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HOSMAC FOUNDATION

HOSMAC Pulse Vol. 1 No. 6 July, 2011

Head Office 120, Udyog Bhavan, Sonawala Lane, Goregaon East, Mumbai - 400 063, Maharashtra Tel : +91 22 6723 7000, Fax: +91 22 2686 3465

IT in Healthcare

Middle East Region HOSMAC Middle East FZ LLC PO Box # 505064, DHCC, Dubai, UAE Tel : +9714 4298345

North Region 1016, Galleria DLF City, Phase IV, Gurgaon - 122 002, Haryana Tel : +91 124 4235 967

South Region 95, Sai Dham, 4th Main HAL (2nd Stage), Kodihalli, Bengaluru - 560 008, Karnataka Tel: +91 80 2521 3486

East Region 5B, BB-99, VIP Park, Prafulla Kanan, Kolkatta - 700 101, West Bengal Tel : +91 33 6455 1246

North East Region Eureka Tower, 1st Floor, Near Chandmari Flyover, Uturn, Guwahati - 781003, Assam Tel: +91 361 2130911

w w w. h o s m a c f o u n d a t i o n . o r g

Metrics That Ma er Pg. 27

Cover Story Pg. 11

HOSMAC FOUNDATION

HOSMAC Pulse Vol. 1 No. 6 July, 2011

Head Office 120, Udyog Bhavan, Sonawala Lane, Goregaon East, Mumbai - 400 063, Maharashtra Tel : +91 22 6723 7000, Fax: +91 22 2686 3465

IT in Healthcare

Middle East Region HOSMAC Middle East FZ LLC PO Box # 505064, DHCC, Dubai, UAE Tel : +9714 4298345

North Region 1016, Galleria DLF City, Phase IV, Gurgaon - 122 002, Haryana Tel : +91 124 4235 967

South Region 95, Sai Dham, 4th Main HAL (2nd Stage), Kodihalli, Bengaluru - 560 008, Karnataka Tel: +91 80 2521 3486

East Region 5B, BB-99, VIP Park, Prafulla Kanan, Kolkatta - 700 101, West Bengal Tel : +91 33 6455 1246

North East Region Eureka Tower, 1st Floor, Near Chandmari Flyover, Uturn, Guwahati - 781003, Assam Tel: +91 361 2130911

w w w. h o s m a c f o u n d a t i o n . o r g

Metrics That Ma er Pg. 27

Cover Story Pg. 11

Editorial Board

Table Of Content A New Value Proposi on

Infusing Eﬃciency into Healthcare

Integra ng Medical Technology with Healthcare

Cover Story – IT in Healthcare

Reﬂec ons on Architectural Design

vinay.pagarani@hosmacfounda on.org

Collaborate, Adapt and Operate Be er

Advisory Panel

Pa ent Experience Portal

NextGen Healthcare

Meliora ng Hospital Eﬃciencies

Metrics That Ma er

Litmus Test of IT

Perfec ng Healthcare Since 15 Years

Quan fying the Quality of Care

Editor-in-Chief Dr. Vivek Desai vivek.desai@hosmac.com

Associate Editors Jonathan Fernandes jonathan.fernandes@hosmac.com Vinay Pagarani

Narendra Karkera narendra.karkera@hosmac.com Isha Khanolkar isha.khanolkar@hosmac.com Vishal Dhangar vishal.dhangar@hosmac.com

Crea ve Consultant Mohan Adep adepm@yahoo.com

Editorial Board

Table Of Content A New Value Proposi on

Infusing Eﬃciency into Healthcare

Integra ng Medical Technology with Healthcare

Cover Story – IT in Healthcare

Reﬂec ons on Architectural Design

vinay.pagarani@hosmacfounda on.org

Collaborate, Adapt and Operate Be er

Advisory Panel

Pa ent Experience Portal

NextGen Healthcare

Meliora ng Hospital Eﬃciencies

Metrics That Ma er

Litmus Test of IT

Perfec ng Healthcare Since 15 Years

Quan fying the Quality of Care

Editor-in-Chief Dr. Vivek Desai vivek.desai@hosmac.com

Associate Editors Jonathan Fernandes jonathan.fernandes@hosmac.com Vinay Pagarani

Narendra Karkera narendra.karkera@hosmac.com Isha Khanolkar isha.khanolkar@hosmac.com Vishal Dhangar vishal.dhangar@hosmac.com

Crea ve Consultant Mohan Adep adepm@yahoo.com

HOSMAC Pulse is an ini a ve of HOSMAC Founda on. High-quality standards have been maintained while preparing and presen ng the informa on in this periodical. However, no legal responsibility will be accepted by HOSMAC Founda on or HOSMAC India Pvt Ltd for any loss or damage resultant from its contents. The views expressed are solely that of the authors or writers, and do not necessarily represent the views of HOSMAC Founda on or its consultants in rela on to any par cular projects. No part of this periodical may be reproduced in any form without the wri en permission of HOSMAC Founda on â&#x20AC;&#x201C; the publisher.

Editor’s Note

Healthcare services in India are growing at a feverish pace. A sound informa on technology pla orm to integrate its various facets for smooth and seamless opera ons to serve the consumer is the need of the hour. Though India is known worldwide for its so ware development skills, we have not made much progress in the healthcare industry, since it remains out of focus of the IT majors. One of the reasons for this is that hospitals themselves believe that expending on IT upgrada on is wasteful and a financial burden. In reality, however, IT can make hospital opera ons more efficient and customer friendly, if used appropriately. They can add significantly to the bo om line. Tight monitoring of inventory at all levels and quick, error-free billing itself can bring in huge profits to a hospital. The main reason for this delay in adop ng technology is the me that it takes to plan, procure and implement a so ware solu on in a working hospital, and the accompanied resistance to change by the front-line users including doctors. Right from a small clinic to a large mul -specialty hospital, all require informa on technology interven on in some way or the other. Capex costs also are an issue which may be resolved by new innova ve “pay-per-use” model, now being promoted by major IT vendors like HP. Picture archival communica ons systems (PACS) and telemedicine solu ons are another two grossly underused technologies in countries like India, where the popula on is spread across large geographies and accessibility is a major concern. Even if you reach technology to remote areas, skilled manpower availability in these regions remain a major problem. Telemedicine can be a boon in such situa ons and its poten al should be fully tapped. With improvement in IT usage by the coming genera on of doctors and paramedicals, we are hopeful that the future will be much be er for IT implementa on in healthcare. Improved usage will also mean a robust informa on database for planners and health economists to strategize for future investments to be made in the healthcare domain, be it public or private. With this view in mind, the current issue of Hosmac Pulse is dedicated to 'Informa on Technology in Healthcare', where some of the best brains in the country have contributed to make you aware of the myriad possibili es of informa on technology applica ons in healthcare ins tu ons. I hope you will like the effort taken by the editorial team in colla ng and bringing forth this issue.

Improved usage will also mean a robust informa on database for planners and health economists to strategize for future investments to be made in the healthcare domain, be it public or private.

Dr. Vivek Desai Managing Director, Hosmac India Pvt. Ltd.

Editor’s Note

Improved usage will also mean a robust informa on database for planners and health economists to strategize for future investments to be made in the healthcare domain, be it public or private.

Dr. Vivek Desai Managing Director, Hosmac India Pvt. Ltd.

A New Value Proposi on Michael Sullivan, Solu on Vice President – Healthcare – Schneider Electric, shares insights on how hospitals can use the integra on of building automa on systems and informa on technology to achieve economic, opera onal, and energy eﬃciencies, while u lizing the latest advances in technology for pa ent care, safety, and sa sfac on.

Informa on technology (IT), building management systems (BMS), and other cri cal systems in hospitals are tradi onally built and implemented in independent silos by separate design teams, with separate objec ves. An IT infrastructure, for instance, is usually considered the sole responsibility of an IT technology company, while BMS solu ons are typically implemented by mechanical design organiza ons. This is also true for other infrastructures as well, such as security systems, which usually are built by electrical design firms. Hence, a very large and complex building such as a hospital includes not only many silos, but also separate project managers from different companies, with li le cohesive interac on. This tradi onal design and build approach o en overlooks the possible integra on between each of the systems in a hospital, resul ng in many redundancies, and, ul mately, wasted energy, produc vity, me, and financial resources. Integra ng the Silos As seen in Figure 1, the tradi onal siloed approach results in separate networks for BMS, video surveillance, access control, and ligh ng, as each is from a different vendor, with different monitoring and control so ware. Besides separate infrastructures for each of these networks, there is also kilometers and kilometers of redundant cabling, which is costly to install and expensive to house and maintain. Conversely, Figure 2 shows the advantages of improved system communica on and efficiencies that result from an intelligent hospital infrastructure. Every system in the hospital is now connected and communica ng with each other, from the security systems, intelligent ligh ng controls, life safety systems, medical areas, electrical power distribu on, and energy management

systems, to informa on technology, opera ng theatres, and data centers. Instead of demarca ons between each network, there is seamless integra on and full interoperability over an open protocol network.

Having a common network ensures flexibility and scalability, allowing for changes, as well as the integra on of emerging and future technology. It also provides a single point of monitoring, control, and maintenance, with fewer so ware programs to manage and troubleshoot. The Holis c Approach: One Point of Ownership In order to realize the efficiencies of an intelligent hospital infrastructure, hospitals are approaching the IT and BMS integra on in one of two ways. Many are issuing RFQs at the ini a on of the project with the specific requirement that IT and BMS vendors work together as a team. This is a good first step, but o en s ll there are redundancies, inefficiencies and conflicts of interest because there is no single source of leadership. The other approach, which world-class hospitals are adop ng, is the use of a single project management team who has extensive experience in the integra on and op miza on of healthcare facility infrastructures. When there is a single leadership team that is knowledgeable in hospital design and construc on, there is a holis c point of ownership and integra on of all hospital systems throughout the en re construc on process, from design, construc on, and installed based services through to maintenance. Each vendor s ll provides their own specific area of exper se, but under the sole responsibility of one project management team. Communica on, processes, and system integra on are all streamlined so that the overall project is simplified, which in turn delivers a new hospital that is built on- me and on-budget. Benefits Throughtout the Hospital So, how can hospitals implement such an approach? And where do the real, measurable benefits of an intelligent hospital infrastructure show up on a daily basis? The following examples illustrate how the integra on of IT and BMS solu ons can work together to provide benefits for the en re hospital, from improved business performance and be er pa ent care, to increased opera onal and energy efficiencies. The energy efficiencies are of par cular importance in India, where green hospitals are being built in order to reduce energy usage. As discussed in the December 2010 issue of HOSMAC Pulse, hospitals that implement energy-saving measures can reduce energy usage by 15 to 46 percent, according to energy audits by India’s Bureau of Energy Efficiency and HOSMAC research.1 The Integrated Opera ng Theatre A hospital’s periopera ve services (from pre- to post-opera ve)

account for about 60 to 70 percent of its revenue, and approximately 35 to 40 percent of their costs.2 Opera ng theatres typically have the highest demands for room ven la on.3 In fact, a survey of five hospitals in India found that HVAC usage, which is responsible for air flow and quality, ranges from 30 to 65 percent of the electricity consump on in a hospital.4 By simply linking a BMS solu on to occupancy sensors and opera ng theatre surgery scheduling so ware, hospitals can reduce energy usage through be er control of the air flow and quality within the opera ng room. This also improves the environment to meet regulatory mandates, and reduce the chances for healthcare-acquired infec ons. The integrated system is alerted as to when the opera ng theaters are in use. The system then automa cally increases the frequency of air changes and also sets proper thermostat and humidity set points. Conversely, the air change rate decreases when the room is empty, as does the temperature and humidity. The chart here, based on one opera ng room in a typical US hospital, shows the significant financial impact that can be achieved. These savings can be mul plied many mes over in larger hospitals with several opera ng theatres. Exact savings will vary based on regional energy costs and a hospital’s usage. For instance, in India, the Na onal Building Code (2005) recommends 6-8 changes per hour in hospital wards, and 15-25 air changes per hour in sterilizing departments in hospitals.5 In new construc on, the project management team works to ensure that energy efficiency is built in from day one of hospital opera on, with poten al savings of up to 25 percent over tradi onally built hospitals.6 Pa ent Security and Staff Tracking Another example of where hospitals benefit from the integra on of IT and BMS infrastructures is with real- me loca on system (RTLS) technologies. By closely integra ng RTLS with access controls, IP security cameras and elevators, a hospital creates an intelligent security management system that can track pa ents, staff, medical equipment, and even pharmaceu cals. Many hospitals are implemen ng such systems in birthing centers and nurseries. By ou i ng newborns with ankle bracelets that use radio frequency iden fica on (RFID), a type of RTLS, security systems can track the loca on of new infants to prevent abduc on. In India, RFID can also be used for temporary access cards or ID bracelets that are issued to iden fy important (VVIP) pa ents and provide them access to special elevators and floors. These technologies also reduce the overall me it takes to locate staff and equipment. Intelligent rou ng of informa on directly to the appropriate staff via workflow so ware helps provide rapid responses to cri cal events and an overall increase in staff produc vity. Improved Pa ent Care

Studies have shown that pa ents that are comfortable and can control their own environment have shorter recovery mes. In addi on, communica on and entertainment systems also help create a sense of well-being within a healing environment and improve recovery. Ongoing Lifecycle Maintenance When designing a new hospital, it’s important to consider the future lifecycle of maintenance. Reac ve maintenance is costly and can present poten al danger to staff and pa ents. An intelligent hospital infrastructure provides opportuni es for predic ve maintenance. With centralized hospital system informa on, facility managers can easily see and address upcoming maintenance and resolve issues before they become dangerous or deplete the hospital’s ongoing opera ons budget. In addi on, planned maintenance can be priori zed and focused through a condi on-based opera ng model. Green Benefits of Integra ons Hospitals built with an intelligent infrastructure have an opportunity to increase their financial performance with other energy-saving measures besides the ones men oned here. For instance, when in-row cooling devices for IT servers are used in a hospital data center, there is as much as 30 percent energy savings. Integrated ligh ng control systems with low-consump on ligh ng can produce another 30 percent energy savings over tradi onal ligh ng systems. To Maximise Benefits, Start in Pre-design To op mize IT and BMS integra on into an intelligent hospital infrastructure, it’s key to establish a single point of project management ownership early on, op mally in the pre-design or func onal design stage. It’s in these early stages that hospitals can reap the greatest building benefits, from building performance to

The integra on of nurse call, life safety systems, and other aspects

machine, IT, building, and security services. This connects and

of pa ent care services provide medical staﬀ with a complete

enables communica on between all key areas of a hospital – from

picture of a pa ent’s environment. The amount of daylight, the

the electrical and HVAC rooms to the security oﬃcer’s desk,

acous cs, and the air quality in a pa ent’s room can be controlled,

opera ng theatre, pharmacy, and pa ent room.

monitored, and op mized through the integra on of the BMS with

Within the scope of a major hospital construc on project, the

a centralized dashboard in a nurse’s worksta on. Pa ents can also control their environment from their own interac ve room controls.

