e-Upchaar: Leveraging information

technology to improve patient satisfaction

and quality of care in public healthcare
facilities of Haryana
State Health Systems Resource Centre, Haryana

Dr Sonia Trikha
Director Health Services
ED, SHSRC, Haryana
Public Healthcare: Challenges

Overcrowding at the Absence of reliable Compromised Retrieval of medical

facilities - poor processes, inventory control records time
patient satisfaction compromising leading to stock- consuming, reliability
PSGs outs, eventually and authenticity of
increasing OOPE data?

2
Project background

 Hospital Management Information

SKG AC Kurukshetra

System (HMIS), ‘e-Upchaar’ initiated by

Government of Haryana in 2014

 Project being implemented by State

Health Systems Resource Centre, BPS MC Khanpur Kalan

Haryana

 Stakeholders: Departments of Health,

Medical Education & Research and
PGIMS Rohtak

AYUSH
SHK MC Mewat

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Objectives
Optimal utilization of infrastructure, equipment, facilities, HR, drugs & consumables

Availability of EMR for every registered patient across 56 facilities(MCs & DHs)

Reduction in waiting time through efficient queue management

Simplification and automation of manual processes

Transparency and availability of information related to hospital services

4
Objectives (contd…)

Integration with external applications, programs and schemes

100% service availability to all patients

Efficient grievance redressal mechanism

Real-time reporting, efficient analytics and decision support

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e-Upchaar Modules
Out Patient
Registration Laboratory Radiology and PACS
Department (OPD)

In Patient Dept
Out Patient (OP)
Pharmacy (IPD) / Intensive Care Emergency & MLC
Billing
Unit (ICU)

In Patient (IP) Birth and Death

Billing Registration Labour Room Blood Bank

Store and Sub-store

Asset & Equipment
Operation Theatre Record Room / MRD Management Management

Central Sterile Human Resource

Services Department Purchase
Maintenance Cell Management System
Management
(CSSD) (HRMS)
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OP Touch Points, Activities and KPIs

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Registration module

• Designated registration counters

• Token system for better queue
management
• UHID for patient identification
• Easy monitoring of patient waiting times

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Doctors’ Module

User Friendly screens

• Capturing diagnosis
• Ordering investigations
• Prescribing medicines
• Viewing diagnostic reports

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Doctors’ Module
View of patient queue (on Doctor’s screen) Favourites/Tick list feature

The doctor can mark the patient as seen, send a patient The regularly used diagnosis can be added to the
for cross referral, order investigations (lab & radiology) Favourite list by an individual doctor. All the diagnoses
and also view the patient’s EMR from this screen. are mapped to the ICD 10 classification of diseases.
… Past Practice
Diagnostic Modules
Laboratory Module
• Unique Barcode for each collected
sample
• Integration of Lab equipment with the
application
• Reduction in the lab errors and sample
re-dos
• ‘Out of range’ values highlighted
• Alerts for critical values
Radiology Module
• Integration of radiology equipment with
the application
• X-ray images are available on the doctors’
screen for view & decision making
• Cost saving due to discontinuation of
printing of x-ray films
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Integration of e-Upchaar with PACS

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Pharmacy Module

• Availability of online Prescription (part of

EMR) for medicine dispensing 
• Automatic linkage with the store inventory
• Alerts for stock outs, expiry etc.

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IP Touch Points, Activities and KPIs

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IPD Module
• Capturing the diagnosis, investigations and
the hospital course of treatment

• Surgical procedures (including OT notes,

Anaesthesia details)
• Discharge summaries automatically
populated with the course of events post
admission

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Sterile linen and instruments transported in linen/instrument
trolleys
Digitisation of patient record

• Patient record captured in the form of

Electronic Medical Record (EMR) against
each patient ID. Available for review and
evaluation by the doctors.
• It includes:

1. Patient diagnosis which is mapped to

ICD 10 classification
2. Diagnostic reports
3. Medicines dispensed/issued
4. Surgery details (if any)
5. Discharge details

