Annual special Issue 2008: January 2008 Issue

V O L U M E 3 | ISSUE 1 | JANUARY 2008

A Monthly Magazine on Healthcare ICTs, Technologies & Applications

Enhancing the Usability of EMR through Multimodal Interactions Vijayrajan A, CTO & CIO, Manipal Hospital, Bangalore

PAGE 10

Standardisation in healthcare delivery will be a major help for smooth IT implementation Sandeep Sinha, Industry Manager, Healthcare Practice, Frost & Sullivan

PAGE 18

The Health Hiway - driving information based healthcare Aparajithan Srivathsan, Head - Healthcare Business Solutions, IBM, India

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Appropriate use of technology for t he beneďŹ t of patients is most desirable Dharminder Nagar, MD, Paras Hospital

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IT preparedness speeds up all core process cycle times Dr Lloyd Nazareth, Associate VP - Wockhardt Hospitals

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w w w . e h e a l t h o n l i n e . o r g | volume 3 | issue 1 | January 2008

Enhancing the Usability of EMR through multimodal interactions

The healthcare IT market as compared to 10 years back has grown 200 - 300% Sanjay Jain, Managing Director, Akhil systems Pvt. Ltd.

Vijayrajan A, CTO & CIO, Manipal Hospital, Bangalore

Standardisation in healthcare delivery will be a major help for smooth IT implementation Sandeep Sinha, Industry Manager, Healthcare Practice, Frost & Sullivan

The Health Hiway - driving information based healthcare

Aparajithan Srivathsan, Head - Healthcare Business Solutions, IBM, India

Appropriate use of technology for the benefit of patients is most desirable

Perception about IT in Hospitals has come a long way...

Prakash S Kamat, Managing Director, SoftLink International

Dharminder Nagar, MD, Paras Hospital

IT preparedness speeds up all core process cycle times

Dr Llyod Nazareth, Associate VP, Wockhardt Hospitals

Emerging markets are driving new models of care, which can only be achieved through IT Dr Brian Cohen, Chief Technology Officer, IBA Health

SMB hospitals are more challenging than the larger hospitals Dinesh Samudra, Director & COO, SEED Healthcare Solutions

There is room for niche initiatives like ours

Dr E S Rajendran, MD, New Steth Diagnostic Solutions Pvt. Ltd.\

January 2008

w w w . e h e a l t h o n l i n e . o r g | volume 3 | issue 1 | January 2008

Healthcare segment today is witnessing a move from point solutions to an enterprise-wide solution

Innovative Products in health insurance

Ritesh Kumar, Head Retail, Rural and Reinsurance, ICICI Lombard

Prasenjit Lahiri, Head - Business Operations, Wipro HealthCare IT Ltd.

TrakCare brings you ePR benefits from inception...

Premium products Ivan Chak, Head, Life Profit Centre and Accident & Health Division, Tata AIG

Life Insurance Company Ltd.

Anantharaman Iyer, Regional Director (India), TrakHealth

Challenges for health insurers & TPAs

Alam Singh, Assistant Managing Director, Milliman

Medical value travel - An amalgam for analysis

Dolly Ahuja, eHEALTH

Indian PACS market - Changing dynamics

Anurag Dubey, Industry Analyst, Healthcare Practice, Frost & Sullivan

Customer relationship management - The key differentiator in high-end healthcare

Ruth Connolly, General Manager, Microsoft Dynamics, Asia Pacific

100

Going the Sahara way Madhuruchi Lamba, Head - Sahara Medical

Insurance sector - Riding high on the healthcare boom

Susan Thomas, eHEALTH

Insurance sector to get healthier

News review

india news 42

world news 37 & 60

business news 52

Product profile

â&#x20AC;&#x192; 66

events diary

102

K C Mishra, Director, National Insurance Academy, Pune

}

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Editorial Guidelines eHealth is a print and online publication initiative of Elets Technomedia Pvt. Ltd. an information research and media services organisation based in India, working on a range of international ICT publications, portals, project consultancy and highend event services at national and international levels. eHealth aims to be a rich, relevant and wellresearched information and knowledge resource for healthcare service providers, medical professionals, researchers, policy makers and technology vendors involved in the business of healthcare IT and planning, service delivery, program management and application development. eHealth documents national and international case studies, research outcomes, policy developments, industry trends, expert interviews, news, views and market intelligence on all aspects of IT applications in the healthcare sector.

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CORRIGENDUM: The interview of Manish Gupta, CIO, Fortis Healthcare as published under ‘In Conversation’ section (pg nos. 22-23) of December 2007 issue, carried some undue errors in terms of technical details of the type of IT systems used in Fortis Hospitals. Mention of ‘VistA’, mistakenly explained as - ‘Veterans Health Information Systems and Technology Architecture’ is not part of the Fortis IT architecture and should be considered in context of ‘Microsoft Vista’ operating system’. The mistake was unintentional and any loss/damage caused due to this is sincerely regretted. Please read the revised version of the interview at www.ehealthonline.org/interview ................................................................................................................................................................................................ The article titled ‘Innovation in ICT Adoption for Health System - minimising risk and investment’ under ‘Expert Corner’ section (pg nos. 16-17) of December 2007 issue wrongly carried the logo of the Sobha Renaissance IT Pvt. Ltd. The same should be attributed to Digital Integrated Health Exchange (DIHE) - a strategic business unit within SRIT. Please find the revised version of the article at www.ehealthonline.org/articles/article-details.asp?articleid=1575&typ=EXPERT%20CORNER

Log on to www.ehealthonline.org for latest in healthcare ICTs, technologies, applications