project management team may be led by a BMS company such as Schneider Electric. Early on, the BMS vendor assigns a hospital solu on architectural team to work closely with the building

cost savings. In this type of approach, there is integrated site supervision with

enterprise performance management for power, process and

designers to create a func onal specifica on that outlines the integra on and delivery of the intelligent hospital infrastructure and expected opera onal benefits. The project management team brings in vendors and technology providers to ensure that the technical specifica ons include the necessary capabili es to realize the integrated system. Throughout the en re construc on project, the management of the risk, which has been minimized by a single point of ownership, is transferred to the project management team for coordina on and effec ve management throughout the project. This reduces significant cost overruns and project delays. Both Capex and Opera on Benefits Because the integra on of IT and BMS solu ons is s ll evolving, there is not a lot of historical data as to the financial performance gains as a result of this approach. However, with a BMS solu on alone, hospitals can realize capex benefits during the construc on process due to a reduc on in

ini al investments and building costs, plus reduced risks of delays and easier work flow processes. Seventy-five percent of a building’s lifecycle costs come from ongoing opera ons. It’s vitally important, therefore, that hospitals build in energy efficiency to combat what is predicted to be a 25% global increase in energy costs, or possibly even higher in India, over the next five years. By building in energy metering and monitoring into new construc on, hospitals can save as much as 30% in ongoing opera onal expenses through reduced energy usage and associated costs, as the examples here show. Understanding India’s Needs As seen here, the ght integra on between BMS, IT infrastructures, and other cri cal hospital systems can result in increased benefits through the whole hospital, with greater strides toward economic, opera onal, and energy efficiencies while improving pa ent care and safety. Companies with extensive experience in hospital construc on as well as others with building experience can help new hospitals realize these benefits today. The author offers 23 years of experience including helping hospitals and healthcare facili es improve their financial performance while improving pa ent safety and the environment of care. He began his career in the IT and automa on businesses and can be reached at michael.sullivan@us.schneider-electric.com. 1

Sullivan, Michael. Saving energy and lives. HOSMAC Pulse, December 2010 2 Randa, Kermit. Using IT to drive opera onal eﬃciency in the OR. Healthcare Financial Management, December 2010 3

Energy Eﬃciency in Hospitals – Best Prac ce Guide. USAID/India, ECO-III Project, Bureau of Energy Eﬃciency, India, February, 2009 4 Ibid 5 Ibid 6 Sullivan, Michael. Saving energy and lives. HOSMAC Pulse, December 2010

simultaneously increase produc vity and improve quality of care. Healthcare providers around the world are looking toward ICT to help them collaborate, improve pa ent experience and deliver be er outcomes. The shi to ‘informa on age healthcare’ (see diagram) has ﬁrmly taken root. The Role of Technology As they con nue to take charge of their health, pa ents in an increasingly connected world where people, devices and applica ons are becoming more integrated, are beginning to demand access to informa on any me, anywhere and on any device of their choice. Increasingly seeking greater transparency within the healthcare system, pa ents today look for informa on regarding early warning of their health condi on and demand a quick connect with their physician, from wherever they happen to

Infusing Eﬃciency into Healthcare Susheela Venkataraman, Managing Director – Internet Business Solu ons – CISCO, takes a prac cal approach to the applica on of informa on communica on and technology into healthcare, and reveals some fascina ng concepts that healthcare providers, big or small, should pay heed to.

Globally, changing lifestyles, increasing incidence of chronic diseases and the rise of new diseases is demanding the need for a specialized workforce to deliver healthcare services – o en across geographically dispersed areas. Simultaneously, there is also an increasing need for accessible, affordable, and responsive healthcare solu ons that meet specific, constantly changing medical and clinical needs of pa ents. For governments across the world, disease preven on is a huge priority. At the same me, there is a visible shi in the way healthcare is delivered, as pa ents are demanding greater par cipa on in the healthcare process. Informa on and communica ons technology (ICT) presents several possible solu ons to address the various challenges in healthcare delivery. There are several trends that any discussion on technology support for healthcare must take cognizance of. The move from ‘care’ to ‘health’ is increasing focus on early diagnosis and treatment as well as avoiding disease. Pa ents today seek modern prac ces which ins ll a sense of well-being by reducing hospital stay and helping to manage the health condi on from the comfort of their home. Both pa ents and their caregivers seek informa on about their condi on, treatment alterna ves and disease management, which would empower them to take charge of their health condi on. No longer are pa ents sa sfied with merely following the doctor’s prescrip on. Par cipa on in the process of ge ng well is seen as necessary, both by pa ents and doctors. Healthcare is becoming more experience-centric, making the ‘pa ent’ a ‘customer’ and their sa sfac on, a key success indicator. The health ecosystem is complex and involves the coming together

be. Preference for knowledge based treatment is resul ng from the ease of access to informa on, through social media tools like Facebook, Twi er, Wikis and Blogs, along with powerful search engines and video, which provide innova ve ways of gathering informa on, learning and sharing. It is not just pa ents; healthcare providers too stand to benefit from these tools. Today’s hospital staff, like the pa ent base they serve, are increasingly using Web 2.0 tools to stay connected with their peers, pa ents, families and friends. The ability to break through geographical and me boundaries means that health experts have a much larger, more global audience, whilst staff in the hospital can have access to global exper se. Use of always-on collabora on breaks down silos and improves communica on between departments and organiza ons, while rich media conferencing solu ons with web-based mee ng capabili es enhance learning. Enterprise-level interconnec vity helps provide be er care for pa ents, whether they are being treated at an urban emergency room or a rural doctor’s office. Integrated clinical systems, accoun ng, personnel, inventory and logis cs management systems support the core ac vi es of a hospital and help to drive greater efficiencies. The availability of hospital Informa on systems, medical records, imaging systems and technology tools for access is enabling care providers to overcome the limita ons of me and loca on and connect so that the required person can be reached wherever they are, whenever required. With integrated systems, caregivers can be alerted automa cally via sms or email, when lab results are available, whilst enabling the hospital to provide support services to in-home caregivers such as family members. Availability of dependable, standards based

of various stakeholders like public health organiza ons, private hospitals, clinicians, emergency/first responders, laboratories, pharmacies, social services, suppliers, insurers, home and caregivers – all of who must work collabora vely to meet the new expecta ons and needs of their pa ents. While collabora on as a way of working is not new to the health system, it is becoming more of an impera ve as the priori es of the industry, its customers and society change. Be er efficiencies and effec veness could be achieved only through closer collabora on within the ecosystem. Globally, the clinician-to-pa ent ra o is rather skewed, with very few qualified clinicians wan ng to work in remote and rural areas. At the same me, there are just not enough specialists available to deliver the level of care required. Therefore healthcare organiza ons today are looking for innova ve ways to Transformation from Industrial Age Medicine to Information Age Healthcare Informa on Age Healthcare

Industrial Age Medicine

Individual self -care

Person

Friends and family Community

Community networks

Primary

Professionals as facilitators

Secondary

Professionals as partners

Transforma on

Professionals as authori es

Ter ary

Service Delivery

•

Physical

•

Virtual

•

Centralized

•

Distributed

•

Fragmented

•

Integrated

Source: Adapted from Tom Ferguson, MD, in Healthcare Forum Journ al, Jan-Feb 1995 by Dr Jai Mohan www.mmaselangor.org/na onalhealthinforma cs.pps

devices that can be remotely read and interfaced to the various applica ons add to the speed and accuracy of diagnosis. Collabora on solu ons enable referring physicians to connect and share knowledge. Combined with video and voice interac on, e-learning and remote educa on makes it easy to share understanding and experience rapidly, as well as to undertake on-going skill upgrade and mentoring by senior professionals. Such programs help clinicians tap into experience, understand facts and gain knowledge which they can then use in their profession. The benefit of all this would ul mately flow to the pa ents. With the help of data mining tools, data generated and collected through an integrated health system can provide insights to policy makers as well as the en re healthcare ecosystem. In-built alerts coupled with workflows can make this massive data store ac onable by highligh ng excep ons and trends, and priori zing ac ons in a pointed and specific way. With remotely managed display systems, it is possible to broadcast to mul ple devices, taking into account differences in language, sensi vi es and literacy levels, thus enabling rapid and effec ve dissemina on of health informa on. ICT Adop on in India While the possibili es are immense, adop on of ICT in hospitals is easier described than achieved. Clearly, high-quality data is central. The focus must shi to s tching together all the informa on residing in several silos, to help people interact and work together closely. Applica on of technology helps to achieve the desired levels of efficiency and effec veness with the healthcare system. Quick adop on is the key to success and helps meet the expecta ons of current and new customers. With Electronic Health Records (EHR) at the centre, at a minimum, the integra on of PACS/RIS, HIS, lab and administra on systems, is required. This implies that open standards must be followed, not just within the boundaries of a single healthcare provider, but the en re eco-system. High quality infrastructure, focused on those in need, for the iden fica on of disease, and its containment must enable rapid dissemina on of informa on, provide for emergency response and empower pa ents and their families to take charge. Essen al to countries such as India, is an integrated health system, which addresses both the response and preven ve aspects of health. A good response system must allow for early detec on of health condi ons. With increasing emphasis being placed on preven on and health, there will have to be a radical change in processes so as to op mize delivery of services, avoid medical errors and control costs. These processes must be centered on pa ents, who play an ac ve role in deciding the most appropriate

course of ac on for them. Ongoing educa on must become an integral part of the agenda for the medical workforce. Healthcare organiza ons will need an integrated network to help various departments to collaborate, learn and communicate effec vely. Using collabora on solu ons to quickly gain access to people, resources and informa on while reducing the cost of care and me to treat, is helping to create an efficient system that contributes to be er health outcomes. As organiza ons align technology and opera onal needs to support and streamline informa on flows, the ability to combine or integrate all of them in a manner that is relevant to the specific situa on and issues to be addressed, would determine their successful adop on. In order to make all of this a reality, there is a pressing need to collect, record, tabulate and disseminate data related to pa ents, health condi ons and treatments, relevant to India. Going forward, as pa ent needs determine pathways through care, services would have to be provided in an integrated way whereby caregivers and pa ents connect, communicate and collaborate across boundaries of care and geography. Using technology to

share vital health informa on enables healthcare organiza ons worldwide to improve the safety, cost-eﬀec veness, and accessibility of care. Improving informa on and knowledge ﬂow helps to make healthcare more responsive and resilient because clinicians and the en re ecosystem spend more me on care outcomes. By embedding ICT into the way the healthcare ecosystem operates, the healthcare industry in India has the opportunity to leapfrog to ‘informa on age healthcare’, even as the industry grows and matures. The author has over 25 years of consul ng experience, including clients such as IBM and PricewaterhouseCoopers, to drive superior organisa onal performance. She may be contacted at sushvenk@cisco.com.

The integra on of nurse call, life safety systems, and other aspects

machine, IT, building, and security services. This connects and

of pa ent care services provide medical staﬀ with a complete

enables communica on between all key areas of a hospital – from

picture of a pa ent’s environment. The amount of daylight, the

the electrical and HVAC rooms to the security oﬃcer’s desk,

acous cs, and the air quality in a pa ent’s room can be controlled,

opera ng theatre, pharmacy, and pa ent room.

monitored, and op mized through the integra on of the BMS with

Within the scope of a major hospital construc on project, the

a centralized dashboard in a nurse’s worksta on. Pa ents can also control their environment from their own interac ve room controls.

project management team may be led by a BMS company such as Schneider Electric. Early on, the BMS vendor assigns a hospital solu on architectural team to work closely with the building

cost savings. In this type of approach, there is integrated site supervision with

enterprise performance management for power, process and

Sullivan, Michael. Saving energy and lives. HOSMAC Pulse, December 2010 2 Randa, Kermit. Using IT to drive opera onal eﬃciency in the OR. Healthcare Financial Management, December 2010 3

Industrial Age Medicine

Individual self -care

Person

Friends and family Community

Community networks

Primary

Professionals as facilitators

Secondary

Professionals as partners

Transforma on

Professionals as authori es

Ter ary

Service Delivery

•

Physical

•

Virtual

•

Centralized

•

Distributed

•

Fragmented

•

Integrated

Source: Adapted from Tom Ferguson, MD, in Healthcare Forum Journ al, Jan-Feb 1995 by Dr Jai Mohan www.mmaselangor.org/na onalhealthinforma cs.pps

The integra on of nurse call, life safety systems, and other aspects

machine, IT, building, and security services. This connects and

of pa ent care services provide medical staﬀ with a complete

enables communica on between all key areas of a hospital – from

picture of a pa ent’s environment. The amount of daylight, the

the electrical and HVAC rooms to the security oﬃcer’s desk,

acous cs, and the air quality in a pa ent’s room can be controlled,

opera ng theatre, pharmacy, and pa ent room.

monitored, and op mized through the integra on of the BMS with

Within the scope of a major hospital construc on project, the

a centralized dashboard in a nurse’s worksta on. Pa ents can also control their environment from their own interac ve room controls.

project management team may be led by a BMS company such as Schneider Electric. Early on, the BMS vendor assigns a hospital solu on architectural team to work closely with the building

cost savings. In this type of approach, there is integrated site supervision with

enterprise performance management for power, process and

Sullivan, Michael. Saving energy and lives. HOSMAC Pulse, December 2010 2 Randa, Kermit. Using IT to drive opera onal eﬃciency in the OR. Healthcare Financial Management, December 2010 3

Industrial Age Medicine

Individual self -care

Person

Friends and family Community

Community networks

Primary

Professionals as facilitators

Secondary

Professionals as partners

Transforma on

Professionals as authori es

Ter ary

Service Delivery

•

Physical

•

Virtual

•

Centralized

•

Distributed

•

Fragmented

•

Integrated

Source: Adapted from Tom Ferguson, MD, in Healthcare Forum Journ al, Jan-Feb 1995 by Dr Jai Mohan www.mmaselangor.org/na onalhealthinforma cs.pps

The integra on of nurse call, life safety systems, and other aspects

machine, IT, building, and security services. This connects and

of pa ent care services provide medical staﬀ with a complete

enables communica on between all key areas of a hospital – from

picture of a pa ent’s environment. The amount of daylight, the

the electrical and HVAC rooms to the security oﬃcer’s desk,

acous cs, and the air quality in a pa ent’s room can be controlled,

opera ng theatre, pharmacy, and pa ent room.

monitored, and op mized through the integra on of the BMS with

Within the scope of a major hospital construc on project, the

a centralized dashboard in a nurse’s worksta on. Pa ents can also control their environment from their own interac ve room controls.

project management team may be led by a BMS company such as Schneider Electric. Early on, the BMS vendor assigns a hospital solu on architectural team to work closely with the building

cost savings. In this type of approach, there is integrated site supervision with

enterprise performance management for power, process and

Sullivan, Michael. Saving energy and lives. HOSMAC Pulse, December 2010 2 Randa, Kermit. Using IT to drive opera onal eﬃciency in the OR. Healthcare Financial Management, December 2010 3

