Transforming Healthcare Through Integrated IT Solutions.
Through Integrated IT Solutions.
Claim & Assurance Management System
Healthcare monitoring systems streamline the medical claims process, enhancing the relationship between healthcare providers and government while expediting patient treatment cycles efficiently. These solutions utilize automation features to enable hospitals and clinics to address or preempt any issues that could disrupt claims processing and billing workflows. The goal of health schemes is to implement a robust online Management Information System (MIS) and Decision Support System (DSS) for Government Plan Schemes. This system tracks fund disbursement from the Government to the final beneficiary under plan schemes and provides real-time utilization reports at various implementation levels. A centralized claim and assurance management system is crucial for providing comprehensive details on Ministry-wise, Scheme-wise, State-wise, and Agency-wise sanction issuances and releases, whether through Treasury or Special Purpose Vehicle routes.
Challenges in administering health insurance schemes can be daunting due to the diverse population, geographic spread, and varying health awareness levels. India’s healthcare system, comprising public and private providers, relies heavily on insurance schemes to offer financial protection and healthcare access.
Key challenges include:
✅ Lack of Awareness: Many people lack understanding of insurance products, available policies, and how to select appropriate coverage for their needs.
✅ Cost of Healthcare Services: With increasing demand, technological advancements, and an aging population, healthcare costs are rising. This contributes to higher insurance premiums and limited coverage options.
✅ Fraud and Abuse: Instances of healthcare providers overcharging, prescribing unnecessary treatments, and inflating bills have resulted in increased insurance claims. This has prompted insurers to tighten policy terms, sometimes leading to legitimate claims being denied.
✅ Implementation and Management: Absence of a centralized system for data management, claims processing, and grievance resolution causes inefficiencies and delays. Government-sponsored schemes often face underfunding, lack of infrastructure, and insufficient trained personnel, impacting the quality of healthcare services delivered.
Addressing these challenges requires comprehensive strategies to enhance public awareness, regulate healthcare costs, combat fraud, and improve the efficiency of insurance scheme administration through robust systems and infrastructure.
The need for health schemes includes:
✅ Providing equitable access to high-quality healthcare services for all demographics.
✅ Ensuring universal access to healthcare at affordable costs.
✅ Enhancing treatment accessibility, reducing healthcare expenses, and improving service quality.
✅ Targeting a 25% reduction in premature mortality from major non-communicable diseases by 2025.
✅ Emphasizing sustainable development and setting clear, measurable goals.
✅ Enhancing overall health outcomes through comprehensive health promotion, palliative care, and rehabilitation services across India.
Features of the system include:
✅ Transaction Management System (TMS): Captures beneficiary information, manages package blocking/unblocking, and stores discharge summaries.
✅ Package Management: Allows administrators to add, modify, and update packages within the system.
✅ Pre-Authorization Management: Manages the pre-authorization process for high-cost packages and other approvals requested through TMS.
✅ Hospital Empanelment System: Enables hospitals to apply for empanelment under the BSKY scheme by submitting required information, with approvals leading to empanelment.
✅ Claim Management System: Facilitates hospitals in raising and tracking claims post patient discharge.
✅ Mobile Application: Used by State Nodal Authority (SNA) doctors for claim approvals, and by frontline facilitators for hospital feedback collection and inspections.
✅ Chatbot: Provides instant assistance to beneficiaries and stakeholders to check query status and answer frequently asked questions.
✅ Grievance Management: Automates handling of grievances and complaints from beneficiaries and hospitals.
✅ Analytical Dashboard: Generates graphical reports across different modules, offering statistical insights crucial for monitoring and decision-making.
Benefits of the system include:
✅ Professionalism and Ethics: Promotes transparency and sustainability in healthcare schemes.
✅ Equity: Aims to reduce disparities based on caste, gender, disability, poverty, and other social factors, focusing on citizens below the poverty line (BPL).
