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Perspectives on Health Information
Systems in Indian Hospitals
Dr Dev Taneja
M.S. (Gen. Surgery)
MBA - Healthcare Mgt., NUS Business School, Singapore
Director CarePoint Hospital. Uran. Navi Mumbai.
May 2017
Why HIS ?
Feel over pulse of the institution
Clinical & Business Oriented Performance
Every Top Management is interested in knowing
How are we doing?
Dr Dev Taneja 2
What to monitor ?
What to measure ?
Dr Dev Taneja 3
Clinical
• Clinical Programs
• Physician Performance
• Clinical Quality
• ALOS
• Mortality & Morbidity
• Medical Technology
• Medical & Paramedical
Manpower
• Clinical Program Marketing
• Corporate & Insurance
Empanelment
Operational
• Hospital Occupancy
• Utilization Rates by
departments
• Days in Inventory
• Facility Maintenance
• Employee Attrition
• Service Excellence
• Profit & Cost Center
Analysis
• MIS / HIS
Financial
• EBITDA
• Earning per bed per day
• Current Ratio
• DER
• % Salary to Total Expenses
• % of Consultant Fee to
Total Income
• % Cash & Credit Business
• Revenue Cycle Mgt.
Healthcare Organisation – Performance Indictors
Dr Dev Taneja 4
What is Changing in the Indian
Healthcare System ?
Dr Dev Taneja 5
Evolution of Health Financing in India
• Financial Risk with Patients
• Seller (Health Provider - Hospital) Power High
• Low Buyer (Patient) Power. Forced to buy services
per Seller’s inflated Tariffs
Out of Pocket
• Financial Risk with Health Insurance Cos
• Seller(Provider) Power remained High
• Hospitals used Cost Plus Models leading to high
payouts by Insurance Cos; threatening HI industries
viability
Introduction
of Health
Insurance
• Health insurance Buyer (Payer) Power has increased
• Fixed Tariff to qualify as Preferred Provider Network
Hospital
• Majority of Hospitals after initial resistance signed
Fixed Tariff Rate List of Insurance Industry (GIPSA)
• Financial Risk shifted to Providers (Hospitals)
Pro Active
Health Ins. Cos
1986
2010
Dr Dev Taneja 6
Existing Healthcare - Cost Plus Model
• Being Effective was enough
• No Costing Challenges for business viability
• Hidden inefficiencies in hospitals
• HIS - Mostly Transaction oriented
• Performance Improvement - Patchy. Limited Enterprise Focus
Emerging Healthcare - At Cost Model
• Not only Effective but Efficient as well
• Service line Costing - Financial Discipline for business viability
• Empowered & Engaged Employees
• Clinical Quality & Service Excellence
• Strategic Application of IT for Performance Improvement
Dr Dev Taneja 7
What Constitutes Healthcare IT?
 Strategic Information Systems
 Administrative Information Systems
 Clinical Information Systems
 Electronic Networking Systems - RFID, Mobile, Telemedicine,
Telemetry, Insurance etc.
Dr Dev Taneja 8
HMIS Applications can be broadly classified as
By Solutions
• Service Delivery Solutions
• Support Services Solutions
By Functions
• Patient Management
• Clinical Services
• Clinical Mgt.
• Administrative Mgt.
• Support Departments - Administrative & Workflow Mgt.
Dr Dev Taneja 9
Management Applications
• Manage and Control
Clinical Performance
Operational Performance
Financial Performance
• Improve workflow, productivity & efficiency
Decision Support Systems
• Managerial
• Functional Heads
• Senior Management
• Clinical Management
Networking / Interphasing with other IT Systems / Applications
Dr Dev Taneja 10
How to Create an Enterprise Level HIS?
Dr Dev Taneja 11
SAP ECC 6.0
SAP Financials and Controlling
SAP Human Resources & Payroll
Reporting and Business Intelligence
SAP Quality Mgmt
A Suggestive Full Fledged SAP Enterprise Management & Support
Procure
raw materials,
machinery,
consumables,
outsourced
services
Manage material
at
stores and
sub-stores
Sales &
Marketing
Despatch
Service
SAP
Purchasing
SAP
Sales &
Distribution
SAP
Materials
Management
Project Costing,
Management,
Monitoring
SAP
Project
Systems
Interfaces – Clinical systems, other point software, Barcoding, RFID
Dr Dev Taneja 12
HIS - What is mostly offered in India?
• Front office/Registration
Desk Management
• OPD Management
• Reporting tool for Patient
Case Sheet / Treatment /
Other reports
• Wards Management
• Lab Management
• Pharmacy Management
• Central Stores
Management
• Blood Bank Management
• Billing Management
• CSSD Management
• Purchase & Stores Mgt.
• House Keeping Mgt.
• Dietetics Management
• Medical Records
Department Mgt.
• MIS Reporting
• Interphasing - PACS, LIS
etc.
Dr Dev Taneja 13
What is missing in India - 1
• Clinical Information Systems
• Clinical Decision Support Systems
• Chronic Disease Management Systems
 Reason - In India there is a huge physician practice
variation in the absence of defined national level
clinical protocols
Dr Dev Taneja 14
Why Clinical Information Systems are required?