Industrial Age Medicine

Individual self -care

Person

Friends and family Community

Community networks

Primary

Professionals as facilitators

Secondary

Professionals as partners

Transforma on

Professionals as authori es

Ter ary

Service Delivery

•

Physical

•

Virtual

•

Centralized

•

Distributed

•

Fragmented

•

Integrated

Source: Adapted from Tom Ferguson, MD, in Healthcare Forum Journ al, Jan-Feb 1995 by Dr Jai Mohan www.mmaselangor.org/na onalhealthinforma cs.pps

The integra on of nurse call, life safety systems, and other aspects

machine, IT, building, and security services. This connects and

of pa ent care services provide medical staﬀ with a complete

enables communica on between all key areas of a hospital – from

picture of a pa ent’s environment. The amount of daylight, the

the electrical and HVAC rooms to the security oﬃcer’s desk,

acous cs, and the air quality in a pa ent’s room can be controlled,

opera ng theatre, pharmacy, and pa ent room.

monitored, and op mized through the integra on of the BMS with

Within the scope of a major hospital construc on project, the

a centralized dashboard in a nurse’s worksta on. Pa ents can also control their environment from their own interac ve room controls.

project management team may be led by a BMS company such as Schneider Electric. Early on, the BMS vendor assigns a hospital solu on architectural team to work closely with the building

cost savings. In this type of approach, there is integrated site supervision with

enterprise performance management for power, process and

Sullivan, Michael. Saving energy and lives. HOSMAC Pulse, December 2010 2 Randa, Kermit. Using IT to drive opera onal eﬃciency in the OR. Healthcare Financial Management, December 2010 3

Industrial Age Medicine

Individual self -care

Person

Friends and family Community

Community networks

Primary

Professionals as facilitators

Secondary

Professionals as partners

Transforma on

Professionals as authori es

Ter ary

Service Delivery

•

Physical

•

Virtual

•

Centralized

•

Distributed

•

Fragmented

•

Integrated

Source: Adapted from Tom Ferguson, MD, in Healthcare Forum Journ al, Jan-Feb 1995 by Dr Jai Mohan www.mmaselangor.org/na onalhealthinforma cs.pps

The integra on of nurse call, life safety systems, and other aspects

machine, IT, building, and security services. This connects and

of pa ent care services provide medical staﬀ with a complete

enables communica on between all key areas of a hospital – from

picture of a pa ent’s environment. The amount of daylight, the

the electrical and HVAC rooms to the security oﬃcer’s desk,

acous cs, and the air quality in a pa ent’s room can be controlled,

opera ng theatre, pharmacy, and pa ent room.

monitored, and op mized through the integra on of the BMS with

Within the scope of a major hospital construc on project, the

a centralized dashboard in a nurse’s worksta on. Pa ents can also control their environment from their own interac ve room controls.

project management team may be led by a BMS company such as Schneider Electric. Early on, the BMS vendor assigns a hospital solu on architectural team to work closely with the building

cost savings. In this type of approach, there is integrated site supervision with

enterprise performance management for power, process and

Sullivan, Michael. Saving energy and lives. HOSMAC Pulse, December 2010 2 Randa, Kermit. Using IT to drive opera onal eﬃciency in the OR. Healthcare Financial Management, December 2010 3

Industrial Age Medicine

Individual self -care

Person

Friends and family Community

Community networks

Primary

Professionals as facilitators

Secondary

Professionals as partners

Transforma on

Professionals as authori es

Ter ary

Service Delivery

•

Physical

•

Virtual

•

Centralized

•

Distributed

•

Fragmented

•

Integrated

Source: Adapted from Tom Ferguson, MD, in Healthcare Forum Journ al, Jan-Feb 1995 by Dr Jai Mohan www.mmaselangor.org/na onalhealthinforma cs.pps

Integra ng Medical Technology with Healthcare Harinath Pudipeddi, Sr. Prac ce Manager – Cerner Healthcare Solu ons Pvt. Ltd, foresees the inevitable merger of tech and healthcare.

Over the last few decades, we borne witness to the increasing role of technology in healthcare. This has indeed increased the coverage and quality of healthcare to many in the world, coming with its own ra onale. Healthcare is associated with two technologies – medical and informa on. While the former deals with advancements in healthcare delivery such as medica ons, tools and methodologies, the la er, coupled with a technological support system, enables the former to work be er with advancements like electronic medical records, automated workflows to reduce human error and so on. But medical technology does not only refer to informa on technology or computeriza on of hospitals and healthcare workflows. It refers to any advancement in the field that would boost the process of care or provide more produc ve tools. Advancements in angioplasty, surgery and others in the surgical process are also considered advancements in medical technology, along with tools like CT scanners, pacemakers and so on. Off by heart In the 70s, cardiac care units were introduced. Lidocaine was used to monitor and treat irregular heartbeats; beta-blockers were used to lower blood pressure in the first few hours of an ‘a ack’; clot-buster drugs became prominent; and coronary artery bypass surgery became more prevalent. During the 80s, blood thinning agents were used to reduce the risk of heart failures. Beta-blocker therapy became a maintenance therapy, and angioplasty was used a er the heart a ack pa ent got stable. Later in the 90s, drugs were introduced to inhibit clot forma on, and angioplasty was used along with stents to keep blood vessels open. In 2000, be er tests became available to diagnose heart a acks. According to sta s cs, between 1980 and 2000 in the US,

the mortality rate for heart a acks reduced from 345 to 186 for every 1,00,000 popula on. This has been the impact of medical technology advancements. About IT Advancements in computer science helped bring computers to the common man. In healthcare too, the progress has been immense, and IT con nues to be er its delivery and care systems. Un l the early 90s, computers were hardly to be seen. Over the years, informa on technology became an integral part of our lives and today is indispensable for many. Healthcare has not been any diﬀerent. Despite shortcomings in the available technologies, doctors have accepted and adapted to computer technology in the treatment life cycle. The recent push for healthcare IT by the US has been an impetus in India. From the 1950s up to the 2000s, just as medical technology has evolved and decreased the rate of mortality in heart a acks, informa on technology, in a similar way, has paved the way for new ways of trea ng pa ents and providing be er healthcare. Advancements in informa on technology help in reducing a hospital’s KPIs (Key Performance Indicators) too. Not only in healthcare delivery, but also mee ng standards and being able to deliver global quality care is a very important factor for hospitals. And IT just enables them to deliver exactly what is required. Let us look at two KPI examples and how IT addresses hospitals in helping them achieve the same: • Master Pa ent Index (MPI) duplica on as percentage of total registra ons – Electronic Medical Record helps achieve this KPI. • Rate of Unplanned admissions to the same hospital due to related problems within XX Days – EMR helps track all the medical history including

interac ons with the hospital and doctors. Cost Costs in advancements of technology can either increase or reduce the overall cost to the end user. As an illustra on, a CT scanner is very expensive and the end user thus pays a high price for the same. However, the beneﬁts and the accuracy with which the report is provided jus fy the cost. Clinical Trials Without the support of technology (medical and informa on), this could not have been possible. Costs incurred for this are huge, but the results are be er. Bypass surgeries would not have been easy and eﬀec ve without clinical trials. Level of Use Cost of technology also depends on the level of use. Is the technology used once/twice or is its use repe ve? This contributes to the cost of implemen ng the technology.

Reduc on in Secondary Diseases Today, given the technological support in clinical trials, secondary effects/diseases for a par cular symptom have reduced dras cally. Technological solu ons provide an advanced analysis of the case and system rules alert doctors while in treatment. Ongoing Improvements Evolu on of technology in healthcare is not a one-day effort, but is ongoing. With technological support, healthcare organiza ons can provide be er care and quality medica ons that help in providing a smooth experience to pa ents. Return on Investments Every organiza on looks at ROI as a key metric, and hospitals are no different. In 2002, Maimonides Medical Center in Brooklyn, NY (a 750-bed hospital) was awarded the HIMSS Davies award for improving pa ent safety. What did they do different? Maimonides implemented the EMR-EHR (Electronic Medical Record – Electronic Health Record) System in 2001, which reduced the concerns/problems with medica on orders by 58% and medica on discrepancies by 55%. During the same year, the system also found 1,64,250 alerts and 82,125 prescrip on changes. The ROI here is the number of lives saved which might have had catastrophic outcomes due to medica on errors. According to World Health Organiza on, one in ten hospital admissions lead to adverse effects and one in 300 admissions lead to death due to medical error. What can help reduce this? Technology. Process Improvements This is one of the classic classifica ons of so ROI for any hospital. Every hospital in the world follows documenta on during treatment (government regula ons, pa ent safety or any other reason). Technology interven on definitely helps in reducing repe ve tasks and achieving standardiza on that will again help in providing

quality care. Technology can help in standardiza on of data used in the hospital, which will help in improving the quality of care. Data standardiza on can also be helpful when pa ents are moving loca ons or when they are referred to different hospitals. Standards and Quality of Care Over the years, countries have come up with standards that focus on quality of care. These standards focus on addressing pa ent care and documenta on. They help hospitals follow similar documenta on, which help doctors understand the pa ent’s condi on much be er when the pa ent moves across hospitals/countries. These have become very important as the world has become flat. People move ci es/countries due to various reasons and this helps them carry their health records and that too in standardised format. These standards also help in capturing the key diagnosis data, which will be used in clinical trials and brining out be er medica on and processes for care. Once very highly prevalent, polio in India is now completely eradicated due to advancements in medical technology. If we look at the infant mortality rate in India since 2000, it has fallen from 64.9 deaths for every 1000 births to 30.15 in 2009. How would this be possible without advancements in medical and informa on technology? The Future Medical and informa on technology are advancing each day providing be er results and research, thereby, contribu ng to upli ing the quality of care and a healthy lifestyle. Brain-computer interface, care giving robots, computer aided diagnosis, drug delivery devices, regenera ve medicine, emo onal/physical control devices, slowing or stopping aging, gene therapy, home/self monitoring devices, molecular and gene c diagnos cs, robo c surgeries etc. are all examples of these advancements. Headway in nanotechnology, biotechnology, computers, understanding the human genome etc. are paving the way for be er care. Personalized Medicine Progress in pharmacogenomics (study of how individual gene c inheritance affects the body’s response to drugs) predict that we will have medica ons based on the human gene c structure rather than symptoms. This will help in faster cure of ailments thereby contribu ng to speedy recovery. Concluding Remarks Integra ng medical technology is more important than assumed. In the UK, the average wai ng me at hospitals for surgeries and cri cal care treatment has reduced to a large extent by adap ng to medical technology. Using standard documenta on processes (accepted globally) and u lizing technology to bring down the costs such as eye transplant costs at Arvind Eye Care have increased India’s poten al in medical tourism. However, there are many regions in the world that are yet to leverage on the benefits of adap ng to medical technology. There is a lot of work which needs to be done to increase the adop on levels and forming global standards. This is just a beginning to a whole new world of possibili es. The author is an expert in So ware Test Engineering and has published acclaimed tle in the sphere. He is currently working on developing Architectural Based So ware Tes ng Methodology for HealthCare So ware. To know more, please visit www.harinathpv.com.

Integra ng Medical Technology with Healthcare Harinath Pudipeddi, Sr. Prac ce Manager – Cerner Healthcare Solu ons Pvt. Ltd, foresees the inevitable merger of tech and healthcare.

IT in Healthcare Dr. Akash Rajpal, Head – Consultancy Services – Hosmac, paints the realm of advanced healthcare that is partly underway in India.

The year of the millennium ushered in the Y2K buzz, with astounding investments in healthcare IT. However, the true return on investment in terms of: • Direct cost savings • Revenue increases • Increased produc vity • Quality service delivery …are yet to be fulfilled. Approximately, one to three lakh rupees per bed is spent on the crea on of urban IT infrastructure in healthcare. On an average, a 100 to 300 bedded hospital spends about ten to thirty million rupees in se ng up its basic digital health framework. Essen ally, this includes the hardware and network infrastructure by way of LAN, computer terminals and HMS with primary modules enabling billing, registra on, and lab. There is no doubt that IT is an enabler of improved quality, safety and efficiency of healthcare. Regardless, u liza on of IT is low – less than 1% by the industry; the tall figure in comparison too is not heartening – 3% in the US of A. Even though, IT in the healthcare delivery model was summoned mainly for this essen al altera on. The much desired electronic medical records capturing to enable a highly competent environment of evidence based medicine is yet to be harnessed to its fullest poten al. The deterrents faced include cost and complexity that require significant process related changes across the organiza on: change of the end user’s mindset and the culture of the organiza on. Healthcare also suffers from the eminent reward policy fallacy. There is huge demand versus low supply i.e. rewarding volumes

rather than quality – and volumes cannot be ignored too. No ma er what is said, the available IT designs and infrastructure has yet to cost-effec vely match up to the volumes enabled by the manual and rudimentary systems, to serve India’s unique healthcare delivery system. Though, the outcome has not been so rosy, there is a slow and steady growth of IT-enabled healthcare delivery for the benefit of pa ents at large. ‘IT’ in Healthcare IT allows healthcare providers to electronically collect, store, retrieve and transfer informa on. IT is a tool rather than the objec ve in itself. In essence, informa on technology in healthcare correlates more to hospital informa on systems in urban hospitals. Though, a lot is also being done in the Indian public healthcare sphere too. What was earlier done manually (and is yet majorly done), by way of complex and me-consuming paperwork, is now electronically captured by a fascina ng array of computers and electronic devices. These include the so ware, bar code readers, cameras, handheld devices, laptops, touch screens etc. A Classic Example In former mes, what used to take days, even weeks, just to deliver a cross con nental message via regular post, now takes only a second by way of electronic mail. Similarly, IT strives to deliver faster and safer healthcare to larger volumes of pa ents with help of lesser healthcare providers and making healthcare more cost-effec ve and affordable. Real- me (or faster) and meaningful collabora on of IT and healthcare for the benefit of the provider and the pa ents at large is the prime objec ve. More than 85% of the healthcare delivery

chain in India is fastened by the private sector. IT therefore plays a crucial role in the private healthcare delivery, as majority of pa ents are mee ng their health needs there. Effec ve IT Effec ve IT implementa on and acceptance by stakeholders at large is possible if the following objec ves are met: • Enhance opera onal efficiency • Add value to the pa ent/consumer • Minimize cost of delivery • Increase produc vity • Reduce pa ent/consumer wai ng me • Boost clinical competency IT in Purchasing IT is u lized in a variety of procurement applica ons including vendor communica ons such as comparing prices and making purchases. Vendor nego a on has replaced face-to-face ac vi es like bargaining, renego a on, price, term agreements. The other popular use is in order placement and order status. Use of IT has also reduced the error rate involved in processing purchase orders. IT in Inventory Opera ons and Management Acknowledged advantages in this area include communica on of stock-outs by customers to vendors; no fica on of stock-outs by companies to their customers; and quick replacement of near

expiry drugs. IT has enabled companies to be proac ve in mee ng their clients’ inventory demands more quickly. Automated calcula ons of lead mes and reorder level features make life much easy for the department. Equipment Management, CSSD Inventory and HR RFID tagging helps locate portable equipment, CSSD inventory for recall and management, in a mely and effec ve manner. The use of RFID tags with horizontal and ver cal shoots save a great deal of me, HR and cost for hospitals. Infosys recently launched their so ware for supply chain streamlining and revenue collabora on in hospitals, providing real- me alerts and diagnos cs with a 360-degree collabora ve dashboard. Breach Candy Hospital and Trust was among the first in Mumbai to have u lized the pneuma c chute system to great effect. It helped reduce dependence on housekeeping staff to transport samples and reports, op mizing turnaround mes. The biometrics for a endance records, payroll management, automa c statutory deduc ons, leaves etc. can no longer be imagined without IT support. Willful HR personnel can effec vely use IT to monitor training efficacy, a ri ons and employee sa sfac on, coupled with proac ve course correc ons.

