It Infrastructure Of Indian Hospitals1

IT INFRASTRUCTURE OF INDIAN HOSPITALS

BY: POOJA PANCHAL

MBA(PHI)

Ist Sem.

Jamia Hamadard

STRUCTURE OF HEALTHCARE SERVICES IN INDIA

Severe resources shortages

Financial struggle

Highly doctor

dependent

Poor accessibilit

y and availability

Multiple silos of health

information

Lack of infrastruct

ure

USE OF IT IN INDIA

Cost effectivenes

Overcome resource shortages

Improved efficiency of healthcare delievery

Improved access of

healthcare

Improved patient safety

and care

Reliable statistics

facilitating in improved

preventive care

Increased transparency in the process

WHERE IT NEEDS TO BE IMPLEMENTED

I/P Lab System

Radiology System

Hosp. Billing System

Pt. Registration System

Hospital Interface

I/P Pharmacy System

Pt. Reported Data (On-Line Dx) (QOL Data) (Compliance)

MasterInterfaceEngine

Elec. Med.Record

Office Billing System

MD Office Interface

O/P PharmacySystems

Home Health System

O/P LabSystem

IT 'CLICKS' HEALTHCARE IN INDIA

Indian healthcare is witnessing a metamorphosis, with the onset of newer, better IT applications as well as a broadening focus and increased investment in technology by hospitals

Technology is gradually but surely penetrating Indian healthcare industry.

Along with newer technological trends appearing on the Indian scene, several positive developments in the last couple of years have driven the adoption of IT in healthcare delivery.

Today the hospital industry is lapping up better technology and is gradually moving on to leverage the benefits of outsourcing their non-core functions.

The US based research firm Data monitor estimates Indian healthcare IT market to be the fastest growing in Asia, with around 22 per cent annual growth, followed by China and Vietnam.

In India, it estimates that IT spent on healthcare will reach $315 million (Rs 1,260 crore) by 2011.

Healthcare sector is always criticised as a laggard when compared to other sectors in accepting IT. However the scenario is changing as more and more hospitals are realising the advantages of IT enabling their hospital.

Commercial IT systems for administrative functions related to patient care introduced in the late 1990s in India have become the most widely installed type of hospital IT.

Almost all medium and large hospitals are now aware of HIS and ~80% to 85% of them have implemented at least basic versions of the system to computerise registrations, admissions and billings.

Adoption of department-specific information systems or clinical information system 1(CIS) is still relatively lower than hospital administrative IT (HIS), however market interests and demand for CIS is Building.

There are an estimated 2,000 CIS installations in over 550 hospitals in India.

Laboratory and Pharmacy Informatics account for the bulk of the 70 – 100 installations detected per year, followed by ICU and operating theatre, with relatively lower demand for prenatal/ neonatal/ maternity CIS.

Indian market for HIS and CIS reached about USD 14 million in 2008,with HIS representing over 70% of revenue and CIS representing the remaining 30%.

It is higher in the private and corporate hospitals segment at around 80 per cent.

However, in the public sector (Government hospitals) segment it is around 25 per cent. We are seeing an increasing interest from both public and and private sector

30%CIS

70%,HIS

India HIS & CIS market size(2008)=USD 14 million

NEED OF IT IN INDIAN HEALTHCARE INDUSTRY LIKE IN HOSPITALS

Four basic areas that benefit from computerisation are-

Patient management activities like admissions, billing and discharge.

Inventory management in a hospital.Implementation of EHR.Back office functionalities like accounts,

human resources and payroll.

STANDARDS FOR MEDICAL SYSTEMS:

DICOM(Digital Imaging & Communications in Medicine)

HL7(Health Level 7)UMLS(Unified Medical Language System)SNOMED(Systemized Nomenclature of

Medicine)HIPAA(Health Instruments Portability And

Accountability Act)

In India, DIT, MCIT is leading the initiative of laying standards for health informatics from Indian Context.

