house doctors (2 in number) found the system too
technical to understand and time consuming to work
on.

BARRIER TO ADOPTION

• Technical Barriers
• User Perception of EHMS
• Resisting Change

USE OF IT TO INITIATE CHANGE
MANAGEMENT

People

Process Technology

8 Steps to Transform an Organization
(‘Harvard business review on change’ by John P.Kotter)
1. Establishing a sense of Urgency
2. Forming a powerful guiding coalition
3. Creating a vision
4. Communicating the vision
5. Empowering others to act on the vision
6. Planning for and creating short-term wins
7. Consolidating improvements and producing
still more change
8. Institutionalizing new approaches

POST INTERVENTION STATUS
• AWARENESS REGARDING EHMS:
all 353 employees.

• SELF- DECLARATIONS FORMS STATUS:
226

• PERIODIC HEALTH EXAMINATION STATUS:
26

• DOCTORS’ CONSULTATION
Motivated and trained. Patient Consultation and Drugs
dispensing through the system.

CADRE WISE RESPONSE TO THE
INTERVENTION PROGRAMME
• Management staff:
▫ Out of 172 people, 107 filled up declaration forms.
• Non Management staff/ Clerical Staff:
▫ 90 out of 124 gave in their self declarations.
• Labor staff:
▫ 29 out of 57 filled up their self declarations

ASSESSMENT OF THE CHANGE
MANAGEMENT PROCESS
• 100% awareness raised
• 64% of the staff entered self declaration forms
• Which contained preliminary health data.
• 7% people filled PHR forms which included detailed
information about person’s health data and past medical
history.
• Implies in spite of awareness, the workforce still needs to
accept and be a part of EHMS endeavor. So, the people
still need to know more about PHR. Awareness needs to
be accompanied with some visual fringe benefits.
• Privacy and confidentiality issues

RECOMMENDATIONS PROPOSED FOR
FUTURE ACTION
• A Change Management Champion.
• Administration should embrace the change in
the process, communicate vision and promote
health seeking behavior in the staff.
• Doctors: not just acceptors but also propagator.
• Doctors, Administrator and staff should sharea
good rapport.
• Periodic review: every six months
• Teams: Seniors and Juniors equal mix.

POINTS TO BE REMEBERED
• Change management is not an event but a process which needs a
focused vision and a visionary.
• The employees should be involved in the process from the initial
level.
• It is the responsibility of top management to assure that the
workforce stays motivated throughout.
• The leaders, who will propagate the change should be the ones who
are trusted by all and share excellent rapport with everyone.
• The more aware people are, the easier is the acceptance.
• The Employees’ expectations from the product should be kept
realistic throughout.
• It is as essential to retain the change as it is to bring the change.

REFERENCES
• McCarthy,M., and Eastman, D., Change Management Strategies for an Effective EMR
Implementation. Ohio: HIMSS; 2010. Available from: www.himss.org/content/files/Change
Management.pdf. Accessed 2011.

• Strebel, P., „Why Do Employees Resist Change?‟ Harvard Business Review May–June 1996

• Cohen D. The Heart of Change Field Guide: Tools and Tactics for Leading Change in Your
Organization. Boston, MA: Harvard Business School Press; 2005.

• .Bridges W. Managing Transitions: Making the Most of Change. 2nd ed. Cambridge, MA: Perseus
Publishing; 2003.

• Campbell, Robert James. Change Management in Health Care. Health Care Manager. 27(1):23-
39, January/March 2008.

• Abraham J, Feldman R, Carlin C,Understanding Employee Awareness of Health Care Quality
Information: How Can Employers Benefit? Health Services Research 39:6, Part I (December
2004)

• Heeks R. (2006) Health information systems: failure, success and improvisation. Int J Med
Inform. Feb; 75(2), 125-37.

• Al-Mashari, M., and Zairi, M. (1999) BPR implementation process: An analysis of key success and
failure factors. Bus. Process Manag. J. 5(1), 87–112

• Beynon-Davies, P., and Lloyd-Williams,M. (1999) When health informationsystems fail. Top.
Health Inf. Manage 20(1), 66–79.

• Chang, R., Process Reengineering in Action: A Practical Guide to Achieving Breakthrough Results.
Jossey-Bass Pfeiffer, San Francisco, 1999.

Hardeep Singh, MD MPH Invited Panelists:
Houston VA Health Services Research Max Health Care EHR Team
Center of Excellence (Divye Chhabra, Nikhil Mishra, Neena
Pahuja, Shubnum Singh)
Dean F. Sittig, PhD And
The University of Texas Health Science Kanav Kahol, PhD,
Center School of Biomedical Informatics Public Health Foundation of India

 Momentum for large scale health reform to
improve delivery and patient outcomes

 Transformation must leverage use of
technology

 Technology use must be accompanied by a
strategic approach accounting for the context
of the environment where implemented.

 A Hospital system implements an EHR but a
year later has to switch to another one
 U.K. Scrapping National Health IT Network
“…(after) nine years and £11.4 billion
($18.7 billion), the British government is
about to scrap its attempt to build a
massive, nationwide health IT network
for the 52 million residents of England,
a London news report says…”

 Efficiency - 10% reduction
 Inconsistent Clinical Decision Support
outcomes
 We expect quality & safety to improve, but…
 22 types of computerized provider order entry
(CPOE) errors
 Unexpected downtimes
 900 patients mistakenly given Viagra instead of
Zyban due to an error in the dispensing
pharmacy’s medication mapping table

 National electronic health record (EHR)-
based intervention in VA
 Required all pathology results (normal or
abnormal) to be transmitted to ordering providers
via mandatory automated notifications
 We analyzed 2 hospitals…results were a bit
surprising…

Laxmisan et al Under Review

 Design, development, implementation, use,
and evaluation of health information
technology is complex and prone to failure

 Need a method of understanding the
relationships to get it “right”