Buckle Up for Accredita on Accredita on demands monitoring of tens and hundreds of vital quality indicators like ALOS, infec on control parameters etc. This requires complex formulae and benchmarks. IT can assist here in a very efficient manner. Discharge process supported by seamless integra on of automated alerts for various processes in the value chain helps provide a quick discharge summary to the pa ent at the me of discharge as mandated by the accredita on standards. SOPs are maintained online to aid training and preven ng presence of any obsolete documents. IT can facilitate less paper use, as many accredita on-related forms and checklists can be filled online instead of paper for quicker turnaround and cost-savings. Medical Errors – Solved It is es mated that almost 1,00,000 pa ents die in US every year as a result of medical errors. Majority of these errors are preventable. IT here, without doubt, is considered as a major force to reckon with to prevent these errors in the future to a large extent. Computerized provider order entry (CPOE) reduced serious medica on errors by 55%. (Bates et al. 1998) CPOE is enabled through mely alerts by way of: • Promp ng cau on for adverse drug reac ons by certain medica on; • Sugges ng right dosage as per data fed about pa ent; • Prescribing medicines precisely with sugges ons from linked databases for the diagnosis made. Electronic drug databases are rela vely common in retail pharmacies today. Hence, alternate drug names, handy crosschecks for adverse effects and pa ent counseling can be done with ease. Tablet Convergence The advent of tablets saw the zenith of IT with assimila on by various IT organiza ons. Healthcare too saw its u litarian proper es on the way. One of the many applica ons such as the AirStrip™ Cardiology for the iPad and the iPhone (see image) allows

me-mo on study best exemplifies this possibility. RFID tags can also be used to collect data for me mo on studies, nurse loca on and movement etc. In recent mes, PACS has made cross-border outsource of diagnos c image reading and repor ng by back offices opera onal in India. In almost negligible me periods due to the global me difference, films taken by technicians in the western hemisphere are diagnosed/reported back by competent radiologists employed in the east. Training Broadband connec vity to global medical libraries, med search, hospital generated informa on, online SOPs help trainers teach with in-depth informa on. IT-enabled instant training feedbacks assist trainers in modifying his or her teaching methods and content. Video conferencing/streaming live surgeries across countries and even con nents for demonstra on purposes are not new. Future Trends As per a survey, the following technologies will see themselves in the spotlight for all the good reasons: 1. Bar-coded medica on and laboratory management 2. Electronic health records 3. Clinical informa on systems 4. CPOE and electronic prescrip on 5. PACS 6. Enterprise-wide clinical informa on sharing 7. Point-of-care decision support 8. RFID for inventory and medical equipment management 9. Be er-informed pa ents with web based or IT assisted interac on by the care provider 10. Pneuma c chutes to reduce human resource interven on 11. Accredita on compliance with help of IT 12. Remote monitoring of vital parameters including cardiac status and blood sugar 13. HMS assisted electronic promp ng for pa ent safety 14. Advanced robo c surgery will help deliver complex care seamlessly across geographies through technology, by sharing clinical and technical competence across borders 15. Digital pens like Livescribe shall be in vogue to capture wri en notes and simultaneous voice of clinicians in real- me for storage, collabora on, archiving and retrieval. It will counter per nent problems of statutory compliance to store large volumes of OPD records , enable a be er-informed and clinically competent environment to interact with pa ents

doctors to check electrocardiogram test results that have just been administered, si ng at home in the middle of a night. The applica on is capable of zooming within half a millimeter of every heartbeat rhythm varia on allowing diagnosis within minutes – remotely. The use of such applica ons has resulted in not only saving me, but also leveraging more technologies to come to accurate diagnosis through these tools. Bo leneck Lubrica on One of the trickiest snags hospitals face is managing wai ng lines at the outpa ent department. Since ac vity at the OPD is inevitable at any me of the day, technology can be u lized eﬀec vely in conjunc on with certain theories. Use of RFID tags to compute a

16. Aimed at reducing capital costs and sharing resources, cloud compu ng and thin clients will be a common trend in the very near future. Already, cloud compu ng has gathered acclaim as a saving grace for organiza ons such as the Indian Railways, with the advent of sophis cated micro-processors.Organiza ons are enabled to exploit its feature for opera ons in a thin client environment Some IT companies are going to the extent of providing direct online access to HIS modules. With turbo charged broadband speeds at reasonable costs, organiza on can simply subscribe to online HIS models, and func on with almost zero capital costs. IdeaObject So ware, Chennai has developed an internet-based HIS applica on enabling organiza ons to go digital, almost instantly. Dis nguishing itself from other numerous HIS systems being implemented, it uses an unconven onal swipe card system for ease and security of doctors and admin staff, doing away with the conven onal login/logout systems. Final words Considering that the regulatory policies are being met, IT should be harnessed to u lize the poten al collabora ve produc vity of various stakeholders to meet the ‘need’, solve a problem and become an ‘enabler’ rather than just a capital investment. There have been instances where en re IT setups were overhauled i.e. re-installed from scratch, thus leading to millions in losses by way of man-hours and produc vity. This happens when the requirement is not mapped as per the need of the organiza on and involvement of the key users. An off-the-shelf product, and even a best-selling foreign product, may not work in every healthcare setup, as their needs and expecta ons vary. IT in healthcare should go beyond the reach of LAN, WAN, USB, billing, registra on and record keeping. An a empt at aiding evidence-based clinical excellence to bring in value to every stake holder must be its promise. Every IT product should ensure that it meets the following objec ves: • Reduces backlogs • Integrate all processes and makes room for dynamics • Monitor processes and analyse meaningful course correc ons • Iden fy problems sooner than later • Augment opera onal efficiency • Add value to the pa ent/consumer • Reduce the cost of delivery • Increase produc vity • Reduce pa ent/consumer wai ng me • Elevate clinical competency As informa on technology increasingly penetrates the healthcare industry, physicians, pa ents, administrators, insurance & actuarial services and government bureaucrats are experiencing the benefits of on-demand access to medical informa on where, when and how it is needed with precise, detailed informa on and analy cs. Enabling the flow of informa on within a healthcare organiza on will become a quality differen ator among healthcare providers, be it private sector or public. While the personal touch will and should always remain the centre point for any doctor-pa ent interac on, IT with a pa ent centric approach is much needed to bring in a highly competent and

well-informed clinical care. Healthcare has tradi onally seen lower levels of investment in IT than any other service industry. This has resulted in a number of problems for healthcare providers: systems in desperate need of moderniza on to overcome challenges that have arisen over the years; disparate mix of so ware systems that struggle to share informa on; infrastructure that hinder rather than help expansion or growth and; programs that are not op mally aligned with clinical workﬂows. Health Informa on So ware that integrates the core medical processes, hardware that allows user friendly, language irrespec ve easy access to informa on at the point of care. Standards like the Health Level Seven Interna onal (HL7) and the Health Insurance Portability and Accountability Act, 1996 (HIPAA) that make integra on of diﬀerent systems easier than before are key ingredients to robust and well-accepted IT systems. Of course, not to forget, the costs involved procuring the above. Recent trends indicate that online shared access models, pay-per-use models, per pa ent models and per transac on models are coming into fray with minimal or zero entry costs to healthcare organiza ons. More than 10,000 Smartphone

applica ons had been filed under healthcare and fitness categories un l September 2010, according to a PricewaterhouseCoopers report. These only indicate the rising trend in digital acceptance in the health domain, reinforcing the way forward. All said and done, there is a much-desired need here for IT companies to understand the pa ent and healthcare processes first and then develop the product. Assistance of consultants with expert domain knowledge can bridge the gap. Healthcare organiza ons too should seek advice (and many are) of consul ng firms to be at the nego a ng table, understand IT products and ensure a maximum return on investment. IT of future will be driven by care, to improve, transform and perform. The author is a qualified medical prac oner with post graduate creden als in public health, hospital administra on and IT. He has worked in both public and private healthcare sector for more than 12 years. To know more, contact akash.rajpal@hosmac.com. or visit akashrajpal.blogspot.com.

IT in Healthcare Dr. Akash Rajpal, Head – Consultancy Services – Hosmac, paints the realm of advanced healthcare that is partly underway in India.

Reﬂec ons on Architectural Design Mr. Hussain Varawalla, Design Mentor — Architecture Services — Hosmac, untangles the design paradox in the minds of healthcare facility designers.

At HOSMAC (India) Private Limited – where hospitals are planned and built, I head the architectural design sec on. What follows are some of my reflec ons on design, in general, and the architectural design of healthcare facili es, in par cular. Design as a professional ac vity, separated from the making of things, is a rela vely recent phenomenon. The ‘trying to understand’ how designers’ design is a field s ll in its infancy. In the early years of serious design research, it was fashionable to see design as an en rely generic and field-independent ac vity. Thus a respected worker in the field, Sydney Gregory, could confidently assert that ‘the process of design is the same whether it deals with the design of a new oil refinery, the construc on of a cathedral or the wri ng of Dante’s Divine Comedy’. I am not convinced of this view and rather doubt that Dante would be either. It would be farfetched to compare the mindset and skills required for the design of a healthcare facility in 2011 to those required for the penning of poetry. Architectural design is generally recognized as presen ng a ‘wicked’ problem. By this, it is meant that such problems defy complete descrip on and lack the clarity of formula on found in scien fic problems. They are the sort of problems where the informa on you need to understand them rather depends on your ideas for solving them. This sort of design is a ‘knowledge-rich’ as opposed to ‘knowledge-lean’ ac vity. In other words, architectural design requires us to have considerable amounts of knowledge beyond that stated in the problem descrip on. Healthcare design demands sensi vity to as diverse concerns as addressing the anxiety of a cancer pa ent undergoing treatment to the engineering requirements of the radia on therapy unit, in which he or she is being treated. Above all, one has to realize that this sort

of design involves addressing such varied fields of knowledge; empathy is a process in which there will be no one recognizably correct or even an op mal answer. Early writers on the design process tended to see it as a sequence of cogni ve opera ons conducted en rely within one brain. Such models have an almost unassailable logic, and appear quite convincing to those not personally involved in the act of designing. However, while the ‘methodologists’ gathered at conferences to discuss the finer detail of such ideas, designers were quietly ignoring them and ge ng on with the business of design. Today it is easy to see why these sequen al models of design were doomed to failure. They began from several false premises – two of which, we need to concern ourselves with here. These concern fallacies about the beginning and end of design: first, that design problems are, or indeed, can be stated clearly; and second, that there are solu ons, which can be considered in some way op mal. As men oned before, today we recognize architectural design problems belonging to a type known as ‘wicked’. They are o en vague expressions about a change of some kind, which is needed or desired rather than a clear statement about a totally defined goal. They should therefore most definitely not be considered to be like crosswords or other popular types of puzzle. These are characterized by a totally defined objec ve and usually have a single, correct solu on, which can o en be recognized as such when it is found. Those, who consider design to be merely problem-solving, do the field a disservice. A large part of the business of designing involves finding problems, understanding and clarifying objec ves, and a emp ng to balance criteria for success. We have now recognized that designers o en come to be er

understand their problems through their a empts to solve them. Most designers are at their best when designing, rather than wri ng about the process they follow. Of course, we must sell our services in the marketplace, and so we may not always describe our processes honestly! My many years of design experience also suggest that when I like a solu on, I can be amazingly crea ve in imagining the ‘logical’ processes that led to that solu on. Other designers too can be quite capable of denying to both themselves and others the obvious importance of issues that they have chosen either to ignore completely or to relegate to minor considera on. Depending on who is ‘driving’ the project, a doctor, an investor, a Vice-President (Projects) or a philanthropist, the frame of reference through which the decision-making process is viewed can vary greatly. The designer then has to ‘wear the hats’ of those users of the facility who are ge ng neglected as to their needs as well as he can champion their interest through the design process. Further to this, architects are expected to have a social conscience, to ensure that the buildings they design are good neighbours and eco-friendly. Design has to address a mul tude of issues; the designer has to put his values on the line. It is a reasonable assump on that clients choose architects to some extent because they like earlier designs they have seen, or, as in the ﬁeld of healthcare design, because of special knowledge of the par cular features of the building type. Some clients have a very

clear vision of how they want the ﬁnal design to be, while others may have almost no idea. Some clients are par cularly concerned about some feature and care li le about others. The rela onship between client and designer, therefore, is not like an examiner se ng students a ques on paper but rather more like someone needing help in a situa on where many courses of ac on are possible.

At its best, the interac on between client and designer can be a highly interac ve and crea ve one. Design is undoubtedly an ar s c business, but it is dangerous to confuse it with art. Most designers see themselves as ar s c but not necessarily as ar sts. Design usually involves making something that must work in some way as well as expressing some values or ideas. Inevitably, the end product of contemporary architectural design o en demands that a great deal of technology be employed. This is especially the case in the design of today’s healthcare facili es. The extent to which the problems posed by technology inﬂuence the designer’s thoughts is a central issue in understanding the design process. Within the same healthcare facility, the architect may switch mental gears (tracks?) while designing the inpa ent areas as contrasted with an Opera on Theater Suite. Nowadays, there is a prolifera on in architectural theory and also a considerable varia on in the way architects regard the role of technology in design. For healthcare facility design in the new millennium, though, architects necessarily need to understand the technological requirements of the building. The new fron ers in

the delivery of healthcare through hospitals are divergent, one concerned with allevia ng mental distress in the form of addressing the anxiety felt by pa ents and their family in highly stressful situa ons, and the other concerned with the fron er of designing for the engineering needs of contemporary medical technology. There are of course many other ques ons about the nature of the design process that could be posed, and the reader will no doubt have his own. The few central issues I have raised are an a empt to s mulate the mind. It becomes necessary to bring some of the issues about design raised here into sharper focus by dealing with them directly, and comparing and contras ng various approaches with them. While there may be as many approaches to architectural design as there are architects, I suspect that in the healthcare design fraternity there may be more consensuses on the general way forward. Being a fragment of the whole, there is likely to be more uniformity within. For now I leav e you with this thought: The great philosopher Ludwig Wi genstein is reported to have said ‘you think philosophy is diﬃcult enough, but I tell you it is nothing to the diﬃculty of being a good architect’. The author has had 20 years of rich experience in healthcare design building. He can be reached at hussain.varawalla@hosmac.com.

