Professional Documents
Culture Documents
October 2013
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Table of Contents
1.
1.2.
2.1.
2.2.
Administrative Structure......................................................................................................... 21
2.3.
e-Governance in Health........................................................................................................... 22
3.
3.1.
3.2.
3.2.1.3.
System Design................................................................................................................... 27
3.3.
3.4.
4.
4.1.
4.2.
Functional Requirements........................................................................................................ 38
4.3.
4.4.
5.
5.1.
5.2.
5.3.
Performance Metrics................................................................................................................ 49
5.4.
5.6.
5.7.
5.9.
6.
6.1.
6.2.
6.3.
6.4.
6.5.
6.6.
6.7.
7.
7.1.
7.2.
7.3.
7.4.
7.5.
7.6.
7.7.
7.8.
8.
8.1.
9.
9.1.
9.2.
9.3.
Risk Management..................................................................................................................... 90
10.
Annexure ................................................................... 93
10.1
1.
1.2.
2.
3.
3.1.
Information Components........................................................................................................ 94
3.2.
3.4.
4.
Registration ............................................................................................................................... 97
5.
Helpdesk .................................................................................................................................... 99
6.
7.
OPD ............................................................................................................................................ 99
8.
9.
10.
11
12
13
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
Ambulance Services (including Referral Transport) .............. Error! Bookmark not defined.
26.
27.
28..
29.
HIS Core Application Admin, Reporting and Audit Trail .. Error! Bookmark not defined.
29.4. User and Group Management ................................................... Error! Bookmark not defined.
29.5. Rights and Privilege Management ............................................ Error! Bookmark not defined.
29.6. Masters (Lists and Values) Management ................................ Error! Bookmark not defined.
29.7. Masters List Table ...................................................................... Error! Bookmark not defined.
30.
31.
32.
33.
34.
35.
34.
37.
38.
39.
Local HIS Lite Application dependencies ................................ Error! Bookmark not defined.
40.
10.2
10.6
10.7
10.8
Annexure 5_ Indicative average number of Scans per Hospital per day ................... 15351
Glossary
Abbreviation
Meaning
NISG
HSHRC
HIS
H&FW
ME
Medical Education
PS
Principal Secretary
DG
Director General
VC
Vice Chancellor
HS
Health Services
MD
Managing Director
PMO
MS
Medical Superintendent
DH
District Hospital
SDH
Sub-district Hospital
CHC
PHC
SMO / MO
I/C
In-charge
Abbreviation
Meaning
TPAA
HSDC
CR
Change Request
EQI
10
1. I ntroduction
and
B ackground
India has faced many serious challenges in Healthcare sector over the years; but there has been
considerable progress especially through various flagship policy and Programme initiatives,
across the nation. Evidently, these are not efficiently manageable without the assistance of IT
systems. An integrated approach to the implementation and use of IT systems is seen as a
potential game-changer, invaluable to all stakeholders involved in the provision of better,
efficient, effective and affordable healthcare services.
However, despite the improving health status of the Indian population, healthcare
infrastructure in India has a long way to go towards achieving high quality and efficient
healthcare delivery systems. In public healthcare, Information and Communications Technology
(ICT), when implemented judiciously, have the potential to reduce administrative costs, reduce
effort, reduce time to deliver service, and improve productivity of the Health Department and
hospitals across a state. Additionally, transparency of information available to the general public
as well administrators can be increased manifold through such initiatives. For any hospital
administrator it is very essential to know service availability of the resources i.e. people
(doctors/nurses/paramedics etc), facilities & equipment (x-rays, CT scan etc) and their supplies
(x-ray films, reagents etc) at any point of time. As non-availability of any one of these services
shall have a huge impact on the service delivery. Therefore it becomes very essential to bring in
effectiveness and quality in utilization of these resources. Therefore it is the ICT which can play
an important role in addressing the issues of efficiency, transparency, and reduction in
healthcare costs, service delivery time and errors; easy storage and portability of data / records,
as well as enable evidence based medical advice.
Many IT systems have been operating at the Centre and in States, providing valuable benefits,
experience and lessons. There is a need to achieve convergence amongst various IT systems in
the health sector to obtain reliable information for policy making, ensure efficient program and
service delivery as well as achieve breakthrough discoveries for diseases.
The Indian healthcare system has recently realized the potential of information and
communication technologies in completely transforming health care and service delivery at
hospitals. Health Information System (HIS) is one of the initiatives proposed by Haryana State
Health Resource Centre (HSHRC), under Health Department, Government of Haryana, that
aims at increasing the availability and accessibility of Healthcare services for the target
beneficiary as well as usage and sharing of timely and accurate health information within and
outside Haryana state, for the State and District administrators for quick decision making and
optimal utilization of resources. The project further aims at creating Information and
Communications Technology (ICT) based HIS in order to improve public health service delivery
mechanisms within the state through various Health institutions spread across the state.
Consequently, HSHRC appointed National Institute for Smart Government (NISG) to provide
required advisory support.
11
1.1.
Project Objectives
The objective of this project is to implement a state of the art ICT enabled Hospital Information
System (HIS) in order to improve productivity of the State Health Department and the state
hospitals / health institutions, thereby improving public health services and bring
administrative efficiency in the entire healthcare system.
The state envisages meeting the following key objectives:
1. Unique ID patients and availability of EHR across all facilities in the State
2. Reduction in patient waiting time, efficient queue management
3. Aim of providing 100% service availability to patients
4. Simplification and automation of manual processes
5. Transparency and availability of information related to services
6. Efficient grievance redressal mechanism
7. Optimal utilization of infrastructure, equipments, facilities, HR , drugs & Consumables
8. Integration with external applications, programmes and schemes
9. Real-time reporting, efficient analytics and decision support
1.2.
The key issues and challenges being faced by various stakeholders have been analyzed during
the assessment of existing processes and functions. The following depicts the current scenario as
observed by the project team, which are the focus areas of HIS:
1.2.1.
ii.
iii.
iv.
v.
12
vi.
Data collection fatigue and loss of attention from main function service
provision
b. Data Reporting
i.
ii.
iii.
c. Capacity Building
i.
1.2.2.
Lack of Training and skills augmentation for hospital staff working at all
levels
ii.
iii.
iv.
v.
vi.
Frequent changes in the reporting formats with regard to the time and
effort taken to get used to new reporting formats
b. HR related
i.
ii.
iii.
c. Infrastructure
i.
13
ii.
iii.
iv.
v.
vi.
d. Capacity building
i.
ii.
1.2.3.
i.
ii.
a. Long waiting time in queues for availing various services within hospital
premises
b. Lack of proper instructions to locate Labs, OPDs, Wards, etc.
c. Insufficient lab facilities including working equipments in comparison to number
of beds
d. Late admission / admission in different wards (like emergency or disaster ward)
due to limited number of beds
14
15
2. S tate P rofile
Haryana Civil Medical Services is the government service in the department of health in
Haryana. Doctors are recruited by Haryana Government to work in various government
hospitals of Haryana state.
2.1.
HEALTH DEPARTMENT: The health Department provides preventive, promotive and curative
services to all persons in Haryana.
The curative services include medical and surgical interventions at the various levels of Govt.
Hospitals in the outpatient or inpatient Departments. In addition it attends to all types of
medical and surgical emergencies which occur anywhere in the state through its wide network of
ambulances and emergency departments of hospitals including Medico-legal cases and Post
mortem. It also provides obstetric services (childbirth) services at all levels of care through the
maternity units in its various hospitals.
The treatment services include provisioning of free medicines and surgical consumables. These
involve a function of procurement of medicines, its storage, its quality testing and distribution to
various facilities across the state.
This also includes procurement, upkeep and retirement of various medical Equipments and
monitoring their utilization and servicing.
The preventive and promotive functions are carried out through large number of health
programs which are carried out by field level health functionaries across the state. Programs
cover both rural and urban areas. These include maternal health care, anemia control,
Immunization programs, provision of preventive health services to school children of primary
and adolescent age groups, programs to control communicable diseases like Dengue, Malaria,
TB, AIDS etc and non-communicable diseases like diabetes, Hypertension, Cancer etc and also
various types of mental illnesses.
In order to provide these services posting of specialists, doctors and paramedical staff is to me
made in a rationale manner so that gaps in services do not occur. Similarly planning of finances
and budget is made to ensure adequate and timely utilization of funds.
The Health Department comprises of the following hierarchy from state to the village level.
16
State Hq Level
MD NRHM
DGHS
DG Ayush
ED HSHRC
DGHS Medical
Education
District Hq Level
Civil Surgeon
Health Programme
Hospital (6 Beded)
Delivery Room
Village Asha
Health Programmes
From every level from District and below the health department carries out Hospital based
curative services and outreach preventive community interventions.
1. Curative Services: The Government health hospital has the following structure and
functions.
17
a. District Hospital / General Hospitals: Every district has a district hospital (except
Karnal) making it 20 district hospitals. In smaller towns there are General
Hospitals. The bed strength of these hospitals varies from 50 to 300 beds.
District Hospital
S. N
Name of Hospital
Number of Beds
1.
GH Ambala
200
2.
GH Bhiwani
300
3.
GH Faridabad
200
4.
GH Fatehabad
100
5.
GH Gurgaon
200
6.
GH Hisar
200
7.
GH Jind
100
8.
GH Jhajjar
100
9.
GH Kaithal
100
10.
GH Kurukshetra
100
11.
GH Karnal
200
12.
GH Mandikhera
50
13.
GH Narnaul
100
14.
GH Palwal
100
15.
GH Panchkula
150
16.
GH Panipat
100
17.
GH Rewari
100
18
S. N
Name of Hospital
Number of Beds
18.
GH Rohtak
100
19.
GH Sonepat
100
20.
GH Sirsa
100
21.
GH Yamunanagar
50
General Hospital
S. N
Name of Hospital
Number of Beds
1.
GH Bahadurgarh
100
2.
GH Dabwali
60
3.
GH Gohana
50
4.
GH S10 Gurgaon
100
5.
GH Hansi
50
6.
GH Jagadhari
50
7.
GH Tohana
50
8.
GH Ambala cantt
75
9.
GH Naraingarh
50
10.
GH Siwani
25
11.
GH Bhawanikhera
50
12.
GH Loharu
50
19
S. N
Name of Hospital
Number of Beds
13.
GH Dadri
50
14.
GH Ballabhgarh
50
15.
GH Sohana
50
16.
GH Haily mandi
25
17.
GH Hansi
50
18.
GH Adampur
50
19.
GH Beri
50
20.
GH Narwana
50
21.
GH Nilokheri
50
22.
GH Kosli
50
23.
GH Meham
50
24.
GH Samalkha
50
These hospitals provide individual citizens and would include Outdoor services,
inpatient services, Surgical services, Deliveries (caesarian or normal), Diagnostics
(Lab and Radiology) and Pharmacy Services.
b. Urban Health Centers: These are located in bigger towns for a population of
10000 to cover slum populations and underserved areas
c. Polyclinics and Dispensaries: Provide OPD and Obstetric services to population
in the HUDA sectors.
d. Community Health Centre(CHC): It caters to a rural population of 120000 and
has 4-7 doctors including specialists, though in Haryana very few CHCs have
specialists. It is also a First Referral Unit where cases are referred from lower
20
g. ASHA: is a health worker recruited for a population of 1000 from the village
where she works and provides community health services. She is a first contact
with the public health system.
2. Preventive Services: These are provided by Sub-centers, PHCs and UHCs in rural and
urban areas through outreach health workers like ANMs, MPW (M) and ASHAs.
21
The organization structure of the Health administration in state of Haryana is depicted in the
organization chart below.
PS (ME)
STATE
PS (H&FW)
HSHRC
DG (ME)
DG (HS)
DG (AYUSH)
MD (NRHM)
VC (Medical
University)
Director
Director
Deputy Director
Deputy Director
Director
(Medical
College)
PMO (DH)
Civil Surgeon
DISTRICT
MS (DH)
MS (SDH)
1,20,000
Population
MO I/C (PHC)
30,000
Population
Health Sub-Centre
(ANM)
5,000
Population
22
registration and tracking of Pregnant Mothers and children, SMS services, Immunization
Monitoring etc. Online status of blood availability website was developed & launched for all nine
blood banks of Faridabad. MedLEaPR (Medico Legal Examination and Post Mortem Reports)
System As per the directions of Honble High Court, MeDLEaPR software has been developed
with necessary security measures and access controls. MEDISC-MS, Medical Equipment and
Drug Inventory & Supply Chain Management System for NRHM Haryana has been initiated.