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Volume 3 | Issue 1 | January 2008

president

EDITORIAL

Dr. M P Narayanan editor-in-chief

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It’s yet another new year ...and a new beginning indeed ! For certain, it is much more than getting used to the number – 2008. For all of us at eHEALTH there is one more reason to celebrate as we complete one year, while at the same time entering third year of our publication (starting with our first issue in November 2006 !). To mark this occasion, we present you a fresh look edition in this new year month - the ‘Annual Special Issue’. To make this issue a truly collector’s edition, we brought together some senior professionals, entrepreneurs, industry analysts and technology innovators across healthcare and IT industry. An array of expert articles and insight interviews covered in this issue, brings out some of the industry best practices, business challenges and innovative solutions that are set to transform this industry forever. Dig into the pages to know what’s in store for you... The year gone past had surely been quite eventful and exciting for the healthcare industry. With a plethora of state-art-of-art hospitals being launched all over the country; handful of mergers and acquisitions that happened all around and a free-flow of investments pouring into the sector – healthcare is surely on a high. However, the most promising segment for this year seems to be - ‘medical technology’. Leveraging on a few strategic (although long awaited) policy decisions from the government and bearing the fruits of a long-drawn persistent effort by a few good domestic and multinational enterprises, India is surely to emerge as a hub of medical equipment manufacturing. While companies like Trivitron is starting up with its own medical technology park near Chennai (with a 1000 crore turnover target in 3 years), the Central Government on the other hand has announced SEZ-style manufacturing hub for corporates looking to start up production in the country. Of late, there have been some exciting news of collaboration between healthcare, IT and medical technology companies, both in private and public domain. GE Healthcare’s recent partnership with Government of Madhya Pradesh for providing low-cost, high-quality diagnostic services is a landmark move by the multinational giant in bringing benefits to the masses. On similar lines, Intel and World Ahead Program Alliance Members recently launched a telehealth project in the old city of Chandni Chowk in Delhi – third of its kind after the successful pilots in Baramati (Maharashtra) and Tindivanam (Tamilnadu). Among B2B collaborations, some of the most noteworthy have been Apollo Hospitals-IBM NHDN initiative, the Fortis-Microsoft technology partnership, Philips-Artemis diagnostic device research initiative, and a host of similar such ventures. Wishing all of you a very Happy and Prosperous Year 2008 !

is published by Centre for Science, Development and Media Studies (CSDMS) is published & marketed in collaboration with Elets Technomedia Pvt. Ltd. (www.elets.in) © Centre for Science, Development and Media Studies www.csdms.in

January 2008

Ravi Gupta Ravi.Gupta@ehealthonline.org

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Enhancing the Usability of

EMR through

Multimodal Interactions

â&#x20AC;&#x153;EMR applications and implementations need to meet the tough demands of care delivery process and environmentâ&#x20AC;? - Vijayrajan A, CTO & CIO, Manipal Hospital, Bangalore shares his thoughts on this critical issue that often becomes a determinant between success or failure of IT implementation in hospitals

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Vijayrajan A, CTO & CIO, Manipal Hospital, Bangalore January 2008

ignificant changes in Information Technology (IT) have occurred over the past two decades. This, with the availability of high performance hardware at lower costs, is having a profound impact on the ways we conduct our business and live our lives. Businesses that could overcome the difficulties associated with technology adoption have seen improvements in profit, through productivity gains and lower cost of operations relative to their peers, and increased market share. By some estimates, more than 75 percent of the world’s population now lives within range of a mobile network. Technology advancements like these have created knowledge societies where knowledge forms a major component of any human activity. Social, cultural, economic and all other human activities become dependent on a large volume of knowledge and information. This also created a new class of workforce called Knowledge Workers. Though healthcare quickly embraces new technology related to diagnosis and treatment, it has been very slow to adopt IT advancements in the care delivery process. In fact the Medical / Clinical Science involved in diagnostic devices and drug discovery have advanced more rapidly than the ability to deliver them effectively and efficiently. One of the key challenges, as always mentioned, is the ability of the care providers’ acceptance and adoption. Care Providers, who are also part of the knowledge society, in turn cite difficulties in usability as the main concern; they feel it reduces their productivity.

“Studies show that hospitals spend only 3 percent of their revenue on IT compared to other information intensive industries where IT spending is many times higher” Electronic Medical Record (EMR) – Definition Conventional enterprise automation – Human Resources, Finance, Procurement, Manufacturing, Customer Relationship Management etc. – is handled by ERP application suites. On similar lines, the care delivery process automation including clinical data management can be realized by EMR solutions. EMR is more than Electronic

patient record. It is a Healthcare IT system. The EMR system provides support for all of the activities and processes involved in the delivery of care. It focuses on tasks and events directly related to care and it is optimized for use by clinicians. • Care Provider’s view of patient’s health history • Accessible anywhere anytime • Sharable among care providers • Document of services – used for billing purposes • Legal document for the services rendered • Source for clinical Audit • Source for clinical research • As per the Gartner Research the core capabilities of EMR include: • A clinical data repository – a permanent data store for the clinical information • Interoperability – has the capability to interface with other systems • Support for privacy – guarantees security while providing legitimate access • A controlled medical vocabulary – to support exchange of information • Clinical workflow – ability to automate the processes • Clinical decision support – supports configuration of rules and alerts • Clinical documentation and data capture – provides the ability to capture the information • Clinical display (plus dash board) – presents data to enable effective usage • Order management - physician order entry, track status and view the results Benefits of EMR Medical Records Institute’s Survey of Electronic Medical Records Trends and Usage summarizes the benefits of EMR as: Over and above facilitating care delivery process, EMR also enables clinical research. For example, post EMR implementation, Mayo Clinic has created a database of more than 4.3 million patient records. Physicians and Scientists can access this information through infinite number of unique queries across, 28 demographic elements, 523 DRG codes, 10,455 ICD-9 codes, 4900 laboratory test conditions. This is a valuable asset for research.

