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Do you want me to treat the patient or type in data?
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You talk of 24x7 availability of patient data, what does
one do every time the electricity goes off in the midst of a surgical
procedure? -
You hand over a CD with a patient’s reports, how is the
next doctor to assess it when the two don’t agree on basic standards for
this? - The information management system we have is no different from one
designed for other fields. Where is the clinical information system that
addresses the hospital’s problems?
For a sector supposedly red-hot on IT-readiness, such murmurs
of discontent are well…unhealthy! This marriage of two diverse streams of
science is clearly not running all that smooth. There is a lot IT and healthcare
(that includes the pharmaceutical industry, but not biotechnology and
bioinformatics) can do for each other. If exploited to its fullest potential,
healthcare can provide a lion’s share of the IT industry’s revenues on the
enterprise side. As for healthcare using IT, it’s everywhere–from point
solutions to end-to-end hospital management and tele-medicine in remote areas to
high-end medical diagnostics applications. But the size of the healthcare
segment with reference to IT remains hazy.
IDC India estimated the total IT spend in Year 2000-01 to be
Rs 441 crore. Half of this was on hardware. With a projected growth of 13%, the
spending in 2001-02 is estimated to be Rs 497 crore (IDC is in the process of
arriving at an estimate for 2001-02). The next two years (i.e. 2002-03, 2003-04)
are expected to witnesss several mergers and acquisitions in the healthcare
segment. Against this backdrop, spending on IT would be treated by organisations
as a strategic investment in order to gain more competitive alliances and grow
marketshare. IT spend in these two consecutive years is estimated at Rs 566
crore and Rs 639 crore, respectively.
Demand drivers
IDC predicts that the growth in 2003 and 2004 will mainly come from domestic
organizations that would be automating their processes and establishing
sophisticated IT setups. These will also be the last two years when
organizations will try and get as many processes possible patented to their
credit and also start gearing up to face the competitive scenario that would
emerge after the WTO laws fall in place. Organizations are also increasingly
investing in their research departments so that they can gain as many process
patents as possible before 2005.
While the numbers have their own story to tell, there are
several factors responsible for the immense potential that healthcare has in
store for the IT industry…To begin with, the entry of corporates in the
healthcare business has transformed the industry’s outlook towards patients.
Now viewed as customers who should be given quality care along with the frills
of modern-day CRM practices, these corporates are extremely keen to improve
efficiency as well as the conduct their operations in a cost-effective manner.
Another factor is that policies and budgetary considerations
towards pharmaceutical as well as biotech organizations are now favorable. The
Government of India has already moved towards the de-regulation of health
insurance and paved the way for the entry of foreign health insurance companies.
The medical equipment industry too is being opened to foreign collaboration in
the manufacturing of high and middle-level technology medical equipment.
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So, where does IT come in?
Automation of organizations in the pharmaceutical space as well as hospitals
and clinics (e.g. SCM, CRM, R&D), bio-medical equipment (e.g. MRI, CT Scan),
health insurance and allied organizations as well as health departments of the
respective federal /state governments and tele-medicine are the broad areas in
which IT is used by the healthcare industry.
A hospital information system (HIS) is essentially a
specialized version of business applications developed for other industries.
HISs are a combination of clinical systems, front office systems, materials
management, financial management, etc. These are usually available as
independent modules that can be integrated and customized as per the
requirements of users. Indian software companies like SISL, TCS, Cognizant, and
Sonata are looking at hospital management systems in a very big way. Given the
popularity of BPO (business process outsourcing) services, several of these
functions can be outsourced. Pune based Zensar Technologies for instance, plans
to use the ASP model for tackling administrative functions. Apart from
increasing the efficiency of hospital operations, patient data, if shared, can
be used for research and demographic purposes as well.
A key area where patient data stored in digital form can be
put to use is drug interaction and decision support. Critical information about
the patient’s medical history, the drugs he may be allergic to as well as
detailed symptoms recorded by one doctor can be stored at a central location and
accessed by the attending doctor. Not only will such a system eliminate the gaps
in information available to different members of the patient’s medical team
but will also be of great help to doctors while diagnosing the patient’s
ailment. India has 9 lakh beds in approximately 43,500 hospitals. The cost of
automating these hospitals (hardware including PCs, printers, scanners) as well
as information management software, will lead to an impressive figure no doubt,
but provided that the problems involved in implementing such application
software solutions in hospitals are sorted out. Non availability of readymade
software packages is a major problem today. There are several products, which
are good in certain areas, but no comprehensive product, which covers hospital
wide operations.
