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- 1. 1 HEALTHCARE IT & TALENT MANAGEMENT A PERSPECTIVE
- 2. 2 Agenda ďž IT in healthcare â from need to necessity ďž IT trends in healthcare ďž Indian scenario ďž Targeted applications of IT in healthcare ďž Market size of IT in healthcare - India ďž Trends impacting healthcare IT ďž Health care IT integration - challenges ďž Healthcare IT integration - implications on talent management ďž Case studies
- 3. 3 IT in healthcare ď from need to necessity Increasing accessibility and quality ⢠Efficient and improved handling of high volumes of patients visits ⢠Reaching the limited and untapped areas and reducing pressure on limited public infrastructure Efficient administrative functions ⢠Reduced patient waiting time through Efficient administrative functions ⢠Increased success rate in treatment and diagnosis Mending the supply chain ⢠Reduce shrinkage in pharmacy operations in terms of better management and control of drug pilferage Advanced use of diagnostic equipments ⢠Transition of diagnostic tools to network aware with digital outputs. ⢠Ensure quick and efficient diagnosis Enhanced healthcare infrastructure ⢠Develop innovative and efficient healthcare infrastructure beneficial for the rural and urban population Regulatory and compliance ⢠The industry is governed by a high degree of regulatory compliance ⢠IT is helping healthcare service providers to enhance customer safety and confidentiality
- 4. 4 IT evolution in the healthcare industry Key disruptive technologies Big data Cloud Future trends Social media Emerging solutions m-health Tele-health Impact Technologies â Mobile health applications have emerged strongly over the past couple of years â Have the potential to bring the patient and healthcare provider closer â Enables patients in rural areas to access specialists at affordable costs â Vast potential in the Indian hinterland; several projects already underway â Healthcare records and apps are increasingly being stored on the cloud â Embedded systems are primarily being used in the US and European markets; less traction in India â AR can be used in training medical professionals Mobility â Big data can be used to processes health records from hospitals and then models outcomes and treatments Embedded systems Augmented reality Technology trends have the potential to change the healthcare landscape in India
- 5. 5 IT in healthcare â India focus Untapped opportunity â Telemedicine: Poised to grow at a CAGR of 20 percent in the next five years, telemedicine as a segment is estimated to have potential worth US$500 million by 2015 â Teleradiology: The market in India has been estimated at US$43 million in 2012 and is forecast to grow at a CAGR of about 15 percent â Hospital MIS: This is a relatively untapped area in India, but it holds with significant growth potential â Screening devices: Tablets are likely to play an integral role in capturing and analyzing sample data; further, with the advent of low-cost gadgets, activity on this front across 2013 and beyond is probable Innovation in IT â Mobile applications: The spread of smartphones has led to various healthcare apps, ranging from basic healthcare information to checking patientsâ ECG â Customized equipment: Equipment tailored to the specific needs of a patient are leading to better post-operative care. These include a remote monitoring solution for patients implanted with CRM devices â Over the phone counselling: âDoctor Saab Hai?â is an entrepreneurial venture which aims to provide free consultation services to consumers across India. They operate through a round the clock call center with certified doctors and nurses to handle all medical queries.
- 6. 6 IT presence across the value chain Self monitoring devices with applications for data transmission Preventive care Diagnosis Treatment Management ⢠Diabetes ⢠COPD ⢠Tele-radiology ⢠Tele-diagnostics ⢠Diabetes ⢠COPD ⢠Remote Foetal Monitoring ⢠Mobile based personal emergency response system ⢠mhealth applications ⢠Cardiovascular conditions ⢠Diabetes ⢠Epilepsy ⢠Post ICU care ⢠Nutrition ⢠Fitness ⢠Tele-medicine initiatives ⢠Tele-counseling ⢠Video consultations ⢠Eye care ⢠Cardiovascular conditions Relatively less presence Relatively high presence Role of technology and communication is being explored at every aspect of healthcare delivery value chain and within multiple categories of healthcare
- 7. 7 The Indian healthcare market ď targeted application of IT Large potential for IT â Indian hospitals need large scale investments in Electronic Health Records â Use of Big data to gather insights from patient data is also needed Better integration with other healthcare players â Ballooning insurance costs has created fissures between patients, hospitals and insurance providers â Use of big data and cloud to cut costs, and prevent diseases needs to be fully utilized Indian Pharma can use IT to leap to the next level â IT can help in narrowing down successful drugs for research â IT can also be leveraged in sifting through gigabytes of clinical data to reduce time-to- market for new drugs Cost-effective equipment â Indian manufacturers need to reduce cost of medical devices/equipment to increase penetration in the Indian market Reduce costs â Use mobility to reduce cost of diagnostic tests
- 8. 8 IT in healthcare â market size (India) 274.2 USD Million 381.3 609.5 1450 2000 1500 1000 500 0 2009 2012 2013 2018E ď Healthcare is among the fastest growing verticals growing at a rate of 17.5 percent (CAGR). ď However, large corporate hospitals in India spend under 1 percent of their operating budget on IT, while spending is closer to 3 percent in the West.