However most of these IT initiatives focus on just one or two health parameters and are
standalone initiatives with limited or no integration with backend automation systems. There is
a need to achieve convergence amongst various IT systems in the health sector to obtain reliable
information for policy making, ensure efficient program & service delivery and achieve
breakthrough discoveries for diseases.
Further in the context of Haryana state, changes are required in aiding the Governments ability
in decision making, health care and medical services management, procedural as well as medical
institutions vise, changes in accountability and the delegation of authority, transparency in
governance, administration, and the resulting loss of vested interest etc. Further changes are
required in improving the communication with citizens, redesigning processes and structures,
enhancing co-operation between governments health care institutions and managing
knowledge for support of complex administrative decisions. In light of the various challenges
being faced in the health sector / hospitals across the state of Haryana, the Hospital Information
System (HIS) project has been initiated by HSHRC, State Government of Haryana (GoH) to
provide a better interface of medical service delivery to citizen for which the government is
committed.
This HIS project aims at creating ICT based HIS to provide benefits to all stakeholders and
enable the state in improving the health delivery system across the state by,
1. Use of ICT to enhance the real time information gathering and reporting for monitoring
and decision making processes such as to manage performance of systems and facilities
2. Automation of the work flow wherever possible and removal of manual processes and /
or dependency on the human resources
3. Reducing patient waiting time; efficient queue management for availing facilities /
services. Real time access to information by the citizens like availability of beds, blood in
blood bank , etc. through multiple channels
4. Maintaining quality of services based on defined parameter of safety and accuracy for
decision
5. Ensuring 100% services and drug availability by automated reporting on availability of
health personals, equipment uptime, utilization, maintenance requirements and Drug
reorder levels for various health facilities.
6. Crisis Management in case of emergency and efficient referral management
23
7. Developing a unique Electronic Health Record (EHR) across facilities, to record all
health events following a life cycle approach and all revisits, referrals etc. one person
one record.
24
3. S cope
of
W ork
This chapter summarizes the overall scope of work that needs to be executed by the selected
Implementation Agency.
A Hospital information system (HIS) is envisaged to be a comprehensive,
integrated information system designed to manage overall functioning of a government
healthcare institution including patient care, hospital administration and the corresponding
service processing.
3.1.
Project Requirements
25
Inception Report:
i.
ii.
iii.
3.2.1.2.
ii.
iii.
iv.
26
3.2.1.3.
System Design
i.
ii.
iii.
iv.
v.
The IA shall consider users inputs when they are finalizing all design
components including user interfaces, mode of data entry, storage and
retrieval, outputs reports, queries and the application design as a whole
vi.
vii.
27
The IA shall configure the specific HIS modules, third party bolt-on
applications (if any), development of interfaces wherever and whenever
necessary.
ix.
x.
The IA shall create and manage all necessary master files for the
proposed HIS.
Note:
1. The IA shall be responsible for designing and developing the a lighter
version of HIS core application which can operate and store
transactional data in offline mode
2. Reference to complete Business Functions are described in chapter 4
of this RFP. The functional requirements are provided as annexure 1
of this RFP
28
29
Note: The detailed infrastructure requirements are provided in Chapter 6 of this RFP
Ensure that all necessary measures are taken for the smooth operation
of the HIS system
ii.
Ensure that designated personnel from HSHRC support team are duly
prepared and groomed in a progressive manner so as to operate the
system on their own, with a view to eventually takeover operations at
the end of contractual term
iii.
iv.
Note: The detailed operational requirements are provided in Chapter 7 of this volume
of the RFP
30
3.2.5. Change Management and Capacity Building including Training of users for
effectively using the system
a. The IA shall impart training to hospital staff and other key stakeholders on the
usage and maintenance of the HIS application
b. HSHRC has come out with an indicative list of training modules and user groups.
Please refer Chapter 8 of this volume of RFP for details.
c. The IA shall provide a change management plan to HSHRC which addresses the
various aspects of capacity building and training
d. The IA shall propose different training modules for different user profiles at
appropriate timelines
e. The IA shall provide such additional training as they deem necessary in order to
ensure that the training imparted is comprehensive, complete and meets the
Service Level Agreement as mentioned in the RFP
f.
The IA must also prepare Training Modules/content to enable the users for selflearning. Please refer Chapter 8 of this volume of RFP for details
31
Following will be the key stakeholders involved during the implementation phase of the HIS
project:
1. DGHS/HSHRC: As owner of the Project, the role of DGHS/HSHRC in the successful
implementation of the project includes discharging the following responsibilities:
a. Frame and Issue Guidelines to the State Administration for implementation of
project during the Pilot and State-wide roll out
b. Setting up of a State Project Committee (SPC) for overseeing the implementation
of the Project
c. Provide technical assistance to the State for effective implementation of the
project
d. Organizational capacity building initiatives
e. Defining service levels for identified services, ensuring service level adherence,
implementation and sustainability of the project and subsequent state wide
rollout
f.
j.
Decide upon the State wide rollout based upon common software, approach and
financial model following the completion of the pilot project
Work closely with the implementation agency (software) to undertake the field
work, comprehend the requirements, document the observations, oversee
preparation of roadmap, develop/customize application as per proposed reengineered processes, etc.
m. Help build capacity for the Hospital staff and executive resources of Health
administration so that they can work closely with the technical solution provider
for developing / customizing the software, and implement the technical solution
as required
n. To manage, supervise and implement backend computerization of Hospitals with
long term vision of Health Department of the State
o. Coordinate, manage & monitor the receipt and utilization of financial support
Haryana State Health Resource Centre confidential
32
Ensure that there is no unauthorized access at any of the restricted areas defined
by the IA at any of the Hospital facilities / location, without prior information
and without maintaining a proper log
2. Project Management Unit / Team: The Project Management team shall work with
DGHS/HSHRC and the Selected IA on day-to-day management of the project. The
responsibilities of Project Management Team will include but not be limited to the
following:
a. Prepare the Project Reports and proposal vetting
b. Provide project management services
c. Support DGHS/HSHRC in monitoring the implementation of the project
d. Provide continuity (from the concept stage) during implementation of the project
e. Provide support to the Hospitals and its field units in their discussions with the
selected IA
f.
33
i.
Periodic review of project plans and progress and advise DGHS/HSHRC and the
Hospital Teams
j.
Track project issues and risks and advise HSHRC on mitigation measures
Periodic inspection of back-ups, storage, DMS, and other systems, at least twice a
year
3. Implementing Agency: The detailed scope of work and responsibilities for the
selected IA are discussed in earlier sections of this document. In addition to these roles
and responsibilities, the responsibilities of the selected IA will include but will not be
limited to the following:
34
g. Procure and Implement the Infrastructure (Software and Hardware) for the
project as per specified requirements
h. Configure the solution to facilitate access to the application from all the identified
locations / users
i.
j.
Work in close coordination with HSHRC, Project Management Team and other
stakeholders for this project; and provide periodic reports
k. Carry out the activities as indicated in the contract agreement and submit all the
mentioned deliverables within the stipulated time-frame
l.
Ensure that the time lines will be adhered to and take necessary actions to
mitigate any slippage in timelines and risks envisaged. Communicate with
HSHRC accordingly
35
q. Any change notified to HSHRC from the UAT phase till deployment on the
production environment will be treated as breach of contract and HSHRC will
take all necessary action within its jurisdiction, even leading to termination of
contract
r. The change requests should be carried out as per the defined Change Request
Procedure and directions of HSHRC
s. Conduct detail survey of all locations across the state and assess the hardware,
networking devices, software, any other infrastructure components and prepare a
comprehensive inventory list before Go- Live
t.
While proposing the exact number of PCs and other auxiliary components,
taking into consideration the re-usage of existing hardware, ensure that any
device or hardware component which is equal to or more than four years old is
totally discarded. All the devices and hardware components which are less than
four years old are upgraded as required. All the devices & hardware components
which are less than one year old and which are in perfect working condition is
accounted in the final sizing
36
37
4. B usiness F unctions
4.1.
The HIS system to be deployed by the Implementation Agency should be able to deliver at
minimum the services listed below. The Implementation Agency shall implement all the
necessary functional, technical, operational and other supporting requirements to meet these
services. The application would have a
A. Patient perspective as depicted by figure 1
B. Administrator Perspective as depicted by figure 2
38
between different modules and an efficient data sharing mechanism so that each module can
showcase complete automated workflow functionality for a seamless backend processing. It is
necessary that all the technical documents, with versions, traceability matrix and updates, are
maintained by the IA as per standard Software Development Life Cycle (SDLC) and submitted to
HSHRC as per agreed milestones and timelines without fail.It is proposed that the integrated
core HIS application shall have following 3 accessibility views:
1. HIS Web Portal 2. HIS Core application with 3. Backend support services
The diagram below provides a view of the proposed functional architecture, distinctly
identifying various functions:
FIGURE 1
Hospital Information System
HIS Web
Portal
HIS Core
Application
Static Web
Content
Public Reports
/ Statistics
4
Application
Admin
11
6
MIS
Reports
HIS Backend
Support
Patient
Administratio
n Services
Patient
Clinical
Services
Non-Clinical
Support
Services
Audit Trail
Personalized
Dashboard
8
User Log-in
/
Authenticat
ion Services
12
Basic Human
Resource
Management
Basic Finance
and Accounts
Assests and
Equipement
Management
Inventory
Control
Record Room
Document
Management
Content
Management
Registratio
n, Password
Retrieval /
Reset
Integration
Services
13
HIS Lite /
Offline
Application
14
Business
Analytics
10
Search /
Advanced
Search
Grievance
Redressal /
Feedback /
Suggestions
39
4.2.1.
4.2.1.1.
4.2.1.2.
4.2.2.
4.2.2.1.
4.2.2.2.
4.2.2.3.
4.2.3.
4.2.3.1.
4.2.3.2.
4.2.3.3.
4.2.3.4.
4.2.3.5.
Record Room
4.2.3.6.
Document Management
4.2.4.
Application Admin
4.2.5.
MIS Reporting
4.2.6.
Audit Trail
4.2.7.
4.2.8.
4.2.9.
4.2.10.
4.2.11.
Personalized Dashboard
FIGURE 2
Haryana State Health Resource Centre confidential
40
The overall envisaged view of HIS for Hospital Administrators is depicted below:
Effectiveness & Quality
Utilization
Service Availability
PEOPLE
Roster
FACILITIES &
EQUIPMENT
Maintenance
& Upkeep
SUPPLIES
Integration with
external systems
Supply Chain
41
External systems
MIDDLE WARE
It is envisaged that all of these applications shall have seamless integration for
data exchange through a common data integration layer / Middleware. The data
exchange may happen in standard format, especially XML or XBRL through
Secure File Transfer Protocol (SFTP) location. The integration layer will be based
on business rules, defined in form of Triggers or Schedules.
The overall process flow for data exchange may be represented as follows:
i.
The HIS Core application will prepare all the messages / datasets in
XML or XBRL formats based on the triggers & schedules, as required by
the external applications
ii.
System will put all these messages and XML or XBRL formats at a
predefined Secure File Transfer Protocol (SFTP) location. These SFTP
locations would be generally identified by HSHRC
iii.
iv.
42
v.
vi.
Similarly, the External application will prepare all the messages in XML
or XBRL formats that need to be passed onto the HIS Core application
and deposit at the specified Middleware
vii.
The HIS Core application will pick up that data from external
application through Middleware and update the same in their own
database(s) after due processing, including adequate checks and
balances, thus synchronizing the databases
Applications
Application Type
Portal
Centralized Application
Centralized Application
Centralized Application
Grievance Redressal
Financial Management
Accounting
Centralized Application
Asset
and
Management
Centralized Application
Inventory Control
and
and
Equipment
Local/Centralized Application
Centralized Application
43
4.4
S. No.
Applications
Application Type
10
Record Management
Local Application
11
Analytics and BI
Centralized Application
Apart from the various functional modules and additional functionalities mentioned above, it is
proposed that the application would be supported by backend components / servers / databases.
The indicative components to be considered as part of the proposed solution and their logical
interaction to support the overall automated system environment are mentioned below.
Application and Web Server
Application Server will form the middle tier and the HIS core application would be hosted on it.
