Public service Innovations through ICT “eHospital-Dompe” Project & “mChanneling” – a story of transformation of a government hospital in Sri Lanka.
Abstract:
District Hospital – Dompe is in Gampaha District, having the bed strength of 102 beds & under Ministry of Health- Western Province. It’s ”eHospital-Dompe” project is the most successful electronic transformation of a government hospital in Sri Lanka. The “eHospital – Dompe” project was aimed making a District Hospital in Sri Lanka more efficient through adaptation of ICT solutions and appropriate change management. “mChanneling” solution is the first ever automated appointment system in a government hospital in Sri Lanka & it is a service provided FREE OF CHARGE to deliver more patient friendly service. A unique public & private sector partnership of Ministry of Health, all categories of hospital health staff, ICTA, Well wishers from the community, software & hardware providers, presidential secretariat & mobile partner were among the cornerstones of the success of this project.
Keywords: eHospital-Dompe, Government Hospital, ICT, Change Management, mChanneling
Introduction:
This project was conceived in 2010. At that time the District Hospital, Dompe was an ordinary government hospital. The hospital was disorganized, overcrowded and there were unnecessary delays that compromised total patient care.
The author, the hospital administration, and the hospital staff wanted to change the situation and make the hospital more efficient. Under the guidance of Regional Director of Health Services-Gampaha and Acting Director of the Hospital, the author, with the help of all categories of hospital staff launched a programme to provide efficient health care. The programme included attitude changing, improving moral, building up of team spirit and obtaining optimal use of the abilities of the staff. In addition re-arrangement of the hospital setting, provision of specific accesses to each service points – especially emergency access and improving the quality of care provided, were also included into the programme. A new patient Registration Desk, Queue Management Centre, and a Reception Desk were established and 5s concepts were introduced. In addition, an uninterrupted power supply solution was installed with the assistance of donors in the community.
Objectives:
Rearrangement of the hospital setting to provide a hassle-free service
Provision of efficient health care service
Uplifting of quality of care provided into international standards
The ultimate goal is to have a “ Happy & Content Patient “
The ICT Solution – Background:
We believed that an information technology solution would help make the hospital more efficient and approached the Information and Communication Technology Agency of Sri Lanka (ICTA) for support. The ICTA’s “eSociety” initiative supported us with a grant of Rs.4,150,000.00 for wired networking, computer hardware, and software. This was facilitated by Director, re-engineering government programme, Head of eSociety initiative and Project Manager for eHealth of ICTA.
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We visited Base Hospital-Karawanella where an ICT system was already in place. This enabled us to get an idea of the software that was available. We found that the software had to be customized to make it suitable for our hospital. After extensive discussions Lunar Technologies, Kalutara, under the direct guidance of the author and his team, developed a new system [Hospital Health Information Management System (HHIMS) Version 1.2]. This system has undergone several revisions since then. It is now available as free and open source software that could be downloaded, installed, and used by anyone. This was facilitated by the ICTA.
To deploy the software solution, we networked all the Units of the Hospital, and bought an in-house server [Processor – Quad core E5530 Xeon 2.4 Ghz]. All the networking was wired and was done by Sri Lanka Telecom Services. All the service points/units were provided with a computer [A total of 41 computers: 31 were desktops (processor – Dual core) and 10 were laptops (processor i3)]. Sri Lanka Telecom Services was also the hardware provider.
The system was inaugurated on 27 December 2011 under the patronage of Secretary, Ministry of Health (Western Province) and Regional Director of Health Services-Gampaha.
The Process:
In this project, all the units of the hospital are networked (wired) with an in-house server. All the service points/units are provided with computers & linked each other. When a patient comes to the OPD, he will be registered in our system (once in life time) & provided with a system generated Patient Identification Number & a Patient specific Bar-Code. With this Bar-Coded Patient’s Health Card, the patient is then sent to Electronic Queue Management Centre. There, he will be given the today’s token to assign the correct place in the queue & correct doctor’s chamber. Then he will be sent to doctor for consultation. All the doctors are provided with laptops & bar-code scanners. When the doctor swipes the patient’s card with the barcode scanner, the doctor can get the patient’s demographic data, past medical & surgical history, allergic history etc. within seconds. After the examination, the doctor enters the prescription/ procedure/lab test to the system accordingly. The patient is then sent to the relevant unit to get the ordered treatment done. When the patient goes to the dispensary, the pharmacist there can get patient’s prescription by swiping Bar-Coded Patient’s Health Card. The Laboratory, dressing room, injection room, E.T.U, Medical clinics & Dental clinic are also connected to the system. All the daily reports (OPD register, Drugs dispensed, Drug Stock Balance) are generated by the system. When the patent is admitted to hospital, his medical records are updated with the relevant details & at the discharge a system generated diagnosis card is issued. Three (03) backups are generated by the system automatically per day & data encryption, predefined user access levels, individual usernames /passwords ensure data security.