Dr Dev Taneja 15
Coordination of Clinical Care
IOM Report, 1999 – To Err is Human: Building a safer healthcare system
Medication Errors
1. Ordering by physicians - 56%
2. Admin. of medication by
nursing staff - 34 %
3. Transcription of medication
orders by secretarial staff - 6%
4. Dispensation of medication by
the pharmacy dept. - 4%
5. Practice variations - Cost of
care in the last 6 mths. of life
were found to vary
tremendously
Clinical Process Improvement
1. Science of Error Reduction -
CQI
2. EMR - virtual data warehouse
3. Design around patients
Dis. mgt. programs - patient
centered
4. Reduction in Medication Errors
5. Research Organisation - RIID
(Research, Investigate,
Innovate & Disseminate)
6. Chronic illness Focus - CDM
7. Link to Financial Performance -
- Report cards
Dr Dev Taneja 16
Dr Dev Taneja 17
What is missing in India - 2
In Absence of CIS - A Proper EMR / EHR
 It is a database & decision support system
 It addresses one of the greatest inefficiencies of
healthcare - the immobility of healthcare records
 It is built around Clinical Protocols
 CPOE - Clinical Physician Office Entry
 Clinical Information Systems & Clinical Decision
Support Systems
Dr Dev Taneja 18
What is missing in India - 3
A Good
IT enabled Chronic Disease Management
System
Dr Dev Taneja 19
IT in Care Process
Health Care Team Patients/Consumers
Case Manager
Patient
Centered
Information
(EHR)
Health plans that seek to better coordinate patient
care – particularly for chronic care patients – should
make sure all health care stakeholders have the same
information when devising treatment strategies.
Placing high-quality, patient-centered data at the
center of the “circle of care” is where IT systems
(EHR) can be of strong value.
Dr Dev Taneja 20
IT Vision
Electronic Health Record
Central Data Repository
First Clinic/HQ
Patients/
Consumers
Community Health
WorkerCare
Consultant
Medical
Officer Paramedics
Case
Manager
InternetInternet
Additional Centers
in Future
Quality Metric
Reports
Dr Dev Taneja 21
IT Plan - Web Based Solutions
◊ Electronic Health Record(EHR)
• Can be accessed anywhere by Health Care Team
• Role specific screens that allows to see/collect information
about patient specific to the care provider’s discipline
◊ Patient Health Record(PHR) portal to facilitate
• Self management
• Open communication with health care team
• Delivery of patient specific education materials in different
formats (videos/web pages, etc)
Dr Dev Taneja 22
What is missing in India - 4
Good Financial Modules from HIS Vendors
What we typically witness in India
Mere inter - phasing with Financial Tally Software
Dr Dev Taneja 23
What is missing in India - 5
¤ A good ERP System in Hospitals
¤ Near Total Absence of Strategic Business
Intelligence or Health Analytics Software
Dr Dev Taneja 24
Business Intelligence / Health Analytics
Readymade Role based Actionable information available
No need to spend time for analysing data
Interactive visualisation of data to support decision making.
Transformation of Data to Information to Knowledge
ERP
Modules cover transactions + support depts.
But +/- Clinical Information Systems
Static MIS Dash boards.
Limited Analytical capability
HIS
Modules mostly capture Transactional Data Limited applications for all support Depts.
HIS, ERP & BI: Advantages & Limitations
Dr Dev Taneja 25
Comparison of HIS Vendors in USA & India
Where are we now?
Dr Dev Taneja 26
Modules NA Basic Intermediate Advanced
Electronic Medical History Records
Financial Mgt & Economic Acc MS
Costing Software
Client Relationship MS (CRM)
Hospital Resource Planning System (ERP)
HR Mgt Sub System
Logistic Mgt Sub Sys
Office Automation (OA)
Comprehensive Search & Analysis Sys
Clinical Decision Making support Sys
Medical Mgt & Quality Control Sys
Clinical Data Warehouse
Remote Medical Service Sys
Patients Enquiry Terminal
Knowledge Mgt Platform / BI
Patient online Service Platform
Medical Ins & Community HC interphase
Patient Card (Intra Hospital)
Patient Card (Inter Hospital)
Medical History Records & Statistics
Indian HIS Vendors - Most Common Module Offerings
Dr Dev Taneja 27
Clinical Information Systems Comparison - Indian Vs MNC Vendors
Modules Basic Intermediate Advanced Not Available
1 Abstracting
2 Chart Deficiency
3 Chart Tracking Locator
4 Clinical Data Repository
5 Clinical Decision Support
6 Enterprise EMR
7 Enterprise Master Patient Index
8 Laboratory Information Systems
9 Pharmacy Management Information Systems
10 Point of Care
11 Radiology Information Systems
12 Surgery
Dr Dev Taneja 28
Financial Information Systems Comparision - Indian Vs MNC Vendors
Financial Information Systems Basic Intermediate Advanced Not Available
1 Accounts Payable
2 Benefit Administration
3 Case Mix Management
4 Cost Accounting
5 Electronic Claims
6 Executive Information Systems
7 General Ledger
8 Materials Management
9 Patient Billing
10 Pay Roll
11 Registration / ADT
Dr Dev Taneja 29
Indian HIS Vendor - Pain Points
 Local HMIS industry capabilities are low on value chain.