Reﬂec ons on Architectural Design Mr. Hussain Varawalla, Design Mentor — Architecture Services — Hosmac, untangles the design paradox in the minds of healthcare facility designers.

Collaborate, Adapt and Operate Be er Sandip Chaudhuri, Manager – BD & Corporate Communica ons – Genesis Hospital, Kolkata, feels that the me has come for the implementa on of Enterprise Resource Planning (ERP) in Indian hospitals to bring in greater eﬃciency and integra on.

• Selec on of the ERP package having the func onal fit with the company’s business processes • Pu ng in place the requisite hardware and networks • Choosing the implementa on consultants • Implementa on of the ERP package and ‘go live’ A scan of the IT landscape in Indian hospitals doesn’t throw up too many ERP success stories, except when the hospital happens to be a part of a conglomerate (e.g. SAP implementa on in the Reliance backed Sir H.N. Hospital, Mumbai). The exhibits* which follow are of hospitals chains in different parts of the world – which are in so many ways similar to their Indian counterparts – except that they have gone ahead and implemented SAP in their organiza onal framework. They are living examples of the financial, strategic and opera onal benefits that ERP brings to the table. Exhibit 1: Siriraj University Hospital, Thailand With a bed count of 2636, Bangkok’s Siriraj University Hospital is one of the largest business medical centers in the country. Around 1,600,000 outpa ents and 80,000 inpa ents visit the hospital, every year, comprising of mainly the poor and medium class of Thailand. System Implemented SAP R/3 System Objec ves & Benefits The key objec ves were to make the finance, accoun ng, budgeting, purchase and inventory func ons robust and efficient. The implementa on of the system ushered in the transi on from the

2011. India is going strong at the world stage with the recession tremors well taken care of. The Indian healthcare industry has its task cut out to achieve the op mis c projec ons of the pundits. In the recent past, the healthcare industry has shown two very encouraging trends. On the one hand, Indian private healthcare groups are not only a rac ng interna onal pa ents to its domes c facili es but are also in fact spreading their wings to diﬀerent parts of Asia and Africa. On the other, government hospitals in several states are going through various processes in a bid to get NABH accredita on. According to a communiqué received from the Quality Council of India, 30 public sector hospitals in Gujarat, 15 in Tamil Nadu, 14 in Kerala, 10 in Jammu & Kashmir, 3 in Andhra Pradesh, 2 in Karnataka, 5 in Punjab and 9 in Delhi are aspiring for the same. (Source: PTI – April 29, 2011) The takeaway cue from the above trends is that both the private and public sector hospitals are looking beyond the obvious. While one has scalability as the core strategy driver, the other has quality impera ves as the trigger behind the trend. And with all its growing complexi es and challenges, data integra on remains the Holy Grail in the healthcare industry. Given the circumstances, one is encouraged to build a strong case for the implementa on of ERP systems in Indian hospitals. For the unini ated, Enterprise Resource Planning (ERP) is a so ware-driven business management system which integrates all facets of the business including logis cs, ﬁnancials and human resources. Integrated, uniform, relevant and up-to-date informa on are cri cal to the survival of the enterprise in a compe ve business environment. Tomorrow’s winners will be those who can streamline their crucial informa on and make quick and informed business decisions. This is only possible when the en re organiza on shares the same informa on and views it with the same

perspec ve. It is important to understand at this stage that ERP aligns IT with business objec ves – focusing on the core func ons of any business including healthcare. Hospital Management Informa on Systems (HMIS) on the other hand have the hospital centric areas as their core modules (pa ent administra on, laboratory, ward, OT management etc.) and suppor ng modules (pharmacy, housekeeping, CSSD etc.). HMIS are designed mainly to cover the clinical and administra ve processes in a hospital. ERP, looked upon as a panacea across several industries, operates on a bigger canvas. Industries have used it to not only lower costs, improve efficiency and increase profitability, but also to bring in the best prac ces in business processes to their setups. In the fragmented ERP market in India, the top ERP vendors are SAP, Oracle, People So and JD Edwards. SAP, clearly the market leader, revolu onized Enterprise Resource Planning with its R/3 system, a family of integrated modules covering the three core func onal areas: logis cs, financial and human resources. In addi ons to these, SAP produces industry specific solu ons such as the IS-H module, which is specially designed to handle pa ent data, pa ent billing, appointment management, admissions scheduling and treatment. These applica ons update and process all transac ons in real me. The ERP implementa on roadmap would be do ed with the following check posts: • Iden fy the objec ves of the ERP package implementa on • Mapping the ‘as-is’ situa on of the organiza on • Crea ng the ‘would-be’ benchmark for the business • Reengineering of the business processes towards the desired objec ves • Analyzing the various ERP packages available in the market

cash to accrual basis for accoun ng standards. With a clearer understanding of the funding situa on, the hospital’s renowned 30 baht (< 1$) clinic has been able to live up to its core promise without stretching beyond permissible limits. Exhibit 2: Ins tut Català de la Salut (ICS), Spain Ins tut Català de la Salut (ICS) runs eight hospitals and 450 primary care units and is regarded as a top-quality healthcare provider by around 6 million residents in the Catalonia region of Spain. With more than 4000 pa ent beds, these eight hospitals house 32% of

all public sector inpa ent beds in the country. The Primary Care units witness a foo all of around 46 million outpa ents in a year. System Implemented SAP for Healthcare Solu ons Objec ves & Beneﬁts With the long term vision of bringing in more eﬃciency to the system to reduce the burden on the public exchequer, ICS turned to SAP for healthcare solu ons to act as the change driver. The

hospitals and the primary care centers are connected to be able to access a common pa ent database containing about six million case histories. While turning pa ent-centric, ICS has also used the integrated system to make aggregate procurement for the group.

The first four years have led to savings of €45 million with €7.5 million annual savings for pharmacy purchases addi onally. Exhibit 3: Klinikum Mi elbaden ggmbH, German Klinikum Mi elbaden has a total of 1, 825 beds spread across four acute-care clinics, a clinic for geriatric rehabilita on, five facili es for inpa ent care, and two for short-term care. The group also has four subsidiaries. System Implemented SAP ERP applica on Objec ves & Benefits The key objec ves were to streamline the 12 clinics and four subsidiaries with respect to materials management, finance and controlling. Among the many pluses, the group has since seen improvements in data, in terms of quality, consistency and availability. These, in turn, have ensured improved responsiveness and lower opera onal cost. Truth Be Told The ERP journey is an adventure in itself and certainly has its share of thrills and chills. It needs a clear understanding of the step-bystep approach to developing an effec ve Enterprise Management system, an ability to comprehend and address all shortcomings, choose the right ERP product, provide strong leadership to inspire the en re organiza on and embrace the new ways of working. Coming back to the Indian context, in 2006, when the Na onal Accredita on Board for Hospitals & Healthcare Providers was set up, if somebody had suggested implementa on of NABH standards in a government hospital, he wouldn’t have done his reputa on any good. But mes, they have changed, haven’t they? 2011. The me has come for Indian hospitals (especially the bigger and the spread out chains) to strengthen their internal IT capabili es and implement ERP to bring in more efficiency and integra on in their ac vi es. The me is now. The author is a cer fied SAP Func onal Consultant and is a keen observer of this space in the hospital industry. He may be reached at sandiffthin@gmail.com. *Informa on a ributable to third-party sources without representa on or warranty of any kind

Pa ent Experience Portal Dr. Anil M. – Func onal Consultant – Religare Technologies Ltd., reveals the true value of pa ent feedback and communica on.

“Good evening, Ms. Jane. Gree ngs from Magnum Hospital! This is Mar n from the Pa ent Rela onship Team. If you have a minute, may I discuss your forthcoming visit to our hospital for a scan this Friday. Would you like to confirm the appointment?” “Hello, my name is Colin Hambley, and I’m calling from Magnum Health. I would like to follow up with you on your hospital stay, current vitals, lab results and some general ques ons.” Don’t be surprised to see more of such pleasantries from hospitals, as they are all working on their pa ent rela onship management skills. Communica on has to be redefined – well-defined for the today’s pa ents – as they are both customers and consumers. Unless the pa ent is in a cri cal condi on and is being driven to the closest hospital, the pa ent can choose which hospital to ‘purchase’ services from. Pa ents are now managing the hospital’s business. So each pa ent, or a prospec ve pa ent, is an asset. When Leonard Kleinrock’s ini al idea of Internet or packe za on way back in 1960’s was floated, li le did people realize the effect of Internet on an already labyrinthine doctor-pa ent rela onship. Two fundamental changes are evident because of the Internet: pa ent empowerment and transforma on of point of care. Pa ent Rela onship Management as a Consequence Healthcare providers such as physicians, den sts, therapists, labs, pharmacies, diagnos c centers and hospitals, and the pa ents have to rethink their a tudes and approaches. The challenge is to manage the new developed autonomy of the empowered pa ent.

Pa ent Rela onship Management is a way to understand, diagnose and evaluate threats, opportuni es and to recognize means of systema c improvement in the healthcare delivery process. Defini on of PRM A defini on of the Swiss ICT on the occasion of the user forum “e-Health” thus phrased: “Under the designa on Pa ent Rela onship Management, all efforts of maintaining the rela onship between health professionals and pa ents including informa on and communica on technologies can be subsumed” Around the Dawn of the Millennium Healthcare showed its interest in Rela onship management. There were approaches from medical prac oners of describing the doctor-pa ent rela onship before. An a empt of describing the new role of the pa ent is made by Smith. He focused on the communica on between pa ent and doctor. The year 2001 was a golden year of PRM research. Now, for the first me the concept of rela onship management was applied on life science and health management. The main focus of a pa ent rela onship management revolves around: • Pa ent sa sfac on • Pa ent reten on • Pa ent acquisi on • Pa ent servicing (average response me for pa ent complaint/inquiry resolu on, first call resolu on)

• Pa ent referral management • Winning back pa ent • Earning pa ent goodwill Pa ent Sa sfac on Over the past several years, the issue of pa ent sa sfac on has gained increasing a en on across the healthcare industry. As a result, our industry leaders have been focusing on improving pa ent sa sfac on through various ini a ves. “Pa ent sa sfac on” is not a unitary concept, but rather a final end product of percep ons and values. Percep ons are pa ents' views about events which reflect what happened. Values are the criteria pa ents apply to those events. They demonstrate the degree to which pa ents consider specific events to be good, bad or ugly. Pa ent feedback is one the proven methodologies of measuring pa ent sa sfac on. Informa on Technology has played a good role in redefining the pa ent feedback process. Pa ent feedback applica ons tradi onally enable the following: • Collate key informa on from pa ent and their family about the healthcare delivery processes • Consolidate feedback from mul ple sources, including surveys, kiosks and staff • Transform pa ent feedback into ac onable informa on • Promote immediate service recovery through real- me alerts • Demonstrate the effec veness of pa ent sa sfac on invest ments through tending reports A no ceable trend catching up are pa ent call back programs. A study by the Agency for Healthcare Research and Quality states that not understanding discharge instruc ons is one of the top eight 'dissa sfiers' to pa ents. In contrast, a Press Ganey study cited in the Studer Group’s Hardwire Results found that pa ents who received post-discharge calls that helped them understand their care regimen were more likely to recommend the calling hospital and to say they were sa sfied with their nursing care. A recognized value of post-discharge call programs is the opportunity to resolve common, avoidable complica ons of medica on errors. Medica on errors or medica on emergencies a er discharge can occur for a variety of reasons, such as the pa ent not understanding the prescrip on, right dosage or inappropriately taking the hospital prescribed medica ons with over-the-counter medica ons. Post-discharge calls present an opportunity to uncover such adverse events before they escalate. This is also why well-executed post discharge call programs include standardized scripts matched

by good listening and interview skills to iden fy ini al signs of medical complica ons in me to ini ate early interven on. Next genera on pa ent rela onship management systems cater to the requirement of having a standardized script based post-discharge calling systems, which would proac vely guide the pa ent rela onship manager on the purpose and the business context of the feedback, simultaneously help the managers to qualita vely analyze feedback and provide meaningful informa on on pa ent experience. Scrip ng Post-discharge Calls The typical script being used by hospitals that are commi ed to post-discharge calling consists of these common ques ons: • Have you experienced any new symptoms or have previous symptoms worsened? • Do you have a lingering or new fever? • Did you receive a discharge summary and have you read it? • Do you have ques ons about your medica ons? • Do you have an appointment with your primary care physician for follow up? • Do you know how to contact your primary care physician or the hospitalist who treated you during your stay? • Has this call helped you feel be er about your treatment?

care, such as Doximity, Askdrwiki and Pa entsLikeMe. These sites work for pa ent-to-pa ent, pa ent-to-doctor and doctor-to-doctor communica on and collabora on. Brand Monitoring In this new age of social media, conversa ons are becoming markets so there is a market for monitoring these conversa ons. Social Media Monitoring tools fit into this requirement and are already widely used. They can be effec vely integrated with PRM. Service Recovery in Healthcare The concept of service recovery involves the service provider taking responsive ac on to "recover" lost or dissa sfied pa ents, alter their nega ve percep ons, convert them into sa sfied pa ents, and ul mately maintain a rela onship with them. Be Aware Hospitals are using social media to increase their capability to reach their pa ents with high-quality pa ent educa on content. At the Henry Ford Healthcare System in Detroit, physicians used Twi er to interact with more than 1900 people and answered tweeted ques ons during an actual brain surgery on a 47-year-old man. Public Rela ons News and informa on feeds are a consistent staple of social media. Social media allows for curated news feeds that elegantly group news items by client-filtered categories. For example, All Children’s Hospital in St. Petersburg, Florida, interacts with pa ents to keep up with hospital news including media references, new services, new recruits and key hospital events. Crisis Communica ons Take control of the message, and keep community updated in real- me. Strategic Hiring LinkedIn, Facebook and other tools are currently being used to recruit clinical and administra ve staff in hospitals. In fact, there is a growing percep on among healthcare providers and marke ng professionals that passionate fans or cri cs who rise to prominence through social media are strategic hires for the organiza on. Hence, pa ent rela onship management solu ons are not only about return on investment; it also caters to the need of hospitals' ROC: Return On Connec ons. In today’s compe ve environment of the provider market, most hospitals provide similar services with comparable quality. The true differen a ng factor would be pa ent experience, which can be enhanced with the usage of pa ent rela onship management approaches.

