by August 3, 2004 0 comments

Many years ago, someone asked me a simple question, “What’s the real use of computers? Can they help me as an ordinary human being?” That was the time when computers were new in the country and were understood only by geeks. There weren’t any killer applications to talk of, at least not for the common man. So at that time, there wasn’t a straight answer to that question. Thankfully, you can write books on the subject today. In a few years, IT has reached just about every walk of life and you find every industry benefiting from it. 

In many businesses, IT has completely changed the business model. Banks today don’t call customers to their branches anymore, instead reach out to them through the Internet and cellphones. In telecom, customers don’t need to go to the operator’s office. They can buy cellphones and a connection from anywhere, use them anywhere in the country, and can get billed via post, e-mail or even pay directly online. Hotel reservations and travel bookings can be done for any place in the world using a Web browser. The news channels are competing with each other to bring out news faster and, in many cases, broadcasted live. A few private hospitals have all patient records online, so that they can be accessible from anywhere in the hospital, whether it’s the OPD, labs or OT. They also have direct links with medical consumables providers to control inventory costs. The BPO industry exists in the market due to the IT solutions it uses, and lastly, the government is trying to leverage IT to cut the red tape and improve efficiencies. 

While IT solutions are doing wonders for businesses, a lot of challenges still lie ahead. Most hospitals and nursing homes for instance, are still trying to achieve complete process automation and information standardization. We still don’t have solutions to determine whether an epidemic is brewing somewhere. A patient in a public hospital has to wait in long queues to consult a doctor, buy medicines from a pharmacy, or even get a diagnosis done. IT in the government is still bureaucrat dependent and driven only by interests of the person heading the project. If the person gets transferred, there’s no guarantee on whether the project will be completed. While banks have all their processes automated, they need solutions for risk management, anti-money laundering, etc. Hotels are trying to figure out ways of maintaining their 24X7 IT systems without bringing them down. The government has computerized quite a few departments, both state and central, but a lot of computerization still remains to be done. A greater challenge is to create information flow across these departments, and most importantly, how to cut the red tape. 

In the pages to follow, we’ve focused on both aspects of IT-the solutions and possibilities that IT can bring, and challenges that lie ahead. Our experts as well as some prominent people from various industries talk about these aspects. 

By Anil Chopra

Expert Speak: Sunil Kapoor Head IT, Fortis Healthcare

Sunil Kapoor

“Today, a doctor would rather see more patients than spend time grappling with a system”

Today, generic computing such as e-mail and office suites are used everywhere, irrespective of the industry, so healthcare is no different. The challenges for IT in healthcare lie in automating all processes and standardization of all information so that it can be exchanged easily. It has the potential to improve the ‘care’ in healthcare, so that patients get faster treatment, and hospitals work more efficiently and become more profitable. 

The level of automation in most hospitals or nursing homes today is still very limited. Having a basic billing and inventory system for a hospital today is no great shakes. Even a small nursing home would have a basic billing system to handle patients’ billing in its OPD or IPD sections. It would even have an inventory system to track its labs, pharmacy and medical consumables and incorporate them to a patient’s bill. But there are so many other processes that can be automated in a hospital, but haven’t been in most cases. These include support services such as CSSD, housekeeping, laundry and medical records; handling enterprise-wide scheduling of tasks; and automation of patient records. Scheduling is still limited to OTs, OPD, doctors, etc and doesn’t go down to individual investigations, for which patients still wait in long queues. There would be hospitals that may have parts of their systems automated, but nobody’s really doing a complete top to bottom integration of all processes. 