Medical diagnostics, which includes procedures like
ultra-sound, angiography, CT scan and MRI (Medical Resonance Imaging) etc, would
form another IT user segment. Here of course, the consumption is of high-end far
more specialized digital gadgets. At the highest end of the chain is robotic
surgery and virtual surgery. Another area that is yet to be fully explored is
virtual reality (VR) or interactive computer technology. Virtual Reality is a
set of computer based technologies which, when combined provide an interface to
a computer generated world, and in particular, provide a convincing interface
such that the user believes he is actually in a real world environment. The
specific applications that are benefiting physicians and their patients include
visualization to guide surgery, robotics to refine its data networks, sensors to
enable care over distance, simulation for medical education, and surgical
training.
At the lower end, consider the use of PCs by doctors for
office management purposes. With 5 lakh allopathic doctors (plus an un-estimated
figure of doctors from parallel systems of medicine) in the country could lead
to an impressive figure again.
IT in medical education
There is a proposal to introduce a module on information technology within
the medical curriculum itself. This will eliminate much of the ‘keyboard
shyness’ that so many in the medical profession suffer from today. Such a move
will naturally translate into higher hardware investment on the part of India’s
approximately total of 950 (200 medical, 450 nursing and 300 pharmacy) colleges.
A rough estimate of Rs 2 lakhs IT expenditure per institute would translate into
a Rs 1.9 crore investment.
Then come the CMEs (Continuing medical education programs)
for doctors. Imagine the IT investment if all research related data is put on
line, lectures converted to multimedia based teaching modules and all procedures
video recorded. Video-conferencing could be useful in conducting distant medical
education programs for rural practitioners. The concept can be further extended
to all health-related mass media campaigns.
Bridging the geographical divide
Tele-medicine is able to provide timely and better health care delivery
besides having its application in medical education. The improved access to
health care is achieved by providing consultation with the specialist, thereby
reducing the time and expense of travel as well. Tele-medicine can operate on
several levels starting from general discussion between doctors and experts,
where a doctor can talk to an expert on telephone and describe the general
condition of the patient for seeking their opinion. The other levels in the
application of Tele-medicine that can be visualized are laboratory report
transmissions–obtaining advice on microbiological reports. On-line remote
monitoring of patients is an ultimate goal in tele-medicine where all the
signals from a monitor can be viewed by a remote specialist. India has around
170,000 primary health centers. A mobile station for every 30 centers costing 12
lakh each would translate into a Rs 68 crore.
Telemedicine can be utilized to provide for better control,
supervision, and logistic-support to satellite hospitals. Apollo Hospital is
currently using tele-medicine to treat the patients in remote areas like Kohima
(Nagaland), Silchar (Assam), Aragonda (Andhra Pradesh) and Guwahati (Assam).
Standardization in health
Another segment in the healthcare vertical being targeted today is health
insurance. Clinical information systems are still evolving in India as most
applications are focused around administrative and billing functions. Non
availability of standards based packages is a concern. Most of the packages
available are not compliant with HL7 standards. HL7 is the standard in countries
such as US, Netherlands, Australia, and most recently Germany. Incidentally,
India does not have a single HL7 certified professional while China and Taiwan
have about 200.
Standardization and automation of hospital operations are
critical for medical insurance players to seriously look at the Indian market.
To address this issue of educating healthcare solution firms in the country,
Michigan-based international affiliate HL7 Inc, has recently set up a chapter in
the country, HL7 India with Dr Saji Salam as its chairman.
The body will provide the latest versions of HL7 standards
and impart training for healthcare solutions firms. Currently, five healthcare
solution firms including vMoksha Technologies, SSI Technologies, Dunken Infotech,
Health Asyst, and Majoris Software have become members of the Indian chapter. By
making HL7 a standard, it would be possible for two different HIS solutions made
by two different vendors to interact, making it possible for hospitals to share
data for research and other allied matters. By making HIS systems talk to one
another, it would be easier to collect medical and administrative data.