Benefits Seen by Clinical Team

Benefits Seen by Admin Team

Share patient record among care providers Improve quality of care Improve clinical processes and workflow efficiency Reduce medical errors & improve patient safety Remote access to patient records Facilitate clinical decision support Improve clinical data capture

Workflow improvement Improve clinical documentation to facilitate billing Improve patient safety Share data among different sites Meet legal, regulatory and accreditation standards Reduce healthcare delivery costs Efficient information infrastructure as a competitive advantage

Improve employee/clinician satisfaction

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Adoption of EMR Having an EMR is seen as essential as an ATM is for a Bank. Patients will demand it. In spite of the benefits and demand from Patients, EMR adoption is yet to be taken up in many healthcare organizations. Many studies show that hospitals spend only 3 percent of their revenue on IT compared to other information intensive industries where IT spending is many times higher.

There are couple of reasons for it. First, the apprehension from the management: “does it benefit the investor of technology?” They perceive that new technology costs are shouldered by hospitals while the benefits – both financial and non-financial – primarily go to payers and patients. In other industries the technology directly improves profitability of the entity that invests in the new technology. Secondly, for those who have invested, it continues to be a challenge to make the clinician to use the systems. The adoption of IT by clinicians is the key for success. The clinicians are reluctant because of usability issues. Usability – Defined Following five parameters define the usability: • • • • •

Utility - can be used to complete the desired task. Goal / Task support - designed to complete task. Accommodation – designed to accommodate different user populations Adoption – better than its competitor designs, therefore will be adopted by more users Extensibility/ Adaptability – has features that allow it to be adapted or extended to suit a new (unpredicted) task.

Usability in an application is incorporated through user-centered design methods but measured through the interaction of four components: Users, Applications, Requirements and Environment. Many IT enabled healthcare applications have failed in usability because of the lack of understanding of complexity in the environment.

‘Though healthcare quickly embraces new technology related to diagnosis and treatment, it has been very slow to adopt IT advancements in the care delivery process’

Care Delivery Environment and the Delivery Process Applications designed for conventional office like environment without taking into account some of the unique challenges of hospital work will not be successful. What makes a medical work fundamentally different from typical office work? Let us look at the Steps in Care Delivery Process: • • • • • •

January 2008

Obtaining patient history Performing a physical examination Ordering tests and evaluating their results Establishing diagnoses Prescribing therapies and monitoring the course of treatment. Each step must be accurately documented

Clinical environment that influences the System Design:

Inherently Collaborative: Care delivery involves many specialists within the healthcare industry – physicians, nurses, radiologists, pathologists etc. Distributed: These specialists are at different locations and departments within the hospital, or outside, in different organizations Interrupted: Clinicians are more frequently interrupted – by colleagues for adhoc co-operation, by patients needing immediate attention etc. This leads to clinicians more often suspending and later resuming their activities. More often they keep switching contexts. Uncertainty and Dynamic Change: The patients’ response to treatment is fuzzy and can vary widely. This dictates a need for a relatively flexible process of patient management, where decisions are tentative and evolving based on reinterpretation of previous data in the light of new information. Information Intensive: Physicians meet patients in their office, attend patients at bed-side and respond to call-in patients. Each requires different ways of accessing information. Multiple Care Settings: It is common for clinicians to work in multiple hospitals. They have to learn multiple applications to effectively function at different places. Documentation Intensive: Near real-time documentation is the essential building block of healthcare processes. For a successful adoption, EMR should be designed not solely by technology considerations, but should also take into account the above environment. In this article, we intend to focus only on the UI and data entry aspects. Structured vs. Unstructured Data In a typical hospital setting, physicians usually spend half their time on activities related to patient interviews, examinations and procedures, and the other half on reviewing and documenting records. Data entry to create all those documentations has always been a major obstacle to clinicians’ acceptance of EMR. To simplify this data entry process, most applications provide Structured Data Entry (SDE), where the user has to select relevant clinical terms from a predefined list. In this paradigm, most of the functions required by the clinicians are

just few clicks away. Though it sounds easier to do data entry through a few mouse clicks, it is not a most preferred method by Clinicians. To appreciate their perspective, we need to understand the clinical decision process. Most medical interaction is driven by a conversational paradigm. Physicians listen to the patients, interview, instruct, counsel them etc. Narratives by the patients are at the heart of clinical decision making and this concept is referred as “narrative reasoning.” Conversion of the narratives into a structure is a major challenge for clinicians. Extracting information from a narrative requires lots of work from clinicians. Medical narrative data are very diverse, and vary by discipline, patient, and over time and coding them to the “select” terminologies of the SDE paradigm is very restrictive. Also, structured data can subtly change the meaning of the original item coded. Narrations could become a set of codes with weakly connected phrases without the semantic richness of the original content. Patients’ clinical records should promote seamless transfer of care from one clinical team to another. This is best accomplished by sharing a narrative data and not just by structured data built using limited vocabulary of the application that too scattered around different screen pages. Though structured data entry is essential for the uniform representation of data, easier reporting, decision support, quality assessment, and clinical research etc., if we want clinicians to embrace the Electronic Medical Record, we must also make the unstructured narrative data entry as easy as possible. Multimodal Interaction W3C’s (World Wide Web Consortium) Multimodal Interaction Activity is developing specifications for extending the Web to support multiple modes of interactions. They are relevant in addressing the usability challenges in clinical applications. Multimodal Interactions extend the user interface by offering users the choice of voice, keyboard, mouse, stylus or digital pen. For output, users will be able to read text, listen to spoken audio, and to view information on graphical displays. Multimodal Systems are the systems that incorporate multimodal interaction through voice, handwriting, typing, etc. To address the usability issues, EMR should be a multimodal system. Data entry through speech: Speech is natural and is also efficient—most people can speak about five times faster than they type and probably ten times faster than they can write. In US, clinicians dictate their notes and get them transcribed

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â&#x20AC;&#x153;For a successful

adoption, EMR should be designed not solely by technology considerations, but also take into account the clinical environment â&#x20AC;?