 No defined clinical protocols in India; Proven products
of Clinical Information systems do not exist
 Lack of Health IT skills
 Hospital leaders have no experience to manage change
after implementing major IT systems & hence hesitant
to increase IT investments
 No defined National Health IT standards
 Limited Health - IT Application Consultancy skills
Dr Dev Taneja 30
Are only Indian HIS Vendors to Blame?
Dr Dev Taneja 31
Weakness in Indian HIS Market - User Factors
 Inadequate fund and irrational investment structures - Hospital IT
spend
 Inadequate planning and misunderstanding of computerisation
 Unclear and changeable requirements
 Inferior organisation structure and lack of talent
 Lack of reliable methods to evaluate products
 Poor execution and lack of experience in project management
 Defective tendering procedures - Hardware Vs Application Software
evaluation methods
Dr Dev Taneja 32
Indian Hospital Industry Maturity is beween Level 1 to 2
Comparatively Indian Pharma Industry Maturity is higher
33
Implementation
Phase
Activities Challenges Role of External Consultant
HIS • Repetitive transaction based data gets
captured at unit / corporate level
• Standard / Generic module
implementation by vendor with
limited customisation
• No Process Mapping
• Limited Operations Depts’.
ownership of implementation
• Frequent Change Requests
• Sub-optimal customisation
• Organisation still works
simultaneously with both
electronic & manual data
• Coordination between
operations depts., in-house IT
team & Software vendor
• Assists in smooth HIS project
implementation
ERP • Enterprise level Integration of data
• Role based static dash boards
available
• Limited Analytical capability
• Limited in-house capabilities of
Enterprise level Systems & Process
thinking per business needs
• It entails BPR & Change Mgt.
• Various depts. need hand holding in
this phase.
• Continues validation and support
from Top Mgt.
• Coordinates with Top Mgt., IT
& ERP Implementation Team
and ERP vendor
• Assists in BPR / Change Mgt.
• Assist in project
implementation & timely
project closure
BI / Health
Analytics
• Data is converted into meaningful
information
• Availability of Role based Actionable
information at every level
• Visualisation and interaction with the
dash boards for insights and decision
making
• +/ - Enterprise Score Card
Implementation
• Limited in house capability of
enterprise level systems, processes
and information flows thinking per
business requirements
• Continuous involvement, validation
and support of Top Mgt.
• Coordinates with Top Mgt., IT
& BI Project Team to map
enterprise wide role based
information requirements
• Assists in drawing metrics /
dashboards
• Assists in developing Org.
Balanced Score Card
• Once information framework
is ready than coordinate with
BI vendor for roll out of BI
solutions
HIS / ERP / BI Implementation Challenges
Dr Dev Taneja 34
What is missing in India - 6
• Application of Strategy Performance Management
Tool - a semi-standard structured report, supported
by design methods and automation
e.g.: Balanced Score Card
• IT Framework designed for the Implementation of
Balanced Score Card in Healthcare Systems
Dr Dev Taneja 35
Finance
Indicator Description
Education
Indicator Description
Customer
Indicator Description
Balanced Scorecard
Strategy
Internal
Indicator Description
Ideally how to Implement HIS?
Treat HIS Implementation as a Strategic Tool
for Improving Enterprise Performance
Dr Dev Taneja 37
REPORTS
SOP
SYSTEM
Structure Process Manpower
Building
Equipments
BALANCED GROWTH OF HOSPITAL(S)
ERP
Tools &
Training
Dr Dev Taneja’s - ‘SPM Model’
Treat IT Applications Strategically
38
Are you leveraging your data to improve outcomes,
increase access to care and reduce costs?
Strategic Application of IT for
“Performance Improvement”
“Business Intelligence”
Using a proven IT Solution
Dr Dev Taneja 39
Ideal Road Ahead
IT in Health – A Reliable Productivity Tool
Move Beyond Transaction Reporting
 Strategic Enterprise Resource Planning
ø Hardware & Softwares
ø Integration Issues
ø ERP, BAM & BI for Monitoring & Control
Performance Improvement, Clinical Outcomes
Informed Decision Making
 Administrative IS
 Clinical Information Systems
 Electronic Networking Systems – RFID, Mobile, Telemedicine,
Telemetry, Insurance
Dr Dev Taneja 40
Healthcare Measures For Optimal Performance
Performance Measures
• Good business decision allows good outcomes today, tomorrow and in the
future. But to make a good business decision require solid performance
measures that:
• Monitor what has already happened
• Help up make the right decisions today
• Guide transformation the organization
• Healthcare providers measure a wide range of activities and results from
various perspectives to monitor, guide or transform
• Clinical quality and results
• Operational activities, costs and results
• Access and outreach efforts and results
• Marketing efforts and results
• Recruiting, staffing and development efforts and results
• Research efforts and results, just to name a few.