An additional feature of the system is immediate notification of notifiable diseases via email. Stand alone clinics in the hospital, such as the Medical Clinic, Family Medical Clinic, and the Screening Clinic for Non Communicable Diseases (NCDs) are also linked to the system. The DMO’s office is also linked to the system and as a result, he can monitor the hospital from his room.
Advantages:
The system has been in operation for approximately 2 ½ years at the time of writing this paper. The system holds data of well over 50,000 patients. The OPD has become methodical, efficient and trouble free after the implementation of the IT solution. Two minor staff officers who manually did daily registrations have been re assigned for other tasks now, saving manpower.
The OPD staff is benefited from the electronic queue management system and system generated daily reports. They enjoy their work in a paperless environment. There is no more manual searching of previous prescriptions as there are no chits & books. The patients are easily managed now as they have faith in the system.
The doctors have benefited by getting accurate, comprehensive past histories with medication, investigations and demographic data. They get to know about the availability of drugs immediately. They can plan the patient’s management and easily retrieve lab reports .With all those information doctors can make a more accurate diagnosis. At the same time they are directed for rational use of drugs, especially antibiotics. Doctors can also make sure that the ordered procedure was performed correctly at the relevant unit. The doctors can have a look at statistics for their personal interest (e.g. the number of patients treated by him/her).
The nurses in each unit have benefited by their tasks being made easy as they get clear orders from doctors in advance of the patients’ arrival, which helps them to get ready for the treatment. In addition, they get system generated daily summaries.
The pharmacists /dispensers are able to get legible prescriptions with automatic calculation of the number of tablets, making their duty easier. In addition, automatic stock balancing has reduced their workload & made the dispensary process methodical & accurate.
The Medical Laboratory Technicians receives properly labeled samples.
The administrator is also benefited as he/she can monitor the whole process sitting in his/her room. Obtaining statistical data is made easy by the system and it helps to utilize manpower optimally. Remote monitoring, easy statistical works, optimal resource utilization made health administrators duty easy.
But, the main advantage is for the patients. With the help of the system they get better care. They will be able to have a personal medical record into international standards & able to get treated in a short period of time in patient friendly environment.
“mChanneling”- a FREE appointment system :
mChanneling solution is the first ever automated appointment system in a government hospital in Sri Lanka & it is a service provided FREE OF CHARGE. It is a joint effort of Presidential Secretariat, Ministry of Health(Western Province),ICTA, Regional Director of Health Services(Gampaha) & District Hospital-Dompe.
The free health system in Sri Lanka is obviously providing a service with quality to the nation. Though the quality of care is high, the efficiency of service is questionable at the O.P.D level. To overcome that delay seen in the O.P.D at D.H Dompe, an IT solution had been implemented 02 ½ years back & functioning well by the moment. When the traditional paper based O.P.D is functioning, a patient’s overall average waiting time at the O.P.D is 01 hour & 41 minutes. With the implementation of the IT solution the average waiting time has been reduced to 55 minutes. But with the busy life style even that time period seemed to be longer & our attempt was to decrease the waiting time up to 30 minutes.
To reach our goal, we planned an automated appointment system called “mChanneling” for the O.P.D of District Hospital-Dompe. As it is a timely need of entire Sri Lankan health sector, the design was made to be more simplified & usable in any hospital in Sri Lanka. The solution can be functioned with only one computer with a internet access at any hospital & the hospital need not to be a eHospital(computerized hospital) also. The mchanneling platform is a web-based one & the administrative powers are with hospital authorities. The number of appointments to be issued each day is decided by the hospital itself & uploaded. The hosting organization (Mobitel) is then open it to the general public by an IVR (interactive voice response).The hosting is FREE of charge & the channeling is also FREE. The patient has to bear the call charge only & there are no hidden charges.
Patient
Calling
SMS
Mobile Connection
API’s
SMS
Web based
Appointment
Requests
Update Database
Hospital
OPD Schedule.
OPD Schedules.
