This document discusses perspectives on health information systems in Indian hospitals. It begins by outlining why HIS (health information systems) are important for monitoring clinical, operational, and financial performance indicators. It then discusses what is currently missing in Indian HIS including clinical information systems, electronic medical records, chronic disease management systems, good financial modules, ERP systems, and business intelligence/health analytics software. The document compares Indian HIS vendors to international vendors and identifies weaknesses in both Indian HIS vendors and hospital users. It outlines an ideal roadmap for implementing HIS as a strategic tool for improving enterprise performance.
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?
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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
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5. What is Changing in the Indian
Healthcare System ?
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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
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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
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8. What Constitutes Healthcare IT?
Strategic Information Systems
Administrative Information Systems
Clinical Information Systems
Electronic Networking Systems - RFID, Mobile, Telemedicine,
Telemetry, Insurance etc.
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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.
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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
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11. How to Create an Enterprise Level HIS?
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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
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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.
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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
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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
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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
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19. What is missing in India - 3
A Good
IT enabled Chronic Disease Management
System
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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.
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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
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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)
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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
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24. What is missing in India - 5
¤ A good ERP System in Hospitals
¤ Near Total Absence of Strategic Business
Intelligence or Health Analytics Software
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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
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26. Comparison of HIS Vendors in USA & India
Where are we now?
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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.
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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
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
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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
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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)
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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.
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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.
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60. How to Improve Public Health System in India?
Implement
National Health Information Systems (NHIN)
State Health Information Systems (SHIN)
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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
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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
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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