Sittig & Singh JAMA 2009

 Discuss a multi-faceted “socio-
technical” approach to safe and
effective health IT implementation
and use
 Discuss how these socio-technical
concepts could apply to health IT
projects currently underway in India

 Dean F. Sittig, PhD - Model Dimensions

 Hardeep Singh, MD MPH – U.S. Case Studies

 Discussion of model application in India:
 Private health system (Max Health Care IT Team
and Leadership)
 Public health system (Kanav Kahol, PhD, Public
Health Foundation of India)

Hardware and
Monitoring
Software

Workflow and
Content
Communication

Issue Under Study

State and
User
Federal
Interface
Rules

Organizational
Personnel
Characteristics

JAMA. 2009;302(10):1111-1113

 Must be capable of supporting ALL
required clinical activities.
 EHR should be able to:
 Calculate a medication dose
 Transmit the order to the appropriate
department
 Notify the nurse of a
placed order

 Standard medical vocabularies to
encode clinical findings

 Clinical knowledge to create specialty-
specific features and functions

 Must be evidence-based, carefully
constructed, monitored, complete, and
error free

 Allows clinicians to quickly grasp a complex system
safely and efficiently
 Displays all the relevant patient data so clinicians can
rapidly perceive problems, formulate responses, and
document actions.
 Physical aspects of the interface (e.g., keyboard,
mouse, or touch screen) may also contribute to error
in input or selection of information.
 ? Common user interface
standards

 Trained and knowledgeable personnel are
essential
 System developers
 Trainers, implementers, and maintenance staff
 Users
 Close interaction among informatics experts,
clinical application coordinators, and end
users is essential

 Staff of dedicated
knowledge engineers

 Subject matter
experts
 Clinical content
committees

 Disruptions in workflow or information
transfer are fertile grounds for inefficiencies
 Careful workflow analysis that accounts for
health IT use could lead to identification of
potential breakdown points
 Errors may result from interventions that are
not delivered at the best point in the
workflow

 Work environment
 Culture of innovation, exploration, and
continual improvement are key
 Organizations should:
 Actively facilitate reporting of errors or barriers to
care resulting from health IT use,
 carefully review their existing policies and
procedures before implementation.

 Regulations may act as barriers or facilitators for safe
EHR use
 Patient privacy
 Policies must address safety and effectiveness of
health information exchange across organizational
boundaries
 State and federal governments should create an
environment compatible with widespread use and
interoperability

 Organizations must continually
evaluate usability & performance of
systems after implementation to:
 Reliably measure benefits
 Assess potential e-iatrogenic effects

Acknowledgments:
VA, NIH, AHRQ, ONC

Eight Rights of Safe Electronic Health Record Use
JAMA. 2009;302(10):1111-1113

Safe electronic health record use requires a comprehensive
monitoring and evaluation framework
JAMA. 2010 Feb 3;303(5):450-1

A new sociotechnical model for studying health information
technology in complex adaptive healthcare systems.
Qual Saf Health Care. 2010 Oct;19 Suppl 3:i68-74.

Hardeep Singh, MD, MPH
Chief Health Policy Quality Program,
Houston Veterans Affairs Health Services Research &
Development Center of Excellence
Michael E. DeBakey VA Medical Center & BCM
Director, Houston VA Patient Safety Center of Inquiry

 Research and evaluation case studies in:
 Communication of diagnostic test results
 CPOE prescriptions
 Electronic Referrals

 How can the model guide us towards a
high performing “EHR enabled work-
system”

 Safety issues related to communication
and coordination breakdowns prevalent

 What affect will technology have on
communication and coordination of test
results and referrals?

Singh & Graber JAMA 2010

▫ Alert in “View
Alert” window

Example of a
critical
imaging alert

 Communication more than information
transfer
 Response and appropriate follow-up action

 Providers may not acknowledge all alerts
they receive; some lost to follow-up
 Timely follow-up should occur if they
acknowledge an alert

Singh et al JAMIA 2007

 Evaluation of timely follow-up actions on abnormal
test result notifications communicated through the
View Alert system
 1,163 outpatient abnormal labs & 1,196 abnormal
imaging results
 7% labs lacked timely follow-up despite
acknowledgment
 8% imaging lacked timely follow-up despite
acknowledgment
Singh et al AJM 2010 and Archives of IM 2009

“One of the issues is just the
sheer volume of alerts, and
there’s a number of alerts that
in all honesty [you] really don’t
have any business seeing.”

 Barriers & solutions span multiple dimensions:
 Software (functionality for saving, tracking, and retrieving
alerts)
 Content (e.g. what alert types are absolutely necessary)
 Usability/ UI (improving existing functionality to improve
signal to noise ratio)
 Workflow (e.g., surrogate alerts when providers out of
office)
 Providers (e.g. knowledge)
 Organizational (e.g. training, policies for follow-up)

Singh et al Under review

 Of 532 scripts reported to have
inconsistent communication
 20% errors had potential for severe
harm, if they reached the patient
 Issues: training, complex orders

Singh et al Arch Int Med 2009

 Transmission and tracking of referrals
finally possible!
 Of 61,931 referrals, 36% discontinued and
0.8% unresolved at 30 days
 Unexplained lack of follow-up actions by
subspecialists in 6.3% of all referrals
 Unexplained lack of follow-up by PCPs in
7.4% of discontinued referrals
Singh et al JGIM 2010

 Marked differences in PCPs' and subspecialists'
communication views (e.g. content)
 Lack of an institutional referral policy,
 Lack of standardization in referral procedures,
 Ambiguity in roles and responsibilities, and
 Inadequate resources to adapt and respond to
referral requests effectively
 Very few technology barriers
Hysong et al Impl Science 2011

Information Technology

Measuring and Tracking the Progress of Implementing a
Comprehensive Electronic Health Record: A Mixed-
Methods Approach
February 5, 2012

