AIIMS DIAMOND JUBILEE
CELEBRATIONS
AIIMS GOES DIGITAL
The First Digital
Revolution in Health Care
How the 3 A.M.
Serpentine Queues Vanished
*V. Srinivas
Introduction
Building strong Institutions is one of the major
objectives of Good Governance. The Digital India initiative represents a
landmark in ushering in the First Digital Revolution in Health Care at AIIMS.
The successful implementation of the AIIMS e-Hospital Project and the AIIMS OPD
Transformation Project, transformed AIIMS to India’s first fully digital public
hospital. In 16 months of implementation since the launch in July 2015, the
AIIMS e-Hospital project has had the largest footprint of Digital India
projects. The creation of a patient friendly hospital has benefitted 35 lac
patients till date, reducing wait times at the Hospital by nearly 6 hours,
brought transparency to OPD appointments; created digital medical records and
represents a sustainable and replicable model for hundreds of India’s
Hospitals.
The
Challenge
The very name invokes images of crowds,
a sea of humanity that is present at the hospital doors, waiting from 3 in the
morning, to rush for expert medical consultation at 8.30 am when the OPD opens.
With an average of 10,000 OPD patients per day, 35 lac OPD patients per annum,
55 Departments, 640 faculty, 2000 resident doctors and 5100 Nurses, AIIMS
represents India’s behemoth in tertiary care super specialty hospitals. While
the Institute led by highly driven professionals works with clockwork
precision, the overwhelming patient loads have proved impossibly challenging
for a manual system and required significant systemic changes in terms of
improved digital practices and process re-engineering, as millions of India’s
population seeks medical care at the Nation’s apex Medical Sciences University.
AIIMS – UIDAI - DeiTY Collaboration:
It was in January 2015 that the first
step in the Digital AIIMS project was taken with the creation of an effective
linkage between AIIMS, Unique Identification Authority of India (UIDAI) and the
Department of Electronics and Information Technology (DeiTY). A unique health
identification number for every patient visiting AIIMS was generated on an
Aadhar platform. The patient could log into the AIIMS OPD Appointment System
(ORS.gov.in) and submit a request for an appointment online using his Aadhar
number. The verification of the demographic details of the Patient was based on
the one-time password for the patient being transmitted to the mobile phone
number of the patient registered in the Aadhar data base. The Unique Health
Identification Number gave every Patient visiting AIIMS a Digital Identity. The
Patient could use the UHID for his entire lifetime and every consultation visit
was documented by the system.
The e-Hospital project proceeding at a
modest pace, suddenly gained significant momentum with the launch of Digital
India Initiative. There was a new urgency in DeiTY and NIC for expeditious
development of the software so that the Online Registration System could be
established. This was followed by the collaboration between AIIMS and Pay Gov
for creation of a payment portal.
The e-Hospital project
necessitated transparency in OPD appointments. AIIMS always encouraged walk-in
patients and also had several follow-up patients coming for consultation. The
streamlining of the new OPD cases began with 15 percent of the total new OPD
appointments being given for online registration. The out-patient appointments
of each of the Departments of AIIMS was placed online and every consultation
room in the OPD was allotted a fixed number of OPD patients identified by name.
AIIMS – TCS Collaboration:
The AIIMS-TCS
collaboration for the AIIMS OPD Transformation Project was conceptualized as a
Corporate Social Responsibility Project in April 2015. It was only after
several months of observations at OPD followed by conceptualization,
discussions, capacity building, consensus building and software development that
the TCS prescribed a model of AIIMS OPD transformation. The approach was to
facilitate faster registration, to dissipate crowds with larger patient waiting
areas, introduction of several new measures like fresh signages, screening at
the entry point, patient care coordinators at the registration/ consultation
areas and the rather unique exit OPD counters for all follow-up patients.
Today, the AIIMS-TCS collaboration has provided the country with a role model
for transforming OPD services at all major Central and State Government
Hospitals.
The newly
adopted model envisaged construction of a Patient Registration Center, with 50
Registration Counters each one equipped with a computer terminal loaded with
e-Hospital software. It was constructed and operationalized in a record time of
six months. Now the registration time was a mere 40 seconds for all new
appointments with UHID numbers generated from the online registration system.
Fast Track Queues were created where the patients who had already registered
themselves under the online registration system could get their OPD cards and
move quickly to the Patient Waiting Areas. Patient Care Coordinators ensured
that Patients understood clearly where to visit during the entire process. The
whole approach was one of empathy and efficiency. The successful
operationalization of the Patient Registration Center meant that the waiting
time in the Hospital had come down by nearly 6 hours per patient. The 3 am
serpentine lines were no longer there. They were replaced by a more orderly
queue system that commenced at 8 am and reached the OPD consultation rooms by 9
am.