- 9. 9 Trends impacting healthcare IT Segment Description Key trends that impact IT Provider ⢠Hospitals ⢠Ambulatory ⢠Other Healthcare ⢠Hospital systems transitioning from best of breed to integrated enterprise solutions ⢠Greater need to store, secure and utilize patient data to improve patient outcomes ⢠Greater push to share data across providers & create patient health records. (e.g. patients, technology vendors, government) Payer ⢠Integrated payer and providers for profit. ⢠Not for profit. ⢠Specialist ⢠More sophisticated data management required to improve medical & performance management ⢠Greater focus on cost reduction particularly in reducing cost of non core IT ⢠Payer IT systems need to accommodate new products Pharma ⢠Infrastructure or Applications ⢠Proliferation of clinical data from multiple sources requires improved analytic tools ⢠Pharmaceutical players exploring new models for R&D (e.g. greater use of electronic data collections during clinical trials) ⢠Greater use of IT to enable sales and marketing Connectivity ⢠Financial (e.g. claims) ⢠Administrative (e.g. practice management, referrals, pre-certification) ⢠Clinical (e.g. laboratory, Rx) ⢠Portion of claims that are electronic continues to increase ⢠Desire for greater technical sophistication to reduce cost and rework (e.g. auto remediation)
- 10. 10 Healthcare IT integration â challenges Buyer Side ⢠Doctors are not IT savvy; used to manual systems ⢠Different modes of training for nurses, doctors and other personnel ⢠Nature of the profession is such that it generates lot of paper documents ⢠Data security constraints ⢠Sector hesitant about the transparency brought about by IT ⢠Budget constraints ⢠Connectivity issues in remote regions Challenges to IT adoption Supply Side ⢠Vendor market highly fragmented and unsophisticated ⢠Most existing products have evolved from custom solutions and many have only basic features ⢠Lack of implementation and post implementation support ⢠Lack of awareness on how IT can plug revenue leakages, improve profitability ⢠Lack of modular packages ⢠Lack of standardization of processes and workflow ⢠Limited IT talent with domain expertise
- 11. 11 Healthcare IT Integration Implications on Talent Management Advances in technology will likely impact on healthcare human resources on following thrusts: 1. Changes in efficiencies brought about at local institutions leading to the removal of some positions and creation of others 2. Changes in types of medical care provided, such as gene therapy and minimally invasive interventions, which will have an impact on shifting of medical healthcare professionals from one subspecialty to others 3. Decentralization of the healthcare delivery system, which will shift significant resources from tertiary care facilities to primary and community care institutions and home healthcare 4. Shift in where patients receive their care - at home and in the community setting, rather than in big tertiary hospitals - will lead to a geographical shift in healthcare professionals from big cities to community and rural settings
- 12. 12 Case studies India
- 13. 13 Healthcare Inclusion â Telemedicine Arvind Eye Care Systems Solution name: ADRES 3.0 (Aravind Diabetic Retinopathy Evaluation Software) Implemented In: Diabetic centres/diabetologists office/laboratory/general physician clinics/hospitals in India where ophthalmologists are not available Benefits: Till 2011, 15,000 diabetic patients benefitted Cost: ~INR500 per patient per sitting Potential for the solution: Timely treatment can prevent vision loss from diabetic retinopathy, which otherwise is challenging due to lack of awareness of the disease, lack of availability of resources and specialists Revenue model for the solution: The local diabetologist can generate revenue through consultation charges from patients for obtaining fundus photographs and the eye centres can charge the patients for diabetic retinopathy diagnosis Ongoing cost: Internet connection - monthly rental of INR 1,350 per month (up to 2 Mbps); salary of trained ophthalmic technician INR 10,000 per month; salary of network administrator INR 40,000 (part time) and maintenance cost of the solution
- 14. 14 Picture Archiving and Communication Systems (PACS) Solutions Teleradiology Solutions India Pvt. Ltd. Aim: Set up an efficient system which understands radiologist availability, work-load and other statistical parameters and assigns the radiologist accordingly Challenges faced by the customer: ⢠Non-transparent, cumbersome process, resulting in communication errors ⢠Non-optimal radiologist assignments and inefficiencies and delays ⢠Lack of collaboration between physicians and radiologists or between radiologists The solution: RADSpa, Radiology workflow Intelligence system Customer Benefits: ⢠Improves efficiency of radiologists (more reports per day) and quality of reports ⢠Faster availability of radiology images ⢠Effective communication between peer radiologists, physicians and hospitals ⢠Ability to provide radiology reporting to remote low-bandwidth sites with optimized image transfer ⢠Automated quality assurance process ⢠Voice dictation feature helps reduce report turn-around time
- 15. 15 Rural Patient â Metro Doctors Connect iClinic Healthcare Private Limited ⢠Conceptualized and founded jointly by Mr. Sanjoy Mukerji, Ex-Chief Commercial Officer of Vodafone India and Mr. Varun Berry, Managing Director, Britannia Industries Ltd. ⢠Tie up with local hospitals in tier 2, tier 3 cities to facilitate consultation of rural patients with doctors in metros through a simple video call ⢠USP â Onsite physical and virtual consultation by reaching out to people directly through local doctors, thus giving it a human touch ⢠Case of 2 year old Vishal from Karnal ⢠Case of 23 year old Jyoti ⢠Currently reaching patients in over 40 remote towns in India ⢠Long term vision to have 'iClinic consult facility' in every hospital in tier 2, tier 3 towns and villages
- 16. 16 Case Studies Global