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Store & Sub Store Module

• Transparenc
y related to
Alerts stock
availability
for
• Reduction in
Analysis of •Stock
wastage due
consumptio outs to Expiry
Dispensing n patterns • Near • Reduction in
of drugs for fixing expiry pilferage of
Mapping through reorder drugs drugs
of the • Improved
levels for • Expired
available pharmacy/ decision
drugs drugs
drugs store making
module
Benefits of implementing e-Upchaar
Structure
• UHID generation, Aadhaar
linkage, facilitation through
registration counters
• In-patient identification
through ID bands reducing
medication errors
• Token system in OPD, ER
and diagnostics to reduce
patient waiting
• Manual records replaced
with lean system
Process Outcome
• Electronic Health Record
• Reduced waiting times
for all registered patients
• Quality patient care
• Online laboratory reports
• Clinical effectiveness
• Monitoring of pre-defined
through standardized
health indicators
treatment protocols
• Improved patient
• Automation of laboratory
outcomes
and radiology services
• Capturing of patient
• System alerts in
feedback through ‘Mera
pharmacy and stores for
Aspataal’
stock-outs and near
expiry • Improved patient
satisfaction levels
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Cost effectiveness
60000

5045
Total savings (in lakhs)
50000 3500000
7703
5178 29,72,220
2253
3545 3000000
3001 25,53,600
40000 25,52,160
1977
24,20,700
2500000
25,09,200

30000
22,94,040 21,81,960
2000000
49537

42536 41820 42560

40345
20000 38234 1500000
36366

1000000
10000

500000

0
Jan/19 Feb/19 Mar/19 Apr/19 May/19 Jun/19 Jul/19 0
Jan/19 Feb/19 Mar/19 Apr/19 May/19 Jun/19 Jul/19
Total no. of X-ray films not printed Total no. of X-ray films printed
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Laboratory errors and re-dos being analysed by the
laboratory staff
Impact analysis
Services/Facilities
Patient Registration
Follow Up visit with UHID
Billing & Cash Collection
Diagnostic report availability
Inventory Control
Blood Bank
Care Planning by Physicians
In Manual System Through e-Upchaar
4-5 mins per new patient once the patient reaches the 1 min per new patient
counter
3-4 mins per patient 30 secs per patient
[In practice, a new card is issued to revisiting patients]
2-4 hours per patient 3-5 Minutes
1 - 2 days Same day in most cases
Poor & lengthy system of management Reduction in wastage with alerts for near
expiry and expired stock
• No track of blood stock, information on available blood Increase in blood utilization
groups etc. • Wastage Avoided
• Manual tracking of blood bag expiry date • Centralized Blood Inventory Information
• Manual Tracking of blood collected during blood camps
Care Planning is event based and time consuming EMR of a patient helps physician in better
care planning and monitoring. Follow up is
easier.
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Overview of implementation

Challenges Solutions Outcomes

●
Implementation of token
•Poor queue management ●
Streamlining of patient flow
management system ●
Availability of Electronic Medical
●
UHID for patient identification Record (EMR).
●
Incomplete/inaccurate data ●
Bar code stickers for patient ●
Reduction in reporting errors.
samples Easy understanding of disease
●
Reporting errors ●

●
ICD 10 classification of diseases burden
●
Breach in continuum of care
●
Integration of diagnostic ●
Timely availability of printed lab
●
Manpower constraints equipment with e-Upchaar reports to patients

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 New Developments
Central dashboard Key performance indicators (KPIs)

HRMS

http://117.252.5.249:9093/#/Login

http://117.252.5.248:8092/dashboard/dashboardLanding.jsp 25
 Change
Integration
management
with
• Training of the external Standardizatio
users applications n of processes
• Shift from manual • Interoperability
data recording to a issues with Operational
more transparent external • Differential price issues
system application master across
facilities Manpower
• Lack of • Issues with data constraints
transparency validation
related to services • Delayed
construction
activities • Inadequate
manpower

Challenges
The way forward..

Web portal and mobile application

Expanding to the remaining healthcare facilities

(Approximately 670): New RFP in the process of finalization

Advanced analytics for decision making at the

state level

Data Mining for research studies/publications

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Thanks

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