Application server would take care of the necessary workflow, accessible through Intranet, and
the web server would be required for interfacing with the Hospitals and external users via web
browser through Internet. The business logic layer will coordinate the application, process
commands, make logical decisions and evaluations, and perform calculations. It also moves and
processes data between the two surrounding layers.
Document Repository Server
All the documents like scanned physical files, invoices, receipts and the any other supporting
documents during the course of any treatment or hospital administrative work should be stored
in this server with proper indexing and integration with other servers. The digital documents
generated through the automated HIS system should also be stored and linked to the core
database.
Database Server
HIS Application integrated with a core database will act as decoupled but yet single data storage.
Since this data is centralized and is very critical, it should be load balanced and clustered to
ensure high availability and reliability. The data would be stored on the storage server.
SLA Database Server
It is expected that the SLA monitoring tool, such as EMS, should be deployed by the IA for
monitoring the defined SLAs. This tool should be deployed in the DC and should be integrated
with all the system components.
44
It is envisaged that the SLA database should be separate from the main HIS database which will
record all the readings captured by the system on the performance parameters. The system
should automatically feed the information on the performance parameters to SLA dashboard,
which should be available to Administrators as per their pre-defined roles and responsibilities,
mapped to their rights / privileges in the system.
The system should also allow generation of MIS reports, as required by the Administrators. The
system should retrieve the data from the SLA database and generate these reports as per the
defined Reporting functionality (Reporting Module). For details on the Reporting
functionalities, please refer to Section 4.2.5 and Annexure 1of the RFP.
Further the advanced analytics and BI should also generate required outputs and feed the SLA
dashboards of Administrators for faster decision making
User Authentication Server
User authentication server, a directory service should store all the user account details and
passwords, along with other verification credentials in a central database. It should allow the
administrators to manage user identities, credentials, information protection, system and other
application settings. This is specifically proposed for the internal Hospital staff using HIS
application. Database of the Patients is proposed to be kept separate but completely integrated
with other servers.
Patient Database
In the view of huge number of Patients records being stored through HIS application, it is
proposed that the Patient data should be kept separate but fully integrated with other databases.
All the demographic information, registration details etc. as well as index of the documents /
reports etc. are proposed to be stored here for ready reference and retrieved through the HIS
core application.
Note: It is proposed that the provision of UID should be available in the system wherever
applicable, in particular where Patient data is being stored. It is mandatory for the IA to
integrate HIS core application with UIDAI, as and when it is operational, and enable
capturing of the UID details for all Patients in future.
Reporting Server
Reporting Server can be used to prepare and deliver a variety of reports, majorly MIS reports.
Users can generate fixed and custom reports through the HIS core application that interfaces
with the Reporting Server. Integration with advanced analytics is also proposed so that
analytical reports should also be available for HIS users in real time for decision making
purposes.
External interfaces / databases
It is envisaged that the HIS core application will need to interact with other applications /
specific databases, either for intelligence purpose or for information / data sharing. It is
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45
proposed that the HIS core application will share the data with any of the other applications /
databases through an Enterprise Service Bus. The necessary data mapping and formats for
data exchange will have to be developed by the IA in consultation with HSHRC and owner of
external applications / databases.
State MIS Users
The HIS application is envisaged to provide higher state officials and other health department
officials / administrators the capability to view customized MIS reports / advanced analytics /
DSS, accessible through Internet and HIS Web Portal. The IA is required to develop and
implement the necessary features in the application.
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5.1
This section details the various Information Technology (IT) related standards that are to be
considered while developing the HIS solution. The below mentioned components need to be
taken care of while developing the technology components on HIS Solution:
1. Platform Flexibility
a. Web-centric, multi-tier architecture shall be used
b. Open Standards and Interoperability shall be considered
c. XML / XBRL based standard shall be used wherever applicable
d. Compliance to SOA and Web-services
2. Interoperability
a. Usage of standard APIs
b. Service-oriented architecture (SOA) based
c. Support for multiple industry standard databases with ODBC, JDBC and Unicode
compliance
3. Usability
a. Applications should comply with Guidelines for Indian Government Websites
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5.2
The Solution shall be based on and compliant with industry standards (their latest versions as
on date) wherever applicable. This will apply to all the aspects of solution including but not
limited to design, development, security, installation, and testing. There are many standards
that are indicated throughout this volume as well as summarized below. However the list below
is just for reference and is not to be treated as exhaustive.
Information access/ transfer protocols
SOAP, HTTP/HTTPS
Interoperability
Information Security
IT Infrastructure management
Service Management
ISO 20000specifications
Project Documentation
Internet Protocol
Medical standards
Imaging
HIS Application
LOINC Coding
Disease Classification
ICD-10 coding
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Investigations
Equipment compatibility
5.3
Performance Metrics
Some of the key considerations that the implementation agency should aim for while designing
the deployment architecture is to ensure that the HIS project meets SLA requirements,
standards, specifications and performance prescribed, by ensuring that the following are
associated with clear, quantifiable metrics for accountability:
1. Performance
2. Availability
3. Security
4. Manageability
5. Scalability
6. Inter-operability & Integration
7. Standards and protocols
The solution must be designed to meet all functional, non-functional and management
requirements as mentioned in the document. Some of the key acceptance criteria are defined in
the table below.
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#
1.
Requirements
Performance - The system should provide fast and steady response times (Quality
of Service). The maximum user response time should be less than 3 seconds over
WAN and less than 1 second over LAN, for the next screen to appear or the existing
screen to refresh for submission of data. The speed and efficiency of the system
should not be affected with growing volumes, especially during search operations,
reporting, MIS, online processes and batch processes.
The system should be operational with good response time using low band width in
the hospital of about 32Kb per user, especially for LAN and internet users.
The system should support high variance in frequency as the volumes are not
expected to be constant and may be subjected to variances in user behavior due to
festivals, seasons, economic state of the country, regulatory changes, behavior of
intermediaries, etc.
2.
High Availability All the components of Haryana HIS must provide adequate
redundancy to ensure high availability of the HIS applications. The systems shall be
designed for 24x7 operations and meet all SLA requirements. Designing for
availability assumes that the systems will fail, and therefore the systems must be
configured to recover from component or server failures with minimum application
outage. All the components of HIS should support SNMP protocol for the effective
monitoring and management.
Haryana HIS should be available for 99.95% of the planned uptime. The accepted
planned downtime should not be more than 60 minutes per month (2 alternate
Sundays in a month at around midnight). The IA needs to indicate the critical
components in the system and indicate the plans for fail-over mechanisms.
3.
4.
5.
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Requirements
shall easily be expanded or upgraded on-demand. Scalability is important because
new proposed components shall constantly be deployed.
Expected number of users of the web-based system during the first year is
approximately 200 users, second year this shall grow to approximately 1000 users,
third year these shall grow to approximately 2000 users. Year on Year growth for
no. of web users beyond third year is expected to grow at 10% per annum.
Expected number of concurrent web-based year wise users shall be around 60%
with another buffer of 15% of the provisioning.
6.
7.
8.
9.
10. Source codes Please refer to Article VII, Intellectual Property clause mentioned
in volume III of the RFP
11. The system should be web 3.0 compliant to ensure the HIS application works on
various platforms, browsers and resolution.
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5.4
Acceptance Criteria
5.4.1 Security
The IA must take rigorous provisions to prevent unauthorized alteration or damage to
HIS application, and all related applications and databases. The IA must describe in
detail all measures to be taken, including the use of security infrastructure including
end-point security, Security Policy and Procedures for each project location, applicability
of the policies and security controls for physical, communication, assets, software
licenses, equipment security etc. as per the ISMS procedures. IA shall provide basic level
of security by providing the end users with username and password to access the
applications. IA shall deploy the application only after it has undergone User Acceptance
Testing (UAT) and is security audited by the Haryana State Information Security
Management Office (ISMO) for vulnerability assessment (VA) and penetration testing
(PT). However IA shall undertake and conduct all sorts of testing and follow a standard
Software Testing Life Cycle approach (STLC) before deployment of application in a
production environment in addition to assessment and certification through the ISMO.
Content Management Software that is part of the portal shall be restricted to specific IP
sources. Additional layer of security shall be provided to sensitive applications by
deploying these behind Application Firewall.
The Governance Framework established for the project shall ascertain what all measured
risks that needs to be accepted; however IA shall at each such occurrence/incident be
responsible for providing resolution in terms of correction, prevention and remediation
throughout the project tenure.
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the capacity that will be required for each of the application and what tools and
techniques will be required to continuously monitor application performance.
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within the development environment set up by the IA within pre-decided premises only.
The IA must comply with all the IT and admin requirements as defined by HSHRC.
Note: In case the State Authorities / HSHRC agrees to continue ongoing upgradation /
enhancements and maintenance activities from outside location, the IA needs to define the
environment and provide necessary controls / access for adequate monitoring to authorized
officials.
The IA must take all reasonable care to protect the integrity of the software application
during development / customization. Use of a version and library control tool is
required. The IA must describe the development environment to be used and tools
deployed for maintaining the version control of the software application. The access
control of the version control tool must be provided to HSHRC or any agency nominated
by HSHRC for periodic review of logs and Audit of the entire development process.
oversee the
of contact for
methodology
The IA must
Within one week of award of contract, the IA must provide HSHRC an Inception Report
including a detailed Project Plan for the development / customization of the application
along with the Performance Management System (PMS) tool. This Project Plan must
include the Project Charter, a work breakdown structure showing all proposed
milestones and deliverables, and a listing of all project issues and risks. Additionally the
IA will also be required to submit the detailed CVs of all resources being deployed for
providing services to HSHRC and also the Resource Plotting sheet as per project plan.
The IA must provide weekly status reports to HSHRC during the development effort as
well as the entire project implementation and maintenance phase, for the entire contract
period. These reports must be submitted by close of business each Monday and reflect
status against the Project Plan as of close of business the previous Friday. Any
falsification of these status reports or failure to inform HSHRC of issues impacting the
deliverables or timeframe of the project may result in imposition of adequate penalty /
action by HSHRC.
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all bugs are maintained and are fixed as per various tests conducted on the application. It
is desirable that the IA maintains a bug tracking tool for the purpose.
5.5
The proposed overall solution framework for HIS is presented in this section, depicting the
overall Logical application structure showcasing the inter-relationships between different
layers.
The 3-tier architecture (also referred to as multi-tier or N-tier architecture) has been proposed
for the Application Solution. It is required that all the automated modules to be developed by IA
should be complying with DeitY, GoI standards and guidelines. This would enable ease of
interoperability and also be significantly more economical for the Haryana Health Department.
It is recommended that IA should opt for Service Oriented Architecture (SOA) for implementing
HIS application modules.
The indicative layers in the proposed application architecture are shown below:
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Web Browser
Citizens / Patients
Mobile devices
Kiosk
Other stakeholders
SMS
Service
Delivery
Channels
Users
Service Helpdesk
Mobility
Common Services
INTEGRATION LAYER
Patient Care
Services
Communication Services
Mailing | Notification | SMS | IVR
Ancillary and
Support Services
Portal Data
Stores
Administrative
Services
ODS
Application
Admin
Process Management
Payment
Services
Audit trail
Central
User
Repository
Financial
Accounting
Other support
services
Content &
Document
Management
Data Store
Functional
Data Stores
Authenticati
on Services
Business
Enablers
HIS Service
and Process Insights Layer
Gateway
Workflow Management
Functional
Modules
Centralized
Authentication
Gateway
Web Service
Security
Application specific
authentication &
authorization model
Enabling Applications
Common
Service
Centers
Database
Security
National / state
Schemes
Infrastructure Security
Mobile Interface /
Downloadable Apps
State Portal
eService Interface
SECURITY
SERVICE
eService
Delivery
Interface
Interface
Services
The description of various layers shown in the diagram above is given below:
The User Layer: This layer forms the internal Hospital users accessing the applications over
Internet or Intranet. Role based access would be defined for the internal users for having
accessibility to the respective application modules, and MIS / DSS which would be accessed by
higher authorities which would help them in decision making as well as at various levels.
Integrated database structure would ensure a one point stop search available to all the units.
The Application Layer represents all the functional modules, i.e. core, supporting and
backend support modules of HIS, along with the additional modules proposed for the Hospitals.
These modules will communicate by sharing of data with one another, or by coordinating an
activity between two or more services as per integrated workflows. Users can easily access
solution components having an interface with single sign-on, identity Management (IDM)
facility provided by the Light-weight e-Governance Interconnect (LeGIT) framework either
through Internet or through Intranet.