January 2008

by third parties. According to the American Medical Transcription Association, about $ 12 billion is spent each year to transcribe medical dictation into medical text. EMR applications should enhance the UI with speech engine that seamlessly integrate digital dictation and speech recognition capabilities to simplify the data entry of narrative text. The converted text could be corrected through “selfedit” or “assisted -edit” mode. Data Entry through Handwriting: In India, clinicians use handwritten records to document clinical notes. Digital penpaper systems offer a convenient way of adapting that familiar handwriting mechanism into the EMR. It is a relatively costeffective way for traditional paper processes to enter the digital world. The digital pen-paper captures the handwriting into an image and either it can be stored as an image in the EMR, without the benefits of search, analysis etc. or can be integrated with handwriting recognition engines to convert the handwritten notes into typewritten text. It also creates the conventional paper record either to share with patients or if required to have a paper trace. Digital pen-paper is less physically intrusive than data entry through keyboard. Multimodal EMR should allow the users to input data with one or more modalities either in the sequential mode or composite mode. In the sequential mode, the user selects the modality and uses it to complete the transaction. In composite mode, even within a single transaction, the user can switch the modalities depending on the convenience and the need. For example, the user can start entering the text using key board, switch to digital pen-paper, switch to voice inputs and back to key board. A multimodal EMR system will address all the concerns of clinicians from the data entry perspective. Usability Evaluation Usability is now becoming an important software “quality” attribute. But can we measure usability? Are there metrics or checklists that can be used to evaluate the usability of a product / application? Fortunately Yes. For Internet sites, it is a business imperative that the users can find the information they want quickly and efficiently. This is a challenging proposition since the users come from varied backgrounds and at varied levels of IT skills. The scientific structuring of the content and intuitive navigation for end user makes for a better user experience resulting in buying (revenue) and repeat visits (loyalty). The Usability Heuristics design rules of thumb, rooted in psychology, are used to develop and audit the Internet applications (see box). The EMR solutions trend being towards web applications, the same Usability Heuristics can be applied to EMR applications design. In the Healthcare domain, the users (clinicians) come from a more common social, economic and education background, but with varied level of IT skills.

‘EMR applications and implementations need to meet the tough demands of care delivery process and environment’

Conclusion The healthcare organisations are not enjoying the potential benefits of Electronic Medical Records (EMR) solutions. This is primarily due to adaptation issues of Clinicians. EMR applications and implementations need to meet the tough demands of care delivery process and environment. An EMR system that supports both structured and unstructured data capture with multimodal interactions and designed with usability heuristics should address the needs of clinicians and accelerate the deployment of EMR.

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Manipal Hospital, Bangalore CHECK-LIST FOR USER INTERFACE (UI) DESIGN A heuristic evaluation is a usability evaluation method for application that helps to identify usability problems in the user interface (UI) design. The following check-list can be used both by the application developers and by evaluators: • Consistency and standards: Users should not have to wonder whether different words, situations, or actions mean the same thing. Standards and conventions in product design should be followed. • Visibility of system state: Users should always be informed of what is going on with the system through appropriate feedback and display of information. • Match between system and world: The image of the system perceived by users should match the model the users have. • Minimalist: Any extraneous information is a distraction and a slowdown. • Minimize memory load: Users should not be required to memorize a lot of information to carry out tasks. Memory load reduces users’ capacity to carry out the main tasks. • Informative feedback: Users should be given prompt and informative feedback about their actions. • Flexibility and efficiency: Users always learn and users are always different. Give users the flexibility of creating customization and shortcuts to accelerate their performance. • Good error messages: The messages should be informative enough such that users can understand the nature of errors, learn from errors, and recover from errors. • Prevent errors: It is always better to design interfaces that prevent errors from happening in the first place. • Clear closure: Every task has a beginning and an end. Users should be clearly notified about the completion of a task. • Reversible actions: Users should be allowed to recover from errors. Reversible actions also encourage exploratory learning. • Use users’ language: The language should be always presented in a form understandable by the intended users. • Users in control: Don’t give users the impression that they are controlled by the systems. • Help and documentation: Always provide help when needed. • Common user interface: Adapt standards wherever available. Reduces training while using multiple applications

January 2008

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Standardisation

in healthcare delivery will be a major help for smooth

implementation What is the current estimate of overall healthcare service market in India and how do you foresee the growth trend over next 3-5 years?

Sandeep Sinha Industry Manager Healthcare Practice, Frost & Sullivan

Currently, the healthcare service market in India is estimated at approximately US$ 23 billion, and growing at nearly 21%. The market forecast for next 3 to 5 years seem to be very exciting and we are expecting this trend to continue for sometime. Apart from the low dollar-to-rupee ratio, what are the key drivers behind the phenomenal growth of Indian healthcare industry? Key growth drivers for the Indian healthcare industry may be identified as â&#x20AC;˘

Increasing corporatisation of the delivery sector (Hospitals, Diagnostics and Retail)