Dr Dev Taneja 41
Source: BI Solutions for Healthcare, Lawson
42
Dr Dev Taneja
43
Health IT
Other Common Applications in
Healthcare
Dr Dev Taneja 44
Information Sharing & Exchange
Direct Impact - Customer
 Online Appointments
 Reminders & Alerts
 Automated Dispensing Machines
 Digital Signage’s – Token Display, Patient Education materials
 Patient Portals
 Wireless Internet Access
 Video Calling Devices in ICU
 Telemedicine Health Communities
 Mobile Health Patient Health Records
 Online Payment Gateways
 Smart Cards
 Patient Entertainment Systems - Movies-on-Demand, Television, Music,
Games
Indirect Impact - Customer
 Electronic Health Record
 Clinical Decision Support Interoperability
 Wrist bands – Barcode / RFID
 Feedback collection
 Robotic Devices
 Surveillance
 Real Time Location Tracking
Future Healthcare – Social Media
IT Solution + Connectivity
Dr Dev Taneja 49
Wi-Fi in Healthcare
• IP Phones
• Laptops / Tablet PC
• PDA / IPAD
• Computer-on-Wheels (COWS)
• Real-Time location services
• Wireless Data Transfer
– Wristband and pharmaceutical scanners
– Wireless glucose meters
• Bedside video conferencing
– Remote telemedicine
• Video surveillance
• Medical telemetry/monitoring
• Visitor and patient Wi-Fi access
Dr Dev Taneja 50
Technology Considerations in Healthcare
Dr Dev Taneja 51
Dr Dev Taneja 52
Paperless Hospital - Myth Vs Reality
Dr Dev Taneja 53
Coordination of Clinical Care Improved Customer Care
Cost Containment,
Productivity Improvement,
Monitoring & Control
Technological Advancements
Push from Govt. & Payers
Profit, Growth
&
Competitive Advantage
Drivers of Paperless Hospital
Dr Dev Taneja 54
Current Status of Paperless Hospitals
There are perhaps few industries that have to gain
more from the internet revolution than
medicine…..(but doctors and) hospitals are real
laggards when it comes to the internet. What e-
health has to be used for is to transform the whole
process of delivering care.
Russell Ricci, M.D, (Steinhauer, 2000)
Dr Dev Taneja 55
E - Organisation Culture
Ø The ultimate barrier and enabler of the digital
transformation are not technical - they are cultural.
Ø A digital divide still exists between the e-users and
e-sceptics and healthcare is traditionally slow to
adopt new technology.
Dr Dev Taneja 56
PAPERLESS vs PAPER
Semi Automated Systems
Healthcare Executives Straddle the
“Digital Divide”
 The healthcare system of tomorrow may never be
‘paperless’ but progress is being made despite the
legendary reluctance of physicians to accept
changes in the way they practice medicine.
 The transformation process of building
electronically integrated systems that manage
patients with “seamless” care has already gained
traction across the globe.
Dr Dev Taneja 59
How to Improve Public Health System in India?
Implement
National Health Information Systems (NHIN)
State Health Information Systems (SHIN)
Dr Dev Taneja 60
Enterprise Hospital
Mgt. System
• Hospital IS – OPD,
IPD, Lab,
Radiology,
Pharmacy etc.
• Purchase & Stores
• HR
• Asset Mgt.
• Finance
• District, Taluka,
Sub -Taluka, PHC,
Sub - PHC
Public Health
Management
• NRHM programs
• Disease
Surveillance &
Control
• Preventive Public
Health Programs
Mgt.
• Monitoring Vital
PH Statistics
• Public Health
interventions -
Outputs &
Outcomes
reporting
Administrative
Authority & Control
• Health Ministry
• DHS
• DDHS
• Directors - Health
Programs
• Civil Surgeon
• DHO
• MS / MO In-Charge
• Administrative
Staff
• Field Staff – ASHA,
MHW, PH
programs Staff
Objectives of State Health Information Network
Dr Dev Taneja 61
Enterprise Hospital
Management System
• Improved Healthcare
Delivery
• Improved Utilization of
resources – capital
assets and manpower
• Efficiencies of Scale -
Purchase items
Standardisation,
Inventory Control &
Mgt, Economy in Group
Purchases, Supply
Chain Mgt. etc.
• Performance
Improvements -
Clinical, Operational &
Financial
Public Health
Management
• Real Time Data
• Improved Disease
Surveillance
• Improved Monitoring
of Preventive Public
Health interventions
e.g. Maternal & Child
Health, School Health
etc.