The Business Logic Layer: All the processes and functionalities within the HIS core
application would be guided by Business Rules and Logics. The rules engines will cater to the
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requirements of each individual functional module at the Application layer and also help in
interacting with the modular databases / data tables.
The Data Access Layer: The Data Access layer is envisaged to contain the Metadata and
also cache of frequently used raw data. This layer will closely interact with the Masters to
control how the data flows to individual databases / tables and also how efficiently it is
retrieved.
The Data Layer: The overall solution would be based on a centralized architecture
comprising of centrally located databases at the Data Centre as central repository. The District
Hospitals and Medical Colleges shall have minimum one server each required for operating the
application in offline mode with all necessary data of that particular facility, which will enable
capturing of data from standalone applications at those places (when the connectivity with
central repository is lost or intermittent). This approach would cater to the functionalities of all
the key processes and functions performed at all other locations and would also allow the users
to have access to the central repository for comprehensive information as and when required.
The data storage, backup and recovery measure will be taken at individual hospital facility as
indicated above.
Networking: The overall networking solution would be based on a combination of SWAN as a
primary connectivity and broadband connectivity to be provisioned by IA, ensuring optimum
uptime at all the desired locations.
The Service Delivery Layer represents the different modes/media of service delivery, which
would be used for availing/accessing the services of HIS. Services would be primarily provided
through system accessed over the specified network. This will also authenticate the different
users through their credentials and control the access to various modules / functionalities in the
system as per rights granted to them.
The IA shall choose the technology such that:
1. It can help Hospitals (HIS functions) respond more quickly and cost-effectively to
changing environment conditions / demands from the general public requiring health
care services.
2. It shall promote reuse at the macro (service) level rather than micro (classes) level. It can
also simplify interconnection to - and usage of - existing IT (legacy) assets, if any.
3. It shall also support the principles of good design: Granularity, interoperability,
modularity and scalability.
4. The issues related to performance, manageability, etc. shall be well addressed and
system shall provide a more manageable system which is less dependent on human
resources.
Note:
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1. The architecture proposed by the IA should include but not be limited to these layers
and modules. This is an indicative solution and logical Architecture. The IA should
carry out a detailed study to develop the exact Solution and Technology Architecture
for proposed HIS considering DeitY, GoI standards and guidelines.
2. The figure above only depicts the key identified layers and the various modules of each
of the layers, however this is only indicative and not exhaustive. The IA needs to
develop a detailed application architecture and database design / schema to cover all
the requirements and functionalities as described in this report. All the technical design
documents along with architecture and DB design reports as submitted by the IA will
be reviewed and approved by HSHRC. The decision of HSHRC will be final and binding
on all parties in such matters.
5.6
Deployment Architecture
Internet
Intranet
State MIS
Users
Patients
Hospitals
Core Router
Core Router
Gateway
Antivirus
Internal
Firewall
FTP
Server
Web Server
Load
balancer
Core
Switch
IDS/IPS
SMS
Gateway
SAN storage
LDAP
Server
Certificate
Server
Database
Server Farm
SAN Switch
Switch
Backup
Server
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Note: The above diagrams are only indicative and do not necessarily represent the physical
servers. The functional / logical interactions of the various servers may remain the same;
however the actual technical design and implementation would be done by the IA and shared
with HSHRC for approval. Also, the overall implementation is proposed to be centralized, with
core application being hosted at DC and all other locations (i.e. District Hospitals and Medical
Colleges) are proposed to access the application through SWAN.
5.7
Testing Criteria
A thorough testing is proposed for the HIS application and its modules, as per standard process
defined hereunder. HSHRC requires thorough and well-managed test methodology to be
conducted. The bidder must build up an overall plan for testing and acceptance of system, in
which specific methods and steps should be clearly indicated and approved by HSHRC. The IA
is required to incorporate all suggestions / feedback provided after the elaborate testing of the
HIS application, within a pre defined, mutually agreed timeline.
The Implementation Agency must undertake the following:
1. Outline the methodology that will be used for testing the system
2. Define the various levels or types of testing that will be performed for system
3. Provide necessary checklist/documentation that will be required for testing the system
4. Describe any technique that will be used for testing the system
5. Describe how the testing methodology will confirm to requirements of each of the
functionalities.
6. Indicate how one will demonstrate to HSHRC that all applications installed in the system
have been tested
Competent Authority from HSHRC shall issue application security audit certificate to
Implementation Agency after successful installation
The IA shall conduct various type of testing on the new build/package before releasing it for
deployment on the production environment according to standard Software Testing Life Cycle
(STLC). These tests shall include unit testing, system testing, security testing, stress testing,
reliability testing, performance testing, audit trail, multi-user capability, volume test, system
integration testing, compatibility and configuration testing, GUI testing etc.
The test documentation shall include test procedures, test data and test results should be
documented. Errors detected during testing should be logged, classified, reviewed, and resolved
prior to release of the software. Software error data that is collected and analyzed during a
development/customization life cycle may be used to determine the suitability of the software
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product for release and installation. Test reports should comply with the requirements of the
corresponding test plans.
The acceptance tests must demonstrate that the Implementation Agency has met each and every
requirement specified in the RFP and has delivered an effective operational system.
5.7.2
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5.8
Hosting Criteria
The IA must work with HSHRC to provide a detailed deployment plan, including but not limited
to, orderly processing of inventory, application version control, and load all application
materials, assignment of user rights and security, and verification of correct functionality. The
IA must present a deployment plan to HSHRC for their approval by the beginning of the test
period. It is necessary that the application is hosted in DC and a Lite version of HIS core
application be deployed at District hospitals and Medical Colleges as per the Implementation
Schedule along with the necessary itemization of all hardware and/or software, as well as any
and all ancillary requirements.
The HIS application must be made available on a 24x7 basis, with scheduled down time as
mentioned in the SLA parameter, including both planned and unplanned outage. The IA must
state how the availability is to be provided, including all measures such as mirrored servers. The
IA must show the ability to report availability to HSHRC on a monthly basis, and must indicate
how availability is to be verified.
The HIS application must meet the standards for web accessibility. All web pages, static or
dynamically generated, must comply as outlined in the World Wide Web Consortium (W3C)
Web Content Accessibility Guidelines. The IA must test the HIS application with an available
accessibility monitor, and with a leading accessibility tool. A test report should be submitted as a
part of relevant documentary proof.
5.9
The selected IA will need to implement comprehensive solutions with centralized workflow
capabilities, integrated policies, and customized reporting, in order to manage Data Loss and
protect sensitive data. They will also need to provide HSHRC with a modular DLP program that
offers capabilities across three main vectors: data at rest, data in motion, and data at endpoints.
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Where the standard DLP mechanism is shown above, the IA needs to propose adequate solution
and define protocols to cater to requirements of data prevention within the system implemented
at each project location with HIS Lite version along with the end-point security and at the Data
Center, and incorporates the same as part of entire solution design. The IA shall provide HSHRC
with the DLP policy and statement of applicability for each aspect of the network, storage and
end point according to the scope of work defined in the RFP. This is a mandatory requirement.
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6 I nfrastructure R equirements
The HIS application is required to be available on Centralized architecture and therefore it is
mandatory that the application is accessible over a common network. The subsequent sections
in this chapter provide the details of respective Infrastructure requirements for smooth
functioning of the HIS application.
6.1
The following are proposed in terms of overall IT infrastructure setup for the proposed
implementation. First is the deployment of HIS Lite application at District Hospitals and
Medical Colleges and deployment of centralized core HIS application at the Data Center. A
detailed IT infrastructure design should be prepared by the IA which would be reviewed and
approved by HSHRC. The bidders are required to provide in their proposal the Bill of Quantities
(BOQ) including the numbers and work out detailed configuration/specification and type of
servers and other hardware, software components that are required under the proposed
technology solution HSHRC shall make provisions for deployment of servers and other required
components as per detailed design and specifications drawn out by the IA. IA is expected to
provide compliance to all the components of BOQ and include un-priced Bill of Material along
with technical proposal.
6.2
It is proposed that the entire HIS infrastructure should be virtualized for optimum
infrastructure utilization and performance. Once the entire IT system is mature enough, the
infrastructure may then be scaled up to Private Cloud. This can be also applicable to all hospital
infrastructures for HIS application and both can be integrated for virtualization. However, in
case of extreme situations where the existing infrastructure even after making a Private Cloud
is found to be insufficient, the usage of other Cloud infrastructure may be allowed to manage
the additional load, however the decision of HSHRC will be final and binding on all parties in all
such matters.
6.3
Data Centre
Data Center for Haryana HIS project shall be provisioned as a service by the Data Center Service
Provider i.e. by HARTRON on behalf of the HSHRC. The IA is required to host the HIS
application and services on the server infrastructure at the facility of DC service provider. The
DC shall comply with the Tier-III standards and TIA-942 norms. HSHRC has provided the
Quality of Service (QoS) indicators and other performance parameters adequately in advance for
the IA to study and make out detailed specifications for the same. The specifications must be
futuristic with atleast a five year horizon to start with and recommended servers for
provisioning shall be on a managed services model from HARTRON/HSHRC. The centralized
compute infrastructure should be able to accommodate any scaling up requirements
necessitated in future. Based on the recommendations, HSHRC shall make provisions through
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HARTRON such that commissioning of servers for deployment of HIS core application and thus
the implementation plan does not suffer. The following are the suggested/desirable features for
the HIS core database to provide optimum performance and scalability on demand and facilitate
quick data response:
1. High Availability
2. Scalability
3. Data Security
4. Automatic Workload Management
5. Access Control
6. High Performance
The IA should assess, design and deploy the components in identified Data Centre either in the
ACTIVE-ACTIVE or ACTIVE-PASSIVE mode in order to meet the project requirements. The IA
should deploy and host the application in the Data Centre for the purpose of backup also. The
IA in mutual consultations with the HSHRC shall identify and ensure that only critical data is
backed up at the DC. Additionally it is proposed that the backup procedure at the DR site would
be near real time, till such time the DR Site is set up/ready for commissioning.
If for any reason, there is a delay in any deliverable that is due to Data Center services and or
Network service provider, the IA shall not be penalized..
IA shall provide the following for the Data Center: proposed DC scope for the IA has been
broadly divided into following categories:
1. All Application and System Software including various system tools as per RFP
requirements
2. The IA shall supply, install, configure and manage the antivirus solution hosted at DC
meant for the client infrastructure including desktops and servers, outside the DC but on
the Haryana SWAN network
3. System Operations & Maintenance Services - Undertake all operations and maintenance
services of all the components being procured and installed to ensure that overall uptime
commitment of 99.95%
4. Backup / Restore Services Design and implement the shared backup and restore
components and provide backup and restore services to the Hospitals.
5. Storage Services - Design, and implement the shared storage components and provide
storage administration and management services to the users in the Hospitals.
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6. OS and Database support services - Provide administration, patches upgrade and update
management services for OS and Database to the Hospitals.
7. IA must provide in their technical proposal all details w.r.t sizing and specifications
(throughput, IOPS, compute capacity, cores, processors, MIPS, bandwidth requirements
etc.) for each of the solution components that are required to ensure that all application
functionality, including data access, file downloads, and online transactions, is
performed within commercially acceptable response times and as per the defined SLAs.
8. The IA must state the capacity that will be required for each of the application and what
tools and techniques will be required to continuously monitor application performance.
There shall be no compromise with respect to the functionality and performance expected of
each of the above components and appropriate care has to be exercised, while finalizing the
device/component specifications and drawing up the final BOM, about scalability, security,
performance, availability and manageability. One more factor to be taken care of here would be
the compatibility of all these components with each other and with respect to the overall
solution deployment.
The sizing should be carried out keeping in mind the peak load requirements, during which, a
rapid growth in the transaction volumes occurs. Infrastructure should be pooled together,
optimally utilized and enabled in virtualization mode so that benefits such as agility, dynamic
and elastic resource allocation can be implemented.
All the applications should be enabled in Virtualization mode making planning in such a way
that peak resource requirements of different applications fall at different times so that resources
of applications with lean requirements can be diverted elastically to applications whose peak
time has occurred.