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• • • • •

Medical tourism (primarily cardiology, orthopedics and dental treatment; projected to bring in US$ 2bn into the kitty by 2010) Growing role of health insurance efforts by private players (insurance premium potential of US$ 1bn; disease specific programs) Health awareness in urban areas and increase in lifestyle related diseases Allocation of large funds by Government (to the tune of Rs 15,291 crore) and national programs like NRHM (having an additional outlay of Rs 8,207 crores) Overall growth in Indian economy (8% annually)

implementation in hospitals is sighted as the biggest deterrent for proliferation of health IT market. Why do you think service providers have such a long learning curve to guage the benefits of IT investments? Traditionally, most of the hospitals are not used to having a planned IT budget, but now they have started allocating a certain percentage of their revenue towards IT. As regards investment, they see a clear ROI in medical devices but not that much in IT. However, it is encouraging to note that they have started appreciating the benefits of IT. IT is anyway playing a critical role in healthcare delivery segment. It is

“Most of the corporate hospitals are investing in new IT applications and they will continue to invest, as they have a clear road-map for Health IT”

What is your perception about the current maturity level of Indian healthcare industry in terms of IT adoption and capacity for technology uptake? The maturity level of healthcare industry in terms of IT adoption and capacity can be well understood by looking at the trend in their IT investment. A mid-size hospital in India spends less than 1.5% of turnover on IT, while a large hospital spends nearly 2% (new investments plus the annual maintenance). In green-field projects, the average IT spend is 3-4% of total project cost for tier I hospitals. Considering expansion plans of existing hospitals, the average IT spend would be between 1.5%-2.5% of annual budget. Although market projections for healthcare IT seem to be very promising, most solution providers bear apprehension as to how much of it will convert into actual investments. What is your observation in this regard? Most of the corporate hospitals are investing in new IT applications and they will continue to invest as they have a clear road-map for Health IT. However, in case of large stand alone hospitals not many of them are adopting latest IT applications - except few progressive hospitals. Mid-size hospitals are still looking for stabilizing their back-end work. Overall, the trend signifies that most corporate hospitals and few large public hospitals are looking for clinical applications, ERP, EMR, PACS, CRM etc., but rest of them (small to midsize) are looking at putting their back-end operations in order by using various low-end IT applications. But in last 2-3 years the IT adoption has gone high in every segment of hospitals. Hospitals have also started hiring professionals to manage their IT infrastructure. Lack of proper understanding of process-related improvements and long-term business benefits of IT

January 2008

just a matter of time when patients, insurance companies, TPAs and government agencies start demanding the hospitals for various information/data, which can be made available only through good IT infrastructure and applications. Standardisation (in processes, care delivery, protocol etc) in healthcare delivery will be a major help for smooth IT implementation in healthcare facilities. Standardisation of service delivery, clinical procedures, information management and pricing are cornerstones for bringing out uniformity across the industry and delivering high value for patients. What possible strategies can government and industry adopt, considering the present fragmentation existing in the industry? To begin with, government should start unique identification number for every citizen as we have for Income Tax Payers. Some of the other means can be accreditation of healthcare facilities, pricing policies for hospitals, health information exchange across healthcare facilities and introduction of an Act similar to HIPAA in US. How important is the need for a National Health Information Exchange in India - something insurers have started demanding in order to regulate the service provider segment? I think it is very critical to have a National Health Information Exchange for India. We should learn from other developed nations where they have implemented such kind of exchanges and implement customized version of the same that will work for us. In addition, the Indian healthcare system should have public private partnership for policy framework and implementation. Hospitals, Government agencies and IT companies should work towards it as part of their corporate social responsibility.

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The Health Hiway - driving information based healthcare 20

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Rapid growth in healthcare services Market for healthcare services in India is growing at a rapid pace, and a large number of healthcare entrepreneurs are setting up different types of healthcare facilities, right from super specialty hospitals to primary care clinics, and alternate therapy units to specialized centers for wellness management - in the process, investing more than US$ 2 billion every year on infrastructure alone !!

and hospitalization often results in financial catastrophe for poor patients, many of who end up borrowing money or selling assets to pay for health services.

While the number of persons with private health insurance is small (around 22 million), this is growing at around 35-40 % per annum, and expected to cross 100 million in the next 8-10 years. This is likely to push the total number of persons covered under some form of third party payments to well over 200 million! At around 20% of the total population, this is significantly lower than in the developed economies, (where 70-80 % of the population is covered by some kind of third party payments), but in terms of absolute number of persons covered it will compare well with the largest third party payment driven market, which is the US, where close to 250 Million People are covered under health insurance programs. This will further fuel the growth in healthcare facilities. Despite such explosive growth on both sides (healthcare services, as well as third party payments), a large percentage of the population will still have problems accessing even basic healthcare, there will be wide variations in the quality of healthcare services, and healthcare costs could go up significantly. Addressing problems relating to access, quality and cost requires data, and data is best collected, stored, shared and analyzed using information technology, which will help to reduce costs, improve quality and increase coverage. The current landscape provides us pointers to the effective use of IT.

“Addressing problems relating to access, quality and cost requires data, and data is best collected, stored, shared and analyzed using information technology” Aparajithan Srivathsan Head - Healthcare Business Solutions IBM India

Current landscape poses several challenges Since independence, India has done well in areas like improving the general health status, developing high-end hospital services as well as a world class pharmaceutical industry. But there are still areas of concern: Public spending on healthcare is stagnant and most of this is by the states. There is an enormous variance across states, and the overall result is that healthcare infrastructure, utilization, and disease burden compare unfavorably with the average of even low income countries. Availability of physicians and hospital beds are low, despite the fact that India accounts for 20 % of the global disease burden. The poor still depend on the public health system for major health services. Non-existent, poor, or underutilized medical facilities and a shortage of medical staff often force patients to travel large distances to get specialist care. Almost 80 % of spending on healthcare is out of pocket,

January 2008

Information based healthcare systems will result in better quality Examples of responses to current challenges could be grouped as follows: Operational efficiency • • •

Improving the efficiency of third party payers by using electronic records Improving efficiency in the procurement and distribution of materials and drugs Using hospital management systems

Health management and planning • •

Monitoring for identifying epidemics at an early stage Planning using health facility maps

What was the inspiration and business case behind conceptualising the Health Hiway initiative? Health industry is knowledge based, and produces tons of data in every patient interaction. Despite being data rich, this industry is information poor. If this information can be harnessed effectively, it will have direct impact on cost of treatment, quality of care, reach of care delivery in vast Indian landscape, and finally result in significant operational efficiency. If IT is deployed effectively at the foundation stage, it can make a huge difference. To lay the foundation of information based healthcare system, a National Health Data Network (NHDN) is created, which is named as Health Hiway initiative.

