Since last week, Bengalureans have been bombarded with news that BBMP’s COVID bed allocation software has major glitches, leading to corruption in allotment. Even before MP Tejasvi Surya came out with allegations of corruption, the BBMP had appointed a three-member committee on May 3, to study how the bed allotment system can be made “transparent and robust”.
The committee comprised of:
- V Ponnuraj, nodal officer for the state COVID war room
- Kumar Pushkar, nodal officer for CHBMS (Central Hospital Bed Management System)
- Vipin Singh, nodal officer for 1912 helpline
The committee submitted its report to BBMP Chief Commissioner Gaurav Gupta on May 7. Meanwhile, Tejasvi Surya came out with allegations that over 4000 COVID beds in Bengaluru had been sold instead of being allotted through the CHBMS. Surya said the zonal war rooms (which are in charge of bed allotment), booked beds in the name of COVID patients who didn’t actually need the beds, and later manually unblocked the beds and allotted them to someone else for a price. While the MP went ahead with his own efforts to plug loopholes in the bed allocation software, the official BBMP-appointed committee submitted detailed suggestions to fix the system.
Read more: Do Bengaluru’s COVID helplines help?
The committee’s report makes a caveat that it was prepared based on a quick analysis, to tackle only the issues reported so far. Since Karnataka is in the peak of COVID second wave, it may not be possible to make major changes in the system now, so such changes have not been recommended, says the report.
As per the report, accessed from the BBMP, following are its key recommendations to improve the system.
Controlling access to CHBMS
- Currently, BBMP’s zonal war rooms allot beds when they get requests from patients through helplines. Zonal war rooms have doctors who triage patients (determine priority of treatment based on patient’s condition) and decide on bed allocation accordingly. The report recommends giving CHBMS access to only these doctors, so as to prevent misuse by unauthorised persons. (A major allegation about CHBMS was that the bed allotment was being done by unauthorised operators in the war room, or even those outside.) Besides, each authorised user should have a unique User ID with two-factor authentication (OTP being the second factor). Captcha should be implemented at login.
- The computers that will be used by the authorised personnel should be whitelisted, and CHBMS access will be given only to those computers.
- A security audit of the CHBMS software should be done immediately, with the support of the e-Governance department.
Improving bed allocation
- For bed allotment, zonal war room should give preference to hospitals in the same zone. If a hospital outside the zone is preferred, the reason should be recorded in CHBMS.
- Currently CHBMS does not create a wait list of patients who request beds. Allocation happens such that, if a bed happens to be available at the time a person calls the helpline, it will be given to them. The committee recommends that, if beds are unavailable, a wait-list of patients should be created for different types of beds. BBMP’s public portal should display the wait-list under the four categories of beds (general, HDU/high-flow oxygen, ICU, ICU with ventilator), zone-wise. Bed allotment to these patients should be done by the central BBMP war room, and not the zonal war rooms. This is because, instead of fragmented zonal wait-lists, there will be a single wait-list centrally. Given that the condition of patients in wait-lists could change rapidly, doctors at the central war room will call these patients and allot beds depending on their health condition at the time. The report, however, says protocols should be created on allotment to wait-list patients (for example, whether a patient in more critical condition should be given preference over someone earlier in the queue).
- Once a patient gets a bed, they should be alerted through system-generated SMS and IVRS system. (As per Tejasvi’s allegations, beds were fraudulently booked under the names of patients who didn’t need it.)
- In the current system, a booked bed becomes automatically unblocked if the patient doesn’t get admitted within 10 hours of booking. The report says the system shows an unusually large number of such auto-unblocks because of patients not taking admission. So the 10-hour window should be reduced to six hours. This window can be further reduced after analysing data.
- Also, in case of beds that get auto-unblocked due to lack of hospital admission, these should get re-allocated to the patients in the wait-list.
- In the Index app (which collects data of all COVID-positive persons), patient record would be bucketed in various categories based on their health condition and requirements (bed, home isolation, medicines, etc). CHBMS can only allot beds to patient records in the two buckets CPT1 and CPT2.
- Bed blocking should not be allowed for
- BU numbers generated more than 10 days back, since these patients are likely to have recovered already. If patients in this category request beds, only the central war room should triage, verify and allot beds to them.
- Patient records in the CPT3 to CPT9 buckets. These records should first be transferred to CPT1 or CPT2 buckets, and only then beds can be allotted.
- Manual unblocking of beds should not be allowed in the system. Under special circumstances, central war room can unblock a bed, after recording the reason in the system.
- A bed can’t be blocked for a person more than once. It’s allowed only if upgradation of the bed is suggested during triage or by the hospital during treatment, or if the hospital denies the patient the blocked bed. In such cases, auto re-blocking of a new bed should be done and the patient informed immediately. (The current system doesn’t easily allow upgradation of bed – from general to ICU bed, for example – or moving the patient to another hospital, like in the case below.)
- A public dashboard should be created on the BBMP website to display reports on bed management, including the number of beds available, blocked, unblocked, admissions and discharges, and the daily waiting list for each bed type. The reports should be almost real-time, or updated every two hours or so.
- There should be a separate helpline for CHBMS.
- Generating daily reports for senior BBMP officers at the zonal and head office level. Zonal Commissioners can be given ‘read-only’ login access to CHBMS app, for monitoring.
- Use data analytics to improve monitoring, with the assistance of e-Governance Department
- Take up data reconciliation to identify discrepancies in the data in different applications like CHBMS, SAST (used by hospitals to enter data of admissions and discharges) and Index.
- While triaging is being done over the phone now, physical triaging can be done at the zonal/ward/CCC (COVID Care Centre) level.
- Central/zonal war rooms should be supervised, preferably by a KAS officer. This officer should ensure due process is followed in bed blocking, and collect signed documents from each CHBMS user on the activities they have done each day.
- Arogyamithras have been appointed in hospitals to enter real-time data on admissions and discharges in the SAST portal. The report recommends that enough number of Arogyamitras be recruited and deployed at all hospitals. They can validate the admission and discharge data of patients entered into SAST through Aadhar-based punching-in system. (There have been cases of beds being booked in one patient’s name, but admission done of another patient, which could be avoided through this system.)
- The hospital official should submit a daily report on admissions and discharges through the Quarantine Watch (QW) app, which should be analysed daily by SAST and BBMP war room. Nurses on duty should also use QW app to report patient status.
- Hospitals can upgrade and downgrade beds for patients based on doctors’ recommendations, and records of this should be submitted daily. Currently upgrades are happening, but downgrades are negligible and all patients are not discharged on time. Hence:
- Vital parameters of patients not downgraded from HDU/ICU/ICU-ventilator beds after five days of admission should be reported by the hospital using QW app. After seven days of admission, the hospital should also upload supporting documents once every two days. Hospital should do similar reporting for patients in any category, who are not discharged after seven days of admission. These reports can be scrutinised by a team of retired doctors or doctors who can be hired on contract by SAST/BBMP.
- Hospitals should tie up with nearby hotels, and use these as step-down hospitals or DCHCs (Dedicated COVID Health Centres)
- BBMP IT Cell should also involve in CHBMS software management, and should submit regular reports.
The report recommends that, in future, a single app should be developed for COVID management to replace the multitude of apps currently. A competent IT agency should develop this software, and it should be designed such that other districts can also use it.