Authors

Sandeep Budhiraja MD1
Nikhil Mishra1
Divye Chhabra MD1
Dean F. Sittig, PhD2
Hardeep Singh, MD, MPH3
Neena Pahuja PhD1
1Max Health Care Institute Ltd., New Delhi

2Professor,School of Biomedical Informatics, University of Texas Health Sciences
Center, Houston, Texas, USA
3Chief,Health Quality and Policy Program, Houston Veterans Affairs Health
Services Research and Development Center of Excellence and Baylor College
of Medicine, Houston, Texas, USA

Disclaimer

No conflict of interest

Some Published Statistics: IT
supporting Healthcare

Ref: http://www.bbc.co.uk/news/health-15340102

• Death rates gone down by 17% among emergency patients
(16,000 deaths preventable)
• Higher accountability of staff
• Lower cases of missed medicine
• Medication allergy alerts supports safer healthcare
• Reduction of medication errors to ½.
• Checks on infection control

Hospital Group Level Systems Integration
Evolutionary need for Health Information Exchange

•Network of 8 hospitals in NCR
•Expanded by 4 new, spreading to
rest of north India. Altogether ~1900 beds
•EHR implementations complete in 4 hospitals

Hospital Data
Group level
integration Centre

Sheer Health
Volume of
Patient care
information ‘cloud’

51

eCare - Key Terms

• CPRS - Computerized Patient Record System
• EHR - Electronic Health Record
• HIS - Hospital Information System
• CPOE- Computerized Physician Order Entry
• BCMA - Bar Coded Medication Administration
• COWs – Computer On Wheels

The eCare vision

• To have a patient centric clinical record
• Embracing change to standardize care processes across the
organization
• To improve electronic access and availability of patient clinical
information
• To capture multi-
disciplinary patient
information
• The implementation of a
minimum data set
ensuring foolproof
documentation

Rationale EHR Implementation

• Complete IT Outsourcing
• WorldVistA integrated to Max-HIS
• Rationale
– Potential reduction of medical errors
– Improved medication management
– Rapid access to vital and accurate information
– Reduced duplication of services and cost
– Access to a more comprehensive picture of health for promoting
advances in the diagnosis and treatment of illnesses
– Improved and informed decision making
– Providing continuity of care to patients

55

Preparation for EHR Implementation

• External Consultants
• Process mapping of as-is workflows
• Data Cleaning
• Design Future-State Workflows (Map “as-is” to system
functionality)
• Approach
– Prepare patient demographics integration
– Prepare for Lab, Radiology & Pharmacy
– BCMA (e-MAR + closed loop medicine administration)
– CPOE

56

Preparation for EHR Implementation

• Training, Training & more Training
• Change Management is the key
• Big-Bang approach for IT- systems
– Phased approach “Slow change” for humans
• Super-Users and Change Managers

• 23rd July 2011 6 months

57

Study Methodology

• Mixed method for measuring and tracking progress of EHR
implementation
First
– quantitative approach
– six “automated” metrics
– extracted from Mumps database (Backbone)
Senior Consultants
Second Junior Consultants
Floor Mentors
– interviewed four groups of representative users Nursing Supervisor
– Content analysis of interviews identify major themes
Third
– fact-finding questionnaires

A total of 5 months of Data
58

Barcode Medical Administration

COW*– Nurse
Login Barcoded Patient
Identifying the nurse Wrist Band
Identifying the
patient

Barcoded Label
on Drug-
Identifying the Drug
Right Patient, Right Drug, Right Time

* COW- Computer on wheels 59

Results I-
Quantitative Approach – 6 automated Metrics

Implementation Metric % Use

1) Use of Progress Notes 76%

2) Use of CPOE for medications, procedures, lab and 100%
imaging tests
3) Documentation of 2 daily inpatient progress notes 65%
(morning and evening) by a consultant on all
inpatients
4) Use of Problem lists involving selection from ICD-9 15%
coded problems
5) Documentation of Input and Output logs by nurses 82% in IPD, Critical care on
parallel paper process
6) Use of BCMA by nurses Real Time MAR 41%,
however including after the
fact goes upto 78%

EHR-Structure 60

Results II-
Interviews with representative groups

Qualitative Analysis
Younger Doctors -more comfortable
Senior Consultants -hesitant with new technology
-had low degree of adoption.
Typing issues - Only 28% were comfortable

EHR system “complexity” - main concern of participants
(mainly senior consultants)
Perceived reduction of efficiency- due to time required in day to day
However most users- post 2-3 days of hands-on EHR use
-perceived its benefits
-reported high degree of comfort in its use.
-Divide between resistors and early adopters

61

Results II contd-
Interviews with representative groups

Differences between doctors and nurses also emerged
– 100% nurses had to use the system from day one
– Also had attended all training sessions
– Doctors were hard pressed for time for training as well as day to day use
– Ongoing Support

Facilitators of the process
• Leadership role (Top Management)
• Clinical Transformation & Change Management
• User friendly clinical templates
• Easy accessibility of all Max enrolled patients’ records
– Any Max facility
– Any Patient
• Light System (client application) - quick response time & stability
– also be credited with aiding its acceptance.