- 17. 17 Remote Paediatric Consultation Queensland Telepaediatric Service ⢠Commenced in Nov 2000 through the University of Queenslandâs Centre for Online Health (COH) in collaboration with the Royal Childrenâs Hospital (RCH) in Brisbane ⢠Provides specialist consultations to children and their families living in rural and remote areas of Queensland via videoconference ⢠Paediatric sub-specialities offered include post-acute burns care, cardiology, diabetes, neurology, oncology, orthopaedics, psychiatry and surgery ⢠Follows a unique referral model â Telepaediatric coordinators ⢠Technology handling of clinicians kept to a minimum at both regional and Brisbane sites with majority of equipment operated by the telepaediatric coordinators ⢠COH also introduced a videoconferencing unit dressed up in the shape of a robot â Roy the Robot â for remote consultations directly at the bedside
- 18. 18 Mobile communication between doctors Mobile Doctors Network (MDNet), Ghana ⢠Challenge: Only 2,000 physicians serving a population of nearly 24 million inhabitants in Ghana ⢠Solution: Ghana Medical Association (GMA) launched MDNet in 2008 with support from New York University in collaboration with a mobile telephony provider in Ghana and Switchboard5 (a US-based non-profit-making organization) ⢠Provides free mobile-to-mobile voice and text services to all the physicians in Ghana currently registered with the Association ⢠A one-way bulk SMS service was also enabled, allowing GMA to send information to doctors about national emergencies and meetings, as well as to contact doctors within a particular speciality ⢠Mobile phones chosen as the mode of communication as most doctors in rural and urban areas of the country already use in their daily practice ⢠Technology: Physicians were provided with over 1,600 free SIM cards that worked with any brand of mobile phone and allowed doctors to make voice calls free of charge to doctors within the MDNet programme ⢠Switchboard extended the service to Liberia in 2009, and was in discussions with the Ministry of Health for its possible implementation in Kenya
- 19. 19 Using technology to recruit, manage and retain healthcare talent ⢠Strong health IT â one of the most significant incentive to attract quality physicians and other health professionals ⢠Healthcare organizations are increasingly using talent management software to recruit for efficiency as well as fit, as opposed to earlier systems which were focused on things like payroll, compliance and process automation ⢠Example â Software for applicants and their references ⢠Human Capital Management (HCM) systems enable an organization to transform from âtrackingâ to âmanagingâ the workforce on a more holistic level ⢠Use of technology that provides potential candidates an easy end-user experience to access and navigate information ⢠Leveraging a variety of platforms, including mobile devices as many of these target candidates are not in front of computers during their normal workday ⢠Online/virtual training for clinical procedures â very efficient and cost effective ⢠Example â Wadhwani Foundation & Narayana Health
- 20. 20 Challenges ⢠Building competencies, finding and retaining skilled personnel for successful application of healthcare technology ⢠No single solution available that will work in all settings ⢠Clinicians have been known to be resistant to change ⢠Lack of training, not being comfortable with using technology, HCI (human computer interaction) factors, lack of trust on technology ⢠Bringing broadband to rural India is a hindrance for telemedicine, as is equipping rooms with expensive and hard to use equipments ⢠Shortage of Healthcare IT talent in the industry ⢠Security of critical infrastructure becomes more difficult ⢠Weak storage infrastructure ⢠Compliance issues
- 21. 21 Recommendations ⢠Effective channelization of the corporate CSR component ⢠Coordinated efforts by Ministries of Health, Education, Finance and Information Technologies and Communications ⢠Corporates and private players need to take lead for mHealth ⢠Computer literacy and training ⢠Increased use of cloud computing and mobile technology ⢠Tele presence in ambulances ⢠Encourage PPP in healthcare IT implementation, education and training ⢠Policies, standards or guidelines need to be formulated ⢠Government funding needs to be improved in this area ⢠Conclusion
Hinweis der Redaktion
- The use of Information Technology (IT) can play a very important role in enhancing the healthcare delivery mechanisms. The need for interaction and information sharing between various participants (hospitals, doctors, labs, insurance providers and the government) and greater use of clinical tools with digital outputs has made Information Technology ubiquitous in Healthcare Administration. In India, information archival, retrieval and sharing has been largely paper based as the healthcare sector is predominantly unorganized and the enforcement of government mandates lax. However, there is a rapid change in the Indian landscape and healthcare providers are turning to technology for improving administration challenges. Indian healthcare providers are rapidly adopting Patient Scheduling, Hospital Information Systems (HIS), Electronic Medical Records (EMRâs), electronic picture archiving and communication systems (PACS), Radio Frequency Identification (RFID), Bar Codes, Clinical Decision Support Systems (CDSS) and Telemedicine technologies. Devising a system supported by IT to keep inventory level trends and stock updated in order to track usage pattern and avoid pilferage. Centralized data management and helps to keep an updated database of the drugs which will help in decision making and for reference purposes to the consultants and management. Helps in preparing reports based on usage/ prescription pattern which helps in classifying drugs into fast moving/ slow moving drugs. Helps in stock management at each department level and track consumption pattern. Helps in maintaining database of vendors and their offer price which helps in decision making while making new purchases. Also, a list of preferred vendors, black listed vendors could be maintained based on the service history. IT helps in managing stock ordering by generating order alerts and