Currently there are no systems that go down to the grassroots to handle the doctor’s prescriptions, the line of treatment and progress notes. It’s an area where IT can make the maximum impact, and there’s no great technology involved in doing it. The challenge is in getting a buy-in for its adoption and a catalyst to speed up the process. For instance, if a doctor can be convinced to use the keyboard and mouse instead of pen and paper, it can work wonders. Typically, in a public hospital a doctor in the OPD sees around 300 patients a day, meaning not more than five minutes per patient. During this time, the doctor writes the prescription on paper. A typical prescription contains the patient’s name, the symptoms he presented, clinical observations and provisional diagnosis, it further has the list of investigations required to confirm the diagnosis, and the line of treatment mentioning the medicines that the patient should take. Suppose this prescription was entered in a system, which is connected to a backend information system. If the doctor prescribes a medicine that’s out of stock, then the system would immediately inform the doctor, who would then change the medicine. This would save the patient multiple trips between the pharmacy and the doctor. If the doctor prescribes two medicines that react if taken together, then the system can alert the doctor. Since this system is connected to an overall back-end information system, all concerned departments in the hospitals would be able to access it. So the labs would be able to see what tests a doctor has prescribed, and would even be able to report the test results into the system. For the doctor, this can work as a great support system. If a patient has to consult another doctor, the treatment and patient record would be available to the new doctor. 

In an in-patient scenario, each patient’s prescription (line of treatment) acts as a ‘to-do’ list for the nurses. They know what tests have been prescribed and what medication has to be given at what time to the patients. Handing over of duty also becomes easier. It also allows better control over the pharmacy, because it helps the hospital determine which medicines are where.

While this kind of a system has immense potential, the challenge is in getting the doctors to switch from pen and paper to keyboard and mouse. Today, a doctor would rather see more patients than spend time grappling with a system. So there is tremendous pressure on IT to deliver a better solution the way doctors want. 

If so much value add is possible from a simple prescription, imagine the other possibilities. There’s a huge amount of data coming into every hospital everyday. If this is captured and analyzed even for one year, imagine what an excellent source of learning or teaching it can become. On the business side, it can boost business between the hospital and pharma/medical equipment companies, because a lot of information about patients and the medicines they consume is known. Taking this data capturing to the national level, imagine if a computer is placed in every primary health center of a district or Taluka of the country, and is used to record the diagnosis of each patient. If this information is then sent to a central location through dial-up or wireless, then it can be used to detect whether an epidemic is brewing. Help can then be rushed to control it and save so many lives. Technically, there’s no great technology involved in making this happen, but unfortunately, it hasn’t been done.

Standardization of information is another challenge. Today, at most, hospital information systems follow the HL7 standard (to communicate data between two systems), and then there’s the DICOM standard. However, there’s no standard format for storing clinical information. Every system would have its proprietary format that can’t understand or talk to another system. This is understandable because the field of healthcare automation is still very young, so the level of maturity in products isn’t as high as in other verticals. In fact, at times even hospitals don’t know what they really want in terms of automation. So the challenge is first to get the hospitals and nursing homes in the country to agree on certain basics, which will ensure that the records they generate follow a standard format. For this, some governance body (not necessarily the government) has to step in, define what the formats should be like, and then take steps to make it happen. 

Let’s face it, IT is an enabler. It has the technology to automate and standardize processes and information. However, what’s needed is a catalyst to really speed up the whole process. To my mind, this catalyst will be insurance. Since most of the Indian population can’t afford proper medical treatment, risk has to be shared, which gives way for the insurance sector. Today, medical insurance exists, but there also exists the dilemmas associated with claiming it. The patient has to first bear the brunt of expenses followed by the brunt of claiming those expenses. A system is needed that will offer cashless transactions for patients. This process will have to be driven by the insurance companies or the TPAs (Third Party Insurance Agents), who will go to a hospital to define, and if required dictate, what documents they require, in what format, etc to pay for a patient’s treatment. If one hospital doesn’t provide this facility, then the TPAs are likely to recommend a different hospital to the patient. This will encourage competition between different hospitals, because they could start loosing patients. If this happens, the hospitals will start providing the information in the required format to TPAs. This is already happening in the US and Europe. 

The deciding factor will be the cohesion between public and private providers of healthcare. We will require dramatic changes for regulatory and infrastructure networks to support this standardization in clinical information. Since government controls a large part of healthcare in rural areas, there will have to be a shift in the importance placed by government in healthcare spending. If the private players are to be encouraged into providing services to these areas then the supporting infrastructure and tax breaks have to be given. All these options do not form the solution to our problem individually, but complement each other to create the basis for a solution, which can realistically be achieved.

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