Integrated Health Management Information System
The core problem that we are trying to solve with an integrated health management information system is the lack of a comprehensive and efficient system to manage patient data and hospital operations. In many healthcare settings, there are multiple systems in place to manage different aspects of patient care and hospital operations, resulting in data silos, inefficient workflows, and potential errors. Following are the relevant issues that we have identified to be addressed with this:
Lack of standardized and centralized patient data: In India, patient data is often scattered across multiple systems, leading to data silos and difficulty in accessing complete patient information.
Inefficient and manual processes: Many healthcare processes in India are still manual, leading to inefficiencies, errors, and delays in patient care.
Limited access to healthcare in rural areas: rural areas in India often lack access to quality healthcare services, with healthcare providers being concentrated in urban areas.
Lack of interoperability between systems: In India, different healthcare providers and systems often use different software and systems, leading to a lack of interoperability and difficulty in sharing patient data.
Limited resources and infrastructure: Healthcare infrastructure in India is often limited, with a shortage of healthcare professionals, hospitals, and medical equipment.
Lack of preventive care: In India, the focus of healthcare is often on treating illnesses rather than preventing them.
Poor communication and coordination between healthcare providers: In India, there is often poor communication and coordination between different healthcare providers, leading to fragmented care and suboptimal outcomes.
Limited patient engagement: Patients in India often have limited engagement in their own healthcare due to a lack of access to information and resources.
Lack of transparency and accountability: In India, there is often a lack of transparency and accountability in the healthcare system, leading to inefficiencies and suboptimal outcomes.
Limited healthcare innovation: Finally, healthcare innovation in India is often limited due to a lack of resources, infrastructure, and expertise.
The healthcare industry is rapidly evolving and becoming more complex, requiring healthcare providers to manage vast amounts of data and provide end-to-end service delivery. To meet this demand, a community-centered health management information system (HIS) with an in-built hospital information system can be developed to cover the complete health system flow and end-to-end service delivery.
Tattva Foundation has been developing the Hospital Information System for primary, secondary, and tertiary health facilities since 2018 based on the BAHMNI open-source HIS. Now, in an advancement to that, we have integrated community health workers' and health and wellness center mobile apps with the said HIS to strengthen the continuum of care through improved referral follow-up and teleconsultation.
The purpose of this product is to develop an open-source comprehensive health management information system that is community-centered, cost-effective, scalable, and customizable, with an in-built hospital information system that can meet the diverse needs of healthcare providers and patients.
The key components of this system are,
Bahmni (the Open Source HIS):
Bahmni is an open-source hospital information system and electronic medical record system. It is designed to support healthcare providers in low-resource settings to deliver high-quality care to patients. Bahmni is built on top of various open source technologies, including:
OpenMRS: An open source electronic medical record system used to manage patient information.
OpenERP: An open source enterprise resource planning system used for inventory management, accounting, and procurement.
OpenELIS: An open source laboratory information system used to manage laboratory orders and results.
DICOM and PACS: for integration with point of care devices and other diagnostic machines.
Bahmni provides a range of features, including patient registration, clinical documentation, order management, appointment scheduling, and pharmacy management. It is highly customizable and scalable and can be configured to meet the specific needs of healthcare providers.
Community Health Worker Application:
The community health application is a mobile based application that functions on both Android and iOS. The key features of this application are,
a. Population Enumeration
Family and member registration
Family Folder
Death registration
Migration Registration
b. Identification and counseling of target beneficiaries
CBAC (NCD Assessment)
Due List
CPW Identification
CPW Counseling
Child Counseling
c. Track, mobilize, and motivate beneficiaries for ANC, PNC, immunization, and family planning services using automated due-lists.
Health & Wellness Center Application:
Gap Assessment Module
a) Human resources, including training status; b) infrastructure as per HWC requirements; c) equipment as per IPHS and NCD norms; d) drugs and supplies e) Registers
POPULATION ENUMERATION a) Household characteristics and socio-economic indicators b) Family member details c) Non-communicable diseases CBAC forms for individuals more than 30 years of age d) Out-of-pocket expenses
HWC Operational Module
a. Unique Family ID;
b. 12 services to be provided as per GOI guidelines
c. Planning for integration with ANMOL for RCH services
d. Linkages with corresponding PHCs and CHCs using family ID
With this kind of innovative and end to end technical support, the integrated HMIS aims to deliver value to users by improving patient care, enhancing care coordination, increasing efficiency and productivity, promoting patient engagement, improving transparency and accountability, and fostering healthcare innovation.