62

Results III-
Fact-finding Questionnaires

• “Did You Know” type features of system identified
– 12 in number, All Specific to doctors, 5 of these generic to nurses
– Nurses faired 5/5
– Doctors varied from 5-8

• Additionally 18 specific fact finding questions ranging from
– Rate your own usage, comfort level, perceived improvements
perceived benefits, suggestions for improvement

63

Results III contd-

Five level scale used (Very Low Low Medium High Very High)
Question Group Majority Others
Comfort level in using system 65% Low to Medium 13-18% on both extremes
Viewing of existing notes/progress
notes
83% Medium to High rest Very High
scattered result 50% low to
Usage of templates on CPRS very few High
Medium
Usage of Orders
(lab/radio/drug/procedures)
83% High to Very High _
Frequency of entering findings of
consult
52% Medium to high 30% Low
Viewing of reports on CPRS software Majority high to Very High _
Surprisingly High to Very
Comfort level of typing
High
Ease of use of CPRS software 78% Medium to High Rest Low, none very high
Rate the overall improvement in time
taken for activities
80% Medium to High 10% low
Rate the overall improvement in the
efficiency for activities
90% Medium to High _
In your deptt. How would you rate the
Scattered results ranging
benefit of using systems over the 64 _
existing process from low to very high

Challenges Identified

• CPOE- Filling time for STAT medication orders,
only 90% compliance
Identified as an area for improvement

• An increase in the overall time in the discharge
process when the EHR was only used partially
- both paper + electronic records
- expected to be transitional phase

65

Discussion

• Early experience Largest implementation of its kind
– 4 facilities, comprehensive EHR, large health care system
• Several lessons learned by measuring and tracking
– Patience and aggressive Change Management is key
– Focus and Support from Leadership
– People don’t like to put in data, but once its there they really value it
– Benefits are perceived only by the ones who use more and vice-
versa
– Early adopters benefit more than laggards
– Laggards resist most
– Aggressive Supporting required at least till ratio tips in favor of adopter

66

Further Benefits

• Chronic Care Management using clinical reminders
– Clinical reminders
– automated reminders
– for the clinicians based on rules (diagnosis/ lab result/ drug allergy etc)

• Diabetic care
– Reminders setup for
– Periodic Glycosylated Hemoglobin (HbA1c)
– Diabetic Foot Exam (Skin and Neurological)
– Diabetic Eye Exam
– Data of these reminders when due is periodically passed to
Endocrinology team who in turn suggest the same to patients
– Services with Ophthalmology, Podiatry and Lab services is coordinated
through Endocrinology

68

Ancillaries

• COWS*
• Wrist Bands
• Drug Labels

*COWS- Computer On Wheels

Change Management Is Key

• It is not an IT project…..its an operations project
• Leadership support

• Support support support…..evolve…support
• Train train ….retrain….evolve….support
• Help on call- 24 hour support …..Human aspects

• Workshops
• As is workflows/future state
• Ease everyone in.
71

Change Management After Go-Live

• Healthcare- Standardized but flexible
• Operations cannot slow down to support change
• Shaken users prone to errors
• Real time support
• Leadership support

72

Results III contd-

Five level scale used (Very Low Low Medium High Very High)
Question Group Majority Others
Comfort level in using system 65% Low to Medium 13-18% on both extremes
Viewing of existing notes/progress notes 83% Medium to High rest Very High
Usage of templates on CPRS scattered result 50% low to Medium very few High
Usage of Orders (lab/radio/drug/procedures) 83% High to Very High _
Frequency of entering findings of consult 52% Medium to high 30% Low
Viewing of reports on CPRS software Majority high to Very High _
Comfort level of typing Surprisingly High to Very High
Rate the availability of the COW(computer on Scattered results ranging from low to
wheels) in a ward
_
very high
Ease of use of CPRS software 78% Medium to High Rest Low, none very high
Rate the overall improvement in time taken for
activities
80% Medium to High 10% low
Rate the overall improvement in the efficiency for
activities
90% Medium to High _
In your deptt. How would you rate the benefit of Scattered results ranging from low to
using systems over the existing process
_
very high

73

Kanav Kahol
Division of Affordable Health Technologies
Public Health Foundation of India
kanav.kahol@phfi.org

Recommendation 3.6.4 Establish a Health IT Network

 Mhealth Solutions.
 Portable with long or
extended battery life.
 Enable non-physicians
to deliver care with
supervision and
monitoring
 Example: Swasthya
Slate

 Indigenized and local
language support.
 Allow co-
development by
central agencies and
local players through
computer supported
collaborative
platforms.
 Need support for
empowerment of
patients and the
healthcare workers.

 Use of semiotics and
images is helpful
 Simplified
questionnaires and
sets.
 Affordance of the
user interface is key.

MyPortal State and District Portals
MyHealth Epidemiology
MyAppointments Early Warning Systems
MyMessages Messaging Center
MyTreatments Certification Portal
Learning Portal
Community Health Portal
eHealth/mHealth
Portals
Physician and Hospital Portal
National Portal
Patient Alerts
Certification Standards and Results
Scheduling Manager
Health Promotion
Message Center
National Security Portal
Information Reporting
Financial Management Portal

 Technology illiteracy
is rapidly reducing.
 People born in 1994
will be 22 in 2016.
 Creation of suitable
cadres already a part
of the UHC Report.
 Usable technology is
the key
 Gap skills training will
have to be
undertaken.

 Public Health Decision
Support System
 Use algorithms from
supply chain and
related fields to help
with optimal resource
usage and allocation.
 West Bengal and
Drishti.

 Promote use
of HealthIT
 Use grants
and universal
payer
mechanism
to ensure
compliance.

 Use single payer as a leverage for adoption along
with grants.
 Clearly define telemedicine (Use telemedicine law
draft)
 Define privacy and security laws.
 Ensure the right to connectivity.

 Monitoring Financial and Clinical measures is the
key.
 EHR enables a method of authentication and
verification.
 Case in Point: Mother Child Tracking System and
Immunization Records.
 Use cloud.
 Caveat: Make reporting easy.
 Caveat: Reporting is not the only or the most
important feature of ICT.

Personal Eternal Health
Passbook

By
Dr. G. D. Mogli, Ph.D., MBA., FHRIM (UK), FAHIMA (USA)
Chief Executive Officer & MD
Dr. Mogli Healthcare Management Consultancy
www.drmogliit.com gdmogli@yahoo.com
Formerly served as
WHO Consultant and Sr. Consultant /Adviser to the Ministries of Health
India, Afghanistan, Iran, Kuwait, Saudi Arabia, Oman, Bahrain, Qatar, UAE &
Sr. Consultant eHealth Management
HEARTCOM INC. (USA)

Evolution of medical records

EHR/PH
R????

