Challenges in integrating IT into the healthcare system in India are many, but they can be addressed through leadership and vision.
In your experience, how has IT helped improve patient care, what are your expectations from it in the coming years?
It was Rudyard Kipling who once remarked “What do they know of England, who only England know”. In the 21st century this aphorism could be replaced thus “What do they know of healthcare who only medicine know”. 21st Century is the age of informatics. Today’s doctor needs to be as well versed in the basics of Information Technology as he/she is in anatomy, physiology and pharmacology No man is an island unto himself. In the 21st century the physician or surgeon is only a member of a multi disciplinary healthcare team which necessarily must include experts from various domains. Information Technology should necessarily be an integral part of any modern healthcare system. Having been trained in the BC era (before Computers and Before Christ are essentially one and the same!!). It has been my good fortune, to have witnessed the growth and development of medical care in the last 35 years in India including the gradually increasing use of HIT. It would be no exaggeration to state that IT has made, is making and will continue to make a significant difference in patient care. Whether it be in the field of diagnosis, investigations, treatment, documentation, retrieval of information, access to state of the art knowledge, medical instrumentation, teaching, research etc IT has made a major difference.
IT in healthcare will level the playing field. It will bridge the gap between the haves and the have nots. In spite of the obvious short term and long term benefits it is a matter of deep concern that the use of IT in the healthcare industry is far less than its use in banking, commerce, travel, automobile or almost any other industry. Less than 2 per cent of gross revenues are set apart for deployment of ICT, compared to 5 to 8 per cent in most other industries. IT improves patient care, by enabling processes and systems to be introduced and repeatedly monitored. Standard operating procedures and audit processes can be introduced in almost every aspect of healthcare.
Viewing healthcare as an industry and attempting to achieve a sigma six though improbable is not impossible. Using ICT should not be viewed as a dehumanising process. IT should be viewed as a tool to achieve an end. Not an end by itself. IT has improved patient care in many, many ways. Providing real time appropriate relevant information to every stakeholder in the healthcare industry makes all the difference. Well informed patients and doctors can make a significant differences in the standard of healthcare. Rapid increase in computing power is accompanied by exponential reduction in costs. Though the healthcare IT market in India has grown 200—300 per cent in the last 10 years, it is accepted that the healthcare sector has to be more IT-oriented. Studies indicate that the use of IT in healthcare has enormous benefits—short term and long term for all stake holders, for e.g. a patient’s hospital stay could be reduced by up to 39 per cent with improved use of IT.
Considering that a majority of Asian countries are still developing, do you think Asia is ready for the rapid technological changes shaping healthcare globally?
A major advantage that developing countries in Asia have, with regards to being ready for the rapid technological changes shaping healthcare globally, is the fact that they have no colonial legacy to ‘disinherit’ in the field of modern healthcare; for example, they do not have to ‘unwire’ to introduce mHealth. One does not have to undo to keep up with technology simply because e-Health is still not a reality. We do not have to follow the advanced countries. We do not have to piggy back. We can leap frog. The apparent lack of progress in the field of healthcare during the last few decades is not a deterrent. It can actually be viewed as an incentive so far as introduction of e-Health is concerned. We may not have achieved ‘health for all by 2000’ but the target e-health for all by 2020 is not impossible. The exponential growth in mobile telephony and in ICT in India clearly shows that we are more than ready to embrace technology. While it is a matter of justifiable pride that e-Governance is slowly being introduced and that mBanking and mCommerce has also commenced it is a matter of deep concern that the use of ICT in the healthcare industry is considerably lagging behind.
What are your comments on the scenario in India?
India is indeed a paradox. While we have world-class hospitals of excellence, these are few and far between. They are like oasis in a desert, confined to the urban elite and the well to do. We are in a position to offer state of the art healthcare, to those who come to us from other countries but are unable to do so for the 700 million Indians living in suburban and rural India. The picture, however, is not totally bleak. It is reassuring to see that the central government and several state governments have accepted Telemedicine as a means to provide healthcare. We are optimistic that the present digital divide in healthcare, existing between the haves and the have nots, will gradually shrink.
The formation of the Telemedicine Society of India, the Medical Informatics Society of India, the publishing of several journals dedicated to e-Health etc. all augur well for the future though we have a long way to go, but then so do scores of other countries. The Government of India has launched the Health Management Information System (HMIS) portal to convert local health data into real time useful information, management indicators and trends which could be displayed graphically in reports.
Real time data provided by web-enabled technologies will strengthen monitoring, enabling policy makers, to make better decisions for public health delivery. Enhancing the information flow at various levels and providing useful and timely inputs for programme development and monitoring. And midcourse interventions in policies would be a direct spin-off. Several multinational companies like GE Healthcare, Intel, Hewlett Packard, Cisco Systems, Qualcomm, Microsoft, Google, IBM, Computer Sciences Corporation (CSC), Perot Systems, TCS, HCL and Satyam, to name a few, have all entered the health space.