As for the opportunity for Indian IT companies, they could
target the health insurance sector for the larger share of HIPAA related
business. They could address the issues of the larger players in the healthcare
industry with implementation services. All of this undoubtedly translates into a
huge opportunity for the IT industry. But the boom that is being feverently
discussed, will occur only if bottlenecks like logistics, mindsets, and
traditional glitches are eliminated.
HIPPA: Standardizing Healthcare Processes
The Health Insurance Portability and Accountability Act (HIPAA), is a Federal
Act passed in 1996 by the government of USA to make healthcare systems more
effective and efficient. HIPAA addresses 11 transactions, which encompass all
processes involved in getting enrolled in a health plan. This legislation has
impacted the communication between the covered entities, which primarily
encompasses providers and payers. This is seen as a very important step in
automating communications between healthcare organizations. HIPAA is aimed at
the standardization of processes for exchange of health-related information
(such as medical and billing records) and transac-tions among healthcare
stakeholders (such as providers, HMOs, insurance companies, clearinghouses,
employers, and patients). HIPAA compliance would require adoption of standards
for eight transactions (such as health claims information, healthcare payment
and remittance advice, health plan premium payment etc); stipulated uniform code
sets (set of codes used for encoding data elements in the transaction standards
for diagnosis, procedures and drugs), and unique health identifiers such as the
social security number, or the tax identification number for each stakeholder.
HIPAA requires organizations to modify existing policies and systems to
ensure the protection of individual patients’ right to privacy and security of
identifiable health information. Compliance with HIPAA guidelines is statutory
and non-compliance by a player would draw civil and criminal penalties. Most
Indian IT companies are in the initial stages of addressing the HIPAA market.
Infosys is planning to offer services on all aspects of HIPAA besides building
capabilities by recruiting people with domain expertise. Wipro has established a
center of excellence for HIPAA that evaluates tools and technologies related to
HIPAA, mentors projects, executes proof of concept projects, trains software
engineers and refines HIPAA compliance methodologies. Satyam has established a
new division, recruiting about 150 professionals to address the HIPAA business.
Source: Nasscom
What are the Big Boys Using? Some case studies:
AIIMS
No of PCs: 1,000
Servers: 20 servers
Locations: 2
Bandwidth: 2 mbps + 128X 2
Applications used: HIS, MIS, Medical education, and research
IT model deployed: In house and outsourced
Total no of IT employees: 25
IT budget: Less than 2% of total
Fortis Healthcare
No of PCs: 200
Servers: High-end Compaq servers
Locations: 2
Bandwidth: 1 gbps
Applications used: HIS with Lab Management System, OPD Front Office, PACS
integrated with HIS/RIS, X-rays, CT, Ultra Sounds, Doppler, and Cath Labs
IT budget: 3-4% of start-up budget
Achieved: cabling for 750 data points, 480
active ports on network
Vision: It has a vision to set up multiple hospitals and medical centers
over the coming years. Fortis commissioned its first hospital in Mohali. The
plan is to have the next hospital commissioned in 2004 in the NCR region and by
then have 2-3 medical centers in northern India. It will link all hospitals and
medical centers, so that the electronic patient records can be moved within the
network.
Apollo
Applications: A Hospital Information System
(HIS) which provides for an end to end integration of the various processes and
functional areas to make for seamless workflow.
Initial budget: Rs 4 crore in investments
Escorts Heart Institute and Research Center
Total no of PCs: 250
Total no of servers: 19
No of locations: 1
Bandwidth: 512 kbps
Major applications used: HIS, IFS, Echo Information System
IT model used: in-house and outsourced
Total no of IT employees: 12
Budget earmarked for IT: 2%
Govt Hospital of Thoracic Medicine
Total no of PCs: 19, to be increased to 38
Total no of servers: 2
Bandwidth: 100 mbps
IT model used: outsourced
Total IT employees: 10 which will be increased to 25
Major applications used: data collection on patients, monitoring/ tracking
of data, clinical and epidemiological research
Budget earmarked for IT: Funded by Disease Control, Atlanta, US
Batra Hospital
Total no of PCs: 100
Total of servers: 1
Applications used: HMS
IT model deployed: In house
Total no of IT employees: 10