Pa ent Care Convergence Pa ents percep on about quality care in a hospital also revolves around assistance/guidance/care provided to him not only during the hospital stay, but also across pa ent’s illness – well-being journey. Pa ent rela onship management can play a pivotal role in managing the pa ent's expecta ons and percep ons. Social PRM So what exactly is social media? A good defini on offered by Chris na Thielst in her book Social Media in Healthcare: Connect, Communicate, and Collaborate is: “Social media are electronic tools that enhance communica on, support collabora on, and enable users across the globe to generate and share content.” Social media is and will con nue to be omnipresent in daily life, and more specifically, healthcare. With approximately 15 percent of hospitals using atleast one form of social media, and anywhere from 60-80 percent of pa ents using some form of Internet content engine to research health informa on, the train is almost up to full steam. Social media ranges from well-known portals, such as Facebook, LinkedIn and Twi er, to lesser known sites more specific to health-

The author has been instrumental in developing various healthcare IT solu ons like EMR-HIS-PRM-CPOE-Nursing and other applica ons for the provider industry. He may contacted at anil.m@religaretech.com.

Pa ent Experience Portal Dr. Anil M. – Func onal Consultant – Religare Technologies Ltd., reveals the true value of pa ent feedback and communica on.

NextGen Healthcare Umesh Oza, Director – Consultancy & Projects – Symphony India, records some of the many beneﬁts that HMIS can bring within a hospital.

Informa on Technology has been successfully used in manufactur-

Cost saving

ing, ﬁnance, transporta on and other sectors for more than 50

Improved pa ent service

years. Therefore, several proven IT-enabled systems and solu ons

Enhanced opera onal eﬃciency

are available to those ﬁelds. Healthcare is a rela vely late entrant in

HMIS

adop ng IT – both in India and abroad. Therefore, enough proven

Outpa ent services from appointments to visit closure; inpa ent

systems are yet not available. In India, we currently have a situa on

services from reserva on and admission ll the discharge stage;

where most hospitals are either uncomputerized or atleast

diagnos cs services such as radiology, pathology, CNP; the wards,

inadequately.

ICUs, opera on theatres, nursing, medical records, EMR/clinical

The good news is that the healthcare sector is now beginning to

informa on, pharmacies, blood bank, material management,

adopt IT. Increased role of insurance and investment by corporates

ﬁnance, human resource management, insurance and pa ent

with tremendous reﬁnements in the health delivery model are

billing – all come under the purview of a typical HMIS. One can

some of the key drivers. Most medical instruments also allow

only imagine how comprehensive and well-integrated these

digi zed informa on about pa ents’ health as well as communicate it to a computer system in standard format. Common issues faced by hospitals: • Pilferage of materials and drugs • Extra wai ng me faced by pa ents • Delay/reduc on in bill payments by insurance companies • Unavailability of pa ents’ medical records and history • Lack of harmony among hospital staﬀ and departments Though, IT is no magic bullet to the problems faced by the healthcare industry, it surely is an enabler to ﬁx them. Many hospitals that

systems must be if they have gathered so much acclaim. The system even goes to the extent of offering computeriza on and integra on of support services such as CSSD, dietary, laundry, housekeeping and maintenance management. Not to men on, the integra on of front and back offices. It can offer high-end, enterprise-wide MIS including dashboards and interfaces. Integrated interface applica ons to devices such as bed side monitor, pathology lab equipment, PACS, speech-to-text system, SMART cards, Smartphone, PDA, RFID, document management system, workflow system, voice recogni on system, CDSS, telemedicine, robo c drug dispensing systems, electronic ICUs

have adopted IT systems with expected opera onal eﬃciencies

and others can also be probed for integra on. HMIS must be

have achieved promising results. Signiﬁcant advancement in the

standards compliant both for pa ent informa on exchange and for

healthcare IT world has paved the way for superior pa ent care

clinical, medical and billing codiﬁca on.

services. Hospital Management Informa on System (HMIS) is one

The actual objec ve of HMIS is to enable an error-free coordina-

such innova on that has already proved its worth in...

on and seamless service to pa ents by the primary servicing

persons and departments (doctors, nurses, theatres, ICUs, wards, labs, radiology, pharmacy, stores) and support departments (CSSD, dietary, laundry, housekeeping, maintenance. A comprehensive and integrated HMIS as described above will offer several benefits such as direct cost savings. Material Holding Costs In material terms, the HMIS so ware can provide accurate inventory requirements based on past history from main and sub-stores as well as assist in reducing stock holding costs. In a recent study by Symphony, it was found that this factor would result in a saving of INR 40 lakhs per annum for a hospital. Consump on Tracking and Control An integrated HMIS can track actual consump on, compare it with standard consump on and provide control over excess or inefficient u liza on/pilferage. This is important for expensive kits, usage of reagents in labs and u liza on of films in radiology, among other departments. Large hospitals have saved upto INR 3-5 lakhs every month by this measure alone, following the implementa on of an integrated HMIS. Expiry of Items An integrated HMIS can provide control and advance warnings for expiring drugs, consumables and other items. It not only restricts issue of expired items for sale or consump on, but also suggests transfers or returns of stock to supplier in advance. Hospitals hold large inventories of expired items, and therefore benefits by avoiding losses due to expiry. The specific saving varies from hospital to hospital, but on an average, they range between 0.5% and 1.5% of the total stock value. Restricted Drug Prescrip on Another method of saving can come from holding/blocking/limi ng certain type/value of drug prescrip ons for certain class of pa ents. An integrated HMIS can recognize pa ent types/schemes and ensure that prescrip on is issued using an applicable drug directory only. Such a check is difficult other than through HMIS, as it can restrict prescrip on at source. With increasing charity and health schemes, hospital managers recognize that savings for them can be significant. Senior hospital managers have indicated that this has resulted in more than 17% of cost reduc on towards issue of drugs to charity/health scheme pa ents. Purchase Price By tracking mul ple vendor price lists and past performances, be er purchase prices can be availed for by hospitals. Direct linkage to supplier portal/web purchase op ons have increased the poten al of saving in this regard, with special schemes being

announced on portals. This is certainly not feasible manually. An es mated 3-4% reduc on in purchase price has been experienced, with regard to this feature of HMIS. Human Resources Savings in human resources cost could be in the order of a few lakh of rupees, every month. While a figure is difficult to surmise, this can perhaps be the biggest type of saving that one can expect from an integrated HMIS implementa on. Hospitals in India and abroad where HMIS has been implemented, the need for manual requisi oning has been fully eliminated for diagnos cs, medica on services besides other requisi on areas such as the doctor’s desk, nursing sta on, OT etc. Furthermore, no manual requisi oning is required for the stock as well. An integrated HMIS eliminates the need to prepare manual MIS reports, opera onal registers, books and other records. Substan al cost benefit in manpower savings alone is immense. Improvement in Service to Pa ents • Health requirements based priori za on: With features of built-in priori za on based on pa ent health parameters and diagnosis, hospitals can gauge the urgency of cases and treatment. This can start from appointment for procedures, admission, doctor and radiology services, extending up to surgery and services scheduling by the HMIS. • Ready availability of pa ent record: With pa ent EMRs maintained, the pa ent medical history and up-to-minute health informa on are at the clinicians’ ready disposal. • Facility for mul -loca on service points: With enterprisewide computeriza on and emerging mul -loca on/mul hospitals environment, HMIS can make pa ent records available at all loca ons. It can offer facili es to take consulta on at nearest clinic of the enterprise, provide sample for radiology test at the nearest collec on centre (or have home service) and go to the hospital only for medical/surgical treatment. • Alerts and assistance to clinician: Built-in facili es for alerts to clinicians while prescribing drugs to which pa ents are allergic. In addi on, it can provide warning of side effects and drug-to-drug interac ons. This helps in prescrip on of appropriate medica on and be er service to pa ent. This extends to automa c SMS genera on to trea ng doctor when a pa ent’s inves ga on results go beyond cri cal values or for pa ent’s health becoming cri cal. • Elimina on of duplicate or repeated inves ga on: With built-in checks for diagnos cs services and prescrip ons, HMIS can assist in ensuring that no repeated inves ga ons are ordered. • Reduc on in Medica on Errors: Issues of legibility, accurate dosage and dispensing issues are eliminated by electronic requisi oning. Clinicians and pharmacists benefit with info about generic composi on and suggested dosage based on crea ng level and body surface area (BSA). • Faster inves ga on result processing: With electronic requisi on, order communica on and automated lab equipment interfaces, test results can be obtained quicker and more precisely resul ng in faster treatments. While this is helpful in all cases, it can surely be vital in emergency cases. Online review of medical results to authen cated doctors via the internet, SMS or email is another added advantage. Even automated deliveries to wards, clinics, pa ents and rela ves can be set. • Faster delivery of drugs: Both for outpa ents and

inpa ents, adequate stock availability and faster issue of drugs with built-in order communica on engine, request status tracking and escala on mechanisms can be ensured.

• Faster discharge: Delays in discharge is a known issue. Wai ng me at discharge can be reduced from hours to only a few minutes. Improvement in Opera onal Efficiency • Integra on of services: HMIS acts as a backbone for integra on of various hospital services, resul ng in quick and consistent delivery of service to a pa ent. When pa ent service request, expansion, processing and delivery points are fully united and well-coordinated by a common system, the speed and quality of pa ent services improve dras cally. This benefits pa ent treatment immensely and assists clinical staff in focusing on treatment rather than on involvement in administra on. In addi on, it ensures that at each stage, all the primary and ancillary services are available for pa ent treatment on me and as required. • Elimina on of duplica on: A single centralized database and repository of informa on in its complete form is invaluable. Process owners and users draw data as per their needs and access rights. This includes clinical staff, management, front office staff, support staff and back office staff. Since the system maintains a single and complete version of the required data, it removes the need for individual departments to maintain their own subset of the same informa on. Thus at the hospital level, it eliminates duplica on of work in a significant manner. • Op mized scheduling of facili es: Due to the online nature of HMIS, up-to-minute scheduling informa on is made available with ease. In addi on, online booking facili es from anywhere by anyone who has the rights to do so are enabled. • Highligh ng bo lenecks and TAT analysis: Valuable informa on on turnaround mes at various points in the treatment lifecycles can be discerned by HMIS. They can help the management in focusing on bo lenecks, op mizing processes and ensuring availability of resources. • Improvement in theatre u liza on: Accurate analysis of theatre u liza on and loss of me at every stage in a procedure can help in improving theatre u liza on. An integrated HMIS, on the other hand, can provide facili es to predefine all the prepara ons required for a surgery. Further, it can ensure the comple on of all the requisite prepara ons by advance informa on and built-in electronic confirma on checklists. • Increased bed u liza on: Accurate bed census with precise informa on on bed availability and faster discharge process can

lead to an increased revenue base. • Standards based: Enhanced clinical, medical, billing and coding standards are emerging for informa on maintenance and exchange such as ICD, ICP, CPT, eBNF, LOINC, HL7 and DICOM. Without computeriza on and HMIS, it would be very difficult if not unfeasible for hospitals to adhere to these standards. • MIS: A comprehensive and well-integrated HMIS can generate valuable cross func onal MIS for decision-making. As per the current trend, mul ple management dashboards are provided – MIS for chief administrator, clinicians, nursing, opera ons, HR, finance and materials. • Usage of interna onal databases: For improved pa ent care, interna onal databases are available for clinical reference. These databases provide all associated informa on to clinicians for be er diagnosis. Online access to these databases from within HMIS, specific to a pa ent’s health condi on (chief complaint/diagnosis) can assist in improving efficiency of pa ent care remarkably. To Summarize An HMIS so ware provides direct cost saving, assists improvement in quality of pa ent services and lays a strong founda on for improvement in opera onal efficiency. While some are summa-

rized in brief above, many more indirect beneﬁts ensue. The vantage point of HMIS is its compa bility with most of the newly developed IT products to be er healthcare delivery systems. The challenges faced by healthcare organiza ons in its implementa on include vendor selec on, adequate knowledge/resources and determined senior management involvement. But ‘the success rate is very high,’ report vendor and management ins tu ons. Installa ons have even given be er than expected ROI. The healthcare sector in India is poised for a steep growth as the opportuni es are ever-increasing. It must gear up to establish and maintain a compe ve edge. The author has over 30 years of rich experience in the IT industry, India and abroad. He has held senior management posi ons in so ware companies, IT vendor organiza ons and in-house IT departments of mul na onal companies. He may be contacted at symumbai@vsnl.net.

Meliora ng Hospital Eﬃciencies Uday Tha e, Director - HITECH MIS Pvt. Ltd., reveals how user-friendly communica on technology can be injected by healthcare providers to involve volunteer donors and pa ents on a mely basis.

The use of technology has magniﬁed in mul farious opera ons of healthcare with me. Hospitals of today spend huge funds to equip their diagnos cal and surgerical units with the most advanced technology to carry out challenging medical tasks with greater precision and superior outcomes. Use of database technology in gene c research has been highly celebrated in the last decade. Devices and diagnos cs are also going digital; advancing long-heralded ideas as telemedicine; personal medical devices for the home and smart pills. Physical sciences have already been transformed with the adop on of informa on technology, advanced materials, imaging, nanotechnology, sophis cated modeling and simula on. However, there has been rela vely li le improvement in making the pa ent – the end customer of all healthcare industry – more

in everything we do. Together with this handy tool, it was essen al to build the necessary informa on technology to send and receive SMS from the web, process and store data in a robust and secure database that is accessible via the internet. Once this was achieved, Dr. Rajeev Joshi – a prac cing pediatrician – gave shape to a very simple concept of registering the date of birth of an infant along with the parent’s mobile number, genera ng a vaccina on schedule and automa cally sending reminders on the scheduled dates. A parent has to simply send 'AROGYA VACC' by SMS to ArogyaMitra’s SMS center number +919246356765, and the automated system kicks in. All remaining details are collected from the parent by an SMS template in the form of a ques onnaire; the reply is stored away in the database. This was followed by another service, it works a er registering the date of the last menstrual cycle, to create a menstrual period calendar and sending reminders for periodic check ups to pregnant women. These services are provided free of charge to parents because the company is able to operate them at a very low expenditure. Success of these two services has propelled the ArogyaMitra team into launching an intelligent blood donor network, in collabora on with the ISBTI-Pune chapter. This is designed to register voluntary donors by SMS (just send 'AROGYA BLDDNR') and fulfill blood requirements of blood banks by matching qualified donors and reques ng them to visit the needy blood bank and donate blood. Aside from matching the blood donors, the system automa cally eliminates donors who have donated in the last 4 months and donors who have other disqualifica on criterion prescribed by the blood transfusion and immunohaematology authori es. Again, how do the blood banks no fy their requirement? Of course, by SMS! These services have received some exposure in media and newspapers around western and central Maharashtra but difficul es in obtaining funding have so far prohibited large scale adver sing and mass outreach of these innova ve services with a noble aim.

informed and enlightened about his/her own health. There are perhaps several reasons behind this – legal, administra ve and such. But in a densely populated country such as ours, one reason outweighs all others – 'there is no me'. Healthcare providers including well-meaning doctors are hard-pressed for me, thanks to the pa ent-to-doctors ra o of 1700:1. Compare this with Peru 850:1; France - 300:1 and; Cuba - 170:1, demonstrate a much healthier sta s c. It is rather obvious that pa ent informa on and pa ent-doctor communica on takes a rather low priority in the big scheme of things. Keeping our country's technology quo ent in mind, India can lead the way with innova ve use of inexpensive informa on technology. Today, more than 80% of India’s popula on uses mobile phones, whereas less than 20% have access to the internet. Moreover, SMS is cheap, instantaneous and user-friendly. We, at Hitech MIS Pvt Ltd, Pune, decided that SMS can take the chief mode of communica on

The author has over 26 years of varied experience in IT, partly as entrepreneur and independent IT solu ons consultant, and partly as employee. He may be reached at hitechmis@gmail.com.

