Medical & Health Information System

In Indian EnvironmentExperiences with

Project Dhanwantari By

Maj Gen (Dr) RK Bagga, AVSM (Retd.) Dr M V Krishnamurthy Dir UOL

ITEnabling Technologies

• High speed Micro Processors - Affordable• Massively Parallel Computer• High Resolution Graphic Monitor• High speed Data Networks-Visualisation• AI and Expert System• Robotics• Multi Media & Virtual Reality• 2G->3G->4G Mobile Revolution

IT for Health Care Management

• Networking– Internet– Intranet– Extranet

• Web– Online Search– Ocean of Information

IT for Health Care Management

• Database Technology– High Performance Database Servers– Object-Oriented Databases– Distributed Fault Tolerant Databases– Data Ware Housing– Data Mining– Security and Privacy– Grid/Cloud Computing

IT in MedicineTypical Application Areas

• Computer Diagnosis– AI/ES– Genemapping

• Surgery– Digital Visualisation– Heart Modelling

• Education & Research– MM & VR– e-Learning

IT in Medicine Typical Application Areas

• Rehabilitation of Handicapped– Robotic

• Information System– Patient Care– Hospital Managements– Telemedicine

PRINCIPLES OF COMPUTER-ASSISTED SURGERY

X

Y

Z

CT - Computer TomographyMR - Magnetic resonance Generation of the Volume Model

3D View of theOperation area & theinstrument’s position

3D Position measurement

CT or MR Slices

Preoperative scanning

Children’s Hospitalof Pittsburgh

Presbyterian University Hospital

School of Medicine;Neurological Surgery

Eye & Ear Hospital Monteflore Hospital School of Medicine Anesthesiology

VeteransAdmn. Hospital

Magee Women’s Hospital

School of EngineeringElectrical Engineering

Deptt. of CS

MEDNET - LINKS REMOTE MEDICAL FACILITIESIN REAL TIME

Real Time Monitoring - 1600 Brain Surgeries/year

Virtual Reality Assisted Surgery Program(VRASP)

Plan

Computingsystem

Comms

Review/Rehearse

Virtual imageSurgeon-A Surgeon-B

Conduct Surgery

PatientPatientWorldframe ofreference

MENU BAR

TV PICTURE

Patient Parameters - Graph

PulseNeuro Comn

TempECGBP

MEDNET SCREEN:- X WINDOW INTERFACE

DHANWANTRI(1994-1996)

A Computer based medical information system for military hospitals to facilitate patient care and hospital administration.

Computer Centre, DRDL, HyderabadMH, Secunderabad

DEBEL, Bangalore

A joint effort by

Modules of Dhanwantri• Phase-I

– Central Registration– Medical Inspection Room(MI Room)– Polyclinic – Pathology

• Phase-II– Medical Stores– Dispensary– Radiology– Operation Theatre – Wards

Salient Features of Dhanwantri• Focus on patient care rather than billing.• Capturing of all the relevant information of

a patient.• Quick updation and retrieval of patient’s

case history.• Elimination/Minimisation of duplication of

data.• Simultaneous access of the database at

several places by several users.

Salient Features of Dhanwantri• Automatic generation of various statistical/

summary reports, registers, slips etc.• Immediate answers to several adhoc queries• Quick accessing of medical data for

research or any other purposes.• Better management of hospital resources

such as bed, wards, medical stores etc.• Highly sophisticated user-friendly interface.• Smooth transition from manual to

computerised system.

System ConfigurationCENTRAL

COMPUTER

Monitor

Key board

Printer

UPS

Ports

Line drivers

ConsoleMonitor

Key board

Printer

Terminal

( Somestations )

Linedriver

Remote stations

Standby Computer System

Central Computer: Pentium server with 32 MB memory & 2 GB hard disk

Standby Computer: PC 486 with 16MB memory & 2GB hard disk.

Remote Stations: Terminals connected through port boxes & line drivers.

Software: SCO UNIX Operating system & ORACLE 7 RDBMS (multiuser).

Methodology• Feasibility Study

– Formulating broad objective– Economic & technical feasibility– Submission of feasibility report

• Requirements Analysis– Studying the existing manual system– Study of forms, registers, reports, slips, etc.– Meetings, Interviews, Presentations etc.– Working out the Configuration Requirements

• Hardware, Software, Communiction

– Preparation of SRS Report & Review of SRS

Methodology

• Preliminary Design– Detailed Data Flow Analysis– Data Modelling & Design– Architectural Design (Structured Charts)– User Interface Design– Control Flow Analysis– Preparation of PDR– Review of PDR

Methodology

• Detailed Design & Implementation– Implementation in Oracle 7.0

• Screens (Forms 3.0)• Reports, Registers, Slips (Report Writer)

• Testing & Integration– Function wise testing– Integration with the Module– Module wise testing– System testing

Methodology

• Installation– Cabling– Installation of HW– Porting & testing of Dhanwantri

• User Training– User level training– System Administrator training

Methodology

• Operational Support– Overviewing– Onsight Hardware/Software Problems– User Feedback

• System & Database Administration– Streamlining Startup/Shutdown Procedures– Streamlining Backup/Archival Procedures– Security

Methodology

• Maintenance– Correction of bugs– Modifications– New Requirements

• Remote Maintenance

Dhanwantri Software

1. No of Modules 90

2. No of Tables 210

3. No of Forms 200

4. No of Reports 100

Dhanwantri Project Team

• Software Development– Scientists 4– Staff 8– Project trainees 12

• Hardware & Networking – Officers 2– Staff 3

• Coordination with MH– Officers 2

Dhanwantri Milestones• Initiation of Project by SA to RM 2 Oct 94• Phase-I

– Requirement Analysis Dec 94– Preliminary Design

Mar 95– Implementation Jul 95– Testing & Integration Sep 95– Hardware Installation & Cabling Oct 95– Software Inst. & User Training Oct 95– Launching by SA to RM 25 Nov 95– Revised Version 1.0 Apr

96– Revised Version 2.0 Aug

96

Dhanwantri Milestones• Phase-II

– Initiation of Project Apr 96

– Requirement Analysis Jun 96 – Preliminary Design Aug

96– Implementation Nov 96– Testing & Integration with Phase-I Dec 96– Installation at MH Dec 96– User training & feedback under progress

• Operational support from Oct 96– Hardware maintenance – Software maintenance

Experiences

• Development Phase– Difficulties in Extracting/Specifying

Requirements– Design Difficulties– Implementation Problems– System Problems

Experiences

• Operational Phase– Resource Constraints

• Terminals, Printers, Stationary etc.

– Infrastructure Constraints• Power, Communication etc.

– Cultural Change• Lack of awareness• Initial fear/apprehension• Additional work load

– Need for Continuous Support

Experiences

• Underestimation of Development Time and Effort

• Manpower Problems• 10 Years ahead of Indian Government

Scenario RR Hospital Delhi

CONCLUSION & LESSONS• It is must for India & Medical field• Realistic plans/Projects in our context• Affordable Infra-Structure-Must• Safety-Critical System-Highly Reliable• Info System for Medical Care-Available• No Computer can replace man• Maintenance of computerised System-Must• Software cannot be taken for granted.

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Any Questions

Thank You