Mohammed Hussain Naseem Vice President - Healthcare IBM India

Kindly provide a brief snapshot of the technological background and architectural overview of Health Hiway. NHDN or Health Hiway, as it is popularly known is in software jargon a transaction engine. A secure, scalable, open, standard based platform, which has infrastructure layer at the bottom, an intra-operable, SOAbased middleware to exchange/share information seamlessly, and application layer at the top, which has a basket of offerings in healthcareIT space like - Claims, ERP, Business Intelligence, CRM, Portal, Clinical Systems, Disease management, Dashboards, Content Management, EMR etc. It defines and support necessary standards, policies, network services, regulations & business rules.

What were the major challenges while designing and developing the technical framework? IBM Research Lab has done similar work in other developed geographies, and in other industry verticals. Challenge was to make it work in Indian environment. Hence, last two years were spent in making sure it has nuances which suits the Indian healthcare industry. What is the target user group of Health Hiway, and how is it designed to deliver low-cost, IT capabilities for the users? Target group at this stage is Mid-Size hospitals (50-200 bed category). The objective is to provide world class health IT applications, which are easy to deploy & use, priced right, and adhere to the best clinical & business practices. Applications are carefully chosen so they adhere to above guidelines, pre-configured to suit the need of mid-size hospitals, and delivered on utility model. What are the basic IT infrastructural requirements and capabilities for a potential user of the Hiway? Starting from registering as a member, what is the average turn-around time for any mid-segment hospital to fully automate its operations using the Hiway advantage? As many of Health Hiway applications are delivered on SaaS (Software as a Service) model, basic IT infrastructural requirements can be minimum. After registration as a member, a hospital has to be prepared for Hiway readiness training. The duration of this can vary from few days to few weeks, depending on how many applications are engaged for service. Typical time for a hospital with 2-3 applications can vary between 6-8 weeks.

Health delivery • •

Linking up primary, secondary, and tertiary referrals using electronic health records Improve access using mobile health teams and telemedicine

Health research and education • • •

Continuing education of doctors and professionals Spread of health awareness Enabling the design of new drugs

There is no doubt that IT can provide foundations for informed decisions to tackle these, and individual IT-based solutions do exist for all the examples listed. However, rather than pursuing piecemeal solutions, India should set its sights on developing an information based healthcare system within which transparent, cost effective and high quality solutions for specific problems can be developed for specific problems, and significantly assist in improving the state of healthcare in the country. Of course there will be barriers to the adoption or increased use of IT in healthcare, which include infrastructural ones like

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HealthHiway is an Apollo Hospitals and industry initiative to build and provide a comprehensive set of offerings for the healthcare community and lay the foundation for a National Health Data Network (NHDN). This initiative will offer the healthcare industry global best practices in healthcare processes and solutions. What were the key drivers behind HealthHiway initiative? Apollo Hospitals has been at the forefront of technology adoption for healthcare in India. Over years, we have understood the complex issues in healthcare arising due to non-adoption of technology in managing data, burgeoning manpower cost, quality costs etc. and the effect that it has on efficiency in the system. We are aiming at creating an information Hiway for healthcare industry in India. The plan is to bring together various entities in the healthcare environment, use collective industry knowledge and build a network using world-class technology. The majority of healthcare environment in India is Ashvani Srivastava occupied by small and mid sized players who act as a first point of care and subsequent referrals President – Strategic Initiatives for the large tertiary care hospitals. Then there is the public health infrastructure managed by the Apollo Hospitals Group government, catering to healthcare needs of the masses. Payers are increasingly becoming important as we move towards a more evolved market in healthcare insurance. The HealthHiway initiative is our effort to offer the industry global best practices in healthcare IT. Standard based, interoperable solutions will bring cost containment, yet more importantly help use this data for patient care and subsequently for research and analytics. This will benefit the providers, payers and most importantly the patients. What had been your experience in bringing together multidisciplinary expertise across Apollo Hospitals while developing the conceptual framework of the Health Hiway? It has been a challenging and insightful learning while studying administrative, clinical and operational processes and the impact of effective usage of data across the healthcare system. Though operational challenges for a smaller operation are different than those in large enterprise provider environments, the knowledge and learning that we have acquired over the last 25 years has been a great enabler in designing the solutions and services on the HealthHiway. Apollo’s learning from putting together the standards framework through the ITIH study and analysis from an in-depth research conducted in multiple cities, across the target audience had been some of the key starting steps towards designing the HealthHiway model that will offer easy to use, scalable solutions for the healthcare players. What will be the expected long-term and short-term gains for users of the Hiway with regard to their operational efficiency and financial performance? HealthHiway is all about bringing 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. In the short term, it will bring in immediate operational efficiency that will lower the cost of operation through reduced process and process time, and delivering enhanced patient care. In the long term, HealthHiway will deliver a National Health Data Network which will create 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 as their center of universe. What is the revenue model and business sustainability strategy of Health Hiway? Though HealthHiway will offer solutions and services for everyone across the healthcare sector, the biggest beneficiary will be the small and mid-size players. We will offer a suite of hosted applications that will be available as pay per use. The philosophy behind HealthHiway solutions and services is simple - Easy to deploy, Easy to use and Easy to pay. What are your future plans for the next level of service enhancement and usability value-addition of the HealthHiway? We plan to introduce applications and services across Revenue Management, Learning Management and CME, Performance Management, including Decision Support and Knowledge Management. We are also going to deploy clinical information systems in a way that is probably first of its kind in India.