Comprehe Computer
• card nsive Unit
Writing on records based
Outpatient medical records
walls s records Comprehensive
unit records

Outpatient cards

Personal Eternal Health Passbook
The “Personal Eternal Health Passbook (PEHP) containing the ID, is a lifelong
electronic, universally available document, initiated at the time of birth, containing,
mother’s delivery information including congenital anomaly, immunizations given.
This will contain entire information such as episodic, hospitalization, self medications
and other habits including significant events. This is maintained by parents/guardian
and contains immunizations, growth charts, significant events and health status. The
PEHP information is contributed by health care providers and self and maintained in
a secure and private environment, with the individual determining rights of access”.

Definition by---
Dr G. D Mogli

PEHP

 PEHP kept by individual, EHR by Hospital

 PEHP is owned by individual and contain every detail.

 PEHP information is managed by (care providers and himself).

 Right of access of record is owned by PEHP owner.

What EHR cannot have? But
What PEHP can have?

 Awareness among patients through media.

 Internet forums and blogs for medical information.
 Persons suffering from minor ailments, doesn’t visit, hospitals,
 Applies self medication, self care/treatment.
 Extensive information leads to Self-medication too.

This kind of information is not recorded in a EHR which could
prove to be detrimental for patient care.

Non Allopathic treatment
 Many types of medicine are coming to light and being practiced.
Ex: Unani, Acupuncture, homeopathy, ayurvedic, yogic healing etc..

EHR is based on allopathic only.
other medications / therapies underwent by the patient is not recorded.

Types of PEHP

 Paper based.

 PC-based.
 Web based. (maintained on private line-accessed by username and password)

 Hybrid (desktop/Web-based.)
A mix of both PC’s and Online PEHP.
 PEHP. Connecting through USB port to the computers.

Personal Eternal Health Passbook

What should the PEHP contain

 Patient Identification Data.
 Health Summary.  Hospitalization.
 Child Development.  Obstetrics & Gynecology.
 Immunizations.  Surgeries/Therapy.
 Chronic Disease (old age).
 Self care/treatments.
 Allergies and Drug
 Medications.  sensitivities.
 Investigations.

Patient ID format
 3 parts
 Part I contains: Personal data.
 Part II contains: allergies, blood group, significant health
problems.
 Part III contains: other habits such as food, alcoholic,
smoking, any addiction, environmental, exercise, etc.

Patient Care Summary
 For recording chronological data.
 Should record details of visits to OP,IP,ER etc..
 Self care or other treatments.

Child Development
 Growth chart for children from 0-5 or 0-14 years.

Immunizations
 Mainly for children and also can be used for adults.
 Indicates due dates for other immunizations e.g. 1st dose, 2nd
dose etc..

Self-care for medication / treatment
 A unique feature of PEHP.
 Available only with the PEHP and not found in the
allopathic healthcare organizations.

Medications
 Chronological account of medications used and being used currently.
 E-prescription, refills, and address of the pharmacies

Investigations

 Chronological account of investigations carried out will be available.

Hospitalization record
 Chronological account of all admissions and
discharges with the results.

Obstetrics & Gynecology
 For women patients from child bearing age onwards.
 Periodic Mammography check information is also recorded.

Therapy
 Different types of therapies such as physical, occupational,
speech, optometric refractions, radio therapy etc. are recorded.

Implementing PEHP

 People Born prior to implementation

 New born records –to be maintained by the care taker

 Carry a pen-drive, external hard drives or any other
portable devices on move.

 Patient with conditions (heart diseases, diabetes, hypertension) should
carry Alert devices for Emergency.

Conclusion…..
 EHR at health institution level and PEHP at personal level
to gain complete 360 degree information.

 For providing continuity of care to patient, at right time,
at right place and at right cost.

 PEHP prevents duplication of investigations,
medications, delay in care, check on risk and cost.

Continue………………
 Standardizing of PEHP information for continuity of care.

 PEHP allows practitioners from different settings and
disciplines to share information.

 Allows the patient to carry this information with him or her
upon referral, transfer, or discharge.

Normal condition

Update
PEHP Physician
treatment
Disease
state

Self
medication Non allopathic
therapy

Effects of PEHP on the Patients
Advantages Disadvantages
 Information on the go.  Cumbersome for
 Ensure Information is maintaining.
accurate and complete.  Access to the Computers.
 Self medication is updated.  Illiteracy.
 Different physicians opinion
recorded.  Costs him extra.
 Careful  Security concerns.
 Handy in Emergency.  Accessing the web in
 Quick treatment remote places.
 prevents duplication

Effects of PEHP for the Physicians
Advantages Disadvantages
 Complete Information.  Distrust on Information
 Quick treatment. viability.
 Opinions of other physicians.  Doesn’t like to expose his
opinion.
 Disease pattern is easy to
understand.  Fear of medico-legal issues.
 Duplication of records.
 Increased workload.

Medical record
 MR history parallels the history of medicine.

 Contains medical information of an individual from
“Womb to Tomb”.

 “A clear, concise and accurate history of the patient's life and
illness, written from the health point of view, and is a complete
compilation of scientific data derived from many sources,
coordinated and integrated into an orderly document for
further multifarious uses”.
--Dr G.D Mogli

Necessity
 Contains patient demographic information, history,
physical examination, progress notes, investigations,
consultations opinions, diagnosis, treatment including
medical, surgical, therapies.