✅ Affordability: Seeks to make healthcare services and medicines more affordable, addressing disparities in social, economic, and health status.
✅ Quality of Care: Ensures safe, gender-sensitive, and confidential healthcare services, aiming to eliminate corruption in both private and public healthcare sectors.
✅ Collaboration: Embraces a multi-stakeholder approach by partnering with health ministries, communities, educational institutions, and non-profit organizations.
Community Health Worker System
A knowledgeable, skilled, and motivated community health workforce is crucial for effective universal health coverage. These workers play a vital role in bridging the gap between communities and formal healthcare systems. They promote community ownership of service delivery efficacy and contribute significantly to achieving health outcomes.
However, countries worldwide face diverse challenges with their health workforce, including issues in education, training, deployment, performance, and retention. There are also disparities in infrastructure and capacity, which result in fragmented information across institutions. In the midst of these challenges, the evolution of future health and social protection systems requires innovative responses to enhance efficiency and outcomes. Effecting responsible change in any country hinges on having reliable, comprehensive, and high-quality health workforce data.
Here are the key features of the system:
✅ Workforce Registry: Offers a comprehensive view of the workforce, including geographic and demographic distribution, institutional sector, and types of facilities.
✅ Citizen Mapping: Enables registration of citizens, focusing on pregnant women, children, and senior citizens attended by health workers.
✅ Service Delivery Tracker: Facilitates recording details of health services provided to citizens, such as immunization, medical supply distribution, family planning counseling, and treatment of minor injuries.
✅ Alerts on Milestones: Notifies health workers about upcoming dates for delivering health services according to a strict schedule for each registered citizen.
✅ Communication: Allows health workers to report field issues like medical supply shortages or disease outbreaks to the health system.
✅ Education and Training: Supports the distribution of supplementary training materials and conducts assessments for capacity building.
Drug Distribution & Supply Chain System
The modern pharmaceutical supply chain is intricate. Globalization and relaxed FDI norms in emerging economies, particularly in Asia, have made it a hub for pharmaceutical manufacturing. Today, medicines are produced using ingredients sourced from various countries. The final product undergoes multiple packaging and distribution stages, crossing multiple borders and changing hands numerous times before reaching the patient. This complexity increases the risk of falsified or substandard products entering the market. The involvement of multiple stakeholders—including pharmaceutical manufacturers, wholesalers, distributors, customers, information service providers, and regulatory agencies—adds further layers of complexity to the supply chain process.
Traditionally, the process is handled manually, facing several challenges:
✅ Inadequate tracking and monitoring of drug indents
✅ Lack of a unified platform for suppliers and drug distributors
✅ Data vulnerability due to physical record-keeping
✅ Time-consuming procedures prone to inaccuracies from manual data entry
✅ Absence of a digital payment gateway
✅ Lack of real-time stock availability information
The key features of this solution include:
✅ Profiling all drug suppliers and equipment manufacturers
✅ Managing drug and equipment procurement
✅ Generating Purchase Orders based on tenders or rate contracts
✅ Automating inventory and distribution management and indent generation
✅ Rating suppliers and quality testing labs
✅ Automatically calculating and disbursing payments to suppliers and labs
✅ Managing stock distribution based on the First Expiry First Out (FEFO) principle
✅ Generating various analytical reports for strategic decision-making
Hospital Administration Management System
Hospitals play a vital role in providing medical care to individuals facing various health challenges, often influenced by factors like climate changes, increased workload, emotional stress, and more. As the majority of people increasingly depend on hospital services, it’s crucial for hospitals to efficiently monitor their daily operations and maintain comprehensive records of patients, doctors, nurses, ward staff, and other personnel. Operational staff and healthcare providers must collect and manage a wealth of information critical for delivering effective healthcare.
Traditionally, patient information gathering involves manually recording basic details such as the patient’s name, age, and gender. Bills are generated separately for each service provided to a patient on individual sheets, which are then totaled at the end. Diagnosis information is typically noted alongside the patient’s details and often discarded later to reduce paperwork. Immunization records for children are kept in separate files. Past medical history of patients is seldom documented or retrieved, usually relying on doctors’ memory or patients’ reminders.