ordering history. Electronic health record (EHR) systematically collect electronic health information about individual patients or population. It record information in digital format which can be shared across different health care settings. EHRs may include a range of data, including demographics, medical history, medication and allergies, immunization status, laboratory test results, radiology images, vital signs, personal information like age and weight, and billing information Along with the growing popularity of digitization in hospitals, market penetration of picture archiving and communication systems (PACS) is likely to increase further in the coming years. The implementation of technology is a cost-effective and compelling method to connect clinics in the cities as well as rural regions. Although there are healthcare challenges we are facing today, the good news is that we have innovative solutions to help address these formidable challenges. Telemedicine, which is the use of IT for delivering health services and information over distances, has a substantial scope for growth in India. Telemedicine is essentially an application of information and communication technologies which uses a combination of hardware and software and transmit signals for the exchange of valid information between the care provider and the receiver for diagnosis, treatment and prevention of diseases and injuries, using the internet network. The use of telemedicine can greatly aid in dealing with the shortage of healthcare staff and improving the penetration of healthcare infrastructure and resources in the underserved semi- urban and particularly rural areas. Regulatory and compliance issues are important drivers for the service providers to adopt IT for efficient operations which not only helps in optimization of existing resource but also helps increase customer satisfaction, safety and confidentiality.
- M â Health : GSMA, mobile technology will play a significant role in the provision of healthcare services globally. It also predicts that the growth of the mHealth market will lead to a revenue opportunity worth Rs. 3000 crores (US $ 0.6 billion) for India and US$23 billion for the world by 2017. With the increasing penetration of smart phones, innovative âconnected devicesâ, and the proliferation of Mobile Broadband networks and services worldwide, the mobile device will play a far greater role in healthcare in both developed and developing countries in the future. To enable this opportunity, governments, regulators and healthcare providers need to work with mobile operators and organisations in the broader mHealth ecosystem, including device vendors and content and application players, to support the roll-out and adoption of new mHealth services. Tele-Health : Indian governmentâs spending on health is a mere 1% of the total GDP. According to the Union Ministry of Health and Family Welfare Department, there is an acute shortage of physicians, nurses and lab staff especially in rural India. In the vision of âHealth for Allâ to be realized, telemedicine could prove to be a game changer by bridging the supply of doctors with demand of patients through telecommunication and broadband. An example of telemedicine is when a patient phones a dedicated helpline number and is attended to by a registered nurse or a doctor. The medical practitioner listens to the symptoms and can prescribe over the counter drugs or write lab tests that need to be done or refer the patient to the nearest hospital. Similarly, consultation can be done via video conferencing. Reports, scans etc can all be looked at. When employed telemedicine can reduce infant and maternal mortality by 90% by sending text reminders about immunization, helping diagnose pregnancy complications and providing timely intervention to contain diarrhoea, pneumonia in new born infants This is an area where the government has invested money while the private sector implements it via point of care stations e.g. Narayana Hrudayalayaâs tele cardiology is supported by the Karnataka Government and ISRO. The consultation charge ranges from Rs. 10 to 50 making it affordable. Other key players include Apollo hospitals, Fortis, AIIMS, Aravind eye care, Sankara Nethralaya and Narayana Hrudayalaya. Narayana Hrudayalaya has treated over 30,000 cardiac patients making it Worldâs largest tele-cardiology programme. Big Data :Big Data refers to the field of study of large data sets in different ways to get valuable clinical and management insights. Industry experts say that it can enable healthcare systems, with complex and large amounts of data, to analyze, understand and predict its own ecosystem. In a data-driven healthcare system,data scientists examine different varieties of data like clinical data, publications, clinical references, genomic data, streamed data, web and social networking data as well as business and organisational data and clinical decisions and business decisions are often made on the basis of these predictions. Cloud : According to recent study on âCloud Computing: An enabler of IT in Indian Healthcare Sectorâ, the total addressable opportunity for Cloud solutions in the Indian healthcare industry (hospitals) is estimated at USD 600 million by 2020. The study highlights that Could can potentially address close to 40% of the total annual healthcare IT spending in India and can potentially help in improving two aspects of Indian Healthcare services delivery- Lower IT Infrastructure cost and Augment service quality at less cost to hospitals. Augmented reality is a thriving technology where digital data merge with real world. This technology superimposes the real world with computer generated data which completely changes the user experience. It changes what we hear, feel and see. The AR technology uses virtual reality to amend with the real world. Augmented reality and virtual reality have can offer many wide range of emerging application. Several technology firms have also jumped on to the AR bandwagon. For instance, Google has introduced Google Glasses to tap the potential of this technology.