Web Interface
Web services, etc
Centralized Database
(OPD Schedules)
The assigned mchanneling HOT LINE Number is 0711-370370 . When a patient calls to the hotline, it is connected with Mobitel’s server & redirected with a predefined voice IVR. It provides appointments only from District Hospital-Dompe & Base Hospital-Dambadeniya by the moment. The patient can select the preferred language & should go on as directed by the voice IVR. The automated IVR will ask for the date for the appointment & the patient has to select time of the appointment. Each appointment contains 15 minutes & any caller can obtain only 02 appointments per day by one phone number. The patients are facilitated to obtain an appointment within next 07 days. At the end of voice IVR, the patient has to confirm the selected appointment/appointments. Then the patient will receive a system generated confirmation SMS with details of appointment & a reservation ID. The patient is asked to come to the hospital with the details of the obtained appointment- the SMS or the phone number from which the appointment is obtained or the Reservation ID . The reception desk staff of the hospital is facilitated with an access to mChanneling web interface & able to track the reserved appointments online & real time. The patients with appointments are provided with a PRIORITY CARD at the reception desk & sent to the doctor assigned for mChanneling, according to the appointment time. The doctor is doing the consultation & ordering the medicines as usual (At D.H Dompe it is done through the already implemented IT solution). Then the patient is sent to the special mChanneling counter at the dispensary for a priority service & his priority card is collected.
Advantages:
The main advantage of mChanneling is to the general public as this solution enlighten the free health system in Sri Lanka by making it more patient friendly. The patients will experience an efficient service with minimal time spent at the Hospital. The Electronic Health Records & Computerized Hospital Health Information Management System will be adding strength to the patients’ overall experience.
The hospital staff will also benefitted by getting to know about the patients who supposed to visit the hospital, beforehand. The administrators will be able to allocate resources & manpower accordingly.
In addition, the health staff can experience the online web applications & its usability & it will lead to a carrier improvement of the staff making a more competent health worker.
Challenges:
There are two main challenges in the Sri Lankan health sector that prevents embracing of IT. First is the complexity of the health sector and the other is poor knowledge and attitudes towards IT. We launched several programmes to overcome the later problem. Several lectures, workshops, competitions (e.g. Best Worker Competition), 5S programmes, productivity programmes (Institutional/Home/Green Productivity) and Out Bound Training(O.B.T) were arranged for all health staff with the view to changing their attitudes. All of our staff has been given basic computer training under the guidance and direct involvement of the Faculty of Computer Science and Engineering, University of Moratuwa. Head of the Department, guided the programme. Then we selected 60 staff members who were directly involved with the system and provided them with software training. A selected small group was trained on basics of hardware as well. They were refreshed and guided regularly by the author. Small user group discussions were conducted to understand and improve the usability.The community was convinced by posters, banners & public addressing system of the hospital. The patients got used to the new system rapidly. They were intelligent enough to understand the value of this project and it made our task easier.
The Acceptance:
Under the ethical clearance of Faculty of Medicine, University of Kelaniya & with the approval of Education , Training & Research Unit of Ministry of Health, a cross sectional descriptive study was conducted to access the Customer satisfaction on using Information Technology in treating patients at Out Patient Department.
384 patients were interviewed. Median age of the study group was 42 years (Inter-quartile range: 33 to 52) and 297 (77%) were females. Among them, 334 (87%) had never used computers, 230 (60%) were not employed and 358 (93%) had more than one visit to the hospital. Three hundred eighty (99%) were highly impressed on using a personal health identification card and 336 (87%) believed their personal data is secured. Majority were “highly impressed” for using Information Technology on obtaining appointment at registration counter (n=381, 99%), during doctor consultation (n=374, 97%) and on obtaining drugs at pharmacy (n=375, 98%). Three hundred and fifty (91.1%) believed overall time spent at hospital has reduced as a result of less waiting time at registration counter (n=369, 96%), doctor channeling (n=367, 95%) and pharmacy (n=346, 90%) and all felt the quality of care has improved after introducing Information Technology. All patients recommended extending the present system to other clinics and wards.
The way forward ..
The system has been in successful operation for 2 ½ years by now. We always try to improve the software and its usability to improve the quality of health care provided by our hospital. Improving the patient’s health card with the Health Identification Number (HIN) proposed by the Ministry of Health is one of our priority expectations. We are working hard to ensure a more patient friendly service with use of Information Technology . Infrastructure development within our hospital is also necessary for the sustainability of the project. The electronic Bed Head Ticket and inter connectivity with other hospitals are needed to have an effective electronic transformation and these are within our reach.
Conclusion:
With the experience gathered through the “eHospital-Dompe” project, we can conclude that appropriate use of ICT can definitely contribute to improvement in the quality of care provided in the Sri Lankan healthcare sector.
Electronic Resources:
1. eHospital- Dompe Project in YouTube.
Available at: http://www.youtube.com/watch?v=-YqujXDfHHQ
2.Hospital Health Information Management System (HHIMS)
Can be downloaded from git://gitrepo.icta.lk/hhims/hhims.git
By:
Dr. K.B Sampath Kulathilaka
(M.B.B.S(Sri Lanka), Cet. In Health Programme Management( Uni. Of Colombo)
Medical Officer In-charge of “ eHospital-Dompe “ Project & “mChanneling”
District Hospital – Dompe
0777-577927 / 0718-672770
Email ; drsampathkulathilaka@gmail.com
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