Elhunt’s Hospital Administration Management System provides the following functionalities:
✅ Patient Registration: Captures essential patient information with customizable fields for priority setting.
✅ Help Desk Management: Manages the availability of hospital services.
✅ Pathology Lab: Tracks samples, analyzes test results, and maintains patient pathology records.
✅ Doctors Module: Tracks doctor details, patient schedules, prescriptions, medical records, medication availability, and treatment plans.
✅ HR Management: Records employee activities, creates rosters, manages payroll, tracks attendance, and leaves.
✅ Operating Theatre (OT): Manages operation schedules, entry-exit times, and assessment forms.
✅ Nursing Management: Tracks ward-wise nurses, bed availability, medicine requisitions, and progress reports.
✅ Outpatient Department (OPD) Billing: Manages billing for consultation, pathology, radiology, procedures, health packages, and other services.
✅ Pharmacy Management: Tracks items, purchase orders, vendor payments, stock availability, sales reports, and other assets.
✅ Blood Bank Management: Registers donors, collects and issues blood, and manages blood bank operations.
✅ Bed Management: Allocates beds department-wise for patients.
✅ Ambulance Tracking: Monitors ambulance movements and driver details.
✅ Public Portal: Provides patient access to hospital information, doctor availability, appointment booking, and other services.
✅ MIS Reports: Generates query-based dynamic reports for quick analysis.
✅ Dashboard: Provides an overview of all system modules with authorized access for strategic decision-making.
Scheme Monitoring System
Universal health coverage (UHC) is the goal of national healthcare systems worldwide, aiming to ensure that all individuals can access the full spectrum of health services—from promotive and preventive care to curative, rehabilitative, and palliative services—of adequate quality to be effective. Importantly, UHC aims to achieve this without financial hardship for the user. It is not only a human rights imperative but also expected to enhance health outcomes, boost productivity, prevent impoverishment due to healthcare costs, and reduce social disparities. While the goal may seem ambitious, notable progress has been made in achieving UHC in low- and middle-income countries like Rwanda, Kyrgyz Republic, and Thailand, demonstrating its feasibility.
Developing nations in Africa and Asia encounter common challenges in implementing health programs and are striving to achieve significant milestones in the Sustainable Development Goals. These challenges include the inability of healthcare systems to reach remote areas, rising rates of non-communicable diseases requiring costly treatments, a growing uninsured population, political and economic instability, escalating budget deficits, and mounting pressure to lower healthcare expenditures. Consequently, effective monitoring and evaluation of schemes have become crucial for ensuring sound strategic planning and successful implementation.
Key Features of the Scheme Monitoring System include:
✅ Beneficiary Registration:
– Authentication and generation of Unique IDs for beneficiaries
– Evaluation of eligibility criteria based on scheme requirements
– Digitization of medical records for streamlined access and management
✅ Hospital Registration:
– Mapping hospital infrastructure capabilities
– Empanelment of hospitals based on readiness and healthcare demand in their respective catchment areas
✅ Treatment Packages:
– Custom creation of treatment packages tailored to the diagnosis found in patient medical records
✅ Claim Processing:
– Online submission of claims by healthcare providers
– Automated workflows for efficient processing, sanctioning, and online disbursement of claims
✅ Grievance Management:
– Ticketing system for registering and managing grievances raised by citizens
– Auto-escalation of grievances to ensure timely resolution and accountability
✅ Decision Support System:
– Advanced analytics and comprehensive reports on:
– Performance metrics of hospitals and insurance providers
– Deployment and utilization of funds under the scheme at district, block, and ward levels
These features collectively enhance the transparency, efficiency, and accountability of healthcare delivery under the scheme, ensuring optimal utilization of resources and improved service delivery to beneficiaries.