Infrastructure services provided by Data Center Service Provider
1. All Server hardware (compute infrastructure)
2. Racks and rack space
3. Building Monitoring System
4. Access control, Physical security & surveillance
5. Power Supply, UPS Backup & Generator
6. Precision AC
7. Fire Prevention System
8. Router for terminating traffic coming from internet
9. Router for terminating traffic coming from intranet over MPLS
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6.4
Business Continuity
Disaster recovery will be a subset of business continuity. While business continuity will involve
planning for keeping all aspects of a business functioning in the midst of disruptive events,
disaster recovery will focus on the IT or technology systems that will support business functions.
In case of Disaster, the prioritization of services that shall be available and accessible to the HIS
users shall include static web services, clinical modules, supporting modules and reporting/
basic MIS only. The decision to change the prioritization of services shall solely lie with HSHRC.
HARTRON in mutual consultations with the HSHRC and its IA shall design the Business
Continuity solution in a manner that the Recovery Time Objective (RTO) of 4 hours and
Recovery Point Objective (RPO) of 2 hours is achieved. System should be designed to remove all
single point failures. Appropriate redundancy shall be built to all critical components to provide
the ability to recover from failures. HARTRON along with Data Center Service Provider shall
perform various tests including network, server, security, local failover tests to verify the
availability of the services in case of component/location failures.
IA is also expected to detail out in its technical proposal and provide a comprehensive BCP
solution for all the entities including but not limited to the PHCs, CHCs, District Hospital and
Medical College in addition to non-availability of the Data Centre facility. The IA in its technical
proposal bring out clearly the scenarios (instance/trigger points) and level at which the DR is
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Application
Server
Applicati
on Server
Crashed
Down
Primary
Site is
completely
Down
Data Base
Server
Database
Server
Crashed
Down
Primary
Site is
completely
Down
Web Server
Web
Server
Crashed
Down
Primary
Site is
completely
Down
Scenario
Solution
Scenario
Solution
Directory
Server
Antivirus
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Infrastruct
ure
Provisione
d under DC
Solution
Scenario
Solution
Server
Network
Component
s
(Including
Core
Network
and
Security
Component
s)
Netwo
rk/
Securit
y
Compo
nent
Down
Primary
Site is
completel
y Down
The above explained solution scenarios can only be met if adequate Control Measures have
been taken at every step while operating the Data Centre. The control measures are steps or
mechanisms that can reduce or eliminate various threats for organizations. Different types of
measures can be included in BCP. Disaster Recovery is a subset of a larger process known as
Business Continuity Planning and should include planning for resumption of applications, data,
hardware, communications (such as networking) and other IT infrastructure. A business
continuity plan (BCP) must be designed by the IA that will include planning for non-IT related
aspects such as key personnel, facilities, and crisis communication and reputation protection.
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6.5
Network / Connectivity
The proposed Network Connectivity between various hospitals of Haryana, as part of this
project is given in the diagram below:
Data Centre Site
10 Mbps (P&S)
DC Internet Router
MPLS LL
SWAN
DC Intranet Router
Secondary
Broadband
Link
Internet
Secondary Connectivity
Broadband
Primary
Link
Primary Link
Primary
Link
Secondary
link
Primary Link
Secondary
Link
Online Patients
Legend
Sub-District
Medical College (4)
Hospital (10) Community Health
District Hospital (20)
Centres (11)
Primary Health
Centres (10)
Primary
Leased Line
Link
Secondary
Broadband
Link
The primary connectivity for all the hospitals connecting to the centralized application hosted at
Data Center in all the cases shall be through Haryana State Wide Area Network (SWAN). The
SWAN services in Haryana State are provided through BSNL. The primary connectivity shall be
provided using a dedicated MPLS leased line. The last mile connectivity to the hospital facility
from the SWAN point-of-presence (POP) in each district shall be provisioned by SWAN provider
in the State. This shall also include the end-user termination equipment and networking
components such as routers etc.
The IA is expected to build network level redundancy through broadband connection from a
different service provider. The network should have high availability switches. The network
should enable easy and effective operations and maintenance. The networking devices including
routers, switches shall be procured with sufficient number of ports for addressing the required
bandwidth. The router/switch may be chassis based with adequate number of free slots for
additional ports in the future.
69
S.
No
Network
Link
N1
N2
Locations/Connectivity
Bandwidth Size
(Indicative)
Service
provisioning by
Primary
connectivity
provided through
SWAN
Redundant
broadband links of 2
Mbps each for all
hospitals terminating
as a single
consolidated pipe at
DC.
DC Network, 10
Mbps Leased Line
link
Secondary
connectivity from
broadband service
provider for
redundancy , to be
provisioned by the
IA
SWAN
The above is an indicative bandwidth requirement for hospital connectivity, which will have to
be studied and finalized by the IA in consultation with HSHRC during SRS stage. The leased line
links for hospital locations shall be provided from primary (SWAN) and secondary sources
(provisioning to be facilitated by IA), as indicated in table above. These will be simultaneously
available for use. HSHRC reserves its right to make IA increase the bandwidth provided on
different network segments if the desired service quality is not being achieved because of any
limitation on account of bandwidth and IA will have to fulfill such a request within an agreed
timeframe.
6.6
The physical space for workstations will be provided by the respective Hospitals at each location.
IA shall procure the entire infrastructure required at these locations. The no. of Hospital Users
(sanctioned staff strength)/ employees should be provided with PCs to cater to the requirements
of HIS and to achieve the complete automation status.
At each such location the following shall be carried out, but not limited to:
70
1. Supply of hardware (servers at Medical Colleges and District Hospitals and desktop for
all hospital locations), software, networking equipments, UPS to all the location as per
the requirements
2. Installation, Testing and Commissioning of UPS
3. Physical Installation of Desktops, Multi Function Device, peripherals etc. as required
4. Operating System Installation and Configuration
5. Installation of Antivirus and other support software if any
6. Configuring the security at the desktops, switches and broadband connection routers
7. Network and browser Configuration
8. Test accessibility and functionality of HIS application from the desktops
9. Ensuring all the systems required are supplied, installed, configured, tested and
commissioned and declaring the site to be operational
10. Implement a Central Management policy for Hospital employees PCs to prevent Virus
attacks
The required number of PCs and other peripheral components is provided in Annexure 3 for
reference. These are indicative and should not be considered as exhaustive. The IA is required to
provide the exact details, as per requirement and based on detailed infrastructure survey.
It is proposed that the IA should make adequate provisions for making the entire Nodes
operational i.e. all additional infrastructure requirements should be covered in that without the
Hospital going into specifics of hardware and other networking components requirements. One
node will comprise of the PCs and all its accessories, like LAN connections, UPS facility, Internet
connectivity, power backup, etc. It is envisaged that this will also take care of any additional PC
over and above the stated PC requirement numbers in future.
The envisaged year on year growth for each location has been determined as 5%, all these users
will need to be provided Desktop as applicable and connected through LAN at each location and
WAN to the central HIS application at SDC. This has to be factored in the overall calculation by
the IA; however the procurement and installation should be done in phased manner as per
directions from DGHS/HSHRC.
The IA needs to conduct a detailed survey to assess the existing hardware and networking
components. While proposing the exact number of PCs and other auxiliary components, taking
into consideration the re-usage of existing hardware, the IA has to ensure that any device or
hardware component which is equal to or more than three years old has to be totally discarded.
All the devices and hardware components which are less than three years old need to be
71
upgraded as required. All the devices and hardware components, which are less than one year
old and which are in perfect working condition needs to be accounted in the final sizing.
It is also proposed that the entire management of computer resources, licenses, support and
security software management, upgrades, etc. will be managed centrally. The IA needs to deploy
adequate mechanisms to monitor the usage of licensed applications / software and other related
computer resources remotely and should be able to dynamically manage the optimum utilization
of resources in consultation with HSHRC. E.g. if any particular user machine has been provided
with a licensed software which he doesnt need them as part of his daily routine work, then the
IA should be able to remotely remove the application suite and assign it to someone who needs
it as part of their job responsibility, hence saving on license cost.
It is a mandatory requirement that UPS should be installed at all locations as per required
power backup needs, taking into consideration the already exiting and operational UPS.
The IA needs to submit the completion certificate for all the installations done, as per
requirement of HSHRC
6.7
The IA is expected to prepare the client sites for setting up the necessary client site
infrastructure. Successful site preparation in all Hospitals of Haryana will be done as follows,
but not limited to:
1. Provision of Local area network (LAN cables, LAN ports,) etc.
2. Provision of interconnectivity between building blocks of the hospital (e.g. OFC, Wifi
etc.)
3. Ensure adequate power points in adequate numbers with proper power back up facility,
including UPS
4. Adequate earthing and electric cabling as required at each location / node
5. Minor Civil works required for the Server room and UPS room
The physical space / premises will be provided by the individual Hospitals at respective
locations. IA shall procure and establish the required infrastructure and setup the facility for
smooth functioning of the HIS at each location state-wide.
72
7 O perational R equirements
7.1.
Performance Requirements
The number of users and approximate concurrency figures are given in section 5.4 of this RFP
volume. Actual requirement of users / module will be ascertained by IA during implementation.
1. The average application response time(s), application availability and other performance
parameters are given in the SLAs of Volume-III of this RFP.
2. The application software should be designed to cater to this load without any
degradation of performance as explained above.
3. The database schema and design should be capable of handling current and future loads.
4. System should be upwardly scalable in the event of increased usage of the system or new
business requirements.
5. The IA shall provide comprehensive report every month on the performance of the
server side infrastructure
6. HSHRC may with prior notice audit such measurements to their satisfaction.
73
74
The physical infrastructure management and maintenance services shall include, but not limited
to, the following:
1. Proactive and reactive maintenance, repair and replacement of defective components (IT
and Non-IT/ Hardware and Software).
2. The IA shall have to stock and provide adequate onsite and offsite spare parts and spare
component to ensure that the uptime commitment as per SLA is met. To provide this
service it is important for the IA to have back to back arrangement with the OEMs. The
IA needs to provide a copy of the service level agreement signed with the respective
OEMs.
3. Component that is reported to be down on a given date should be either fully repaired or
replaced by temporary substitute (of equivalent configuration) within the time frame
indicated in the Service Level Agreement (SLA). In case the IA fails to meet the above
standards of maintenance, there will be a penalty as specified in the SLA.
4. The IA shall also maintain records of all maintenance of the system and shall maintain a
logbook on-site that may be inspected by State Authorities / HSHRC or any nominated
agency by HSHRC at any time during the contract period.
75
Note: The IA shall provide the MIS reports for all the devices installed in the mini Data Centre,
DC and DR site, if operational, in a prescribed format and media as mutually agreed with
HSHRC on a periodic basis. Whenever required by HSHRC, IA should be able to provide
additional reports in a pre-specified format. These formats may be discussed and agreed at the
time of finalization of contract.
76
9. Warranty should not become void, if Hospitals buys, any other supplemental hardware
from a third party and installs it within these machines under intimation to the IA. The
entire responsibility for providing onsite support and getting services from OEM for all
such procurements by the Hospitals will remain with IA.
10. The IA shall carry out Preventive Maintenance (PM), including cleaning of interior
and exterior, of all hardware and testing for virus etc., if any, and should maintain proper
records at each site for such PM. Failure to carry out such PM will be a breach of
warranty and the warranty period will be extended by the period of delay in PM.
11. IA shall monitor warranties to check adherence to preventive and repair maintenance
terms and conditions of all equipments and components.
12. The IA shall ensure that the warranty complies with the agreed Technical Standards,
Security Requirements, Operating Procedures, and Recovery Procedures, as defined by
Government.
13. IA shall have to stock and provide adequate onsite and offsite spare parts and
spare component to ensure that the uptime commitment as per SLA is met.
14. Any component that is reported to be down on a given date should be either fully
repaired or replaced by temporary substitute (of equivalent configuration) within the
time frame indicated in the Service Level Agreement (SLA).
15. The IA shall develop and maintain an inventory database to include the registered
hardware warranties.
77
increase to minimum of 55 resources including the one point contact at District hospitals and
Medical College.
Note: This is indicative manpower requirement to manage the IT support services at all
locations within the project scope. However the IA may suggest an appropriate model with
adequate resources deployed phase wise but not more than proposed manpower as stated
above at any given point of time.
7.7.
The help desk service will serve as a single point of contact for all ICT related incidents,
information and service requests as well as grievance redressal. The service will provide a Single
Point of Contact (SPOC) and also resolution and tracking status of incidents.