NextGen Healthcare Umesh Oza, Director – Consultancy & Projects – Symphony India, records some of the many beneﬁts that HMIS can bring within a hospital.

Informa on Technology has been successfully used in manufactur-

Cost saving

ing, ﬁnance, transporta on and other sectors for more than 50

Improved pa ent service

years. Therefore, several proven IT-enabled systems and solu ons

Enhanced opera onal eﬃciency

are available to those ﬁelds. Healthcare is a rela vely late entrant in

HMIS

adop ng IT – both in India and abroad. Therefore, enough proven

Outpa ent services from appointments to visit closure; inpa ent

systems are yet not available. In India, we currently have a situa on

services from reserva on and admission ll the discharge stage;

where most hospitals are either uncomputerized or atleast

diagnos cs services such as radiology, pathology, CNP; the wards,

inadequately.

ICUs, opera on theatres, nursing, medical records, EMR/clinical

The good news is that the healthcare sector is now beginning to

informa on, pharmacies, blood bank, material management,

adopt IT. Increased role of insurance and investment by corporates

ﬁnance, human resource management, insurance and pa ent

with tremendous reﬁnements in the health delivery model are

billing – all come under the purview of a typical HMIS. One can

some of the key drivers. Most medical instruments also allow

only imagine how comprehensive and well-integrated these

have adopted IT systems with expected opera onal eﬃciencies

and others can also be probed for integra on. HMIS must be

have achieved promising results. Signiﬁcant advancement in the

standards compliant both for pa ent informa on exchange and for

healthcare IT world has paved the way for superior pa ent care

clinical, medical and billing codiﬁca on.

services. Hospital Management Informa on System (HMIS) is one

The actual objec ve of HMIS is to enable an error-free coordina-

such innova on that has already proved its worth in...

on and seamless service to pa ents by the primary servicing

inpa ents, adequate stock availability and faster issue of drugs with built-in order communica on engine, request status tracking and escala on mechanisms can be ensured.

The author has over 26 years of varied experience in IT, partly as entrepreneur and independent IT solu ons consultant, and partly as employee. He may be reached at hitechmis@gmail.com.

NextGen Healthcare Umesh Oza, Director – Consultancy & Projects – Symphony India, records some of the many beneﬁts that HMIS can bring within a hospital.

Informa on Technology has been successfully used in manufactur-

Cost saving

ing, ﬁnance, transporta on and other sectors for more than 50

Improved pa ent service

years. Therefore, several proven IT-enabled systems and solu ons

Enhanced opera onal eﬃciency

are available to those ﬁelds. Healthcare is a rela vely late entrant in

HMIS

adop ng IT – both in India and abroad. Therefore, enough proven

Outpa ent services from appointments to visit closure; inpa ent

systems are yet not available. In India, we currently have a situa on

services from reserva on and admission ll the discharge stage;

where most hospitals are either uncomputerized or atleast

diagnos cs services such as radiology, pathology, CNP; the wards,

inadequately.

ICUs, opera on theatres, nursing, medical records, EMR/clinical

The good news is that the healthcare sector is now beginning to

informa on, pharmacies, blood bank, material management,

adopt IT. Increased role of insurance and investment by corporates

ﬁnance, human resource management, insurance and pa ent

with tremendous reﬁnements in the health delivery model are

billing – all come under the purview of a typical HMIS. One can

some of the key drivers. Most medical instruments also allow

only imagine how comprehensive and well-integrated these

have adopted IT systems with expected opera onal eﬃciencies

and others can also be probed for integra on. HMIS must be

have achieved promising results. Signiﬁcant advancement in the

standards compliant both for pa ent informa on exchange and for

healthcare IT world has paved the way for superior pa ent care

clinical, medical and billing codiﬁca on.

services. Hospital Management Informa on System (HMIS) is one

The actual objec ve of HMIS is to enable an error-free coordina-

such innova on that has already proved its worth in...

on and seamless service to pa ents by the primary servicing

inpa ents, adequate stock availability and faster issue of drugs with built-in order communica on engine, request status tracking and escala on mechanisms can be ensured.

The author has over 26 years of varied experience in IT, partly as entrepreneur and independent IT solu ons consultant, and partly as employee. He may be reached at hitechmis@gmail.com.

NextGen Healthcare Umesh Oza, Director – Consultancy & Projects – Symphony India, records some of the many beneﬁts that HMIS can bring within a hospital.

Informa on Technology has been successfully used in manufactur-

Cost saving

ing, ﬁnance, transporta on and other sectors for more than 50

Improved pa ent service

years. Therefore, several proven IT-enabled systems and solu ons

Enhanced opera onal eﬃciency

are available to those ﬁelds. Healthcare is a rela vely late entrant in

HMIS

adop ng IT – both in India and abroad. Therefore, enough proven

Outpa ent services from appointments to visit closure; inpa ent

systems are yet not available. In India, we currently have a situa on

services from reserva on and admission ll the discharge stage;

where most hospitals are either uncomputerized or atleast

diagnos cs services such as radiology, pathology, CNP; the wards,

inadequately.

ICUs, opera on theatres, nursing, medical records, EMR/clinical

The good news is that the healthcare sector is now beginning to

informa on, pharmacies, blood bank, material management,

adopt IT. Increased role of insurance and investment by corporates

ﬁnance, human resource management, insurance and pa ent

with tremendous reﬁnements in the health delivery model are

billing – all come under the purview of a typical HMIS. One can

some of the key drivers. Most medical instruments also allow

only imagine how comprehensive and well-integrated these

have adopted IT systems with expected opera onal eﬃciencies

and others can also be probed for integra on. HMIS must be

have achieved promising results. Signiﬁcant advancement in the

standards compliant both for pa ent informa on exchange and for

healthcare IT world has paved the way for superior pa ent care

clinical, medical and billing codiﬁca on.

services. Hospital Management Informa on System (HMIS) is one

The actual objec ve of HMIS is to enable an error-free coordina-

such innova on that has already proved its worth in...

on and seamless service to pa ents by the primary servicing

inpa ents, adequate stock availability and faster issue of drugs with built-in order communica on engine, request status tracking and escala on mechanisms can be ensured.

The author has over 26 years of varied experience in IT, partly as entrepreneur and independent IT solu ons consultant, and partly as employee. He may be reached at hitechmis@gmail.com.

Metrics That Ma er Robert H. Cohen, Vice President - Siemens Healthcare, presents how a hospital is revolu onized to the hilt by IT solu ons.

Figure: Solu on Architecture and Pla orm Overview – A Technical Perspec ve

In India, IT investment in healthcare is generally not considered as a strategic requirement to drive business; IT adop on in hospitals is s ll at a nascent stage. The healthcare IT market has thus become challenging. In addi on, the market is highly fragmented with mul ple healthcare vendors and fierce compe on. However, as consumers become more demanding, healthcare delivery systems are forced to reexamine their opera ons to find new ways to introduce efficiencies and posi on themselves as world-class organiza ons. For all the above reasons, it is indeed impressive, when a mid-sized healthcare provider decides to use IT as an enabler for business transforma on. We are talking about S.L. Raheja Hospital (an associate of For s) – a 140-bed private trust based hospital located in Mumbai. When For s Group took over the opera ons of S.L. Raheja Hospital, a couple of years ago, there existed quite a few challenges. The new management introduced significant changes including a transforma on of the work culture. One of the early decisions was to use IT as an enabler for the change process. “We wanted to upgrade and use a Hospital Informa on System (HIS) that could func on as a key enabler for driving pa ent safety, quality of care and process efficiency in our hospital and also help us drive the change in work culture,” said Dr. Uma Nambiar, CEO, S.L. Raheja Hospital. The hospital was keen to provide their pa ents a sense of comfort that they are coming to a place that drives clinical excellence, offers excellent quality of pa ent care and is based on good governance including transparent and ethical medical care. When S.L. Raheja decided to partner with Siemens to implement Soarian MedSuite

HIS solu on, they looked at Siemens as a leading innova ve company well-known in healthcare technology. During the evalua on process, S.L. Raheja Hospital team observed that the solu on is ground up built on an advance technology pla orm with rich set of administra ve, clinical and ﬁnancial func onali es that would not only help meet their current objec ves but also future needs of the hospital. The primary objec ves of implemen ng the Soarian MedSuite

solu on at S.L. Raheja Hospital were: • Improve the pa ent care and safety • Improve the pa ent experience • Improve quality and effec veness of the clinical processes The solu on covers pa ent administra on, billing, scheduling, laboratory, pharmacy, clinical management, clinical documenta on, computerized physician order entry, electronic medical record, imaging services and integra on to back office (finance and purchase).

Integrated Healthcare IT System Soarian MedSuite is a perfect example of feature func onality and technology mix that gives healthcare providers a lever for driving opera onal efficiencies and business transforma on. The Technical Perspec ve The Soarian MedSuite Architecture and Technology Pla orm is delivered with a powerful and highly scalable business process management engine to define and customize business processes and integra on flows. A reference XML-based syntax (metadata) is used to define them. This reference XML process defini on can be translated into a number of emerging standards for business process and workflow defini on. Soarian MedSuite’s built-in integrated business process management engine provides a powerful solu on to define and execute business processes that coordinate people, systems and services. Specifically, the pla orm provides an integrated solu on to implement Workflow–enabled process defini on and management, which required ac ons and input from users to stop and start the flow of work. Workflows were configured to take the transi on state to the correct user and authoriza on level by assigning role-based menus and specific rights, thereby… • Streamlining revenue related workflows to plug leakages • Suppor ng mul ple level authoriza ons for certain billing decisions • Establishing correct level of authoriza on channels across processes Ac ons owners were defined for each of the workflow transi ons that streamlined the business processes. • Manage Business Process-enabled integra on and coordina on of users and systems, and implement formally defined business processes, thus aiding: • Rou ng of services based on departmental or service category specific SOPs

• Clarity on the precise ac ons to be performed by different sets of users, resul ng in improved TAT (Turn Around Time) for different services • Orchestrate Web Services to coordinate and assemble func onality that is exposed as web services • Provide users with easy access to latest informa on, thereby resul ng in reduc on of Average Length of Stay through quicker decisions The integrated business process management pla orm provides tools to define business processes, a highly scalable engine to execute process defini ons and administra ve tools to monitor processes and ac vi es. Full order life-cycle management is the first example to u lize business process management func onality. This architecture allows new component elements to be integrated in future releases of the pla orm. The implementa on of the ini al phase of the project at S.L. Raheja Hospital was completed in August 2010. The project team, however, did not stop with the commissioning of the HIS at the hospital, but went on to conduct a ‘Proven Outcomes’ exercise, in which certain key parameters were iden fied and monitored. The purpose of this exercise was to understand the key benefits from the solu on implementa on. Maximizing Efficiencies in Pa ent Care Several parameters were iden fied and pre- and post-implementa on data was collected for these parameters. The outcomes demonstrated significant improvement. The outcomes for some of the key parameters measured are presented below. Metric #1: Improvement in Bed Management Efficiency Due to the well-defined SOPs adopted in the discharge workflow, a significant improvement can be seen. The improvement in the efficiency of the discharge process results in enhanced pa ent sa sfac on and increased bed u liza on for the hospital. During the pre-live phase, the me to discharge for majority of the

wards without having to worry about the billing implica ons, as billing func ons automa cally places the charge as and when the nurse in the ward accepts the dispensed medica on. This is how the business process was configured to func on in Soarian MedSuite’s workflow manager. Users are able to place the service orders directly from the nursing sta on or the wards, where the pa ent is admi ed. These are then routed to different ac on owners who complete the order life cycle. Metric #3: Average Length of Stay (ALOS) reduced from 6.47 days to 4.71 days Soarian MedSuite made it possible to discharge pa ents mely and in turn increase the bed u liza on. The discharge workflow immediately informs billing, pharmacy and all concerned departments to start the discharge process. This is en rely driven by user specific worklists and tasks. It also blocks the final discharge and shows the bed as occupied ll all other open transi ons are addressed. Pre-live, the discharge process was not supported by an automated workflow. Post-live, Soarian MedSuite was configured for automa on of complex service workflows, which enabled users to act promptly on requests, ac ons, transi ons, informa on, etc., which in turn resulted in reduced ALOS. Metric #4: Turnaround me for Radiology repor ng (Sonography) me improved by 3 folds Soarian MedSuite has been configured separately for imaging services and the workflow takes care of all the important states such as ‘Consent required’, ‘Pa ent Counseling’, etc. This streamlined the imaging workflow, which took care of all the stat orders. Pre-live, all the Sonography reports were typed using word document and only 6.74% of reports were delivered within 1 hour me frame; whereas post-live, all the reports are entered in the Soarian MedSuite result repor ng template, which is mapped to the service workflow leading to an increase of 27.6% of results reported within 1 hour me frame thereby improving the turnaround me efficiency by almost 3 folds. This automa cally becomes a part of the pa ent’s Electronic Medical Record. Metric #5: Turn Around Time (TAT) for short lead me tests improved for Biochemistry and Hematology by 59 % and 52% respec vely

The me taken from the moment the physician marks the pa ent for discharge to the me when the pa ent actually vacates the bed and leaves the hospital premises pa ents Bed Management Efficiency 45% 40% 35% 30% 25% 20% 15% 10% 5% 0%

40.74%

36.79%

30.69%

26.73% 16.12% 11.41% 0.00% <2hrs

Pre-Live %

9.61%

8.86%

2.26% 2-3hrs

Post-Live %

3-3.5hrs

3.5-4hrs

10.18% 6.61%

4-4.5hrs

The me of accessioning the order in the laboratory un l the me, the report is authorized and released to physician/nurse in the ward

4.5-5hrs

Ti me t a k e n f or di sc ha r ge

Figure: Percentage of pa ents with the me taken to discharge

was 3 hours or more, owing to lack of availability of real- me informa on. Post-live, over 37% of pa ents were discharged within 2 hours from the me physician marks for discharge as against average me taken to discharge a pa ent at 3.5-4 hrs. Metric #2: Medica on Dispensing Turnaround Time improved by more than 15% Online order entry has resulted in improvement, immediately a er the order entry for inpa ents; the order is made visible to the pharmacy for dispensing. Pre-live all the pharmacy orders were manually wri en by the nurses and sent to the pharmacy. Post-live all the pharmacy orders were placed using Soarian MedSuite, which reduces the me from order to dispense, thus enhancing pa ent care and response mes. Pharmacy users get list of medica ons to be dispensed to diﬀerent