TRENDS & TECHNOLOGIES:

Clinical Decision Support System (CDSS) Most important tool. The benefits of CDSS are immediate minimisation of

medical errors and availability of clinical analytics. Designed to assist physicians and other health

professionals with decision making tasks. It links health observations like patient data with health knowledge like established clinical protocols to help doctors take right decisions for improved healthcare.

Even though they are not currently implemented in India, they will play a great role in the future in reducing medical diagnostic errors which take a toll on any hospital.

CONTS..

Computerised Physician Order Entry (CPOE)

A process of electronic entry of doctor's instructions for the treatment of patients under his or her care

Orders are communicated over a computer network to the staff (nurses, pharmacists) or to the departments (pharmacy, laboratory or radiology) responsible for fulfilling the order

CPOE decreases delay in order completion, reduces errors related to handwriting and simplifies inventory and posting of charges

CONTS..

E-learning3-D training is an alternative to actual

trainingDone in a virtual environmentWith the advent of laparoscopic and robotic

surgery, this offers a great potential of training future surgeons

Advanced virtual training is also available today for simpler procedures like vascular access

e-Learning is also used for the capability development purposes in the hospital set-up.

IT USED IN INDIAN HOSPITALS: Apollo Hospitals

Plans to integrate their information systems across their network of 42 hospitals.

Will also introduce HIPAA standards in its systems for EHR implementations.

The growing IT budget at Apollo constitutes around 4.5 per cent of its operational expenses. Apollo has been already started the Telemedicine programme all over the India called as ATNF (Apollo Telemedicine Networking Foundation).

Also Indian Government supported it and started its own programme in rural India.

Ruby Hall Clinic

Initially relying more on paper and verbal inputs so led to leakage in revenue, lack of information flow and time was wasted in doing routine repetitive tasks.

In 1999, RHC started revamping the IT infrastructure of the hospital and implemented HIS, RIS, PACS, EMR, ERP and telemedicine as some of the IT solutions.

PACS enabled it to improve patient care by streamlining clinical processes and creating a seamless flow of information.

HIS system has unique medical record number to identify a patient.

Telemedicine technology allows to extend the distance at which patient consultation occur.

EMR allowed protection for medical information and improve data sharing without any threat to patient privacy.

Today, activities related to patient billing, consulting charges, payments to be made to vendors are all recorded electronically.

Critical patient information like lab results, radiology images, medications available on-line, led to reduction of file movements and has helped the doctors to take decisions on time.

It enables them to provide single window service for all patient related activities. They are able to get morbidity / mortality information which are just a matter of few clicks.

Fortis Healthcare

It is building a mobile-cum-wireless communication framework on IP enabled PBX to connect the nurses, doctors and patients.

Nurses can use handheld devices to input patient data within the hospital's network, removing the process of taking handwritten notes and then inputting the data by hand.

Patients can also communicate easily with the doctors and nurses faster.

The other initiatives taken by the Hospital includes the 'web based interface' and 'database shadowing' for performing data check-in/check-out operations.

Sir Ganga Ram Hospital

It has invested funds for the implementation of a PACS system which will allow images from radiology, CT, MRI to be available on all computers within the organisation.

It is planning a RFID tagging system for its fixed asset management system.

Soon the Hospital would also introduce PACS for enterprise-wide imaging.

Every system is integrated with HIS leading to easy availability of data that helps the hospital management make better and informed decisions.

Max Healthcare

Max Healthcare's hospitals are spread across eight locations within the boundaries of Delhi.

The main purpose for opting IT solution was to get all these hospitals at various locations connected to each other with a centralised system making it convenient for both the hospital and the patients.

They felt a need of having such a system which could make the health analytic to understand the disease trend and decide the medicine, required treatment to be provided to the patient, thus reducing the occurrences of medication error.

IT implementations The 'lease line connectivity' is a service through which all the

hospitals can remain connected to the data server. 'Bharti' is the lease line connectivity service provider for Max. The speed of the connectivity was upgraded from 512 kbps to 4 mbps since the last two years. 'PACS' is incorporated in MAX through this data.