The scope of work will include:
1. Facility for providing any kind of assistance to all internal as well as external Users
regarding general information related to healthcare services, facilities, timings, fees, etc,
along with information related to automated modules / workflow in the application,
interpretation of any errors, functionalities and usage, etc.
2. Facility for reporting issues / problems with the IT infrastructure.
3. Should operate from 8AM to 8PM on every business day i.e. 6 days a week; if necessary it
should be also available on Holidays as per prior information and demand. The term
Holiday would include all public / government holidays as well as weekends.
4. Should also operate during late hours on demand; if necessary. The term late hours
would mean time period of 8PM of current day to 8AM of the next day, on all working
days and Sundays.
5. To provide a service desk facility and to set up all necessary channels for reporting issues
to help desk. The incident reporting channels will be the following:
a. Specific E-Mail account
b. Toll Free Phone Numbers
c. HIS Web Portal / HIS Application
d. SMS (expandable feature)
6. To implement a call logging system in line with the severity levels as mentioned in the
SLA.
78
Supervisor
Helpdesk Executives
Hospital User
Patient
The services must be available in atleast two languages, viz. Hindi and English. A call at the
helpdesk will be defined as successful registration of the call and a complaint ticket is generated
in the system, or successful dissemination of information sought by a User. All calls will be
monitored as per the call logs generated from the system. It is also proposed that the issue /
79
complaint / Grievance statistics should be analyzed and also a knowledge base, based on
frequently asked questions to aid the users, should be created in the long run.
Note: It is proposed that initially there will only be a Helpdesk counter at individual Hospitals,
with couple of parallel lines of Toll free number and an Operator. The operator will be
responsible for handling the calls, assisting the Patients who visit the operator in person,
providing general information on facilities, services, procedures, timings etc., and recording
the incidents / complaints / grievances in the system. Later on, the entire system will matured
to a centralized Helpdesk / Incident Management centre.
The resources for IT support and the Helpdesk / Incident Management services may be
responsible for both and Facility Management as well, to optimize the deployed manpower.
However the IA need to ascertain the exact requirement and model of operations for providing
adequate support services for these two categories.
80
a. Dynamic Scalability
b. Centralized and Simplified Management
c. Improved quality of Data storage and retrieval
d. No risk of data loss
e. Higher availability of systems and data - 24x7x365
f.
j.
81
8 T raining R equirements
8.1. Training and Change Management Requirements
The IA shall provide training to the application users to efficiently use the system. IA shall
conduct training after implementation of the HIS Application and Training will be provided by
the selected IA to the Users within each Hospital / Health institution of Haryana.
The selected IA must assume the following responsibilities:
1. The IA shall provide training to the Hospital Administrators and workforce in two to
three batches per day for a specified duration / working days. However, the training days
can be revised by the Change Management Team or HSHRC, based on requirement.
2. It is proposed that the Hospital Users and Administrators would be divided in the
following groups:
Band
Users
Group 1
Group 2
Doctors, Nurses, Paramedics, and other Technicians / Departmental incharge, various operations staff of the Health institutions
Group 3
3. The IA needs to conduct a Training Needs Analysis (TNA) and impart Training to the
Users as per Groups provided above, according to their needs and requirements. Based
on the TNA, a training curriculum will need to be evolved and proposed. The indicative
Training Modules and Training plan are enlisted below:
#
Training Module
Frequency / year
1.
Sensitization / Orientation
2 days
Once
2.
2 days
Twice
82
3.
Process Training
3 days
Once
4.
Specialized Computer /
Module Training
5 days
Twice
5.
2 days - Application
Quarterly
4. It would be the IAs responsibility to set up the entire Infrastructure helpful in providing
successful training to all Hospital staff and Health Administrators like, computer,
network, LCD projector, printed course material and Utility Software CDs( optional) etc.
5. The schedule and the training material such as audio-visual, self-based/ computer based
training for imparting training shall be developed by the IA in consultation with the
Change Management Team at HSHRC and proper correspondence and acceptance needs
to be taken from HSHRC also. The IA shall prepare the training material in consultative
mode
6. In case of modifications either in the Training Plans or substitutions of the regular
trainers, proper correspondence with the Change Management Team shall be made.
7. Training program shall be continuously monitored by the representatives of both the
Change Management Team and HSHRC so as to ensure quality standards of the
Training. It is the responsibility of the IA to prepare a feedback mechanism (i.e., printed
feedback forms) and get it filled by the participating batch and submits the same on a
regular basis to the Change Management Team.
8. The IA shall provide audio-video content based multimedia software as training
material. The IA shall install and train the application users using the same. It is the
responsibility of the IA to prepare documents including User manuals, technical
manuals, installation manual, and administration manuals, and provide the same to the
Change Management team. The Change Management team needs to provide the
necessary inputs for preparing the training material.
9. Reinforcement training is to be provided when applicable.
10. Evaluation of participants and effectiveness of training methodology must be proposed
and approved by nodal officer.
Note: The plan and proposal related to this section will be evaluated as part of bid
response.
83
9.1.
Implementation Schedule
Following is the indicative timeline for different phases proposed for the IA to carry out
implementation activities. The timelines are calculated from the time of award of contract.
1. Phase 1: Phase 1 will include implementation of HIS in DC along with 1 District
Hospital (Panchkula), including one attached hospitals within the district namely 1 CHC
and 1 PHC. Additionally 1 Medical College is also proposed to be implemented during the
pilot phase. The implementation is proposed to be completed in 6 months time with
stabilization period of 3 months. Total implementation time - T to T + 9 + 3 = T + 12
months
2. Phase 2: Phase 2 will include implementation of HIS in 6 District Hospitals, , including
all the remaining attached hospitals within the pilot district Hospital (Panchkula)
namely 1 CHC and 9 PHCs. In addition, 2 other Medical colleges are also proposed to be
implemented during this phase. The implementation is proposed to be completed in 6
months time. Total implementation time - T + 12 to T + 18 = T + 18 months
3. Phase 3: Phase 3 will include implementation of HIS in rest of the 13 District Hospitals,
and 1 Medical college. This phase will also include rest of the First Referral Units (FRUs)
which have not been covered in above two phases. Please refer to Annexure 4 for the list
of FRUs covered under the project scope. The implementation is proposed to be
completed in 6 months time. Total implementation time - T + 18 to T + 24 = T + 24
months
Note: HSHRC may expand the gamut of services and include other modules as well. However
the final decision will be taken later on and currently they are not included in the scope of
work for the IA. All decisions taken by HSHRC will be final and binding on all parties.
Various activities within each phase of the project implementation cycle are also envisaged. It is
proposed that the IA should conduct a thorough assessment of the requirements, existing
84
infrastructure, and site preparation requirements at the start of each phase. The reports should
be submitted to HSHRC for review and approval, which will form the milestones for that phase.
It must be noted that these are only indicative timelines and milestones, and the IA is expected
to submit a detailed project plan and resource allocation plan to HSHRC at the time of award of
contract, without which the contract agreement will not be considered as valid.
The tentative timelines and deliverables for the pilot phase are listed below:
Activity
Timelines
(Weeks)
Deliverables
Requirements Analysis
and Design
T + 10
T + 28
T + 36
T+8
Procurement, Installation
of Hardware and
Networking components
T + 24
T + 28
T + 36
85
Activity
Timelines
(Weeks)
Deliverables
T + 48
Live
Stabilization period
5 years after
48 weeks i.e.
Go-Live
Note: The percentage payment for completion of any milestone will only be released to the IA
if the deliverable has been duly accepted and signed-off by HSHRC. The IA must ensure that
the deliverables mentioned above are completed as per industry defined quality standards for
smooth sign-off process on completion of each milestone.
The tentative timelines and deliverables for the 2nd phase are listed below:
Activity
Timelines
(Weeks)
Deliverables
T + 48
Requirements for
phase wise
functionality
T + 50 (3
Months)
Configuration &
customization
T + 50 (3
Months)
T + 62 (3
Months)
86
Activity
Timelines
(Weeks)
Deliverables
Site preparation
requirements and plan
T + 60 (2.5
Months)
Procurement, Installation
of Hardware and
Networking components
T + 68 (2
Months)
T + 68 (2
Months)
T + 76 (2
Months)
The third phase will follow the similar schedule as mentioned above for phase 2
Note:
1. The bidder is expected to propose and detail out an implementation plan in its technical
proposal according to the tentative timelines and deliverables as mentioned in the
table above.
2. The percentage payment for completion of any milestone will only be released to the IA
if the deliverable has been duly accepted and signed-off by HSHRC. The IA must ensure
that the deliverables mentioned above are completed as per industry defined quality
standards for smooth sign-off process on completion of each milestone.
3. The exit management exercise should be initiated at the beginning of the last year of
Contract expiration and the future option for project continuity should be in place by
the end of last year 0f contract expiration. This will involve the complete Handover and
Takeover activities.
87
Project Management
Team (HSHRC)
Strategy / Operations
Committee
PMO / MS
Feedback and
Directions
Hospital Project
implementation team
Feedback
Quality/Impact
Assessment
Project Manager
Components/Delivery
Team
88
steering committee, and aid in providing required level of advocacy for the HIS project
and also set directions which are acceptable to all stakeholders. It may include private
and industry participation as well, based on requirement.
3. HSHRC Project Management Team: A group of resources specializing in different
domain like project management, finance, database administration, application design
and development, as well networking and hardware should form a team having the
overall responsibility of HIS project. It would be the nerve centre of the proposed
institutional framework, and will also be responsible for coordinating efforts of various
agencies / organizations, involved in HIS project implementation. This will be PMU;
including representatives from HSHRC and risk management will one of the core
responsibilities of this team.
4. Hospitals / CHCs / PHCs: These will be the actual owner of the processes and
functions covered under HIS system, and will be responsible for constituting the project
teams headed by the PMO or MS. The PMO / MS of the concerned healthcare institution
will be the final deciding authority and own of the processes / functions under the scope
of this project.
Also, there will be Hospital Project Implementation teams which will be the single point
responsibility centre to implement the project in line with the strategic directions and
approvals from Project Management Unit / Team. This will be headed by the team leader
(SPOC) for all conceptualization, design and implementation purposes within their
Hospital premises. This is proposed for all individual Hospitals / Health institutions
during pilot phase as well as during the state wide rollout.
5. Project Manager: They will serve as a single-point contact within the institutional
framework for the purpose of project monitoring / reporting purposes and may be
deployed by the selected IA. They will be responsible for all the activities within the
project and will report to Project Management Unit / Team in coordination with the
team from Health institutions. They will be directly responsible for providing periodic
project statuses, tasks schedule and Action Taken Reports (ATRs).
6. Components / Delivery Team: They will be delivery team from IA / other
components / Agencies which will provide assistance in select areas of the HIS
implementation phase and may also constitute of various other teams within Hospitals
or outside.
It is also proposed that Quality Assessment / Audit will be conducted by any nominated agency
by HSHRC, and will be responsible for providing feedback to the PMU at a predefined
frequency.
89
For this project a simple yet very effective risk management approach is being proposed. There
will be a periodic review of the risk management component, which will be evaluated jointly
with HSHRC and Project Management Team, and a recommendation will be presented for the
way forward. The risk management program will require the project management team to report
their top risks looking forward and propose a response to proactively deal with them. This
approach is the simplest way to direct the project delivery team to elevate themselves above the
day -to-day issues and past performance. The following format will be used for this purpose:
S.
No.
Risk
Scenario
Impact
Impact
on
on Cost
Duration
Corrective
Action
Responsibility
Center
Completion
Date
Status
90
Owing to the nature of the project and the far-reaching consequences that it has in functioning
of District Hospitals, other Health institutions as well as on external interactions, risks
associated with delays and those relating to change management issues are envisaged.
IA shall adopt suitable Risk Management methodology to mitigate all risks envisaged under the
contract. IA shall underwrite all the risk related to its personnel deputed under this contract as
well as equipment and components of the HIS application, equipment, tools and any other
belongings of the IA during the entire period of their engagement in connection with this
contract and take all essential necessary steps to reduce and mitigate the risks.
Following are the key risks envisaged for the pilot HIS implementation:
S. No.
Lack
of
equipment/IT Required IT infrastructure must be in place at
infrastructure in terms of the time of actual implementation of the project.
hardware
and
software
91
S. No.
availability
Actual Users / Hospital staff Actual Users / Hospital staff members must be
members
not
taken
into taken into confidence, as he/she is the actual
confidence
source of information and actual user of the
System.