The flexible and integrated advanced hospital information system has the potential to deliver significant value to its users, including:
Improved patient care: By providing healthcare providers with access to comprehensive patient data, including medical history, diagnostic test results, and medication history, the healthcare information system can help improve patient care and outcomes.
Enhanced care coordination: The healthcare information system can facilitate communication and collaboration between different healthcare providers, leading to better care coordination and outcomes.
Increased efficiency and productivity: The healthcare information system can automate many routine tasks, such as appointment scheduling and medication dispensing, freeing up healthcare providers to focus on more complex tasks and improving overall efficiency and productivity.
Better patient engagement: The healthcare information system can empower patients by providing them with access to their medical records, health education materials, and other resources, leading to greater engagement and better health outcomes.
Improved transparency and accountability: The healthcare information system can improve transparency and accountability by tracking healthcare provider performance, monitoring patient outcomes, and providing patients with access to information about their care.
Greater healthcare innovation: Finally, the healthcare information system can provide a platform for healthcare providers, researchers, and entrepreneurs to develop and test new ideas and technologies, leading to greater healthcare innovation and improved outcomes.
Tattva Foundation is an Indian not for profit ICT4D entity committed to the creation of an equitable society through technology driven social innovations and currently focuses on public health, climate change, and education.
Tattva Foundation has been working on strengthening the HIS and healthcare systems since its inception through various mobile based and web based applications,
Some of our past experiences with this kind of product are,
Project Name: Hospital Information System (HIS) for Nagaland
In an effort by the State Govt. of Nagaland, India, to digitize district hospital processes and health records of the people of Nagaland in order to improve patients' access, quality, and experience of care in line with the Ayushman Bharat Digital Mission, the state of Nagaland has a population of 22 lakh, whose healthcare needs are primarily served by the public health infrastructure consisting of 531 sub-health centers (SC), 137 primary health centers (PHC), 23 community health centers (CHC), and 11 district hospitals. Tattva Foundation has customized and developed an integrated hospital information system (HIS) for all 11 district hospitals in the state that cater to the secondary and tertiary care needs of about 600,000 patients annually, or approximately 30% of Nagaland’s population.
Project: Digital Health Management Information System
Aligned with the vision of MP NHM and WISH Foundation to scale up high-impact innovations to make quality primary healthcare accessible and available to underserved populations, We developed an integrated system of mobile and web-based applications that communicate with one another for data transmission and service delivery as part of this project. In this project, we created two Android applications: one for community health workers and another for digitising the service delivery flow at health and wellness centre facilities. Then, as the foundation of this digital health information system, we provided an integrated and customised HIS named Bahmni to primary and community health centres, as well as tertiary and specialty care hospitals.
Product: Integrated Health Management Information System (Current One)
The healthcare industry is rapidly evolving and becoming more complex, requiring healthcare providers to manage vast amounts of data and provide end-to-end service delivery. To meet this demand, a community-centered health management information system (HIS) with an in-built hospital information system can be developed to cover the complete health system flow and end-to-end service delivery. The purpose of this product is to develop an open-source comprehensive health management information system that is community-centered, cost-effective, scalable, and customizable, with an in-built hospital information system that can meet the diverse needs of healthcare providers and patients. This HMIS is being built using Bahmni at its core and a microservices architecture that allows for independent deployment and scaling of each module, including the patient portal and Doctors app.
- Enable continuity of care, particularly around primary health, complex or chronic diseases, and mental health and well-being.
- India
- Pilot: An organization testing a product, service, or business model with a small number of users
The HIS system provided by Tattva Foundation is being implemented for all 11 district hospitals in Nagaland state that cater to the secondary and tertiary care needs of about 600,000 patients annually, or approximately 30% of Nagaland’s population. To get an idea of the user base and people registered so far with this system, I am adding a screenshot of the state dashboard to get an idea of the numbers of beneficiaries and users.
We would like to benefit from the MIT Solve community’s learning and guidance to:
Improve and accelerate a perception change towards the culture of data use among grassroot level communities and organizations such as FLWs and the primary health facilities.
Attain a wider acceptance for the solution and trigger conversations regarding it among global stakeholders.
Overcome the barriers of information asymmetry existing in such systems by making information accessible to all stakeholders in the program alike for a more harmonious care continuum service delivery effort.
Financial and operational partnerships for scale-up and the next phase of development of the project
With such strategic partnerships, we intend to conduct the following activities:
Conduct design science research to measure the efficacy of the model in improving integrated health management information systems.