power supply, telecommunications and connectivity issues, as well as poor IT awareness. But an information based approach will form the cornerstone for a modern healthcare system that will be more efficient and transparent and in the long term will result in better quality and coverage. A national health data network, electronic records, and standards will form the foundations of an information based healthcare system. The

January 2008

Health Hiway is a National Health Data Network. Building the Health Hiway The Health Hiway is a reliable, secure, national health data network that will form the backbone of a national health information infrastructure. The Hiway is -A “Network of

Networks”, built on the Internet, that makes patient health information available online to healthcare providers, when and where they need it • •

A “System of Systems”, that includes Payer Related administrative information exchange, as well as clinical health information exchange Includes infrastructure to define and support all necessary standards, policies, network services, and regulations and business rules

the participation of public sector organizations and private enterprise. These standards will cover areas like electronic health records, drug databases and interactions, laboratory formats and technical specifications. The Hiway will eventually help create electronic health records for all Indians, that will provide every patient, provider, and payer with the information necessary for optimal care, while reducing errors, lowering costs, and administrative overheads.

It will allow sharing of health information amongst consumers, providers, payers, regulatory bodies and health professionals. The Hiway will include mechanisms for dealing with multiple data formats, languages, input devices, and IT-readiness. It will impact on healthcare by -

The primary mission of the Health Hiway is to:

•

- Increase speed and accuracy of treatment

• •

Providing a uniform architecture for health care information that can follow consumers throughout their lives. Bringing together technology developers with doctors and hospitals to create innovative state-of-the-art ideas for how health information can be securely shared Implementing data and communications standards for the secure exchange of health care information

Standards will enable the use of IT to share medico-legal records, follow up referrals, ensure an efficient supply chain of drugs, keep nationwide inventories, exchange information seamlessly between hospitals and diagnostic laboratories and so on. Standards will specify what data are stored, how they are stored, and the mechanisms for sharing them. Development and maintenance of these standards will require

- Improve the quality and safety of care - Reduce errors

- Improve efficiency - Reduce healthcare costs - Go beyond day-to-day healthcare delivery - Rapid translation of scientific knowledge into daily practice - Ability to help patients manage chronic disease - Public health surveillance and reporting - Promotion of clinical research and scientific study

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The Health Hiway seeks to improve patient safety and quality of care The Health Hiway opens for claims submission traffic Developed countries have discovered that sharing patient health information has huge advantages, and can bring down costs, administrative and otherwise, associated with third party payment systems. For instance, in the US, for an insured population of 280 million, more than a billion claims are raised every year and administrative costs incurred by private health insurance companies is close to US$ 80 billion !! In India, the 22 million people with private health insurance result in around 1 million claims. But the claims volumes are expected to grow exponentially due to the following reasons: • • • • • •

Overall increase in the number of persons covered under third party payment Persons with health Insurance more likely to use hospital/ physician services, even if not entirely required Hospitals prescribing unnecessary or inappropriate procedures for financial gain Frequent utilization of physician services will result in large number of smaller value claims Physicians resorting to defensive medicine to safeguard themselves in the event of a malpractice suit, thereby causing an increase in number of procedures carried out Opportunities to benefit from fraudulent claims

Health Insurance companies are already grappling with loss or claims ratios in excess of 100%, and will attempt to reduce these ratios to ensure profitability. Faced with increased claims volumes, they might • • •

Reject claims, or require multiple resubmission of claims Delay payments Insist on eligibility verification ahead of treatment, so that patient’s insurance eligibility is validated

•

Create increased administrative workload and costs for the hospital/physician practice

•Telephone calls for eligibility verification/follow-up on payments •Claims preparation (in formats specified by Payer) •Claims submission (courier/fax charges) •Accounting (to keep track of payments received) •Collections (from patients - difference between bill and amount approved by payer) Health insurance companies have already realized that electronic transactions will help them manage large volume of claims while keeping the costs down. What is less known is the impact that electronic transactions can have on provider organizations. A hospital that currently relies on paper, fax and telephone calls for insurance administration may not only be able to save money, but improve customer service by implementing electronic transactions for operations like preauthorization requests, and claims submissions. Electronic transactions can create tremendous value for hospitals •

•

• •

Electronic claims submission reduces rejections and the need to resubmit claims multiple times improves cash flow and reduces accounts receivable days because claims are paid more quickly Electronic eligibility verification allows hospitals/ physicians to easily validate patient’s insurance eligibility on every visit, reducing the collection and billing costs for patients without coverage, and reducing bad debt Electronic transactions reduce administrative staff telephone time Electronic payment posting significantly reduces accounts receivable errors and improves customer satisfaction Aparajithan Srivathsan Head - Healthcare Business Solutions IBM India

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January 2008

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Dharminder Nagar Managing Director, Paras Hospital

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Appropriate use of technology for the benefit of patients is most desirable Dharminder Nagar, MD, Paras Hospital shares with eHEALTH views and experiences on healthcare IT and technology applications used in his hospital.

What was the guiding force behind your venture in building the ultra-modern and highly sophisticated Paras hospital?

a document that reflected what we needed and how we saw the path of technology and IT in our hospital over the next few years.

The guiding force for this venture has been my father Sh. Vedram Nagar who instilled in us beliefs and values which are reflected in the hospital. He saw social responsibility as a part of good business practice rather than something separate from it. Healthcare is one area where you can have the perfect blend of business and social responsibility, when the same is carried out honestly.