- According to a report by Frost and Sullivan, India's healthcare information technology market is expected to hit $1.45 billion in 2018, more than three times the $381.3 million reached in 2012. And as per Springboard Research, healthcare IT spending in India is expected to grow from $274.2 million in 2009 to $609.5 in 2013, growing at a Compounded Annual Growth Rate (CAGR) of 22 per cent from 2009-2013.
- There will be an elimination of a number of clerical and other "low-tech" positions. There will be a dramatically increased need for health informatics specialists (with both medical and non-medical backgrounds) trained specifically to meet the complex ICT needs of healthcare organizations, including (1) the management of electronic databases; (2) the development and maintenance of systems that provide universal standards or access; (3) the development and support of clinical decision support systems; and (4) the supervision of access to data from both a database security standpoint and a medical ethics standpoint (monitoring access for such purposes as quality assurance, assessment of outcomes and disease surveillance). These developments in the way in which diseases are detected and managed are expected to bring significant changes to the healthcare teams of the future. Many of the new technologies described above will create the need for multidisciplinary treatment teams that include experts in bioengineering, biomaterials or genetics technology Decentralizing the healthcare system will create a significantly expanded role for community physicians, nurses and healthcare professionals. By enabling them to do more, we make the jobs more attractive and increase recruitment and retention in the remote parts of the country As healthcare finally embraces information technology in its full scope, we can expect to see significant changes in human resources brought on by efficiencies at the local level, which will lead to decreased needs in administrative areas and increased needs in medical informatics and other specialized areas. Changes in patient care teams will be seen as a result of dramatic developments in the types of medical care we provide, which will necessitate changes in direction and training. Finally, the shift in where patients receive their care - at home and in the community setting, rather than in big tertiary hospitals - will lead to a geographical shift in healthcare professionals from big cities to community and rural settings, as well as to changes in the roles played by professionals at all levels and in all types of healthcare organizations.
- ADRES 3.0 (Aravind Diabetic Retinopathy Evaluation Software) permits exchange of images of retina and clinical information of diabetic patients interactively via Internet with the client computer at the Diabetic centres. By using a fundus camera, the retinal images of the diabetic patients can be sent to the Eye Hospital using this software. The software helps in grading the images received from remote centre and gives severity levels of Diabetic Retinopathy and suggests treatment which is sent as a report format to the remote centre. India is home to around 7 crore diabetics. Timely treatment can prevent vision loss from diabetic retinopathy. This means that all of the diabetics will need to be regularly examined for the occurrence of DR. However, most diabetics do not access screening and treatment due to challenges like lack of awareness of the disease, lack of availability of resources and specialists. At present, most of the diabetic patients come to the ophthalmologists only after experiencing considerable vision loss. Most physicians do not refer diabetic patients for routine examination of the retina.
- Aim of the Project: Set up an efficient collaboration and communication system which understands the Radiologist availability, work-load, and other statistical parameters and assigns the radiologist accordingly Challenges Faced by the Customer: With their incumbent system, the status of the studies was not transparent. Physician requests were routed through the call centre â a cumbersome process and there were multiple communication channels, often resulting in communication errors causing customer frustration & underutilization of Radiologist time. Studies were assigned to the radiologist manually by the support staff without complete understanding of Radiologists work load, expertise, location, etc. â leading to non-optimal Radiologist assignments and inefficiencies and delays. With pressure to reduce radiology reporting costs, it was required to significantly improve productivity of radiologists to sustain margins and grow business while maintaining & improving report quality. Making images accessible to radiologists on the click of a button for quick turn-around of emergency radiology reports. Existing systems lacked tools for collaboration between physicians and radiologists or between radiologists in different locations. The Solution: RADSpa, Radiology workflow Intelligence system Customer Benefits: Significantly improve efficiency of radiologists (more reports per day) by eliminating multiple systems & automating manual tasks; anytime, anywhere availability; also improve the Quality of reports Faster availability of radiology images Effective delivery, communication & collaboration with peer radiologists, physicians & Hospitals Ability to provide radiology reporting to remote low-bandwidth sites with optimized image transfer Automated quality assurance process Voice dictation feature helps reduce report turn-around-time significantly The web-based platform enabled hospitals/physicians to view & respond to clarifications & requests from radiologists and vice-versa, thus streamlining the communication channels and ensuring decrease in average wait times for the patients and high customer satisfaction Being a web based system it can be easily and quickly deployed for a new hospital or radiology centre without much of infrastructure investment. Being a configurable workflow system, this can be used and configured to meet the needs and workflow of any radiology practice.