Figure: Increase in percentage of short lead me tests completed within 90 minutes

Specimen label genera on and barcode labeling has improved the collec on, processing and result repor ng me for two of the busiest laboratory departments – Biochemistry and Hematology. Pre-live, there was no bar-coded sample to track specimens and no laboratory instrument interface. Post-live, all collected specimens

are bar-coded and laboratory instruments are interfaced. Hence, the TAT for specimen handling and processing is improved. Laboratory specimen collec on is completely bar-coded for correct specimen iden fica on and automa c sending-retrieval of orders and results. Manual interven on with all the interfaced laboratory analyzers is reduced to only the result cer fica on part. Metric #6: Reduc on in the In-Pa ent Pharmacy Returns by 67% through process improvements Pre-live, medica on orders were manually wri en by the nurses/doctors, which resulted in delays, order duplica on and medica on errors. Post-live, all the medica on orders are placed online in Soarian MedSuite, where system validates for duplicate orders and automa cally calculates the dispense quan ty and also provides order traceability and tracking. This in turn reduces the over dispensing of medica on and hence the need for drug returns. Metric #7: Improved Billing efficiency, Minimized Pa ent Refunds significantly through workflow enhancements Pre-live, there was no workflow specified for refunds and no authoriza on required for the refund. Post-live, specific workflow has been configured to check the refunds with authoriza on at mul ple levels. This provides be er control over the service cancella on and refunds and results in greater accountability. Local billing rules such as bed type billing, corporate, insurance billing and packages were configured along with the workflows. This eliminated the manual interven on required for calcula ng the insurance payment. The audit trails capability of Soarian MedSuite ensures that the organiza on has transparency regarding the transac ons performed by different users. The S.L. Raheja Transforma on: Informa on Technology Empowers Clinical Excellence Implementa on of Soarian MedSuite has resulted in improvement of overall opera onal efficiencies including revenue cycle op miza ons and elimina on of revenue leakages in the system. The clinicians at S.L. Raheja Hospital shared a vision in which quality of the pa ent’s experience could be transformed and new levels of personalized a en on were within reach. It is this clarity of purpose, guided by a passion for pa ent well-being that drives the success of any investment in healthcare IT. This connec on was achieved at S.L. Raheja Hospital – and the data is there to show it. Guided by leadership, vision, training, and a strong sense of mission, informa on technology can bring meaningful

improvements to the broad set of processes touching the pa ent. Going ahead, S.L. Raheja will focus on clinical excellence including pa ent safety, clinical quality and clinical audit tools. About the Solu on Soarian MedSuite is a comprehensive and scalable HIS solu on that helps customers to orchestrate complex administra ve, clinical and financial processes suppor ng cri cal business ac vi es across the healthcare enterprise. Unlike tradi onal module based systems, Soarian MedSuite is configurable as a role-based applica on that allows users to work in a natural and efficient manner to support the tasks that complex healthcare professionals must complete. This allows ins tu ons to drive towards increased efficiency, produc vity and enhanced quality of pa ent care. The powerful solu on streamlines processes by seamlessly coordina ng data across the healthcare enterprise to provide clinicians a longitudinal view of the electronic pa ent record and enable them to deliver knowledge based and personalized healthcare experience. Soarian MedSuite leverages an innova ve technology pla orm to deliver a deeper, richer and unique ‘role-based applica on’ to healthcare ins tu ons around the world. This provides customers a highly scalable solu on, which is quick to implement and upgrade,

ﬂexible to adapt to complex hospital processes and interoperable with other applica ons. The rich user experience enables faster adop on of the applica on and helps to provide ROI (Return on Investments) to the organiza on. Developed in the US, Soarian MedSuite is backed by the body of healthcare knowledge and global best prac ces that Siemens has gained via successful system implementa ons in over 37 countries. The author may be contacted at robert.cohen@siemens.com.

Metrics That Ma er Robert H. Cohen, Vice President - Siemens Healthcare, presents how a hospital is revolu onized to the hilt by IT solu ons.

Figure: Solu on Architecture and Pla orm Overview – A Technical Perspec ve

40.74%

36.79%

30.69%

26.73% 16.12% 11.41% 0.00% <2hrs

Pre-Live %

9.61%

8.86%

2.26% 2-3hrs

Post-Live %

3-3.5hrs

3.5-4hrs

10.18% 6.61%

4-4.5hrs

The me of accessioning the order in the laboratory un l the me, the report is authorized and released to physician/nurse in the ward

4.5-5hrs

Ti me t a k e n f or di sc ha r ge

Figure: Percentage of pa ents with the me taken to discharge

Figure: Increase in percentage of short lead me tests completed within 90 minutes

Metrics That Ma er Robert H. Cohen, Vice President - Siemens Healthcare, presents how a hospital is revolu onized to the hilt by IT solu ons.

Figure: Solu on Architecture and Pla orm Overview – A Technical Perspec ve

40.74%

36.79%

30.69%

26.73% 16.12% 11.41% 0.00% <2hrs

Pre-Live %

9.61%

8.86%

2.26% 2-3hrs

Post-Live %

3-3.5hrs

3.5-4hrs

10.18% 6.61%

4-4.5hrs

The me of accessioning the order in the laboratory un l the me, the report is authorized and released to physician/nurse in the ward

4.5-5hrs

Ti me t a k e n f or di sc ha r ge

Figure: Percentage of pa ents with the me taken to discharge

Figure: Increase in percentage of short lead me tests completed within 90 minutes

Metrics That Ma er Robert H. Cohen, Vice President - Siemens Healthcare, presents how a hospital is revolu onized to the hilt by IT solu ons.

Figure: Solu on Architecture and Pla orm Overview – A Technical Perspec ve

40.74%

36.79%

30.69%

26.73% 16.12% 11.41% 0.00% <2hrs

Pre-Live %

9.61%

8.86%

2.26% 2-3hrs

Post-Live %

3-3.5hrs

3.5-4hrs

10.18% 6.61%

4-4.5hrs

The me of accessioning the order in the laboratory un l the me, the report is authorized and released to physician/nurse in the ward

4.5-5hrs

Ti me t a k e n f or di sc ha r ge

Figure: Percentage of pa ents with the me taken to discharge

Figure: Increase in percentage of short lead me tests completed within 90 minutes

Litmus Test of IT Dr. Bhavesh Chhadidar, Consultant – Hosmac, analyses the…

Process Area

Ac vi es to analyze

Key users to be involved

Prepara on of medical le ers

All the ac vi es from viewing of discharge le er to signing, sending and ﬁling

Doctors, clerks, head of IT

OT registra on, planning, coordina on and documenta on

Admission staﬀ, head of OT, OT nurse, head of IT

Radiology and Laboratory

Order-entry taking i.e. request for examina on and acceptance of results for ward or OPD pa ents. Acceptance of requests and communica on of results by laboratory or radiology departments

Nursing staﬀ, laboratory/ radiology assistance, head of IT

Factors aﬀec ng process cost changes

Example

Change in the dura on of an ac vity

Entering an inves ga on request on a paper form v/s. reques ng on a computer

Addi on or aboli on of an ac vity

Prin ng and ﬁling of papers

Changes in frequency of an ac vity

Taking X-ray prints only in 20% of the cases, thanks to availability of so copy images

Shi ing of material cost for organiza onal means

Elimina on of cost of forms

determined on the basis of frequency, me needed to complete an ac vity, as well as qualiﬁca on of the staﬀ employed. This analysis

New reali es are placing pressures on the healthcare industry, and how pa ent care is being delivered. Soaring hospital management costs, aging popula ons and lacking healthcare workforce are some of the challenges the healthcare system is trying to cope with, today. Besides, unearthing ways to ease access of services and medical informa on, and tend to issues of safety and quality. The healthcare industry has drooped in a chasm – they need to decipher how services can be delivered more effec vely, reduce costs, improve quality and extend reach. The cri cal ques ons facing the industry today include: • How do we adeptly manage hospitals and provide services, without placing addi onal burden on a system already pushed to its limits? • How do we provide care in a cost-efficient manner, at a me, when healthcare spending is rising? • How do we resourcefully support front-line staff to reduce medical errors and enrich quality of care? The way out looks bleak, but there’s hope. There are technologies available today to assist, pacify and take the edge off situa ons. Informa on technologies (IT) that enable immediate, informa on-rich communica on and provide easy-to-use collabora ve tools are increasingly becoming a vital part of healthcare. While the advantages of IT support concerning quality enhancement are very o en evident, quan ta ve effects are hard to determine. Therefore, it is impera ve to quan ta vely evaluate the economic advantages achieved through the use of HMIS. Before/A er Approach The basic approach should be: comparison of investment costs and running expenses of IT support with the reduc on in process cost

a er implemen ng HMIS. The cost of process before and a er introduc on is documented, and evalua on of efficiency can be carried out in the sense of a before/a er approach. Iden fica on of process area: • Iden fy key process areas with the department proposed to get benefit from the input, here HMIS, and allocate different modules suppor ng them • Determine and document ac vi es required to complete a process, and separate those covered by so ware a er introduc on of HMIS • Focus the study upon ac vi es secured by so ware Involve key users: • In order to achieve a realis c assessment of the HMIS u lity, analyze processes in co-opera on with key users • Key users should have ample knowledge with regard to the func onality of HMIS Ac vity-level approach: • With the help of ques onnaires and interviews answered by users, valuable data of processes must be acquired in accordance to the guidelines geared to the main ac vi es of the process area Process Cost Analysis Systema c ac vity based cos ng can enable us to determine cost per ac vity a er a segmenta on of the processes. For each ac vity, the personnel cost as well as relevant consumables’ cost before and a er the introduc on of HMIS are to be calculated. Also, judiciously spread overhead cost to relevant cost heads. The personnel cost generated by a specific ac vity can be

results in price per minute for the personnel involved. The evalua on of improvements focuses on the me personnel(s) give toward administra ve and organiza onal ac vi es concerning respec ve process areas. Ac vi es and mes of pa ent treatment shall not be considered, as they remain the same. The process cost changes generated by the introduc on and use of HMIS as explained above. Expenditure for HMIS Cost involved in HMIS can be dis nguished between ini al cost and opera ng cost. Ini al cost should be spread on opera ng life of HMIS, which corresponds to the economic useful life assumed at the me of HMIS introduc on. Ini al costs include: • HMIS license fee include charges for database and interfaces relevant to HMIS modules, if any • Other services at the me of HMIS installa on – consul ng, user training, customizing and so on • Expenditure on implementa on Opera ng Costs are mainly for:

• Personnel cost of IT department • Deprecia on on hardware and other infrastructure • Maintenance cost The annual cost for HMIS, determined in this manner, is balanced against the improvements established in the process cost analysis. This methodology further enables us to derive breakeven me and return on investment. Even hospitals unsa sfied with the economic benefit of HMIS can used these financial indicators, as a tool to explore the scope of improvement, and yards ck to measure the

beneﬁts of HMIS. Hospitals planning to invest in technology can ascertain their expecta on from HMIS providers, by understanding their actual need. While secured and evaluated experience shall help poten al and exis ng customer during the decision process of investment in IT, HMIS providers can prove the economic eﬃciency of their products to the customers. The author is a dude and can be reached at bhavesh. chhadidar@hosmac.com.

Litmus Test of IT Dr. Bhavesh Chhadidar, Consultant – Hosmac, analyses the…

Process Area

Ac vi es to analyze

Key users to be involved

Prepara on of medical le ers

All the ac vi es from viewing of discharge le er to signing, sending and ﬁling

Doctors, clerks, head of IT

OT registra on, planning, coordina on and documenta on

Admission staﬀ, head of OT, OT nurse, head of IT

Radiology and Laboratory

Order-entry taking i.e. request for examina on and acceptance of results for ward or OPD pa ents. Acceptance of requests and communica on of results by laboratory or radiology departments

Nursing staﬀ, laboratory/ radiology assistance, head of IT

Factors aﬀec ng process cost changes

Example

Change in the dura on of an ac vity

Entering an inves ga on request on a paper form v/s. reques ng on a computer

Addi on or aboli on of an ac vity

Prin ng and ﬁling of papers

Changes in frequency of an ac vity

Taking X-ray prints only in 20% of the cases, thanks to availability of so copy images

Shi ing of material cost for organiza onal means

Elimina on of cost of forms

determined on the basis of frequency, me needed to complete an ac vity, as well as qualiﬁca on of the staﬀ employed. This analysis

Perfec ng Healthcare Since 15 Years Isha Khanolkar, Assistant Manager – Opera ons – HOSMAC, records key conversa ons from the 15th Hosmac Day in Mumbai.

There comes a point in everyone's life when one looks inward: assesses experiences, ruminates learnings, and uses them to catapult oneself into the future. HOSMAC reached that point, when it celebrated 15 years of healthcare consul ng and construc on on July 24, 2011. Every step conquered has been a result of the culmina on of efforts by a team that has stood unde ered, while crea ng a niche space for themselves in an almost non-existant ver cal. HOSMAC was built on the pure trust and faith of our early clients: Mahaveer Hospital Trust, Hiranandani Group, and Dr. Panda of Asian Heart Insitute & Hospital. The credence they placed in our ability to deliver custom made solu ons to problems was extraordinary. A labor of love that emerged saw its share of ups and downs; the startup office being the living room of a suburban Mumbai apartment. Narendra Karkera, who is the Director, Opera ons at HOSMAC, recollects, "I met vivek when he was very young, and he told me about his dream of star ng such a consul ng firm. Today, he has done an excep onal job with the company, and I am yet to see another business man with genuine concern such as he shows." While Dr. Desai simply puts it as "a 15-year roller coaster ride." It has been an incredible journey for him. Over the years, HOSMAC has moved from its peviously defined space of management consul ng to architecture, and rounded it off with an entry into the construc on space. It soon developed into a one-stop shop for anyone desirous of se ng up a healthcare facility. O en misunderstood to be a firm that only services the corporate bigwigs, HOSMAC has worked with governmental agencies like

NSHRC, ESIC, State Health Socie es on projects ranging from quality accredita on of district hospitals to developing PPP models for the Andhra Pradesh Government alongwith IFC. The success of HOSMAC lies in its ability to solve problems that plague even the best in the healthcare industry. More importantly, the incredibly passionate and mo vated employees take to their tasks with as much care and eﬀort as one would take to keep their own house in order. In the years ahead, HOSMAC will look at expanding into more exci ng ver cals of consul ng. Strengthening our construc on prac ses and pushing the barriers in healthcare architecture are also forseen. HOSMAC also hopes to start a subsidiary in Africa, which is teeming with poten al. The last 15 years hasn't really been smooth sailing. But the next ﬁ een will transpire much healthier. For a Hosmacian, the future is without doubt very exci ng. To know more, visit www.hosmac.com.

Perfec ng Healthcare Since 15 Years Isha Khanolkar, Assistant Manager – Opera ons – HOSMAC, records key conversa ons from the 15th Hosmac Day in Mumbai.