Last week, MP Tejasvi Surya caused a furore when he made allegations of corruption in the allotment of hospital beds to COVID patients. Even before Surya made the allegations, the BBMP, on May 3, had appointed a three-member committee to study and recommend changes in the CHBMS (Central Hospital Bed Management System). The committee was to plug loopholes in the CHBMS software that allowed for its misuse. On May 7, the committee submitted its 33-point recommendations; the very next day, BBMP passed an order specifying the timeline for implementing each of those.
Meanwhile, there have been other efforts – side by side — to improve the software. They also caused confusion as to which of them is official and whose improvements will eventually reflect in the software. Tejasvi Surya is apparently working with a team from Infosys Foundation, while urban expert R K Misra is working with another team of developers.
Currently three apps are involved with bed blocking:
- Index app – which has data of all patients, and categorises them in different buckets – CPT 1 to CPT9 – based on their requirements (home isolation, beds, medicines, etc)
- CHBMS app – which is used by zonal war rooms to book beds
- SAST app – used by hospitals to enter data of admissions and discharges in real-time
In this interview with Citizen Matters, D Randeep, Special Commissioner for CHBMS, clears the air.
He explains that BBMP has a mandate to implement all the 33 recommendations made by the official committee, and that Surya and Misra are supporting BBMP to implement only two of the recommendations. He also reveals the timeline for fixing the current glitches, and explains why a total revamp of the software is planned in the future.
Edited excerpts of the interview:
There were 33 points in the committee report to reform CHBMS. Is there a final decision on which points will be implemented?
All the points in the committee report have to be implemented. There’s no choice. Sooner or later we have to do all. Some timelines have also been fixed. Some we have already completed – like sending SMS to the patient [upon bed blocking], removing manual bed unblock facility by the zonal war room, ensuring a timeline of six hours for a bed to be auto-unblocked [in cases where the patient blocks a bed but doesn’t occupy it].
We have also implemented the reporting system – every evening, we [Randeep and CHBMS nodal officer Kumar Pushkar] can see how many beds are blocked in which zones, who has used their discretionary power to shift the patient to another hospital, etc. Zonal war rooms are now headed by senior KAS officers. These reports are going to be made available to them also.
Also earlier, the records of all patients used to be there in the bed-blocking portal. Now, only the records of those patients certified as fit for hospitalisation in the Index app (those in CPT1 and 2 buckets) will flow into the bed blocking portal. Patients in other categories have to be shifted to CPT1/2; so that creates a trail as to who has done what, and thereafter in CHBMS the bed will be allocated.
For example, if someone calls up and says they need a hospital, and if the Index app shows they are still in the home-isolation bucket, those in the war room have to ascertain why they were categorised so and what has happened. If the patient says their symptoms have aggravated, then quickly their category will be changed to CPT1, and then bed can be blocked. So you no longer will have a complaint that someone who was designated for home isolation or somebody who was in a private hospital has been shifted.
These we have done, and there are two prominent things we are yet to do – public portal [showing real-time bed availability] and queue system [patients in wait-list for beds]. There, some external resources are also helping us. So within the next 3 days, we should be in a position to roll out these.
There are multiple efforts happening now – MP Tejasvi Surya and R K Misra have been saying that they have teams working on this issue. So, are those unofficial initiatives? Is what you’re taking up now, the official initiative?
We have brought all these on the same platform. Mr Misra as well as the MP’s office has a couple of resources. So it basically boils down to two organisations, one is Infosys and the other is EGovernance Foundation. (RK Misra had written a letter to us saying that they are willing to offer their services. So, we took them on board.)
They have given us some external tech resources, and we are actively involving them in developing the concept and modules. Finally it will be delivered on CHBMS by the in-house team. However the external resources are helping us build the queuing logic [for the patient wait-list system] and helping design the user interface for the public portal. So we are actively collaborating with them. But finally it is the internal CHBMS tech resource as well as the state war room tech resource who will get this done.
There is no conflict because of multiple teams working on this?
There is no conflict at all because we are all on the same page, we are on a common Whatsapp group, and on alternate days the teams converge. We have also clearly told them that certain things have already taken place, like the internal dashboard and the reporting system. We told them ‘don’t waste your time on that because that’s something the state war room tech resource has already delivered on; so rather than reinventing the wheel, focus on the two other issues – public portal and queuing system’. And there they are actively engaging with us.
And this is something that they develop. We adopt and run it on our own CHBMS portal. They move on. So it’s not that it will be hosted on a private server.
What is the timeline for implementing all of the committee recommendations?