- iClinic Healthcare Private Limited Close to 20 million of our population, primarily residing in tier 2, tier 3 cities, is languishing in poor health with little or no access to quality medical assistance. iClinic has taken on the herculean task of reaching out to them through providing onsite specialist medical care by successfully establishing the much needed connect between local doctors and specialists in metros to ensure the best medical assistance for the small town patient. iClinic Healthcare was conceptualized and founded jointly by Mr. Sanjoy Mukerji, Ex-Chief Commercial Officer of Vodafone India and Mr. Varun Berry, Managing Director, Britannia Industries Ltd to make quality healthcare a reality in India. iClinic operates through a one of a kind model wherein it has tied up with local hospitals in tier 2, tier 3 cities where the doctor can facilitate a consultation with a renowned specialist sitting in a metro through a simple video call. iClinic not only gives 24/7 online medical solutions like many other healthcare portals in the online space, but actually conducting an onsite physical and virtual consult by reaching out to people directly through local doctors who facilitate specialist consults. So it is not just a cut and dry online medical help site which is rolling out medical prescriptions and advice but actually delivering good quality healthcare with a human touch among a section of population which is neglected and in desperate need of specialist healthcare. Ram Prasad, father of 2 year old Vishal, had given up all hope when his son was suffering from violent seizures and the doctors at Karnal were not able to decide on what to do next. The parents had no other option but to shift him to another hospital in Chandigarh but the little child was in no state to travel. Dr. Om Narain who was handling Vishal's case, required urgent consultation from a pediatric neurologist but since there are not many such specialists in Karnal, he turned to iClinic for help. The iClinic team promptly arranged a session with renowned pediatric neurologist Dr. Saurabh Chopra within 2 hours and based on his advice, Vishal was successfully treated in the same hospital in Karnal. iClinic saved the family from the hassle of shifting Vishal and the risks and expenses associated with it. iClinic Healthcare has also reached out to patients who have no insurance and access to quality healthcare in this country. They came across a patient Jyoti, 23, a poor lady suffering from headache, vomiting and seizure. A MRI was done as doctors had a query regarding "space occupying lesion" and "infected pathology". However, the radiologist at Karnal was not very sure. Hence, iClinic took an online consultation and neurologist Dr. Shamsher Dwivedee reviewed the film and said this was an infected lesion and she needs to be given antibiotics and antifungal medicated cream. This brought about a considerable improvement in the patient and saved her money and time. She would have had to spend Rs. 4 lakh if she went to Delhi to get treated and here iClinic could manage the expenses in less than Rs. 30,000. iClinic has helped many such patients get access to specialist healthcare and is currently reaching patients in over 40 remote towns in India as a first step to reaching millions in the need of specialist care across over 1000 towns. iClinic has already started its operation in Karnal, Jind, Kurukshetra &, Sirsa in Haryana, Mandi (Himachal Pradesh), Agartala in Tripura, Kosi in UP - and a pilot unit in Lagos, Nigeria. People from neighbouring towns are also finding it convenient to come to iClinic centres to consult specialists in Delhi and Kolkata. The long term vision is to have 'iClinic consult facility' in every hospital in tier 2, tier 3 India and connecting their patients with super specialist doctors. Healthcare should no longer be a distant dream for these people.
- Queensland Telepaediatric Service The telepaediatric service in Queensland commenced in November 2000 as a research trial through the University of Queenslandâs Centre for Online Health (COH) in collaboration with the Royal Childrenâs Hospital (RCH) in Brisbane, and in time has emerged as a routine service. The telepaediatric service provides specialist consultations to children and their families living in rural and remote areas of Queensland via videoconference. More than 5000 consultations have been conducted since the service began, benefiting thousands of families statewide. Paediatric sub-specialities offered by the telepaediatric service include post-acute burns care, cardiology, diabetes, neurology, oncology, orthopaedics, psychiatry and surgery. Both patients and providers have reported high levels of satisfaction with the service.  An important factor in the success of the telepaediatric service is the unique referral model developed by the research team. Firstly, a centralised referral centre has been developed which gives selected regional hospitals direct access to a telepaediatric coordinator via a dedicated toll-free number. Staff in regional hospitals could easily make a referral by contacting the service instead of automatically sending patients to Brisbane to see the specialist in person. Once a referral is made to the telepaediatric service, a response is guaranteed within 24hrs. Telepaediatric coordinators liaise between the referer and specialist, and coordinate the response subject to the urgency of each case. Upon the specialistâs arrival, the coordinators ensure that an adequate (videoconference) link is made to the regional site, that the sessions run smoothly and accurate usage records are maintained.  The specialists use videoconference studios at the COH. Technology handling of clinicians has been kept to a minimum at both regional and Brisbane sites. Basic training is offered to all clinicians, but the majority of responsibility for operating the equipment is maintained by the telepaediatric coordinators.  In addition to standard studio-based videoconferencing units, the COH introduced a videoconferencing unit dressed up in the shape of a robot in a regional hospital which lacked a full-time paediatrician. âRoy the Robotâ (named after Royal Childrenâs Hospital) has been used for ward rounds where specialist paediatricians from Brisbane could offer remote consultations directly at the bedside. Indicating the success of this method, four new robots are now being launched in different distant sites in Queensland.