• Better Mgt. of
epidemics & PH
emergencies
• Improved PH statistics
for Research &
Planning
• Superior PH Outcomes
Administrative Authority
& Control
• IT enabled
Performance &
Efficiency Improvement
• Cost Effective
• At every level,
Improved Monitoring &
Control - Finance,
Manpower, Assets &
Resources
• Real Time MIS at every
level
• Superior Real Time
Data Quality for
Planning & Resource
Allocations
Benefits of State Health Information Network Implementation
Dr Dev Taneja 62
SHIN
Standardisation
• Project Scope
• Data &
Processes
• Hardware
• Software
• Security
• Storage
• Network
Applications
Phase 1
• District Hospitals
• District Level
NRHM, Disease
Control
&Preventive PH
programs
• Vital Public
Health Statistics
• Administrative –
District, Division,
DHS, Health
Ministry
• SHIN – District
Level
Phase 2
• Extend
Computerisation
to Primary
Health Network
at PHC & Village
levels –
Healthcare
Delivery, Disease
Control &
Preventive PH
programs
• SHIN – Primary
Health
Institutions
Level
Start with a District Level Pilot
State Health Information Network – Proposed Roll Out Plan
Dr Dev Taneja
63
Thank You
Contact Info:
Dr Dev Taneja
Director
CarePoint Hospital,
Plot No 45, Sector 29,
Dronagiri Node. Uran
Navi Mumbai. India. 400702
Mobile: 09987708685
E-mail: drdevtaneja@gmail.com

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Perspectives on health information systems in indian hospitals dr devtaneja_may2017

  • 1. Perspectives on Health Information Systems in Indian Hospitals Dr Dev Taneja M.S. (Gen. Surgery) MBA - Healthcare Mgt., NUS Business School, Singapore Director CarePoint Hospital. Uran. Navi Mumbai. May 2017
  • 2. Why HIS ? Feel over pulse of the institution Clinical & Business Oriented Performance Every Top Management is interested in knowing How are we doing? Dr Dev Taneja 2
  • 3. What to monitor ? What to measure ? Dr Dev Taneja 3
  • 4. Clinical • Clinical Programs • Physician Performance • Clinical Quality • ALOS • Mortality & Morbidity • Medical Technology • Medical & Paramedical Manpower • Clinical Program Marketing • Corporate & Insurance Empanelment Operational • Hospital Occupancy • Utilization Rates by departments • Days in Inventory • Facility Maintenance • Employee Attrition • Service Excellence • Profit & Cost Center Analysis • MIS / HIS Financial • EBITDA • Earning per bed per day • Current Ratio • DER • % Salary to Total Expenses • % of Consultant Fee to Total Income • % Cash & Credit Business • Revenue Cycle Mgt. Healthcare Organisation – Performance Indictors Dr Dev Taneja 4
  • 5. What is Changing in the Indian Healthcare System ? Dr Dev Taneja 5
  • 6. Evolution of Health Financing in India • Financial Risk with Patients • Seller (Health Provider - Hospital) Power High • Low Buyer (Patient) Power. Forced to buy services per Seller’s inflated Tariffs Out of Pocket • Financial Risk with Health Insurance Cos • Seller(Provider) Power remained High • Hospitals used Cost Plus Models leading to high payouts by Insurance Cos; threatening HI industries viability Introduction of Health Insurance • Health insurance Buyer (Payer) Power has increased • Fixed Tariff to qualify as Preferred Provider Network Hospital • Majority of Hospitals after initial resistance signed Fixed Tariff Rate List of Insurance Industry (GIPSA) • Financial Risk shifted to Providers (Hospitals) Pro Active Health Ins. Cos 1986 2010 Dr Dev Taneja 6
  • 7. Existing Healthcare - Cost Plus Model • Being Effective was enough • No Costing Challenges for business viability • Hidden inefficiencies in hospitals • HIS - Mostly Transaction oriented • Performance Improvement - Patchy. Limited Enterprise Focus Emerging Healthcare - At Cost Model • Not only Effective but Efficient as well • Service line Costing - Financial Discipline for business viability • Empowered & Engaged Employees • Clinical Quality & Service Excellence • Strategic Application of IT for Performance Improvement Dr Dev Taneja 7
  • 8. What Constitutes Healthcare IT?  Strategic Information Systems  Administrative Information Systems  Clinical Information Systems  Electronic Networking Systems - RFID, Mobile, Telemedicine, Telemetry, Insurance etc. Dr Dev Taneja 8
  • 9. HMIS Applications can be broadly classified as By Solutions • Service Delivery Solutions • Support Services Solutions By Functions • Patient Management • Clinical Services • Clinical Mgt. • Administrative Mgt. • Support Departments - Administrative & Workflow Mgt. Dr Dev Taneja 9
  • 10. Management Applications • Manage and Control Clinical Performance Operational Performance Financial Performance • Improve workflow, productivity & efficiency Decision Support Systems • Managerial • Functional Heads • Senior Management • Clinical Management Networking / Interphasing with other IT Systems / Applications Dr Dev Taneja 10
  • 11. How to Create an Enterprise Level HIS? Dr Dev Taneja 11
  • 12. SAP ECC 6.0 SAP Financials and Controlling SAP Human Resources & Payroll Reporting and Business Intelligence SAP Quality Mgmt A Suggestive Full Fledged SAP Enterprise Management & Support Procure raw materials, machinery, consumables, outsourced services Manage material at stores and sub-stores Sales & Marketing Despatch Service SAP Purchasing SAP Sales & Distribution SAP Materials Management Project Costing, Management, Monitoring SAP Project Systems Interfaces – Clinical systems, other point software, Barcoding, RFID Dr Dev Taneja 12