These new healthcare models initiated by the IT companies, while delivering quality care will explore the possibility of innovative new technology that are simple to use, cost effective, portable and power independent. Challenges in integrating IT into the healthcare system in India are many. They include lack of Standards, lack of in-house IT expertise, reluctance of medical, nursing and other staff to change, fear of technology failing (paper systems appeared more reliable), poor support from vendors, reluctance of vendor to make changes in software when requested. These can be addressed by leadership and strong message from the top , ownership by the departments and long term vision, Health Administration acting as facilitator and recognising IT as a felt need in health, recognising champions among the health personnel, customising IT solution to needs of the users, confidence building, good co-ordination and communication between vendors and users. Reasons for relative failure in IT implementation initiatives in Indian hospitals are many. They include customisation of software used to computerise manual processes without proper refinement in policies and procedures; lack of proper implementation methodologies (detailed process study and refinement strategy). To make the management aware about time and efforts required for successful computerisation and not using standard inter operable, scalable software.
How do you see the adoption of PHRs and EMRs in Asia? Do you think Asian hospitals are prepared to shift toward the trend?
Universal adoption of Personal Health Records (PHRs) and Electronic Medical Records (EMRs) is a challenging and daunting task even in the most advanced countries. The very fact that we have started talking about it in India is itself a good sign. It was Confucius who once remarked “a journey of a thousand miles begins with the first step”. The concept of Personal Health Records (PHR) continues to gather steam as several healthcare and insurance providers established connectivity with PHR platforms like Google Health and Microsoft HealthVault, which allows their members to access and store personal health information online. Microsoft also continued with its strong strategic alliance plans to promote several of its healthcare offerings. The development of a common strategy and roadmap for e-health standards development, to support interoperability and the adoption of electronic patient records is crucial. One of the barriers in the adoption of international e-health standards in hospitals, is the priority given to internal process functionality. Standardisation of data and processes across hospitals will go a long way in enforcing the use of PHR, EMR etc. A Hospital Information Management System (HIMS) should essentially interconnect all departments of the hospital seamlessly and attempt to minimise operations on paper. No doubt it will take a long, long time before PHRs and EMRs become a reality in India, but it will certainly happen.
What are the areas of Healthcare IT that you think need to be further developed?
With the exponential increase in mobile telephony and the imminent deployment of 3G, it is imperative that broad band wireless technology be exploited and used to develop mHealth. While mBanking, mCommerce, mEntertainment is becoming a reality we need to develop mHealth. Pilot studies carried out by Apollo Telemedicine Networking Foundation in conjunction with Erricson in Tamil Nadu, Bhutan and Bangladesh have shown that mHealth can be a reality in India. The number of ‘Hospital on Wheels’ are very few. This needs to be considerably increased, with facilities for real time two way audio video contact with a tertiary center. Virtual skills laboratories where a large number of medical and surgical procedures are simulated on virtual patients are now a reality in advanced countries. We need to have such learning centres. To achieve all this, IT should be a part of the medical curriculum. Similarly, Applications of IT in Healthcare should be taught to all IT students.
Any other comments?
HIT strategy should be driven broadly by business, clinical and societal requirements. Business needs are around administrative work, financial and procurement. Clinical and social needs are quite specific. For example, patients need to access their health records, get reminders and be advised by doctors even when mobile. Data needs to be captured at source, whether from doctor’s written/spoken word or from equipment or even at patients’ home. On the output end, portable health information should be disseminated to patients’ families and their general physicians.
Many hospitals are committed to the use of innovative technology. Apollo Hospitals is working on a project with Tata Consultancy Services that would give each of its patients a Universal Hospital Identification Number (UHIN), thereby providing access to the entire medical records of the patient. The medical data will be stored for life. Any doctor anywhere in the world will be able to access the patient’s medical history using the number. Apollo has been at the forefront of technology adoption for healthcare in India. The complex issues in healthcare arising due to non-adoption of technology, in managing data, burgeoning manpower cost, quality costs etc. and its impact has been understood. HealthHiway is an Apollo Hospitals and industry initiative to build and provide a comprehensive National Health Data Network ensuring global best practices in healthcare processes and solutions HealthHiway will ensure efficiency in day to day processes in a healthcare system, thereby impacting the key performance indicators—patient services, clinical outcome and financial health of user companies. This will help the companies in creating satisfied patients and create knowledge for the community. Reduced process and process time will deliver enhanced patient care, lowering operational costs. In the long term, HealthHiway will deliver a National Health Data Network which will create an interoperable, standards based healthcare network that will enable the healthcare community to interact and share data in an efficient and secure environment, with the patient in the center of the universe. According to Ashvani who spearheads the HealthHiway initiative, “Easy to deploy, Easy to use and Easy to pay” best describes the project. Revenue Management, Learning Management and CME, Performance Management, including Decision Support and Knowledge Management, and Clinical Information Systems form the core of the system
While several pilot projects and proof of concept validation studies have been carried out, confirming how IT in healthcare can make a significant difference, these need to be scaled up. A solution is not a solution unless it is universally available. The time is now ripe to go all out and make sure that in the next decade India will be in the forefront of e-Health. Improbable? Perhaps. Imposible? No.
Krishnan Ganapathy an eminent Neurosurgeon was formerly Secretary and President of the Neurological Society of India A pioneer in introducing telehealth, Dr. Ganapathy is the President of the Apollo Telemedicine Networking Foundation. He is a co-founder of the Telemedicine Society of India. A member of the National Task Force on Telemedicine, he has a number of presentations and publications (www.kganapathy.com). He was invited by the United Nations Organisation and the Institute of the Future California to deliver key note addresses on mHealth. He is also an adjunct professor at the IIT Madras and Anna University.