Conduct a cost-benefit analysis for the scalability of the solution in low- and middle-income countries.
Run a full-fledged model for a period of one year to demonstrate the effectiveness of the solution and take appropriate course correction measures.
- Business Model (e.g. product-market fit, strategy & development)
- Product / Service Distribution (e.g. delivery, logistics, expanding client base)
With this kind of innovative and end to end technical support, the integrated HMIS aims to deliver value to users by improving patient care, enhancing care coordination, increasing efficiency and productivity, promoting patient engagement, improving transparency and accountability, and fostering healthcare innovation.
The flexible and integrated advanced hospital information system has the potential to deliver significant value to its users, including:
Improved patient care: By providing healthcare providers with access to comprehensive patient data, including medical history, diagnostic test results, and medication history, the healthcare information system can help to improve patient care and outcomes.
Enhanced care coordination: The healthcare information system can facilitate communication and collaboration between different healthcare providers, leading to better care coordination and outcomes.
Increased efficiency and productivity: The healthcare information system can automate many routine tasks, such as appointment scheduling and medication dispensing, freeing up healthcare providers to focus on more complex tasks and improving overall efficiency and productivity.
Better patient engagement: The healthcare information system can empower patients by providing them with access to their medical records, health education materials, and other resources, leading to greater engagement and better health outcomes.
Improved transparency and accountability: The healthcare information system can improve transparency and accountability by tracking healthcare provider performance, monitoring patient outcomes, and providing patients with access to information about their care.
Greater healthcare innovation: Finally, the healthcare information system can provide a platform for healthcare providers, researchers, and entrepreneurs to develop and test new ideas and technologies, leading to greater healthcare innovation and improved outcomes.
The expected outcomes/results of the 12-month project for the development and implementation of an advanced healthcare information system could include:
Improved efficiency and accuracy of healthcare services: The system can help to streamline healthcare processes and reduce errors, leading to better outcomes for patients
Better patient experience: The system can provide patients with easy access to their medical records, appointment scheduling, and other services, leading to improved patient satisfaction.
Increased collaboration among healthcare providers: The system can facilitate better communication and collaboration among healthcare providers, leading to improved coordination of care and better outcomes for patients.
Increased data security and privacy: The system can ensure that patient data is stored securely and accessed only by authorized personnel, leading to increased data security and privacy.
Better decision-making: The system can provide healthcare providers with access to real-time data and analytics, enabling them to make more informed and timely decisions.
The above points will be captured through the appropriate data indicators and compared to the control areas and the intervention geographies.
To showcase evidence of impact, the project will track various metrics such as:
Number of healthcare providers, patients, and administrators using the system.
Improved accuracy and efficiency of healthcare services.
Patient satisfaction ratings.
Number of successful patient outcomes.
Reduced wait times for appointments and procedures.
Improved data security and privacy.
Increased collaboration among healthcare providers.
These metrics will be tracked and analyzed over time to demonstrate the impact of the system on healthcare services and outcomes. Additionally, feedback from users can be collected and incorporated into the system to continually improve its effectiveness and impact.
- 3. Good Health and Well-being
- 9. Industry, Innovation, and Infrastructure
- 10. Reduced Inequalities
To showcase evidence of impact, the project will track various metrics such as:
Number of healthcare providers, patients, and administrators using the system.
Improved accuracy and efficiency of healthcare services.
Patient satisfaction ratings.
Number of successful patient outcomes.
Reduced wait times for appointments and procedures.
Improved data security and privacy.
Increased collaboration among healthcare providers.
These metrics will be tracked and analyzed over time to demonstrate the impact of the system on healthcare services and outcomes. Additionally, feedback from users can be collected and incorporated into the system to continually improve its effectiveness and impact.
Tattva Foundation plans its interventions using the BG Fogg behavioral model as the basis for creating change.
The BJ Fogg model is built on three major components: motivation, ability, and trigger. When these three factors converge at the same moment, behavior changes.
According to this paradigm:
Behavior (B) = Motivation(M)*Ability (A)*Prompts(P)
The model states that people need the motivation to change their behavior. But they also require the ability to do the desired behavior. In absence of either one of them, it is not possible to elicit a behavior change.
IHMIS comes in at this precise point where it acts as a medium to improve the motivation of the facility staff and front line health workers by
1. Providing them easy to use application interface and information in simple and effective ways.
2. Providing them tools for better management of Health system service delivery.
3. Linking various levels of health system for easy monitoring and review
3. Providing information curated to needs of health facility and health workers.
the following outcomes can be achieved through this model,
Improved Access to Healthcare: The system aims to increase access to healthcare services by providing a centralized platform for healthcare providers, patients, and administrators. This can lead to reduced barriers to care, improved appointment scheduling, and better coordination of services.