KLES Hospital & Medical Research Centre

The KLES HOSPTIAL & MRC’s IT Department provides support for the use and development of information and communications technologies to facilitate and expediate the patient services.

Servers: Application Server Mail Exchange server Data base server Anti-Virus and Firewall Server Web Server These servers include Dicom with Telemedicine Application with

a dedicated Data base server. These dedicated servers cater certain specified programs and

also meet a health working environment. Three tier architecture is created with the introduction of new

HIS/HIMS software where about 27 different modules have been created to integrated the entire Hospital Services to be delivered through system based management.

Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow

Did the first attempt by implementing CDAC . CDAC took the challenge of implementing HIS software with domain

knowledge. It has 14 modules covering all aspects of patient management and

patient related administration. The Institution has been able to oversee a smooth transfer of a 100%

manual system to a 100% computerized one over a 2-year period. It was the first fully computerized hospital in the country with all patient

related activities taking place online and continues to be only one in the Government sector.

Telemedicine Infrastructure at SGPGIMS

showing the Intra-hospital telemedicine network of the

operation theatre for real time interactive tele-surgical conference

Workstation

Products developed In Health Informatics in Indian Hospitals

Talbros : TACL - IT Division OPD Services: B.O.O. basis (Built, Operate &

Own) TACL -IT Division has been offering its services to

Directorate of Health Services, Govt. of NCT of Delhi for the computerization of its OPD Services on B.O.O. basis. This is a particularly challenging project as the people we are dealing with are already under huge stress because of the state of their health.

Some of the Hospitals under the Government of Delhi which have been automated by TACL -IT Division are:

Dr. Hedgewar Arogya Sansthan Acharya Sri Bhikshu Govt. Hospital Sardar Vallabh Bhai Patel Hospital Bhagwan Mahavir Hospital Baba Saheb Ambedkar Hospital Attar Sain Jain Eye &Gen. Hospital Guru Govind Singh Govt.Hospital Lal Bhadur Shastri Hospital Maharishi Balmiki Hospital Sanjay Gandhi Memorial Hospital Maulana Azad Dental College & Hospital Deen Dyal Upadhya Hospital

C-DAC’S• Mercury- Telemedicine solution• Sanjeevani- Telemedicine solution• E-SUSHRAT-Hospital management information system• Tejas-Software suit for oncology• Auysoft-Decision support system for ayurveda• E-Chavi-Picture archival communication system• Medical standards libraries• Digital programmable hearing aidHIS -DEPLOYMENTS REPRESENTATIVES LIST• Sanjay Gandhi Memorial Hospital• Guru Teg Bahadur Hospital, Delhi• Mahatma Gandhi Institute Of Medical Science,

Sevagram,Maharashtra• Regional Cancer Centre,Thriuvananthapuram

MOBILE E-HEALTH & TELE HOSPITAL IN INDIA

Mobile Health is Synonymous with e-Health E-health or electronic health can be defined as the use of ICT for

enhancing health and seeking information. E-health can mean creating electronic versions of patient records across a national system

Mobile health (M-health) can de defined as the use of mobile technology for health related purposes. M-health can serve as access points to provide remote information to healthcare providers.

In developing countries, these technologies find a wide array of applications that include remote data collection and monitoring, disease and epidemic tracking and diagnostic and treatment support amongst others.This bus has VSAT connection with regional hospital.

SETBACKS Though IT has been established in many Indian Hospitals but yet we

have certain limitations for its complete implementations in India. These are as follows:

Policy: There are no clearly articulated/ communicated government policy on IT adoption in public hospitals. Government funding for HIT is nearly non-existent.

Computer literacy: Limited computer literacy of staff. Infrastructure :Infrastructure to support HIT adoption is

underdeveloped. Co-ordination: Coordination between public and private sector is

yet to emerge. Legacy systems: Patient health records are paper based in most

hospitals (except for large, private hospitals). Standards: HIT systems developed locally do not follow standards

for information representation and exchange. This is complicated further by the multitude of languages used across the country.

Privacy: Confidentiality of patient health information is still being debated and the apex court is yet to come out with an opinion on this.