92
1.2
1.2.1
1.2.3
1.2.4
1.2.5
1.2.6
1.2.7
1.2.8
1.2.9
1.2.10
Site Map
1.2.11
1.2.2
93
1.2.12
2.1
3.1
Information Components
3.1.1
3.1.2
a.
Hospital name, type of Health care facility and
location details
b.
c.
d.
94
g.
Helpdesk information
3.1.3
3.1.4
3.1.5
3.1.6
3.2
Search Component
3.2.1
3.2.2
3.2.3
3.2.4
3.2.5
3.3
3.3.1
95
3.3.2
3.3.10
3.3.11
3.3.12
3.4
3.4.1
3.4.2
96
3.4.3
3.4.4
3.4.5
3.4.6
3.4.7
4
4.1
4.2
97
4.3
4.4
4.5
4.6
4.7
4.8
98
e. Token Number
f. Any other relevant information, as applicable
4.9
4.9
5.1
5.2
5.3
5.4
5.5
6
6.1
6.2
7
7.1
7.2
Billing
Consolidated billing for all the outpatient services. The system
should allow the operator to collect applicable fee, as defined
in the Payment component
Automatic receipt generation
OPD
The system should allow configuration of maximum number
of patients to be assigned to a particular OPD doctor in a
particular shift.
The system should allow patient registration record to be
automatically forwarded to the dashboard of the concerned
OPD doctor. The Patients should be queued in chronological
sequence with facility to override as per token for exception
cases.
Haryana State Health Resource Centre confidential
99
7.3
7.4
7.5
7.6
7.7
7.8
7.9
7.10
100
7.11
7.12
7.13
7.14
7.15
7.16
8
8.1
8.2
8.3
8.4
8.6
8.7
Emergency
The system should allow patient categorization and
registration through the use of bar coded wrist tags. The
system should have the facility to later fill up the demographic
as well as emergency Triage assessments
Post treatment standardized registration process
8.5
101
8.8
8.9
8.10
8.11
8.12
8.13
8.14
102
8.15
8.16
8.17
8.18
8.19
8.20
8.21
103
9.1
9.2
9.3
9.4
9.5
9.6
9.7
9.8
9.9
10
10.1
The system should allow the IPD doctor / Nurse to select the
relevant section on the screen for entering diagnosis,
treatment, investigation, minor procedures, diet, drugs,
referrals, blood requisition, etc. at the Nursing station. The
system should have interfacing / integration capability for the
use of handheld devices by the IPD doctors.
104
10.2
10.3
10.4
10.5
10.6
10.7
10.8
10.9
11
11.1
Maternity module will have all the features of the ward/ IPD
management module
11.2
11.3
11.4
105
11.5
11.6
11.7
11.8
11.9
12
12.1
12.2
12.3
12.4
12.5
106
12.6
12.7
12.8
12.9
12.10
12.11
12.12
12.13
12.14
12.15
12.16
107
13
13.1
13.2
13.3
The system should have provision to mark/ flag the MedicoLegal cases. These cases should be tracked. All the
assessments done by the concerned doctor in case of
Emergency should be tracked and recorded through Unique
patient ID.
The system should have a predefined checklist to validate the
legal requirements and status for the doctor / presiding
Nurse. The system should generate auto alerts / intimations
reminding the concerned doctor / Nurse of necessary action
to complete the legal requirements and update the status in
the system.
The system should be able to capture patient treatment
details.
13.4
13.5
13.6
13.7
13.8
108
14
14.1
14.2
14.3
14.4
14.5
14.6
14.7
109
14.8
14.9
14.10
14.11
14.12
14.13
14.14
14.15
14.16
14.17
110
14.18
14.19
14.20
14.21
14.22
14.23
14.24
15
15.1
15.2
15.3
111
15.5
15.6
15.7
15.8
15.9
15.10
15.11
112
15.12
15.13
15.14
15.15
15.16
15.17
15.18
15.19
113
16
16.1
16.2
16.3
16.4
16.5
16.6
114
16.7
16.8
16.9
16.10
16.11
16.12
16.13
16.14
16.15
c.
d.
e.
Expiry date
f.
115
16.16
16.17
16.18
16.19
16.2
16.21
16.22
16.23
16.24
16.25
116
16.26
17
Birth Registration
17.1
17.2
17.3
17.4
17.7
18
17.5
17.6
117
18.1
18.2
18.3
18.4
b.
Unique ID (having State, District, Year, and random
unique system generated number)
c.
Date and Time Stamp
d.
18.5
18.6
18.7
18.8
18.9
118
19
19.1
19.2
Integration of the
applications like:
Birth & Death
19.3
MLC
19.4
Post Mortem
19.5
MCTC
19.6
HIMS
19.7
Referral Transport
19.8
SNCU
19.9
Reconciliation of Accounts
19.10
HR (Training)
19.11
19.12
20
proposed
software
with
available
Pharmacy Management
20.1
20.2
20.3
20.4
119
20.5
20.6
20.7
20.8
20.9
20.10
20.11
20.12
20.13
20.14
20.15
20.16
20.17
Quantity
The system should be able check the availability and quantity
of items / drugs / articles / tools etc. at all sub-stores and
main store.
Stock would be classified and maintained on any and all of the
following categories like sub store wise, VED , ABC, Expiry
date of medicine, disease wise, FSN and high risk medication,
High Cost
The system will facilitate retrieving details of available drugs
(batch number, expiry date, location) in the pharmacy / drug
store & reserve drugs for the indent based on the item code
and quantity mentioned in the approved indent
A list of available and authorized medications with their
source (warehouse or local purchase) will be maintained and
auto updated from existing software.
Monitoring and Tracking of Supplies to Hospital units,
Management
of
materials,
Management
of
suppliers/drugs/items/equipments
120
20.18
20.19
20.20
20.21
20.22
20.23
20.24
20.25
20.26
20.27
20.28
20.29
121
20.30
20.31
20.32
20.33
20.34
20.35
20.36
20.37
20.38
20.39
20.40
20.41
122
20.42
20.43
20.44
Expiry date
The system will have the ability to validate the receipt against
the Indent & Dispatch note
The system will have the ability to generate Receipt Report
in which item details like quantity demanded , Expiry date,
Batch number, quantity received, quantity accepted,
quantity rejected etc are included
The system should allow entry of drugs procured locally and
maintain complete inventory of list of items/articles.
REPORTS AND ANALYSIS
20.45
20.46
20.47
20.48
20.49
20.5
20.51
20.52
20.53
20.54
21
21.1
21.2
21.3
21.4
123
The system will have the ability to link unique Machinery &
Equipment number with the Supply Order
The system will have the ability to maintain all relevant
information about the M&E including: Location
M&E description/specification
Supplier ID
Date since in operation/Installation
Life of the asset
Order No.
21.7
21.8
21.9
21.10
21.11
21.12
21.13
21.14
21.15
21.16
124
21.18
The system will help in costing of the maintenance activity.
21.19
21.20
21.21
21.22
21.23
21.24
21.25
21.26
21.27
21.28
21.29
21.30
22
22.1
22.2
125
iii.
Trainings
It is proposed that the HIS should maintain the Employee
master, Hospital master and Sanctioned Posts within the
system, so that the above 3 can be easily managed. The HIS
may integrate with the existing HR system to achieve the
functionality requirement.
23
23.1
24
24.1
24.2
24.3
24.6
24.7
24.4
24.5
25
25.1
25.2
126
25.3
26
26.1
26.2
26.3
Emergency Department
c.
d.
OT
e.
Labor Room
f.
Wards
26.4
26.5
Each of the central stores and sub stores should have the
capacity of raising an indent through the store module as well
as auto indent based on minimum reorder levels.
Illustrative list of items can be General Store items,
instruments, linen etc.
26.6
26.7
26.8
26.9
127
26.10
26.11
26.12
26.13
27
27.1
27.2
27.3
27.4
Document Management
The proposed solution should support storing of various
documents / reports in any type of electronic format including
word processing, spreadsheet, image, etc. A Document
management system should provide storage, versioning,
metadata, security, archival as well as indexing and retrieval
capabilities.
The proposed solution should support archival of digital
documents in any format (like PDF, PDFA, Word, Excel, Image,
etc.), support roles and rights based security where there can
be multiple levels of access right to the content like read,
create, modify, delete, etc. The proposed solution should
support inbuilt Document Image Viewer for displaying
image document without native viewer.
The proposed solution should support the search functionality
within the content. It should support search criteria like
search by metadata fields, content objects, documents, pages,
etc. It should support Full Text Search on image and electronic
documents.
It should support extensive Audit-trails and support logging of
all the actions done by individual users. The proposed solution
should support Image Assisted Indexing of Scanned
Documents and support direct upload of Scanned Document
to DMS. Apart from this, DMS should have option to link to
scanned old physical files repository. The proposed DMS will
have search facility having different search criterias.
28
Content Management
28.1
128
28.2
28.3
29
HIS Core Application Admin, Reporting and Audit Trail
29.1
29.1.1
29.1.2
29.1.3
29.1.4
Application Admin
It is envisaged that there would be a User Interface provided
for the Admin module, for User Management, Rights
Management, and Masters Management etc. The UI for Admin
need to be configured as per the ACCESS CONTROL policy
drafted by the Haryana State Authorities / HSHRC and agreed
upon by other stakeholders.
This should be the heart of the HIS application software. And
for every change carried out as during the Change
management, the impact analysis with reference to the Admin
controls must be analyzed, discussed, approved by Haryana
State Authorities / HSHRC and then implemented.
Maximum and/or nearly all the variables must be dynamically
controlled through masters from Admin instead of being hard
coded.
Admin USER will be strictly a single USER login for the HIS
application software and the ACCESS policy shall be integrated
and collaborative for the HIS users.
29.2
Authentication
129
29.2.1
29.2.2
29.3
29.3.1
29.3.2
29.3.3
Privilege Administration
Privilege Administration is the process of assigning privileges
to individual Users or User Groups. The privileges specify the
level of authority assigned to User or User Group i.e. whether
it is for a tab, a screen or a field.
If a User Group has certain privileges, and a User gets assigned
to that User Group, then automatically the User inherits those
privileges. The application allows selective revoking or regranting of privileges e.g. if a User has acquired certain
privileges on account of being assigned to certain User Group,
then for that User, the application should allow revoking of
the inherited privileges at individual User level, as required.
There should be a UI available for adding new privileges also,
with due approval and verification process inbuilt in the
system. This will allow the Administrators to configure new
privileges and will apply to all Users once configured and
committed in the systems.
29.4
29.4.1
29.4.2
130
29.4.3
29.5
29.5.1
29.5.2
29.5.3
29.5.4
29.6
29.6.1
29.6.2
b.
Option to Exclude or Include for selection.
c.
Option for add / edit / delete records in a particular
Master list
The system should have facility to display number of records
per page i.e. Display <X> Records per page option. It should
have pagination facility, to display the number of records in
more than one page. Also the system should allow sorting of
records on the Masters list Name.
131
29.7
29.7.1
29.7.2
29.7.3
29.7.4
29.7.5
29.7.6
30
30.1
30.2
30.3
MIS Reporting
This module will give HIS Administrators and other Users the
ability to have a customized view of the entire list of reports
they use or wish to use. Required security will be applied to
this module providing a restricted access as per different
category of Users within HIS.
This module may be further linked to the Personalized
Dashboard where the same links to these reports can be
displayed in small port lets, so that any User may not always
search for their frequently used reports from the Reports
module, and they can add it to their own dashboard for ease of
use. All the reports made available need to be controlled
through Admin module for variable access depending upon
the nature and status of the User,
The access control list of the reporting servers needs to be
mapped and configured with the admin access control
policies.
132
30.1
30.2
30.2.1
30.2.2
B.
(iii)
133
(iv)
31
31.1
Audit Trail
Audit trail will be a detailed record showing who has accessed
the system/application and what transactions / operations
have been performed by the concerned user during a given
period of time. Audit trail must display the following details,
but not limited to, with filter / sorting criteria options:
a. Timestamp
134
31.2
f.
Remarks (if any)
It is must that the Audit Trail module does not have a Delete
or Edit right granted to any user irrespective of any type or
hierarchy as created in the system. The view rights should
also be controlled through RBAC in Admin Module.
