Amarnath Talwade, I D.No 02 Dr Ashish Dixit, I D.No 05 Dr SP Chaudhry I D.

No 07

The Maxwell School, Syracuse University Group Policy Memo

Implementation of Hospital Information Management Systems (HIMS) in Railway Hospitals and Health Units of Indian Railways
(For better management of Healthcare delivery System)

Indian Railways has huge health care infrastructure, consisting of 125 Hospitals and 586 health units available all over India, under the single management system under the administration of health directorate, under Director General of Railway Health Services (DGRHS), Railway Ministry (Railway Board), New Delhi. In the recent years, in view of aware citizens and beneficiaries there has been tremendous increase in the court & RTI cases

pertaining to health department of the railways all over the Indian Railways , necessitating health department to provide immediate information to various agencies such as citizens, patients , courts, and under RTI act. And as per Report of Comptroller and Auditor General (CAG) of India, Report No.5 of 2006 (Railways),Chapter IV ,Performance appraisal of Medical and Health Services ,it was noticed that there is inadequate documentation of beneficiaries and deficiency in beneficiary data used by the Medical and Health Department for planning over all the zonal railways audited.(Para 4.7.3). Due to inadequate documentation and record keeping it becomes very difficult and sometimes impossible to provide information asked by various agencies from time to time as mentioned above causing embarrassment to the railway authorities and administration wasting huge time of the administration by utilizing professional manpower for non professional works as mentioned. On date most railway hospitals and health units are not yet using any Hospital Information and Management Systems (HIMS), as used in private hospital in India in view of globalization of healthcare industry.
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HIMS are increasingly becoming an emerging tool in health care arena to efficient delivery of high quality health services. Hospital Information system is one of the most common computer systems have been designed to support health care services. These systems are large computerized data bases were intended primarily for communication and store health and administrative information. HIS has a different components and includes broad scope and level of systems from departmental (a system limited a specific clinical or financial domain) to knowledge. It works at the Clinical, Para-clinical, Administrative, Logistical and statistical levels, in other words it can be used for better planning, governance, monitoring and for sharing and updating the clinical data and knowledge. Today, biggest problem in efficient health care management is improper and inadequate documentation of data, may it be patient records or may it be the drug distribution data, of staff attendance or Laundry and catering management. Lack of data in turn leads to a poor analysis which in turn effects the further development and fault rectification. Use of computers and internet can be used to overcome these short falls and improve the services. In todays world, electronic documentation and record keeping is not only the need but it also simplifies much of the complex work with the use of the computers.

WHY HIMS for Railway Hospitals and Health Units: On date, HIMS for Railway Hospitals and Health Units is not the need of the hour but it is essential for better management of the hospitals & health Units available as well as for better administrative efficiency all over India over interiors as well, and to provide better health care to the people. HIMS can be used for better management of medical and health service, as an important tool for better monitoring, data collection and analysis, for planning and implementation of the services, to find out key areas needing attention, for indoor & outdoor management, record keeping, for Emergency and ambulance management ,for manage the supportive hospital services like catering and laundry ,for medical store management and drug distribution, as a platform for telemedicine, to establish contact between the health units and railway hospitals, for effective implementation of Public health programs, for Continuing medical education and professional upgrading of the medical, paramedical and other support

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staff; last but not least , most importantly in todays world and environment, for quick and reliable source for information in cases pertaining to RTI and court cases.

HIMS consists of Electronic Health Records (EHR) which is a medical record or any other information relating to the past, present or future physical and mental health, or condition of a patient which resides in computers which capture, transmit, receive, store, retrieve, link, and manipulate multimedia data for the primary purpose of providing health care and health-related services). Guidelines are required to be framed for the technologies, standards, laws, policies, programs and practices that enable health information to be shared among health decision makers, including consumers and patients, to promote improvements in health and healthcare.The platform and the usage for HIMS has to be standardized to create trust and confidence in the health care services, Increase market relevance, To facilitate exchange of information, Help prevent duplication of effort and ensure interoperability between the various technical solutions in health care. There is a need for transportability that will enable the next provider easy access to the latest patient records. There is a need for personal health record which contains the patient-entered information. There is a need for containment of cost by developing a more systematic approach to healthcare information transportability whereby all disciplines work together towards a documented, integral approach to the individual patients.

Recommendation In view of better management of various services pertaining to medical and healthcare delivery system in todays scenario, it is highly recommended that Indian railways should adopt and implement HIMS in its hospitals and health units all over India, by doing it indigenously or by outsourcing it on a turnkey basis, the later will turn out to be a cheaper option. Indian railway is having an indigenous internet service Rail Net this connects the complete 65000 route kilometers of the railway organization. All railway hospitals and health units all over India are need to be vertically and horizontally connected to each other. This will improve the quality of treatment, the promptness in the health care delivery and better management. A central server is to be installed at the Ministry of Railways (Railway board), New Delhi which will run this
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program and will give a vertical and horizontal connectivity to various Railways Zonal and Divisional management to control the Zonal, Divisional and sub divisional hospitals and the health units. A multi user program on this server will be low cost, easy to maintain. A web based program can be devised for easy and remote maintenance. For achieving desired results all the railway hospitals & health Units and controlling headquarters are needed to be get integrated. Looking at the current developments in the Health IT landscape, delay in coordinated efforts will lead to further divergence and will further escalate installation costs to the Railways, which could be difficult to deal with later. Infrastructure wise we have all the ingredients available for a perfect recipe; i.e., technological expertise, good internet infrastructure across the country, skilled and trained manpower, increasing willingness for adoption among professionals. All we need is a coordinated effort and a directional leadership which could steer us towards an integrated health system so that the beneficiaries and various authorities can reap the benefits. A PPP model of an out sourcing on a turnkey basis can also be considered for economic implementation. Therefore it is highly recommended to consider the proposal as adaptation and implementation of HIMS over healthcare delivery systems of Indian Railways will be successful as in todays world and to cope with forces of globalization, the IT is the only way to be more productive in less time, as the world is going digital unless we start using the IT applications in our health care system we will not be able to match the speed of development of the world.. Developed countries like USA also have adopted this system for better and efficient healthcare and administrative management.

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