Enhanced Quality of Care: The system intends to improve the quality of healthcare by providing healthcare providers with comprehensive patient information, decision support tools, and data analytics capabilities. This can lead to more accurate diagnoses, better treatment plans, and improved patient outcomes.
Increased Efficiency and Productivity: The system aims to streamline healthcare processes, reduce paperwork, and automate routine tasks. This can result in improved operational efficiency, reduced administrative burden, and increased productivity for healthcare providers and staff.
Empowered Patients: The system intends to empower patients by giving them access to their medical records, appointment scheduling, and educational resources. This can enable patients to actively participate in their healthcare decisions, leading to improved health literacy and patient engagement.
Strengthened Healthcare Ecosystem: The system aims to foster collaboration and information sharing among healthcare providers, diagnostic centers, pharmacies, and other stakeholders. This can lead to a more integrated and coordinated healthcare ecosystem, resulting in improved healthcare delivery and outcomes.
Tattva Foundation has been developing the Hospital Information System for primary, secondary, and tertiary health facilities since 2018 based on the BAHMNI open-source HIS. Now, in an advancement to that, we have integrated community health workers' and health and wellness center mobile apps with the said HIS to strengthen the continuum of care through improved referral follow-up and teleconsultation.
Bahmni as the core of this system uses AngularJS as the front-end framework to build the user interface, while OpenMRS and OpenERP/Odoo serve as the back-end frameworks for managing patient data and hospital operations, respectively. Node.js and OpenMRS Web Services act as the middleware to handle communication between the front-end and back-end. Bahmni uses MySQL as its primary database and runs on the CentOS operating system with the Apache web server. For development and testing purposes, Bahmni uses Vagrant and VirtualBox virtualization tools.
Front-end framework: AngularJS
Back-end Framework: OpenMRS and OpenERP (now called Odoo)
Middleware: Node.js and OpenMRS Web Services
Database: MySQL
Operating System: CentOS
Web Server: Apache
Virtualization: Vagrant and VirtualBox
The other community health worker application and health and wellness center mobile applications are built using Kotlin and are used for its development. The backend framework for the application is PHP Laravel, which provides a powerful and flexible development environment. MySQL is typically used as the database management system, while Apache serves as the web server. RESTful APIs are used to enable communication between the Android app and the PHP Laravel backend.
Android App Development: Kotlin
Backend Framework: PHP Laravel
Database: MySQL
Web Server: Apache
API: RESTful API
The analytics dashboard is built using R, powered by Python. R has an effective data handling and storage facility,
Below is the architecture of the integrated system in development,
Integrated Architecture Overview
The following diagram depicts the concept of how various subsystems of the Digital Health Management System will integrate with each other. The integration scope will include the ASHA application, HWC and Hospital (PHC, CHC and DH) level systems.
- A new business model or process that relies on technology to be successful
- Artificial Intelligence / Machine Learning
- Crowd Sourced Service / Social Networks
- Internet of Things
- Software and Mobile Applications
- India
- India
As the current HMIS is using a microservices architecture, we have already completed the implementation of the required HIS modules into 11 district hospitals in Nagaland State, and we are in the maintenance phase, which we are hoping to extend for the next one year. And we also have one more project on the integrated health system of HIS with two mobile applications that are nearing the piloting phase. Apart from these two, we will also be aiming to create some revenue by providing the following services to existing and future clients:
Key Customers and Beneficiaries:
- Healthcare Providers: Hospitals, clinics, and healthcare facilities that require an integrated and advanced information system to manage patient records, streamline operations, and improve patient care.
- Healthcare Administrators: Managers and administrators responsible for overseeing healthcare systems and ensuring efficient resource utilization, data management, and compliance.
- Patients: Individuals seeking access to their medical records, appointment scheduling, and engagement with healthcare providers.
Products or Services:
- HMIS Software: Development and provision of a comprehensive, flexible, and integrated healthcare management information system, catering to the specific needs of healthcare providers and administrators.
- Customization and Integration Services: Tailoring the HMIS software to the unique requirements of healthcare providers, including specific modules, features, and integrations with existing systems.
- Training and Support: Offering training programs and technical support to ensure healthcare professionals and staff can effectively utilize the HMIS software and maximize its benefits.
- Data Analytics and Reporting: Providing advanced data analytics capabilities to extract insights from healthcare data, enabling informed decision-making and performance monitoring.