AIIMS attracts 10,000 patients per day
but the patient waiting areas had only 2500 seating capacity. This meant that
patients rushed to consultation areas without any wait time in a comfortable
environment. The TCS model envisaged creation of seating spaces for an
additional 3500 patients. Air conditioned Patient Waiting Halls were developed
where the patients could comfortably wait for their turn to visit the OPD
Consultation rooms.
Initially, the new model was implemented
in the Medicine and Pediatric OPD areas on a pilot scale in December 2015. The
Clinicians would commence work at 9 am. Patients would reach the clinician’s
rooms in an orderly manner. All multiple registration counters in these
Departments were discontinued. The successful implementation encouraged AIIMS
to introduce the model in all the 5 floors of the Rajkumari Amrit Kaur OPD
covering all 55 Departments.
The most innovative feature of the new
model was the introduction of EXIT OPD Counters. Patients who were recommended
for advanced Laboratory Tests, Radio-Diagnosis, Virology and Pathology Tests as
follow-up appointments, all of which could be scheduled from the EXIT OPD
Counters. The Patient thus had a very orderly journey from the point of entry
to the Hospital to the point of exit. Even the VIP Patients including the
officials at senior position in government willingly went through the entire
OPD Transformation Process and found the entire experience quite expeditious
and satisfying.
Specialised Cadres
AIIMS transformed itself into a patient friendly
hospital by its willingness to adopt the modern day digital practices and
create specialized cadres who enabled rapid scaling up of the new technology.
The Nursing Informatics Specialists provided the linkage between the Clinical
Departments and the OPD appointments. Nurses with an aptitude for technology
were deployed to coordinate between the Departments, OPD, Wards and the
software professionals. The Patient Care Coordinators touched every patient
entering the OPD with their empathy. They were the friends and guides who
ensured patients followed the established protocols. They were also deployed to
assist with the E-Kiosks to enable literate and tech savvy patients with
appointments. The Data Entry Operators were deployed at Patient Registration
Center and the EXIT OPD Counters. They were trained to handle cash collections
simultaneously. Security Personnel were trained in Queue Management systems
with a considerable degree of patience.
AIIMS–India’s First Fully Digital Public Hospital
Hitherto, the
implementation of the e-Hospital project had not been orderly. For AIIMS to be
a fully Digital Hospital, each of the e-Hospital modules needed to implemented
in an orderly manner to create a comprehensively digital hospital. By June
2016, the e-Hospital module implementation in AIIMS was completed. The NIC took
a big step forward in completing the AIIMS e-Hospital Project. NIC Teams from
Tripura worked with each of the Departments in AIIMS in a prescribed time frame
to transform AIIMS as India’s first fully digital public hospital. The modules
comprised of Blood Bank module, Billing Module, In-Patient Department comprising
admission and bed to bed management, Laboratory Module integrating 55
laboratories, establishment of nearly 200 Kiosks with Net Banking Facilities
for ease of payments, Laundry Module for monitoring the central laundry
operations, Store management for inventory purposes, Dietary Module for
preparation of electronic diet charts for in-patients, and RIS-PACS (Radiology
Imaging System – Picture Archiving Communications System) for exchange of
radiology data.
The Titanic is Saved
The transformation of AIIMS to a patient
friendly hospital under the Digital India Initiative can be compared to “Saving
the Titanic”. Under the Digital India Initiative, a core team of officials
collaborated cordially and constructively over a long period of time to make
the First Digital Revolution in Health Care possible. There was considerable resistance
from every possible quarters– patients, support and administrative staff, security
apparatus and even some medicos had their share of doubt during the course of the
implementation of the Project. Needless to say, now everyone is satisfied and
happy. As the success story unfolds benefitting 35 lakh patients, in 12 months’
time, the hours and hours of effort put in by those involved in the project, are
adequately rewarded. The Prime Minister launched the Online Registration System
as part of the Digital India Initiatives in July 2015. Following a year of
successful implementation wherein the project benefitted 35 lac patients, the
Prime Minister mentioned the successful implementation of the AIIMS e-Hospital
Project from the ramparts of Red Fort in his Independence Day Address this year.
The AIIMS OPD Transformation Project has enthused several State Governments.
AIIMS has been mandated to conduct on-boarding workshops for replication across
all 12 Central Government Hospitals.
Thus the AIIMS Transformation Project
represents India’s First Digital Revolution in Health Care. No doubt, it is a remarkable success story.
*****
*Author is a
senior civil servant, an IAS officer of 1989 batch, presently serving as Deputy
Director Administration, AIIMS New Delhi.
The views expressed in the Article are his personal.