Necessary for various reasons.
Insurance sector
Medico legal cases

&
analysis Also for effective
Patients forget but Records remember"

Advantages of EHR
Manual records Electronic records
Inaccessibility, parts of Decentralized,
the records are simultaneous access all
geographically widely the time.
distributed.
Active it can trigger
Passive: unable to certain actions according
trigger certain actions to the data

 “Manual” linkage “Increased” linkage
with external health care
Time consuming to providers
explore for clinical or
financial studies Excellent basis to
conduct clinical and
financial studies

Some Current PEHP Providers

And many
more……

Problems with EHR
 Interoperability
Vendors develop readymade software’s
/ In-house tailor made
to suit only certain
health institutions.

 Survey indicates old
people want to follow the
manual records.

These are problems which can be solved by developing
of standards.

EHR (Electronic health record)
 Refers to an individual patient's longitudinal
medical record in digital format.
 Easy to maintain.
 Usually accessed on a computer,
often over a network.
 Instantly accessible to all authorized from
different stations.

 High end gadgets are available for
making the recording easy.

Precautions In selecting a PEHP provider
 Ensure Security of the records.
 Maintain Confidentiality of records.
 Ensure Privacy.
 Technologically stable and advanced.
 Should be Interoperable.
 Cost.
 Provide long term support.

A Wireless Sensor Network based Fall
Detection and Activity Monitoring System
for the Elderly
By
Prof. Subrat Kar, Sanat Sarangi and Akshat Bisht

Bharti School of Telecommunication Technology and
Management, IIT Delhi, India

NCMI 2012, AIIMS

Motivation
 Prevalent technologies-
 Smart Insole, Smart Cane and Smart Headset monitor underfoot
pressure, improper usage behaviour and EEG signals
respectively.
 Armbands, waistbands and ankle-bands have been developed
that measure skin temperature, energy spent (calories) and
activity.
 Our concern is to not just to create a smart device but a smart space
using a number of such devices – a sensor network.
 A sensor network helps communicate events of interest over large
geographic distances without using a legacy network.

Sensor Networks
Sensor Nodes:
 Low-cost
 Resource-constrained
 Autonomous
 Form a resilient Mesh
Network, hence the
term- Sensor Network
 Fault Tolerant

Gaitsense
(Gait Assessment System)
 Consists of

 A sensor network formed by gait nodes and relay nodes.
 A multi-tier control and notification system (consisting of a gateway, user application and
DBMS) that talks to Internet and cellular networks.
 Gateway acts as an interface between the sensor network and the GUI-based user
application and logs all communication in the DBMS.
 User Application provides multi-dimensional visualization capabilities for sensor
events through charts, tables and maps.
 User Application runs custom algorithms that take specific actions based on user
requirements and sends appropriate notifications.

Gait Node
 Consists of a sensor node and an accelerometer.
 The Sensor node has a extremely low-power micro-controller and on-board
radio transmission capabilities.
 The accelerometer can sense acceleration on upto three axes. Acceleration is
used to recognize gait characteristics.
 Gait Node can be conveniently worn at the waist or ankle to detect the state of
the subject- standing, sleeping, walking, running, fallen.

Status of gait node 1 as seen in user application

Gait Node

Deployment Scenario
 A Geriatric care unit as shown, can
be a possible application scenario
for GaitSense.
 The objective is to monitor
residents wearing gait nodes and
auto-notify events such as postural
changes, activity changes or
number of steps taken.
 Fixed relay nodes installed at
strategic positions and the gait
nodes form a sensor network that
reliably streams events to the
gateway and user application in the
administrative section.
 Services like email, twitter or sms
are used to send notifications.

Conclusion
 A fall detection and activity monitoring system for the elderly is
proposed and its integration with the public communication
infrastructure is discussed to enable its widespread adoption.
 By notifying events like a fall, the system promises to help
reduce human casualties by allowing effective rescue and
remedial operation-planning.
 The systematic automated recording of all behavioural aspects
could also provide valuable information to doctors for analysing
medical conditions.
The work done in this paper is supported by DST project titled
“Development of a wireless sensor network based gait
assessment system for fall prediction in elderly patients” vide
sanction ref- SSD/NI/020/2007-TIE dt. 31 Jan, 2008.

Thank You
Contact:
Prof. Subrat Kar
Professor, Electrical Engineering & Bharti School of
Telecom, IIT Delhi, Hauz Khas, New Delhi – 110016
Ph: (011) 26591088
Email: subrat@ee.iitd.ac.in

MediCall: Hospital Resource System
Based on VistA implemented at
JPNATC, AIIMS

Easily Accessible, Affordable &
Advance Healthcare Solution
GTI Infotel
http://www.gtiinfotel.com
Corporate HQ: A-51 SECTOR 8, NOIDA, UP; Tel: +91-120-427-3656; Fax: 433-7855

Table of Contents
 Affordable, Accessible & Advance Healthcare for Hospital &
Patients
 VistA Implementation & Integration with HIS
 Integrated HRS Implementation at JPNATC, AIIMS:
– Block Diagram
– Back ground & Service provided at JPNATC, AIIMS

 Integrated HRS: Components
– Hospital Information System:
 Registration, ADT, OPD, Stores, Inventory, Display, Equipment management & Utilization, Waiting
times, In-patient Bed status

– CRM:
 Patient data, Appointments, Complaints, Information, IPD Data & SMS/Email, Integration with PACS
& other HIS.

– Website:
 Real time data of OPD, IPD, Stats, etc. Hospital Info, Faculty Info

 Awards received

Affordable, Accessible & Advance Healthcare for all
 GTI MediCall Hospital Resource System helps in
providing affordable, accessible & advance
healthcare for Patients as well as Hospitals:
– Developed on the most stable healthcare platform
VistA developed over decades of research.
– Accessible over the internet
– Accessible over telephone
– Availability of Patient Data & Healthcare provider at
lower cost
– Available 24x7 over the internet, telephone (Call
Center) & on-site (at the hospital)

Healthcare computing:
Mapping industry needs to technology capabilities

There are several reasons why GTI MediCall HRS is
solution to the health industry’s unique blend of
requirements:
 It can lead to easier update and higher quality
patient data—a feature especially important in
health care, where fragmented, redundant, and
inconsistent data is rampant today.
 SaaS-based electronic medical record (EMR)
solutions area natural fit for small physician
practices to which most physicians belong
because of their affordability, ease of use, and
small requirement for ongoing technical
support.

