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THE GROWTH DRIVERS: More Than a Healing Game

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DQI Bureau
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  • Do you want me to treat the patient or type in data?

  • 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?
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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.

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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.

For instance...
Birlasoft
Developed a Hospital Management System (HIS) product called

CarePlus. The product is being used in BMBHRC, Kolkata. Its clients include BM Birla Heart Research Center,

AIIMS, AMRI (Kolkata) and Saudi Aramco (Saudi Arabia)
vMoksha
The company developed a Healthcare Practice solution in mid 2002. In three years the company expects to see 10% increase in the revenues coming from its Healthcare and Life Sciences Practice solution. It also sees HIPAA re-mediation as a definite opportunity, and is aggressively pushing it in the US market. The other areas are system integration, clinical data management, and outsourcing of IT services.
Note: This is not a comprehensive list but a sample of the IT initiatives in the 



healthcare segment
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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.

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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.

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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).

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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.

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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

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