While technology is widely acknowledged to be a boon wherever it intervenes, there is no doubt that an ill-conceived project could turn out to be a white horse.
As Union Health Secretary Sujatha Rao made the point recently at the International Conference on Health Systems Strengthening, she went on to add that IT systems had not really made a big breakthrough in the country's health care sector thus far.
A unique experiment started four years ago in Tamil Nadu, however, seems to be bearing more fruits than it was initially estimated, says P.W.C. Davidar, Tamil Nadu's Information Technology Secretary, who in his stint in the Health Department essayed the beginning of this project.
The Tamil Nadu Health Systems Project's Health Management Information Systems (HMIS) is what has gone beyond its purpose. Initially, it was meant to digitise health information gathered at district and taluk hospitals, and was then, the Hospital Management Systems project (HMS).
The HMS is the IT infrastructure that helps to streamline the functioning of the hospital through automation and proper management of data. From registration of a patient to preparation of discharge summary, online entry of diagnosis and prescriptions from the doctor, maintaining the inventory of drugs and other disposables, and maintenance of all hospital-related services happen through the HMS.
The “HMIS is distinct because it is used to analyse all other information systems used in regular activities, and thereby contains HMS within,” explains S. Vijayakumar, Project Director, TNHSP. So the basic data from the HMS will also go into this larger information network (HMIS) in order to facilitate evidence-based budgeting and planning, and also epidemiological research at some stage.
The data will be channelised to the State bureau of health intelligence and from here, health policymakers will derive the evidence needed to draw funds and bolster support for fresh initiatives. For instance, Dr. Vijayakumar says, if data from the dynamic HMIS could be analysed to show an alarming increase in, say, cardio vascular disease in certain districts, action could be initiated immediately.
It began with a pilot project in five hospitals, Mr. Davidar explains. “We were treading zones where no one had ever gone before. Gujarat had a system, but that was data entry operators putting information into the system. This would be real time online loading of data, and would not be a success unless the staff cooperated.” But they did, and the project helped to activate the HMS and the HMIS in five districts (covering 36 hospitals); the HMIS in 272 hospitals; and for the first time, in the PHCs (five of them) both the HMIS and the HMS.
Phase II of the project, currently on, involves bringing 222 hospitals in 26 districts and 15 PHCs. Open Source software without a vendor lock at any stage of development has been used, and TCS provides the software solutions support. The Electronics Corporation of Tamil Nadu provides connectivity through the Tamil Nadu WAN, a 2 mbps leased line with redundant broadband fallback to ensure that there is no break in connectivity .
“The way we see this, the HMIS will evolve into an intelligent dynamic network that will be a central point of reference for any kind of health decision and financing, especially in the government sector, in Tamil Nadu,” Dr. Vijayakumar says.