 The exoskeleton nature of the cloud makes it relatively
easy to inter-connect disparate systems from different
health organizations, and provide an elastic infrastructure
that can start inexpensively and quickly scale as adoption
increases.
 Thus, it provide an ideal architectural alternative for
Health Information Exchanges (HIEs). There are promising
advances across a broad spectrum of patient-facing and
telemedicine/telehealth applications.
 There is also growing attention on providing direct,
continuous engagement between patients and providers
through “in the cloud” relationships that include
advanced continuous home and portable monitoring.
 Technopak Healthcare, a consulting firm, expects
spending on health care in India to grow from $40 billion
in 2008 to $323 billion in 2023.
Sources: Gartner, Factiva [from Accenture ‘Cloud Computing in Healthcare’ deck, date Feb 19 2010,

On the Cloud or
Physically Co-located Solution?
 GTI can provide both On the Cloud as well as
Physically Co-located solution for the Hospital.
 The Hospital can choose between the two
solutions or a hybrid of both solutions (as
implemented at AIIMS)
 Both Systems provide equivalent & optimum
solution for the Hospital.

MEDICALL HOSPITAL RESOURCE SYSTEM :

SOLUTION IMPLEMENTED AT JPNATC, AIIMS
(VISTA INTEGRATION)

IN ANOTHER FIRST BY AIIMS, AN INTEGRATED HRS STARTED OPERATIONS FOR
JPN APEX TRAUMA CENTRE, AIIMS

Integration & Implementation of VistA &
Development of HIS on top of the VistA Engine

The company specializes in Implementation of
VistA for Hospitals & integration with HIS & PACS

The current system has been Integrated with:
• VistA at the Hospital
• PACS at the Hospital

MediCall Hospital Resource System

Services that include
not only call center
for the patients &
doctors but a total
back office support to
the entire hospital.
We integrate with
your existing database
or develop new
software for you to
offer round-the-clock
services.

MediCall Hospital Resource System (HRS)

Communication Call Center

Hospital Resource System:
- Website
- Hospital Info System
- Call Center CRM

Hospital Mobile Support

Our Solution features:
 End-to-end solution with Software, Hardware & Manpower:
The systems & processes are ready & available to be deployed on-site or on the cloud. Hence, providing the right solution
deployable in 2-3 weeks is now possible.
 Completely outsourced and scalable:
This frees up valuable real estate at the Hospital besides potentially decreasing the overheads like electricity, parking and
toilets which an on-site facility would use. Being completely scalable, the call centre can quickly ramp up operations in line
with increased demand and in case of disasters.
 Professional operations:
The call centre will provide best-in-class service to clients with quality control at every stage and 100% call recording for
auditing and quality purposes.
 Patient services:
With the main thrust on improving the quality of patient care, the call centre will manage all appointments and follow-up of
patients. The call centre will also answer queries on all admitted patients and will provide information on all diagnostic &
therapeutic services available, the procedure and pricing of getting a specific service or test done and the approximate wait-
times. Thus the patients may not need to approach anyone physically for information.
 Research:
Research is one of the key mandate of AIIMS and the call centre will facilitate research by ensuring follow-up of patients,
administering surveys and ensuring authenticity of data.
 Centralized help desk & support:
The call centre will take over the responsibility of logging & initial troubleshooting software & hardware problems helping in
providing professional 24 X 7 support services
 Inventory Management & support:
The call centre will act as the single window for all inventory related issues for the Hospital. The call centre can provide
completely audit trail for any breakdown or even and follow up with the vendor and end user to ensure optimal utilization of
resources.

MediCallHRS: Hospital Info System Modules (partial listing)

Registra
tion
Inventor
Roster
y Mgmt

Equipm
ent
Billing
Mgmt &
Maint.

Equipm
ent
OPD
Utilizati
HIS on

Surgery
ADT Patient
Waitlist

Real
Call
Time Pt.
Centre
Mvmnt
& CRM
Nursing In- Display
Quality patient
Imp. Bed
Mgmt Status

Solution Overview

1 Hospital Info. Benefits
System (HIS)
A ADT Registration - Admission
- Discharge
- Transfer
- Registration
B OPD Out Patient Department Management
- Takes care of all the Waiting lists, Queue management,
Appointments etc.
C Billing Integrated Billing
D Duty Roster Includes duty roster as well as time schedule, leaves, monitoring, etc.
E Laboratory Investigations & reporting on all the Lab findings & integrating with
other modules
F Radiology Supports DICOM for direct access to equipments.

1 Hospital Info. Benefits
System (HIS)
G Registration - Computerized for future access & control
- Maintain database
H Inventory/Stores - Control pilferage
- Know status of each item
- Know movement of each item
- Know low stock details for ordering
- Paperless system
I Equipment - Monitor AMC of all medical equipment
Management & - Less breakdown
Maintenance - No burden on hospital manpower for maintenance issues
J Utilization of - Equipment wise utilization details
Equipment - Know the utility & cost/use of each equipment
K Surgery Waitlist - Transparent & seamless maintenance
- Patients get information from the call center regarding date
L Real-time Patient - Movement of patient recorded
Movement - Realtime info seen by attendants, hence reducing burden on the
Display staff
- Helps patients to know his movements

# Functions Benefit
2 CRM integrated - Appointment system for the Doctors & Patients
with VistA & Call - Queue-less OPD
Center - Appointment information on phone/SMS
- Change of appointment by Patient/Doctor now possible
- Patient Information on phone
- Hospital Information available on phone
- Complaint handling & monitoring
- 24x7 availability to patients, attendants, staff
3 Website - Hospital Information on the internet
- Real time appointment & wait-time info to patients