- Mobile communication between doctors in Ghana improve medical practice Project overview: With an estimated two thousand physicians serving a population of nearly 24 million inhabitants, doctors in Ghana need to have a reliable communication system for conducting consultations and referring patients. With support from New York University and in collaboration with a mobile telephony provider in Ghana, and Switchboard5 (a US-based non-profit-making organization) the Ghana Medical Association (GMA) launched the Mobile Doctors Network (MDNet) in Ghana in 2008. It provides free mobile-to-mobile voice and text services to all the physicians in Ghana currently registered with the Association. More recently, a one-way bulk SMS service was also enabled, allowing GMA to send information to doctors about national emergencies and meetings, as well as to contact doctors within a particular specialty. MDNet is the first service of its kind implemented in Africa and aims to promote the transfer of knowledge between physicians in Ghana using mobile phones â the means of communication most doctors in rural and urban areas of the country already use in their daily practice. MDNet also facilitates emergency response communications between doctors in the form of rapid, unlimited access to peer advice over the phone. Technology: To gain access to MDNet, GMA-registered physicians were provided with over 1600 free subscriber identity module (SIM) cards, linked to telephone numbers within the mobile network. The SIM cards work with any brand of mobile phone and allow doctors to make voice calls free of charge, as long as they are contacting other colleagues within the MDNet programme. Based on the success of this programme in Ghana, Switchboard extended the service to Liberia in 2009, and was in discussions with the Ministry of Health for its possible implementation in Kenya.
- Strong health information technology is the number one incentive to attract higher wage-earning primary care physicians and other health professionals to a community. As the healthcare industry transforms, healthcare organizations also need to transform their Healthcare IT systems in order to keep up with the competition, as well as source, employ, and retain the best talent. In the past, HR systems were very tactical. They werenât focused on whether or not someone was doing a job well or was the right fit, they were focused on things like payroll and compliance and process automation. Now, healthcare organizations are using talent management software to recruit for efficiency as well as fit. Software can help ensure that you are hiring employees that have the right clinical and general competencies, managing your employees to goals, and assessing employees for leadership. For example, many healthcare organizations are using web-based software that enables applicants to provide contact info for their references. Their references get an email and take a web-based survey about the applicant. Then, survey results are combined and presented to a recruiter. This speeds up the reference process from a few days to a few hours. And it lets organizations pinpoint the behavioral profiles that theyâre looking for. Many healthcare organizations today are running disparate human capital management (HCM) technologies across the different functions. For example, they may track learning and development data in one application, performance data in another application, and compensation data in yet anotherâmaking it challenging to get a holistic, 360-degree view of the employee. Without a holistic, 360-degree view of such a diverse group of employees, itâs extremely hard to provide actionable information that alerts executives and managers to challenges so that they can be proactive in managing their workforce. The key to success in this new paradigm is being able to not just track data for employees, but to manage the workforce through enterprise-class HCM technology. In the past, HCM technology was focused on tracking the workforce on a global basis across all departments and entities. With newer HCM technologies, managing people through the talent lifecycle becomes possible. The type of employee, the skill sets required, learning, development, performance, and compensation come to center stage, enabling an organization to transform from âtrackingâ to âmanagingâ the workforce on a more holistic level. Organizations need technology that provides potential candidates an easy end-user experience to access and navigate information leveraging a variety of platforms, including mobile devices. Many of these people in the target candidate pool are in patient-facing roles, and are not in front of computers during their normal workdayâtheyâre nurses, doctors, and technicians. The acquisition and onboarding process needs to be very simple, streamlined, and automated from the candidate and employee perspective, as that is what potential employees of most organizations have come to expect. Classroom training is still the norm but more and more people are moving to online classes for training on clinical procedures. It has become a very efficient way to get people trained more effectively and with much less cost. Wadhwani Foundation is leveraging technology to repurpose existing training content into a ground breaking online, offline education model of training to new nurses, as well as refresher material for existing nurses and healthcare support staff across 20 multi-specialty hospitals of Narayana Health. More than 160 hours of content with 60-minute lesson segments revolve around job-specific and functional healthcare industry knowledge including video-based instruction, activities, games and simulations, and peer-learning. Based on the success of the collaboration with Narayana Health, Wadhwani Foundation aims to scale its e-learning initiative in order to reach 3 million students by 2020 in association with new skills colleges, also known as community colleges, across India.