32
32.1
32.2
32.3
135
33
33.1
33.2
33.3
34
34.1
35
35.1
35.2
136
35.3
36
36.1
36.2
(A)
(B)
Personalized Dashboard
The dashboard functionality should enable each of the key
Hospital staff (Doctors, Anesthetists, Surgeons, CMO, etc.) to
view their virtual personal space and manage their tasks,
organize their work etc. based on their roles and
responsibilities in the Hospital functions and assigned
privileges.
This should be strictly privilege restricted section based on
Role Based Access Control (RBAC) mechanism defined
through the Admin module. The following features are
proposed for the personal Dashboard facility controlled
through the Admin module for all the internal users:
Quick Links Links within the application as well as external
links to access any application module or website other than
HIS)
Pending Activities/Tasks A list of tasks assigned / to be
performed by the concerned User, arranged sequentially,
along with number and type of tasks. The standard sequence
of completing the tasks for all users should be First in First out
(FIFO) sequence. To override the standard sequence, the
concerned user will need to specify the reason and enter the
details in the system. Audit trail would capture any such
change in the system. An additional facility to view other
Users tasks, if sufficient rights are provided (especially to
senior hospital officials) should also be provided, but strictly
controlled through Admin module of the application. Senior
Hospital officials in some cases might want to view the work
load and performance efficiency of any junior staff in handling
particular set of tasks. They may also want to reassign a
certain task to themselves or to other staff members, due to
any administrative reason, and get the task completed. All
such functionalities and features must be developed by the IA,
while designing the automated processes within the HIS
application.
137
(C)
(D)
(E)
37
INTEGRATION SERVICES
37.1
37.2
37.3
138
38.2
38.3
139
38.4
39
Local HIS Lite Application dependencies:
Local application shall have the following features to operate
independently without any dependence on the network
connectivity:
a.
Master data management with persistent queue
mechanism for local and central data synchronization. Master
data management shall maintain HIS core application and
support services records which will eliminate the data
inconsistency , data duplicity and facilities in identification
and merging of records
b. All hospitals shall have the same version of localized and
centralized application. Any version upgrades shall be
uniformly deployed to all hospitals and the central application
c.
Master index
ii.
Terminologies
iii.
User access control and
authentication details of that particular hospital/ facility
iv.
Master data of users
The above mentioned dependencies are indicative only.
Implementation agency shall identify and implement all the
local dependencies during the implementation stage.
40
Online Help/Reference with Search Option
140
141
As shown in the above diagram, a fully automated HIS process requires 3 steps from
start to finish, with responsibility centre as 3 different Users namely User1, User 2
Haryana State Health Resource Centre confidential
142
and User 3 respectively. In this case, if the User 1 logs into the system, he will see one
task pending on his personal Dashboard, which he can click to see other details of the
task. If however, at the first step the User 1 who is the responsibility centre to
complete that step, and if he doesnt perform this task in stipulated 1 day, it will be
automatically escalated to Senior User, who can then take necessary remedial action.
Similarly, it will be for other 2 steps also. The Senior User may be same for all steps
or different, as the case maybe.
Each automated process in the HIS system is envisaged to have this feature, so that
the Dashboard feeds for individual internal users can be derived by the system and
displayed accordingly. Similarly all the Red Flags or Escalations can also be
displayed.
General
Functionality
143
the system. The online help pages should have search functionality so that user can
search using the relevant keywords
7. The system should have a proper authorization and authentication mechanism.
8. If a user is inactive for a specified period of time, the user session should expire.
9. The system should allow for scheduling and Roster management for all Doctors, Nurses,
Paramedics and other hospital staff as required on the daily basis. This should be
controlled through Application Admin in the system.
10. The system should allow patient registration record to be automatically forwarded to the
dashboard of the concerned doctor / department.
11. Users should be able to access audio visual training content in addition to plain text
search as part of the online help functionality. Audio Visual clips should have the
functionality to start, stop, pause, back and forward options, so that the user can play the
training content as per his/her own free will and requirement
12. All the specific module / sub-module / section wise audio-visual help content should be
integrated to form a complete training of the HIS application and processes, and
uploaded on the HIS system for free access, download and ready reference
13. Users should be able to download the user manuals in PDF format.
14. The system should have a counter at the bottom of the Web Portal Home page to record
the number of people hitting the website / web page over Internet; this would help
analyze the usefulness of information presented through Web Portal.
15. The system should support multi-lingual interface (minimum Hindi and English) as per
localization and language technology standards for National e-Governance plan defined
on the e-Gov standards and guidelines published by Government of India.
16. The system should have roster management, schedule management, and resource
management kind of functionalities / features.
17. The system should have maximum select options, and very minimal free text option for
entering information / data.
18. The system have Intelligent suggestion feature based on pre-defined rules / logic /
parameters.
19. The system should automatically project, if the Patient is an exempted for paying fees /
bills.
20. The system should display the admission fees based on the category of patient i.e. free
delivery in case of Obstetrics, below poverty line (BPL), indoor package program (IPP),
surgical package program (SPP), etc.
144
21. The system should have the facility to forward requisition / orders from various
departments online.
22. The system should be able to maintain real time inventory at the store and sub-store
level.
23. The system should be able to generate auto e-indenting and indentify the re-order level
at each store and sub-store.
24. The system should be able to generate auto procurement notice based on defined criteria
/ parameters.
25. The system should allow seamless flow of information / data throughout the modules
and sub-modules.
26. The system should assist in making auto maintenance calls / alerts, scheduled
maintenance and AMC / CMC, etc.
27. The system should have Pre defined forms with section marker, to allow auto population
of data in reports. Template based forms / sections / screens are proposed for easy
administration and usage.
28. The system should allow publishing of various reports on Web, after due authorization of
the concerned authority, for public consumption, along with key statistics.
29. The system should not allow selection of particular tests in case of breakdown of
equipments or non availability of tests. The system should track such incidents and make
it available on through the MIS and DSS for authorities to take corrective actions.
30. The services should be made available through Web Portal as well, after due registration
and authentication of the Internet Users. The final decision on the type of services to be
made available through Internet will be defined by HSHRC and the IA is expected to
implement the same accordingly.
31. The system should track and maintain the stock mentioned in Essential Drugs List,
especially at Pharmacy level.
32. The system should have configurable Store and Sub-Stores, with personalized dashboard
at each store level.
33. The system should have configurable MIS and DSS functionality at State, District as well
as Hospital Level, for administrators.
34. The system may also integrate with comprehensive BI tools for generating advanced
analytics / business intelligence reports and assist administrators in faster decision
making.
145
146
Supervisor
Helpdesk Executives
Hospital User
Patient
The services must be available in atleast two languages, viz. Hindi and English. A call at the
helpdesk will be defined as successful registration of the call and a complaint ticket is generated
in the system, or successful dissemination of information sought by a User. All calls will be
monitored as per the call logs generated from the system. It is also proposed that the issue /
complaint / Grievance statistics should be analyzed and also a knowledge base, based on
frequently asked questions to aid the users, should be created in the long run.
147
Note:
1. It is proposed that initially there will only be a Helpdesk counter at individual
Hospitals, with couple of parallel lines of Toll free number and an Operator. The
operator will be responsible for handling the calls, assisting the Patients who visit the
operator in person, providing general information on facilities, services, procedures,
timings etc., and recording the incidents / complaints / grievances in the system. Later
on, the entire system will matured to a centralized Helpdesk / Incident Management
centre.
2. The resources for IT support and the Helpdesk / Incident Management services may be
responsible for both and Facility Management as well, to optimize the deployed
manpower. However the IA need to ascertain the exact requirement and model of
operations for providing adequate support services for these two categories.
AREA
DH
Registration
2
3
4
Billing
Pharmacy
Laboratory
2
5
5
Breakup of DH
4 Main
Registration
1 Emergency
Registration
3- Laboratory
2- Phlebotomy
Printer
at DH
SDH
Printer
at SDH
CHC
Printer
at CHC
PHC
Printer
at PHC
2
3
2
1
3
2
1
1
148
OPD
23
6
7
8
9
Ward
OT
HR
Labour
Room
DMS/ Admin
Equip Store
Blood Bank
Admission
Counter
10
3
1
2
10
11
12
13
2- Medicine
2- Surgery
3- OBG
2- Paediatrics
1- Psychiatry
2- Emergency
2- Eye
2- ENT
2- Ortho
2- Skin
2- Dental
1- AYUSH
1
1
3
1
2
2
64
4
2
1
1
2
1
1
1
1
1
2
1
1
1
15
30
1
1
2
1
1
21
Quantity
Compliance (Y/N)
Remarks
Server(s)
Desktops
64
Multifunction Laser
Printers
15
Online UPS
Antivirus Clients for Client
desktop
149
Item Description
Quantity
Compliance (Y/N)
Remarks
Compliance (Y/N)
Remarks
LAN Setup
Site preparation with
passive and electrical
cabling, earthing, server
rack, AC 1.5 TN, Fire
extinguisher etc.
Redundant Broadband
connectivity
Quantity
Server(s)
Desktops
Multifunction Laser
Printers
30
7
Online UPS
Antivirus Clients for Client
desktop
LAN Setup
Site preparation with
passive and electrical
cabling, earthing
Redundant Broadband
connectivity
Haryana State Health Resource Centre confidential
150
Quantity
Compliance (Y/N)
Remarks
Compliance (Y/N)
Remarks
21
Online UPS
Antivirus Clients for Client
desktop
LAN Setup
Redundant Broadband
Connectivity
Quantity
Desktops
Online UPS
Antivirus Clients for Client
desktop
LAN Setup
Redundant Broadband
Connectivity
151
Annexure
List of FRUs
Sl.No.
District
Name of FRUs
Status
District Hospital
District Hospital
District Hospital
District Hospital
District Hospital
District Hospital
District Hospital
District Hospital
District Hospital
District Hospital
District Hospital
District Hospital
District Hospital
District Hospital
District Hospital
District Hospital
SDH
SDH
SDH
1
2
3
4
5
6
7
8
9
10
11
AMBALA
BHIWANI
FARIDABAD
FATEHABAD
GURGAON
HISAR
JHAJJAR
JIND
KAITHAL
KARNAL
KURUKSHETRA
12
MEWAT
13
14
15
16
MOHINDERGARH NNL
PALWAL
PANCHKULA
PANIPAT
GH Ambala City(DH)
GH Bhiwani DH
BK Hospital Faridabad(DH)
GH Fatehabad(DH)
GH Gurgaon DH
GH Hisar(DH)
GH Jhajjar DH
GH Jind(DH)
GH Kaithal
GH Karnal(DH)
GH Kurukshetra
AL Afia hospital Mandi
(DH)
GH narnaul DH
GH Palwal
GH Panchkula(DH)
GH Panipat(DH)
17
18
19
20
21
22
23
24
REWARI
ROHTAK
SIRSA
SONIPAT
YAMUNANAGAR
AMBALA
AMBALA
BHIWANI
GH Rewari(DH)
GH Rohtak (DH)
GH Sirsa
GH Sonipat (DH)
MLGH (DH)
SDH Ambala Cant
SDH Naraingarh
SDH Charkhi Dadri
District Hospital
District Hospital
District Hospital
District Hospital
District Hospital
152
25
26
27
28
29
30
31
32
33
34
35
FARIDABAD
FATEHABAD
HISAR
JHAJJAR
JIND
KARNAL
YAMUNANAGAR
JIND
KURUKSHETRA
PANCHKULA
PANIPAT
GH Ballabgarh SDH
SDH Tohana
36
37
38
ROHTAK
SIRSA
MOHINDERGARH NNL
CHC Meham
CHC Dabwali
SDH Mahendragarh
39
FARIDABAD
FRU I
FARIDABAD
FRU II
40
41-44
44-53
54
55
4 MEDICAL COLLEGE
PANCHKULA
PANCHKULA
GURGAON
GH Hansi(SDH)
GH Bahadurgarh SDH
SDH Narwana
Nilokheri CHC-Cum SDH
SDH Jagadhri
CHC Safidon
CHC Shahbad
CHC Kalka
CHC Samalkha
10 PHC
CHC Raipur Rani
Sector 10 Hospital
SDH
SDH
SDH
SDH
SDH
SDH
SDH
CHC
CHC
CHC
CHC
CHC
CHC
CHC
Urban FRUs at
Faridabad
Urban FRUs at
Faridabad
4 Medical Colleges
10 PHC
CHC Raipur Rani
153
2. CT Scan: 10
3. MRI: 30
4. Ultra Sound: 70
154
155