Objective

1. A Central Repository of Demographic Data, Public Health Data and Electronic Medical Records pertaining to the State which will get dynamically updated. Each citizen record in the demographic data repository will be uniquely identified which will be used by all the services provided by eHealth Kerala.

2. Centralized Healthcare Information System with Central Electronic Medical Records (EMR) Repository which has the functionalities of an Integrated Hospital Management System, Disease Surveillance, Management Information System and Healthcare Planning.

3. Centralized Monitoring and Management: The systemic outcome is the availability of a universal data base, dynamically updated, by which government can plan for and monitor the provision of health care services which are accepted as part of the essential health care services. Scientific Supply Chain Management of medicines and biomedical devices made possible through the framework will optimise inventory management and ensure timely availability of medicines, equipments and other stores.

4. Disease Surveillance: Statistical reports from the Electronic Medical Records (EMR) will provide valuable data on Non Communicable diseases and enable State to proactively intervene to reduce the disease burden.

Demographic Data: The dynamically updated demographic data is perhaps most valuable outcome of the project. This will provide accurate and complete information of the population of the State. This database for healthcare planning will be a treasure house of information for various other departments such as Social Welfare, Education, Public Distribution System, Census, Local Self Government etc.

Quality Control of Hospitals: The eHealth system shall be fully compliant with the requirements of NABH and KASH in terms of creation and maintenance of Medical Records, maintenance of required Registers, monitoring of performance indicators and the Information System Standards

5. Medical Research: Kerala has achieved remarkable progress in public healthcare as is evident from the numerous healthcare indices. What is needed is a scientific analysis of the healthcare data to monitor, identify and suggest corrective measures to maintain the health of the society which is fast degenerating due to diseases often related to life style and demographic peculiarities. There is a high risk of these women developing Gestational Diabetes, Type II Diabetes Mellitus at a later age. Same is the case of ‘Pregnancy Induced Hypertension’ (PIH) where there is a high possibility of them becoming hypertensive over a period of time. At present there is no way these women can be traced and a follow up study can be conducted. Such study is very essential to learn the after effects of these conditions on the women and evolve effective remedial measures.

Implementation Methodology

The project was  implemented in 590 institutions. Roll out phase is again divided in two phases. In the first phase 7 districts and second phase seven districts are targeted. The eHealth system is hosted at the state data centre with three layer architecture. The Database servers are Postgre, and web servers are multiple Tomcat application servers on a high availability load balanced mode implemented on cloud virtual machines. Each hospital user will connect to the central webserver and in case of a network failure will connect to the lean server which is locally present and having a back up data of the patients of those hospitals.

The main strategy of the Change management is to reduce the resistance to change through small incremental stages of transition. Different stages of implementation are described below. This strategy is followed and are changed based on the actual requirements at site during implementation

Stage 1:

Many of the hospitals in government sector are either over crowded or understaffed. In the first stage only those modules that will eliminate the drudgery in the routine functions of the doctor and paramedical staff are introduced. These modules will bring some order and discipline to the Hospital Administration. This may include the following modules / functionalities:

1. OP Counter Registration

2. Pharmacy

3. Laboratory

4. Prescription of Drugs

5. Queue management Module

Stage 2:

In the next stage following functionalities are added

1. Patient Discharge Process

2. IP Registration

3. Ordering investigations

Stage 3:

As the Doctors get used to the new system they are encouraged to Use IP Clinical Module and start entering Past History, Symptoms and Diagnosis in of the In-patients.

Stage 4:

In the last stage complete functionalities of the OP Clinical module will be added and the implementation will be completed.

All throughout the history of health informatics was to create and electronic environment to automate the treatment of diseases based on past history and family history. This is the first time government has planned t move to a preventive approach to prevent diseases by collecting public data on drinking water source, sanitation, pets usage and sources of communicable diseases and non communicable diseases.

·         Highly secure Open Source database and services provided on service oriented architecture.

The entire application is built on Postgre database with service oriented architecture(SOA) with features which are added as the new modules are getting developed. The entire source code is Java based.

·         AADHAR based unique identification and electronic health record.

All citizens are captured during demographic survey using a GPS enabled tablet which scans the AADHAAR card and is linked to the unique health id in the eHealth system. All medical records are linked to the unique AADHAAR and hospital ID during the entire lifetime of the citizen.

·         Interoperability with other international medical systems on HL-7, SNOMED-CT and LOINC systems.

International coding system of diagnosis and nomenclature of diseases(SNOMED-CT, LOINC) are used so that patients can seamlessly transfer between health institutions and also with international health care institutions. Even they investigations are ordered on international standards.

·         Provide proactive disease prevention by monitoring civic sanitation, drinking water management and communicable disease surveillance.

Prevention of epidemics and vector borne diseases control using GIS based disease localization and containment mechanism using advance alert system system to health care professionals.

·         Provide seamless patient referrals between different categories of hospitals.

Patient has to register only once in the system and can be referred to higher level health care facility using the system itself.

·         Paper less patient disease diagnosis, investigations and prescriptions and follow up treatments.

·         Automation of administrative functions of department of health and family welfare.

·         Automation of inventory management, supply and distribution of medical equipments and medicines.

·         Integration of health management system with civil registrations and other government systems.

The system consists of two main softwares. The first one is a public health management system which is an Android application running on a tablet with 4 GB ram, 16 GB SD disk,5 Megapixel camera and 8 hours of battery backup suitable for field level operation. This application is used for demographic survey and delivery of medical services at the door step of citizens. The JPHN and JHI from the health services department will visit each of the household and each member of the system will be registered into the system by scanning of the AADHAAR card and clubbing the members into a family. This data is used for tracing of family related hereditary ailments. The data on village and house sanitation, drinking water and electrification status are captured into the system using this tablet. Also the treatments rendered to the aged patients are also captured in the systems.