- Human resource development and skills in information systems design and implementation is critical to successful application of ICT in healthcare. Building competencies, finding and retaining skilled personnel, improves quality, value and patient satisfaction. Experience shows that there is no single solution that will work in all settings. The complexity of choices of technologies and the complexity of needs and demands of health systems suggest that the gradual introduction, testing and refining of new technologies, would be the way forward. Clinicians have been known to be resistant to change for ages. As an example, usage of stethoscope amongst the medical community took almost 100 years. If the systems that they are expected to use in their day-to-day work is unfamiliar to them and takes too much of their time, without tangible benefit, there is a very serious risk of non-usage. If the new system upsets an existing hierarchy or even gives an impression of doing so, it can be a serious risk. Technical reasons such as lack of training, not being comfortable with using technology, HCI (human computer interaction) factors such as clinicians in the operation theatres being expected to remove their sterile gloves to type can also jeopardize a project. The challenge of wireless networking in hospitalsânot to mention bringing broadband to rural Indiaâis one technological factor hindering the spread of telemedicine, which connects specialists (often in urban facilities) to patients in areas underserved by doctors. Another is equipping rooms with teleconference equipment, which can be expensive and hard to use. The medical community has traditionally resembled an academic environment more than a business, open to collaboration and information sharing. In this dispersed environment, EMRs are always on the move, and the security of critical infrastructureânetworks, PCs, servers, databases, and moreâbecomes more difficult. The need for data storage in healthcare doubles every 18 months. The typical healthcare data center is bursting at the seams, inconveniently located and a low priority for executives focused instead on expanding clinical space. Healthcare storage requirements are often intertwined with compliance issues. How long information must be retained, who can see it, and who can retrieve it are questions healthcare organizations wrestle with every day, because of both internally generated policies and government regulations.
- Recommendations The government, by effectively channelizing the CSR component introduced in the last budget, should facilitate corporates to adopt villages. Corporates can in turn deploy the CHP platform, trained paramedics and initiate tele-consultation from a city/district headquarters. The respective state governments will have to pitch in by taking care of other infrastructure like rental space, electricity and connectivity to the PHC. With an annual running cost of 5 to 6 Lacs INR per PHC and the average cost per patient working out to approximately INR 125 (15 patients over an 8 hour schedule daily), this initiative can be managed through local NGOs or funds sourced by the village panchayat in the event that no corporate is willing to do the same. Ministries of health, education, finance and information technologies and communications must coordinate efforts to improve ICT infrastructure, expand broadband access and support e-learning initiatives in health professional institutions and health programmes. In absence of adoption of mHealth as an immediate priority by government health authorities, it is clearly evident that the corporate and private players need to take the lead in adoption and dissemination of mHealth among patient and provider community for chronic disease management, remote patient monitoring, real time availability of patientâs vital parameters in case of critical patients in post op care, ICU & trauma units. Computer literacy, particularly for women, should be a high-priority competency in all training programmes for health-care workers. The government should encourage private players to implement healthcare IT through PPP model. Partnership can be also done with the private sector for conducting training and education programmes on using healthcare technology for the healthcare staff. Cloud computing and mobile technology will play a major role in taking healthcare to the next level across India. These solutions will primarily take care of the present hindrances like high costs, reach, patient records, infrastructure etc. that the sector faces. Tele presence in an ambulance will enhance patient survival rates. Patient condition is assessed by monitoring vital signs, all preliminary tests are completed and results transmitted to the base hospital. The consultant in the hospital using all these inputs can keep the treatment process ready and can start the actual treatment immediately on patient reaching the hospital. This will minimise precious time loss, especially in cardiac emergencies. Policies, standards or guidelines need to be formulated to maintain and control the quality of healthcare IT infrastructure in the country. Government funding needs to be improved in such areas which can result in availability and improvement in current infrastructure, purchasing and installing technology, recruiting the competent staff or train existing staff.   Conclusion There is an opportunity for current and emerging technologies to play a major role in transforming healthcare delivery, like clinical information systems, robotics, imaging, genomics, telemedicine and nano-technologies. These solutions will play a catalystâs role in determining the growth and the reach of the sector. However these technologies are often complex and require an unprecedented level of integration. While we witness a considerable amount of improvement in healthcare facilities with the help of information technology in the metros, the challenge that still remains is to extend these services to the rural areas. Evolving technology is a steamroller that is even now changing the healthcare delivery landscape. All of us now have a short time to decide whether weâll be part of the steamroller ⌠or part of the road.