Delivery Approach:
- Software Licensing: Offering licenses for the HMIS software, allowing healthcare providers to install and operate the system on their own infrastructure.
- Software-as-a-Service (SaaS): Hosting the HMIS software on cloud servers and providing access to healthcare providers on a subscription basis.
- Consulting and Professional Services: Providing consultancy services for system implementation, data migration, and workflow optimization.
Value Proposition:
- Improved Efficiency and Productivity: The HMIS enhances operational efficiency, reduces paperwork, automates tasks, and streamlines workflows, leading to time and cost savings.
- Enhanced Quality of Care: The HMIS improves access to accurate patient information, decision support tools, and analytics, resulting in better diagnoses, treatment plans, and patient outcomes.
- Better Patient Experience: The HMIS empowers patients with access to their medical records, appointment scheduling, and educational resources, promoting active engagement and personalized care.
Revenue Generation:
- Software License Fees: Charging upfront or recurring fees for healthcare providers to obtain licenses for the HMIS software.
- Subscription Model: Charging healthcare providers a regular subscription fee for access to the HMIS software hosted on cloud servers.
- Consulting and Customization Services: Generating revenue through consultancy services, customization, and integration of the HMIS software.
- Support and Maintenance: Offering ongoing support and maintenance services to healthcare providers, including bug fixes, updates, and technical assistance.
- Government (B2G)
As the current HMIS is using a microservices architecture, we have already completed the implementation of the required HIS modules into 11 district hospitals in Nagaland State, and we are in the maintenance phase, which we are hoping to extend for the next one year. And we also have one more project on the integrated health system of HIS with two mobile applications that are nearing the piloting phase. Apart from these two, we will also be aiming to create some revenue by providing the following services to existing and future clients:
Custom development and implementation services
Support and maintenance services for bug fixing, security updates, and technical support
Hosting and cloud services for the software allow healthcare providers to access the system from anywhere without the need for on-premise hardware.
Training and certification for healthcare professionals who wish to become proficient in using the software
value-added services such as data analytics, telemedicine, or patient engagement tools, which could be integrated with the core software.
We are also aiming to bid for 2-3 more projects on our product, but for the open source tool, we are looking for funding support through grants, innovation funds, and challenges.
With this modular and scalable system, we will be aiming to support it through module-wise releases for existing and future customers, followed by ongoing maintenance, updates, and support through
Regular releases of the software that include bug fixes, new features, and updates.
Creating a strong community around the software to encourage user engagement, feedback, and contribution through forums, user groups, and chat rooms.
issue tracking to manage bugs and feature requests.
Comprehensive and up-to-date documentation to help users get started with the software and troubleshoot issues (user manuals, installation guides, and API documentation).
thorough testing of the software before each release to ensure that it is stable and free of bugs.
Implementing version control, regularly backing up the data and software, and taking strong security measures.
The development of this product started with the aim of digitizing district hospital processes and health records of the people of Nagaland in order to improve patients' access, quality, and experience of care. In line with the Ayushman Bharat Digital Mission, the state of Nagaland has a population of 22 lakh, whose healthcare needs are primarily served by the public health infrastructure consisting of 531 sub-health centers (SC), 137 primary health centers (PHC), 23 community health centers (CHC), and 11 district hospitals. Tattva Foundation won the bid of 200,000 USD for the digitization of the 11 hospitals.
Then in next project where we aigned with the vision of MP NHM and WISH Foundation to scale up high-impact innovations to make quality primary healthcare accessible and available to underserved populations, Tattva Foundation has won a bid of the 60,000 USD to developed an integrated health and wellness information system to enable digitization of household and family censuses, creation of longitudinal community electronic medical records, automation of clinical workflows with integrated patient-aware clinical decision support systems, inventory and drug management, linked to telemedicine Central Hubs to provide audio-video consultations using common, shared electronic medical records, and artificial intelligence-powered data analytics.
Now, to provide this solution as an open source model and then to advance further features, we will be looking for the following revenue streams along with applying for the innovation challenges:
- Software License Fees: Charging upfront or recurring fees for healthcare providers to obtain licenses for the HMIS software.
- Subscription Model: Charging healthcare providers a regular subscription fee for access to the HMIS software hosted on cloud servers.
- Consulting and Customization Services: Generating revenue through consultancy services, customization, and integration of the HMIS software.
- Support and Maintenance: Offering ongoing support and maintenance services to healthcare providers, including bug fixes, updates, and technical assistance.