  • 13. HIS - What is mostly offered in India? • Front office/Registration Desk Management • OPD Management • Reporting tool for Patient Case Sheet / Treatment / Other reports • Wards Management • Lab Management • Pharmacy Management • Central Stores Management • Blood Bank Management • Billing Management • CSSD Management • Purchase & Stores Mgt. • House Keeping Mgt. • Dietetics Management • Medical Records Department Mgt. • MIS Reporting • Interphasing - PACS, LIS etc. Dr Dev Taneja 13
  • 14. What is missing in India - 1 • Clinical Information Systems • Clinical Decision Support Systems • Chronic Disease Management Systems  Reason - In India there is a huge physician practice variation in the absence of defined national level clinical protocols Dr Dev Taneja 14
  • 15. Why Clinical Information Systems are required? Dr Dev Taneja 15
  • 16. Coordination of Clinical Care IOM Report, 1999 – To Err is Human: Building a safer healthcare system Medication Errors 1. Ordering by physicians - 56% 2. Admin. of medication by nursing staff - 34 % 3. Transcription of medication orders by secretarial staff - 6% 4. Dispensation of medication by the pharmacy dept. - 4% 5. Practice variations - Cost of care in the last 6 mths. of life were found to vary tremendously Clinical Process Improvement 1. Science of Error Reduction - CQI 2. EMR - virtual data warehouse 3. Design around patients Dis. mgt. programs - patient centered 4. Reduction in Medication Errors 5. Research Organisation - RIID (Research, Investigate, Innovate & Disseminate) 6. Chronic illness Focus - CDM 7. Link to Financial Performance - - Report cards Dr Dev Taneja 16
  • 18. What is missing in India - 2 In Absence of CIS - A Proper EMR / EHR  It is a database & decision support system  It addresses one of the greatest inefficiencies of healthcare - the immobility of healthcare records  It is built around Clinical Protocols  CPOE - Clinical Physician Office Entry  Clinical Information Systems & Clinical Decision Support Systems Dr Dev Taneja 18
  • 19. What is missing in India - 3 A Good IT enabled Chronic Disease Management System Dr Dev Taneja 19
  • 20. IT in Care Process Health Care Team Patients/Consumers Case Manager Patient Centered Information (EHR) Health plans that seek to better coordinate patient care – particularly for chronic care patients – should make sure all health care stakeholders have the same information when devising treatment strategies. Placing high-quality, patient-centered data at the center of the “circle of care” is where IT systems (EHR) can be of strong value. Dr Dev Taneja 20
  • 21. IT Vision Electronic Health Record Central Data Repository First Clinic/HQ Patients/ Consumers Community Health WorkerCare Consultant Medical Officer Paramedics Case Manager InternetInternet Additional Centers in Future Quality Metric Reports Dr Dev Taneja 21
  • 22. IT Plan - Web Based Solutions ◊ Electronic Health Record(EHR) • Can be accessed anywhere by Health Care Team • Role specific screens that allows to see/collect information about patient specific to the care provider’s discipline ◊ Patient Health Record(PHR) portal to facilitate • Self management • Open communication with health care team • Delivery of patient specific education materials in different formats (videos/web pages, etc) Dr Dev Taneja 22
  • 23. What is missing in India - 4 Good Financial Modules from HIS Vendors What we typically witness in India Mere inter - phasing with Financial Tally Software Dr Dev Taneja 23
  • 24. What is missing in India - 5 ¤ A good ERP System in Hospitals ¤ Near Total Absence of Strategic Business Intelligence or Health Analytics Software Dr Dev Taneja 24
  • 25. Business Intelligence / Health Analytics Readymade Role based Actionable information available No need to spend time for analysing data Interactive visualisation of data to support decision making. Transformation of Data to Information to Knowledge ERP Modules cover transactions + support depts. But +/- Clinical Information Systems Static MIS Dash boards. Limited Analytical capability HIS Modules mostly capture Transactional Data Limited applications for all support Depts. HIS, ERP & BI: Advantages & Limitations Dr Dev Taneja 25
  • 26. Comparison of HIS Vendors in USA & India Where are we now? Dr Dev Taneja 26
  • 27. Modules NA Basic Intermediate Advanced Electronic Medical History Records Financial Mgt & Economic Acc MS Costing Software Client Relationship MS (CRM) Hospital Resource Planning System (ERP) HR Mgt Sub System Logistic Mgt Sub Sys Office Automation (OA) Comprehensive Search & Analysis Sys Clinical Decision Making support Sys Medical Mgt & Quality Control Sys Clinical Data Warehouse Remote Medical Service Sys Patients Enquiry Terminal Knowledge Mgt Platform / BI Patient online Service Platform Medical Ins & Community HC interphase Patient Card (Intra Hospital) Patient Card (Inter Hospital) Medical History Records & Statistics Indian HIS Vendors - Most Common Module Offerings Dr Dev Taneja 27
  • 28. Clinical Information Systems Comparison - Indian Vs MNC Vendors Modules Basic Intermediate Advanced Not Available 1 Abstracting 2 Chart Deficiency 3 Chart Tracking Locator 4 Clinical Data Repository 5 Clinical Decision Support 6 Enterprise EMR 7 Enterprise Master Patient Index 8 Laboratory Information Systems 9 Pharmacy Management Information Systems 10 Point of Care 11 Radiology Information Systems 12 Surgery Dr Dev Taneja 28
