Challenges of setting up hospital management information system (HMIS) in Pakistan: Pakistan Institute of Medical Sciences A unique success story

Dr. Haroon Khan Chief HMIS

This i P ki t Thi is Pakistan

PUNJAB

SINDH

NORTH WEST FRONTIER PROVINCE

BALOCHISTAN

Short history of Pakistan Institute of Medical Sciences (PIMS) computerization

Process of computerization started in 1993 in Dept gy of Pathology. Dept. own initiative and finances Software developed and maintained by private p y p software house. Extended to other parts of the hospital later but as p p each dept own initiative. In 2005 Ministry of Information Technology (MoIT) and Ministry of Health (MOH) approved funds for this project for purchase of Hardware, networking and training. training
Contd..

Short history of Pakistan Institute of Medical Sciences Hospital Management Information System (HMIS) d t established 12 staff members dept. t bli h d t ff b Hospital staff trained Presently 450 active nodes, 14 integrated modules Registration R i t ti de-centralized. d t li d 2400 patients ti t registered per day in Out Patient Department (OPD) Diagnostics (Pathology and Radiology) Stores and wards admission/discharge is paperless

Problem
Doctors data entries (OPD OT and Wards) (OPD,

Financial problems of Hospital computerization

Process of acquiring funding from the Government of Pakistan (GOP) is very tedious Interacting and satisfying two separate Govt Govt. Ministries, Ministry of Health (MOH) and Ministry of Information Technology (MoIT) is a y gy ( ) daunting task Ownership and commitment by the end user is a crucial factor for the acquisition of finances

Finance document Government of Pakistan

Technical problems Software issues

Reasons computerization projects fail: easo s co pute at o p ojects a Poorly developed, implemented or maintained software, lack of commitment, ownership or lack p of resources GOP does not want to be involved in the development and maintenance of softwares resource constraints, and commitment issues Pi d has the source code. E d user i h d End Private vendor h is always under pressure of the vendor Development of software i an on going process as D l t f ft is i the end user familiarity increases his demands for change also increases

Hardware
Hardware maintenance and service contract are expensive. expensive Release and availability of funds is a long slow process, this leads to frequent breakdowns and end user frustrations Hardware back ups are not provided in time by the p p y vendor causing problems in providing uptime. Technical support by the vendor is also weak due to non availability of highly trained technical people Unreliable electricity.

Human resource issues

Staff training is an ongoing process as hospital is dynamic environment. Basic computer program usage and typing skills unsatisfactory unsatisfactory. No incentive for learning computer skills Insufficient number of trained staff to perform various t k i tasks Frequent replacement of staff At PIMS staff training is through on job training g g j g and computer lab training a

Staff Training

Hospital Management Information System T S t Team PIMS

Management issues
Complex interaction between PIMS, MOH and MoIT End user MOH. Funds and services provider MoIT p Both depts. have to be satisfied p These problem dealt at PIMS by the PIMS coordinator

National replication of HMIS

GOP wishes to replicate this HMIS model in all the Federal Govt. Hospitals

Issues
End users want to develop their own software Multiple soft wares: Maintenance communication between these Maintenance, soft wares, source code custodian Piracy i Pi issues IT l i l ti not effective legislation t ff ti

HMIS standardization issues

Communication/interfacing of software with equipment and between hospitals in the city, provinces and in the country. Problem: Single software central data base software, base, web based software, HL7 compliant/ compatible soft ware Vendor s Vendors inability standardization to provide solutions for

Current computerization efforts in hospitals

Some successful computerization models in private sector, mostly small scale. t tl ll l Reasons for success Private company, own rules and regulation, authority for hiring and firing of staff g g Output based incentives for staff Management desires to improve efficiency financial efficiency, management transparency and patient care Computerization i public sector i slow C i i in bli is l Reasons for slow progress: Commitment and ownership issue. Bureaucratic hurdles and no incentive for bringing change

Telemedicine & HMIS

Concept paper for establishing Tele Medicine Center at PIMS developed Collaboration for Telemedicine between Ministry of Science and Technology (S&T) and PIMS Novel idea as expertise from two different Govt. Ministries is being utilized to provide tertiary care h lth f ilit t rural areas l health facility to S & T will maintenance of bandwidth etc etc. provide technical telemedicine support and equipment,

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Telemedicine & HMIS PIMS will provide telemedicine duty roster for the doctors from various specialties. Doctors will be p performing this duty as part of their routine daily g y p y work

Issues
Ensuring availability of doctors on time Availability of reliable electricity at rural centers Ensuring maintenance of equipment at the rural center Incentive for doctors Cost benefit analysis

Accreditation of Health facilities

GOP through MOH is very keen to develop National Hospital standards leading to accreditation One of the perquisites of such accreditation is the documentation and availability of reliable and retrievable data HMIS is the answer to this problem especially in district d Federal hospitals di t i t and F d l h it l

Medium and long term challenges

Cost benefit Analysis Commitment and Owner ship Development of eHealth planning and Strategy for the Policy makers Advocacy of eHealth at the Policy maker level eHealth legislation

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