1. Hospital Info System: HIS home
based on VistA

Registration
 Parameters captured:
– Name, Address, Phone, Symptom, General
ID/Ref. No., custom reports, Diagnosis, Pupil,
Injury & much more
 General Registration
 Specialty Registration based on Gen. Reg:
– Ortho/Neurosurgery/Surgery
 Output:
– Online Reports, Specialized Reports, Admin,
etc.
 Logistics:
– Operation Timings: 24x7
– Manpower Required: Minimum 5 for 24x7
operation
– Hardware: PC with 30mins UPS
– Internet Access: Data Card/Broad band

Inventory Management System
 Inventory of
– Consumables like medicines, tables, powder,
etc.
– Disposables like syringes, gloves, etc.
– Utilities like bed, etc.
– Equipment
– Complete detail including location of the
Inventory
 Output:
– Status, Stock levels at wards/stores/etc.,
Indents, etc.
 Logistics:
– Different types of Alarms at various predefined
levels
– Operation Timings: 6 days a week (7 hrs x 6
days)

Equipment Management & Maintenance module

 Assist to monitor the AMC/Warranty
of all medical equipments
 Book complaints
 Monitor performance of Contractor
under AMC/Warranty
 Identify Repeat faults
 Take Preventive maintenance
 Replacements of active elements in
time
 Mandatory calibration of equipment

Equipment Utilization
 Equipment wise utilization:
– By day
– By week
– By month
 Utilization efficiency of:
– Machine
– Operator
 Equipment Applied & removal days
 Equipment used on which Patient
 Breakdown & likely repair time estimation

Surgery Patient Waitlist & OT Management

 Patients earmarked for surgery
 Type of Surgery
 Doctor allocated to carry out the surgery
 Waitlist in weeks/months
 Weekdays for surgery according to its allocation to
individual Doctor
 Patients to be informed accordingly on
– Phone/SMS/Email
 Admission to Surgery after waitlist
 OT Management

Real Time Patient Movement Display System

 Patient (under treatment) movement display
system
 Helps attendant to know movement of
patient undergoing different tests/stages
 Displays on 40” LCD monitor include
– Patient Name
– Department
– Process
 Helps patients in moving from one test to
another
 Specialty Dept does their own data entry &
the same is displayed
 Realtime Bed Availability: for the patient &
Doctor alike

In-patient Bed Status
 Real time bed status / availability of Beds.
 Data can be sorted as per
– Ward
– Doctor
– Date
– Department
 Criticality of Patient including complete detail
online
 Number days stay & much more

Nurse Quality Improvement Mgmt
 Captures the Error incident detail done by
the Nurse
 Helps in monitor Nursing Quality service
 Capture Patient Care lapse
 Patient wise details are captured
 Nurse wise details are captured

2. CRM: Integrated with real-time info for
the call center
Call Center CRM to be deployed at the call center/Cloud to have
following functions:
 Patient Information
 Appointments
 Staff Information/Rosters
 Dashboard for Faculty/Doctor
 SMS/Email
 Reports
 Complaints handling & monitoring
 Inventory/Stores
 Integration with VistA/PACS & other HIS.

Appointment Information & Search

Complaints Registration & Monitoring

Appointment Details
# Patient Existing Appointment

Call Status
TC No. Name Disc. Date Resident Dr. Ward Diagnosis Procedure Date Time Exec Rem

DR. MAMRAJ Connected/
1 195719 Akash FEB 1,2010
GUPTA
TC6-15 BTA WITH SPLENIC LACERATION non operative management Feb 6,2010 10:00am Bhavana Ist Call
confirm

LEFT ICD WITH WATER SEAL DRAIN
LEFT A/E GUILLOTINE AMPUTATION
RTC WITH MULTIPLE RIBS # WITH LEFT UNDER BRACHIAL PLEXUS BLOCK ON
DR. AMAR
Shri Ram HEMOTHORAX WITH GANGRENOUS 19/10/2010 DELAYED PRIMARY Connected/
2 193779 JAN 31,2010 NATH TC6-01
LEFT FEOREARM CLOSURE OF LEFT A/E AMPUTATION
Feb 6,2010 10:10am Bhavana Ist Call
Naresh MUKERJI confirm
STUMP UNDER GA ON 25/1/2010

EXPLORATORY LAPAROTOMY, ILEAL
DR. ANURAG RTA WITH BTA AND ILEAL TRANSECTION EXTERIORIZED AS
3 195089 Pramod JAN 31,2010
GUPTA
TC6-19
TRANSECTION DOUBLE BARREL ILEOSTOMY,
Feb 6,2010 10:20am Bhavana Wr Number Ist Call
PERITONEAL LAVAGE AND CLOSURE

BLUNT TRAUMA ABDOMEN WITH
DR. ANURAG EXP. LAP. & PERITONEAL LAVAGE WITH Connected/
4 192915 Satpal JAN 11,2010
GUPTA
TC6-18 HEMO. & PNEUMOPERITONEUM WITH
DRAINAGE.
Feb 6,2010 10:30am Bhavana IInd Call
LIVER LACERATION confirm

Dashboard for the Faculty displaying Faculty’s
Appointments, Patients, Stats, Roster ,etc.

HIS implementation at AIIMS:
OPD & Doctor Consultation

Gen & OPD Registration &
Reception

Server Room & Computer Facility

3. Website: JPNATC dynamic website

Week, Month & Yearly Statistics

eINDIA 2010 award at Hyderabad

mBILLIONTH 2010 award at N. Delhi

THANK YOU
ROHIT@GTIINFOTEL.COM
098114-12342

“8th National Biennial Conference on Medical Informatics 2012”

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