  • 29. Financial Information Systems Comparision - Indian Vs MNC Vendors Financial Information Systems Basic Intermediate Advanced Not Available 1 Accounts Payable 2 Benefit Administration 3 Case Mix Management 4 Cost Accounting 5 Electronic Claims 6 Executive Information Systems 7 General Ledger 8 Materials Management 9 Patient Billing 10 Pay Roll 11 Registration / ADT Dr Dev Taneja 29
  • 30. Indian HIS Vendor - Pain Points  Local HMIS industry capabilities are low on value chain.  No defined clinical protocols in India; Proven products of Clinical Information systems do not exist  Lack of Health IT skills  Hospital leaders have no experience to manage change after implementing major IT systems & hence hesitant to increase IT investments  No defined National Health IT standards  Limited Health - IT Application Consultancy skills Dr Dev Taneja 30
  • 31. Are only Indian HIS Vendors to Blame? Dr Dev Taneja 31
  • 32. Weakness in Indian HIS Market - User Factors  Inadequate fund and irrational investment structures - Hospital IT spend  Inadequate planning and misunderstanding of computerisation  Unclear and changeable requirements  Inferior organisation structure and lack of talent  Lack of reliable methods to evaluate products  Poor execution and lack of experience in project management  Defective tendering procedures - Hardware Vs Application Software evaluation methods Dr Dev Taneja 32
  • 33. Indian Hospital Industry Maturity is beween Level 1 to 2 Comparatively Indian Pharma Industry Maturity is higher 33
  • 34. Implementation Phase Activities Challenges Role of External Consultant HIS • Repetitive transaction based data gets captured at unit / corporate level • Standard / Generic module implementation by vendor with limited customisation • No Process Mapping • Limited Operations Depts’. ownership of implementation • Frequent Change Requests • Sub-optimal customisation • Organisation still works simultaneously with both electronic & manual data • Coordination between operations depts., in-house IT team & Software vendor • Assists in smooth HIS project implementation ERP • Enterprise level Integration of data • Role based static dash boards available • Limited Analytical capability • Limited in-house capabilities of Enterprise level Systems & Process thinking per business needs • It entails BPR & Change Mgt. • Various depts. need hand holding in this phase. • Continues validation and support from Top Mgt. • Coordinates with Top Mgt., IT & ERP Implementation Team and ERP vendor • Assists in BPR / Change Mgt. • Assist in project implementation & timely project closure BI / Health Analytics • Data is converted into meaningful information • Availability of Role based Actionable information at every level • Visualisation and interaction with the dash boards for insights and decision making • +/ - Enterprise Score Card Implementation • Limited in house capability of enterprise level systems, processes and information flows thinking per business requirements • Continuous involvement, validation and support of Top Mgt. • Coordinates with Top Mgt., IT & BI Project Team to map enterprise wide role based information requirements • Assists in drawing metrics / dashboards • Assists in developing Org. Balanced Score Card • Once information framework is ready than coordinate with BI vendor for roll out of BI solutions HIS / ERP / BI Implementation Challenges Dr Dev Taneja 34
  • 35. What is missing in India - 6 • Application of Strategy Performance Management Tool - a semi-standard structured report, supported by design methods and automation e.g.: Balanced Score Card • IT Framework designed for the Implementation of Balanced Score Card in Healthcare Systems Dr Dev Taneja 35
  • 36. Finance Indicator Description Education Indicator Description Customer Indicator Description Balanced Scorecard Strategy Internal Indicator Description
  • 37. Ideally how to Implement HIS? Treat HIS Implementation as a Strategic Tool for Improving Enterprise Performance Dr Dev Taneja 37
  • 38. REPORTS SOP SYSTEM Structure Process Manpower Building Equipments BALANCED GROWTH OF HOSPITAL(S) ERP Tools & Training Dr Dev Taneja’s - ‘SPM Model’ Treat IT Applications Strategically 38
  • 39. Are you leveraging your data to improve outcomes, increase access to care and reduce costs? Strategic Application of IT for “Performance Improvement” “Business Intelligence” Using a proven IT Solution Dr Dev Taneja 39
  • 40. Ideal Road Ahead IT in Health – A Reliable Productivity Tool Move Beyond Transaction Reporting  Strategic Enterprise Resource Planning ø Hardware & Softwares ø Integration Issues ø ERP, BAM & BI for Monitoring & Control Performance Improvement, Clinical Outcomes Informed Decision Making  Administrative IS  Clinical Information Systems  Electronic Networking Systems – RFID, Mobile, Telemedicine, Telemetry, Insurance Dr Dev Taneja 40
  • 41. Healthcare Measures For Optimal Performance Performance Measures • Good business decision allows good outcomes today, tomorrow and in the future. But to make a good business decision require solid performance measures that: • Monitor what has already happened • Help up make the right decisions today • Guide transformation the organization • Healthcare providers measure a wide range of activities and results from various perspectives to monitor, guide or transform • Clinical quality and results • Operational activities, costs and results • Access and outreach efforts and results • Marketing efforts and results • Recruiting, staffing and development efforts and results • Research efforts and results, just to name a few. Dr Dev Taneja 41
