Prescription for Change

The advantages of using IT in running enterprises are well known–and

heatlhcare has seen companies making a beeline for it as well, though the true

potential is yet to be tapped. While delivering huge benefits, IT, at the same

time, raises certain issues pertaining to standardization, acceptance and the

type of approach adopted by the sector. The Dataquest-Satyam CIO Meet was

organized with the intention of reviewing the effect of IT on day-to-day

functioning of hospitals, the extent of usage, and to examine the process of

migration to a paperless support system. Panel members were Escorts Heart

Institute and Research Center advisor (IT) MP Singh, Fortis Healthcare’s head

(IT) Sunil Kapoor, MCD deputy commissioner (IT) DS Pandit, Brig VK Singh, the

deputy director-general of Medical Services in the Indian Army, RK Gupta of

Batra Hospital, Government Hospital of Thoracic Medicine deputy superintendent S

Rajshekharan, Indraprastha Apollo Hospitals assistant manager (IT) R Srinivasan,

Satyam Computer Services assistant V-P (healthcare solutions) Chandra

Sangubhotla, Dr Naval Kishore, medical director of Tendercare Infotech India, SN

Reghu Kumar from the computer facility at AIIMS, and Kishore Bhargava,

Consulting Editor, computers@home, also the moderator of the discussion.

Vision

Sunil Kapoor (Fortis): Two years ago, our vision was to have a

filmless and paperless hospital. We scaled this down to near-paperless and

filmless. Paper is only used for certain tasks stemming from government

regulations and requirements. With that vision in mind, loose but specific, we

were on the lookout for specific IT solutions.

MP Singh (Escorts): We developed our own application. The practices

followed by an individual hospital depend on doctors and collective

administration and so it doesn’t really make sense to have a ready-made

package. Today we have applications running on 250 computers in two buildings,

sitting on 19 servers and with a 24/7 availability. What we have done since the

last 12 years, and which is advisable, is to build the system ourselves, and

implemented a ready-made package only towards the end when we were ready to

accept the changes that came with it.

Brig VK Singh (Indian Army): We control 109 hospitals and 87 mobile

hospitals across the country. The number of beds in these 109 hospitals range

from 50 to 1,060. And in the 87 mobile hospitals that we oversee, the total

number of beds are 60,000. All of them are centrally monitored.

Brig RK Gupta (Batra Hospital): We have not yet computerized patient

records from the IPD or the OPD. Hospital services like accounts, serial and

operation theatre management are kept on electronic records. We put laboratory

services online. Any department can view the reports as they are all connected.

We are interfacing the services that are already online like finance, inventory,

and purchase order to mainstream functions like the laboratory for instance.

S Rajashekharan (GHTM): We started offline in-patient (IP) data entry

initially and found problems like missing links in information. After which we

thought we would go online. We have only 10-15% of patients getting admitted

unlike large institutions. And if we have only an IP online then we miss a large

chunk of the OP data of patients.

Chandra Sangubhotla (Satyam Comptuer): Satyam focuses mainly on the

non-Indian markets. In the US, IT spending is less than 2%. They buy

off-the-shelf products rather than developing them in-house. Right now we are

seeing different medical requirements, like a need to be integrated, say with

the pharma industry and a need to integrate with insurance companies.

Hurdles in implementation



MP Singh (Escorts Heart Institute): There are hardly any integrated

packages available in the world and they are so expensive and it does not really

suit the Indian conditions.

Dr Naval Kishore (Tendercare): Smaller hospitals cannot afford to

develop their own software. Readymade software packages should allow flexibility

and some customisation.

Who are the beneficiaries?



Tendercare: Rather than evaluating their needs first and then looking into

packages, people are negating their own requirements that might become critical

to the system functioning operations at a later stage.

Escorts: It is the nurses who are making it possible to run the system

successfully. But doctors are either keyboard shy or want others to feed the

data for them.

Indian Army: The minute there is slight system error, doctors lose

their patience. They are not ready to wait till the error is rectified. It’s a

culturally inherited habit that even if they were trained, they would not be the

ones who would feed data into the system. Fourteen years ago we computerised

four hospitals and failed. We did everything on our own, and even trained our

personnel overseas. A similar episode ensued with AIIMS too. And now, three

years back, two private firms handled the system for us, and they in turn

failed. We knew what we wanted, we have the training for it, but when it came to

using it for our everyday functioning, we didn’t.

OPD or IPD?



Indian Army: Since the defence sector has been low on cost

considerations we are not yet facing any billing issues. We have only started

using billing. Our patient module does not computerise the OPD as the first

task. It is the in-patient records that must be first computerised. In-patient

records remains in the system for 12 or 21 days or for even a longer time

period. On the other hand, the records from an OPD remain for less than half an

hour.

Fortis: We went computerising the OPD first because it was the first

area that was commissioned. Today, we are on a single window clearance, the

patient or a relative can approach our OPD counter. One can enquire about a

doctor or the system could instruct the front office people as to which doctor

the patient should be assigned to. They can quick search doctors on 

the panel,

duration of duty and time-slot according to which they suggest waiting hours.

Luckily some doctors are using the system when advising or suggesting a line of

treatment. By the time the patient walks down to pay for, say a x-ray, a request

goes to the Radiology department, alerting that a x-ray needs to be done.

Reghu Kumar (AIIMS): From 1995 onwards, we started developing islands

of information. We began recording information from the OPD, IPD, setting up few

PCs and started in-house development. With bare essential data recorded in the

system and a bulletin medical record we are now in the process of integrating

them. We have developed the software well in advance and are now implementing it

separately in departments.

Standardization



Indraprastha Apollo Hospitals: What we are doing in the health care sector

is borrowed from the business industry like the billing information system.

However, the area in the healthcare sector that we are missing out on is having

a central core in the clinical information systems space. And for that, we need

standardization.

MCD: Then when we came about laying standards we ran into another

difficulty. This time it was the type of standards that need to be put down for

application development. It was easy for the non-clinical side but was difficult

on the clinical side. We set up a committee for the same and they are yet to

submit their recommendations. But it should not be difficult for standards to be

laid down, as most hospitals are similar across India.

Batra Hospital: We need standardization in our hospital management and

technical management systems. We may have a part of "technical"

readily available–as medical information or in the form of literature. Because

two clinicians will differ in their approach, we cannot set any standards, even

if it is drug interaction. But in other areas like bypass or gall bladder

surgery we can set certain standards.

MCD: One of the issues, which we faced, was identifying application

developers or system developers. As in all government departments, we had to

float tenders, and could not pick and choose. And for which, we had to get some

standards laid down by which it became easier for us to determine the

suitability of the kind of solutions they are offering. Medical insurance 

has

been in the market for a long time now, but hasn’t actively communicated with

hospitals because of the lack of standardization.

Indian Army: We would be integrating 87 mobile hospitals by

telemedicine. We have some pilot project, which is under linkage between here,

Srinagar, Udhampur and Leh. They are all on experimental pilots and in the next

three years, we will link up all these. In fact, we had moved seven of these

mobile hospitals into Bhuj during the earthquake.

Kishore Bhargava (Consulting Editor, C@H): In terms of what IT has

currently been deployed we are seeing benefits from the patients point of view,

the doctors point of view and from the view of the hospital management.

Telemedicine, is the way for the future specially for a country like India with

more that 70% constitutes rural population.

RADHIKA BHUYAN in New Delhi