There are various timelines. Some are for 13th May, 15th May, 20th May. All in all, the upper time limit would be 20-22 May, to completely ensure that all are implemented. One recommendation was that Aadhar-based biometric entries should be used [to update hospital admission/discharge data in SAST portal]. So in some cases Aadhar biometric devices have to be procured and integrated.
So some recommendations will take about a week to 10 days’ time. But nothing will go on beyond May 20-22 is my sense. There is an order issued on the timelines.
Following are the timelines for some major recommendations. To see the timeline for all recommendations, check this BBMP order copy.
|Recommendation||Timeline for implementation|
|1) Controlling access to CHBMS (restricting access, creating unique user ID with two-factor authentication, white-listing computers that use CHBMS)|
2) Informing patient about bed allotment through SMS and IVRS
3) Auto-unblocking of a booked bed if the patient doesn’t get admitted in six hours
|1) A separate helpline for CHBMS, Generating daily reports for higher officials in BBMP|
2) Scrutinising if a patient is in hospital for too long, and moving them to stepdown hospitals/discharging them if needed
|1) Resolve data discrepancies across apps|
2) Giving preference to hospital in the same zone, for bed allotment
|1) Bed allocation only for patients categorised under CPT1 and 2 buckets|
2) Disallowing manual unblocking of bed except by central war room
3) Validating admission/discharge data of patients in SAST using Aadhar-based punching-in system
|1) Security audit of CHBMS app|
2) Creating wait list of patients for different category of beds
3) Restricting bed blocking for BU numbers generated over 10 days ago, or for the same person more than once
4) BBMP public portal to display real-time data of beds; public portal showing waitlisted patients
Were the current applications developed by the BBMP in-house team itself? Or was there external support?
CHBMS is a complete in-house system. Obviously, the developers were from outside – Mcware Technologies, which has a back-end team in Bijapur and have resources in Bengaluru also.
But the software was conceptualised and designed in-house, because obviously no one from outside can come and do it for us. It was not a ready made plug-and-play software which was available. It was developed on the go.
Wave 1 and 2 are different, so a lot of change requests keep coming. So we needed an in-house team which can keep conceptualising things, and thereafter the company will bring in the changes. Tushar Girinath had headed that committee last time, now it is Mr Kumar Pushkar.
So we had to really think through the workflow, down to how a bed should be blocked, etc. We had the additional challenge of integrating this with the SAST portal. Unlike other cities where the same portal is used by the bed blockers as well as the hospital, here the bed blockers use CHBMS and hospitals use SAST portal. So there was one level of integration again which had to take place between the two.
And on the other end, we had to integrate the Index app with the state war room, ICMR and the bed portal. So the bed portal is basically a sandwiched app [sandwiched between Index and SAST apps] in that sense. So that’s what makes it unique and it’s not really easy to adopt any other plug-and-play model to replace this one.
Now there are multiple apps – SAST, CHBMS, Index. The committee has recommended that these apps should be integrated in the future. There was another discussion about adopting the Cochin model, which is on similar lines. So is there a plan to implement this?
That’s a complete ERP solution. Obviously both systems cannot run simultaneously. We have to transition towards that. That per se, is not under our ambit right now, because in the middle of the second wave we don’t want to switch the system and create chaos. So in the medium term, surely yes, there would be a team working on that. As and when it’s appropriate, we will switch over after doing the test runs. But nothing in the short term.
If the current system of multiple apps is complicated, why was it originally designed so?
The way it was designed is, the bed blocking portal was designed to be kept separate. The advantage in Bengaluru, because we have multiple systems, is that you can see the entire journey of the patient (right from his lab test report coming into the ICMR portal, to him categorised as a patient in Index, to his bed being blocked, and then him being admitted as a patient in SAST). I don’t know how many other cities have it.
So you can see the entire journey of the patient, and these 4-5 apps are tightly integrated with APIs. There are no loose ends. It’s not that you’ll find a person in one app who’s not in the other. There is minimal chance that a record will get missed out or lost. We used to have these problems earlier in the first wave. But now there is absolutely no issues in terms of integration of these apps.
What’s the rationale behind now trying to bring them all under one platform?
Rationale is that it’s easy to administer and monitor. If the platform is common, there is seamless flow of information. And any change request comes, we don’t have to develop APIs every time. Now for any small change request, we need to change in Index, and then again in CHBMS and SAST. So the modifications and changes can be seamlessly done if it is in one platform. However, in terms of functioning, there is absolutely no issues right now. That’s only a desirable aspect; Not being on the same platform doesn’t stop the show.