  • 42. Source: BI Solutions for Healthcare, Lawson 42
  • 44. Health IT Other Common Applications in Healthcare Dr Dev Taneja 44
  • 46. Direct Impact - Customer  Online Appointments  Reminders & Alerts  Automated Dispensing Machines  Digital Signage’s – Token Display, Patient Education materials  Patient Portals  Wireless Internet Access  Video Calling Devices in ICU  Telemedicine Health Communities  Mobile Health Patient Health Records  Online Payment Gateways  Smart Cards  Patient Entertainment Systems - Movies-on-Demand, Television, Music, Games
  • 47. Indirect Impact - Customer  Electronic Health Record  Clinical Decision Support Interoperability  Wrist bands – Barcode / RFID  Feedback collection  Robotic Devices  Surveillance  Real Time Location Tracking
  • 48. Future Healthcare – Social Media
  • 49. IT Solution + Connectivity Dr Dev Taneja 49
  • 50. Wi-Fi in Healthcare • IP Phones • Laptops / Tablet PC • PDA / IPAD • Computer-on-Wheels (COWS) • Real-Time location services • Wireless Data Transfer – Wristband and pharmaceutical scanners – Wireless glucose meters • Bedside video conferencing – Remote telemedicine • Video surveillance • Medical telemetry/monitoring • Visitor and patient Wi-Fi access Dr Dev Taneja 50
  • 51. Technology Considerations in Healthcare Dr Dev Taneja 51
  • 53. Paperless Hospital - Myth Vs Reality Dr Dev Taneja 53
  • 54. Coordination of Clinical Care Improved Customer Care Cost Containment, Productivity Improvement, Monitoring & Control Technological Advancements Push from Govt. & Payers Profit, Growth & Competitive Advantage Drivers of Paperless Hospital Dr Dev Taneja 54
  • 55. Current Status of Paperless Hospitals There are perhaps few industries that have to gain more from the internet revolution than medicine…..(but doctors and) hospitals are real laggards when it comes to the internet. What e- health has to be used for is to transform the whole process of delivering care. Russell Ricci, M.D, (Steinhauer, 2000) Dr Dev Taneja 55
  • 56. E - Organisation Culture Ø The ultimate barrier and enabler of the digital transformation are not technical - they are cultural. Ø A digital divide still exists between the e-users and e-sceptics and healthcare is traditionally slow to adopt new technology. Dr Dev Taneja 56
  • 59. Healthcare Executives Straddle the “Digital Divide”  The healthcare system of tomorrow may never be ‘paperless’ but progress is being made despite the legendary reluctance of physicians to accept changes in the way they practice medicine.  The transformation process of building electronically integrated systems that manage patients with “seamless” care has already gained traction across the globe. Dr Dev Taneja 59
  • 60. How to Improve Public Health System in India? Implement National Health Information Systems (NHIN) State Health Information Systems (SHIN) Dr Dev Taneja 60
  • 61. Enterprise Hospital Mgt. System • Hospital IS – OPD, IPD, Lab, Radiology, Pharmacy etc. • Purchase & Stores • HR • Asset Mgt. • Finance • District, Taluka, Sub -Taluka, PHC, Sub - PHC Public Health Management • NRHM programs • Disease Surveillance & Control • Preventive Public Health Programs Mgt. • Monitoring Vital PH Statistics • Public Health interventions - Outputs & Outcomes reporting Administrative Authority & Control • Health Ministry • DHS • DDHS • Directors - Health Programs • Civil Surgeon • DHO • MS / MO In-Charge • Administrative Staff • Field Staff – ASHA, MHW, PH programs Staff Objectives of State Health Information Network Dr Dev Taneja 61
  • 62. Enterprise Hospital Management System • Improved Healthcare Delivery • Improved Utilization of resources – capital assets and manpower • Efficiencies of Scale - Purchase items Standardisation, Inventory Control & Mgt, Economy in Group Purchases, Supply Chain Mgt. etc. • Performance Improvements - Clinical, Operational & Financial Public Health Management • Real Time Data • Improved Disease Surveillance • Improved Monitoring of Preventive Public Health interventions e.g. Maternal & Child Health, School Health etc. • Better Mgt. of epidemics & PH emergencies • Improved PH statistics for Research & Planning • Superior PH Outcomes Administrative Authority & Control • IT enabled Performance & Efficiency Improvement • Cost Effective • At every level, Improved Monitoring & Control - Finance, Manpower, Assets & Resources • Real Time MIS at every level • Superior Real Time Data Quality for Planning & Resource Allocations Benefits of State Health Information Network Implementation Dr Dev Taneja 62
  • 63. SHIN Standardisation • Project Scope • Data & Processes • Hardware • Software • Security • Storage • Network Applications Phase 1 • District Hospitals • District Level NRHM, Disease Control &Preventive PH programs • Vital Public Health Statistics • Administrative – District, Division, DHS, Health Ministry • SHIN – District Level Phase 2 • Extend Computerisation to Primary Health Network at PHC & Village levels – Healthcare Delivery, Disease Control & Preventive PH programs • SHIN – Primary Health Institutions Level Start with a District Level Pilot State Health Information Network – Proposed Roll Out Plan Dr Dev Taneja 63
  • 64. Thank You Contact Info: Dr Dev Taneja Director CarePoint Hospital, Plot No 45, Sector 29, Dronagiri Node. Uran Navi Mumbai. India. 400702 Mobile: 09987708685 E-mail: drdevtaneja@gmail.com