What is the current level of automation in your hospital in terms of IT implementation in patient servicing, administrative and clinical operations?

To begin with, what was your strategy in terms of investing in technology and IT in your hospital? Evolving a successful IT strategy for healthcare is one of the biggest challenges for any new or even existing healthcare providers today. The challenge is enormous when you are looking for the best IT and technology solution for your needs; as the solutions and platforms that are available today are simply mind boggling, ranging from homegrown solution providers to the worlds leading IT and technology providers. Instead of going through the maze of what providers were offering, we started out with our Chief Technology Officer, Mr. Prashant Singh to pen our needs. To begin with, we identified the stakeholders in this process - from doctors, nurses and technicians in clinical departments, to people working in administration and finance. We looked at the patient flow and our process flow for determining the amount of IT and technology interface that was needed. We also determined what would be desirable if there were no budgetary constraints and how much incremental productivity would be achieved through desirable solutions. With several rounds of discussions we prepared

January 2008

As part of our strategy we have started the IT implementation without capturing clinical operations and covering all other areas like OP-IP billing, admissions, transfer discharge, pathology & machine integration, diagnostics, payroll, MRD, inventory management etc. How challenging was the vendor selection process, particularly, while choosing the HIS solution? What parameters did you evaluate during the selection process? Selection of an HIS vendor is a challenging job. Before actually selecting the vendor we formulated the business objectives and key indicators, which we tried to observe in the HIS presentation and consequently the gap analysis. Number of existing clients of the solution provider was also one of the important criteria of selection. Which vendor did you partner with for your HIS and what has been your experience with them so far? We have partnered with â&#x20AC;&#x2DC;Akhil Systems Pvt Ltdâ&#x20AC;&#x2122; for implementing HIS and so far the support has been time bound and appropriate. The best part is that they have worked as a partner, rather than just a vendor. Most importantly, they have been open to suggestions from the hospital towards betterment of the system, and at the same time they kept firm in their principals.

By implementing IT and different automation practices we have gained tremendous satisfaction and increased efficiency

What returns-on-investment are you enjoying and/or foresee in the near future for your IT investments - in both qualitative and financial terms?

number of hospitals under the Paras umbrella. We will have to integrate all the hospitals in different locations seamlessly.

By implementing IT and different automation practices we have gained tremendous satisfaction and increased efficiency different departments. It has also helped in delivering a high level of job satisfaction among our doctors and employees.

What is your comment in terms of the need for standardization in capturing, usage and sharing of medical records across service providers and development of a national health information exchange?

In financial terms, we could achieve the minimum level of inventory by practicing different inventory automation for stock analysis. Different analytical MIS reports were used for departmental analysis in financial terms and further actions/ targets. What are the cutting-edge medical technologies and facilities that you are offering across departments and super specialties? At Paras, we believe that appropriate use of technology for the benefit of patients is most desirable in order to provide the best and most reasonable healthcare services. We have the most modern diagnostic department with services ranging from MRI, CT Scan, Mammography, to the most advanced Colour Doppler and Ultrasound machines. In all our specialized branches like neurosurgery, we have most advanced microscopes to intra-operative TCD. Now we have also connected our OTâ&#x20AC;&#x2122;s to our auditorium for live demonstrations. What percentage of your annual budget is allocated for IT and technology purchase? Currently, it is around 1%. However, we believe that this is bound to rise in the future as we increase the

This will help immensely and should be implemented at the earliest. But, it will be effective only if it becomes a mandatory compliance issue. From patientsâ&#x20AC;&#x2122; perspective this is highly desirable and necessary, as it will help them keep track of there medical records and have controlled over their own treatments. This, I believe, will only happen through legally binding requirements for all the service providers. What is your wish list in terms of government intervention for facilitating the growth of healthcare industry in India? The government needs to give healthcare the infrastructure status that has been a long pending demand of the healthcare industry. We need the government to take active part in developing social and medical insurance for all groups; by either directly offering medical insurance or subsidizing the same for the poorest, or even enforcing medical insurance as a mandatory requirement. The government needs to create incentives for providers through mechanisms of tax breaks, so as to enable them to offer subsidised healthcare for the poor. At the same time, there should be strict vigil and enforcement on all commitments made by providers on the basis of which tax concessions are to be availed.

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PREPAREDNESS

SPEEDS UP

ALL CORE

PROCESS CYCLE TIMES Dr. Lloyd Nazareth, Associate VP - Wockhardt Hospitals

In which areas of operation and healthcare service have Wockhardt Hospitals heavily invested in IT-based systems? Which of your hospitals would you consider as the most tech savvy?

We have invested in a completely integrated HIS system which takes care of most of the business related functions like supply chain management, billing, admissions, appointment bookings, food and beverage services as well as functions which meet the clinical needs of patients namely the diagnostic services, the electronic medical records, pharmacy services etc. All our hospitals are using the same IT platform and hence almost all of them are equally tech savvy. In what ways has the hospital chainâ&#x20AC;&#x2122;s IT preparedness facilitated the well being of its patients and the productivity of its facilities?

Our IT preparedness speeds up all core process cycle times. Hence, we are able to admit and discharge patients much faster. We have real time information on bed availability or beds that are going to be available. Booking of procedure rooms and equipment is online, and hence information is available to all service providers who are able to then plan accordingly. In patient care areas, diagnostic reports are available online

as soon as they are released and validated by the concerned department. This allows information to flow much faster to the treating team who otherwise would need to wait for the physical copy to be made available to them. Retrieval of electronic medical records makes it so much easier to track a patient across multiple visits to the healthcare facility. Going forward we will extend this to visits across various facilities in our network. One area, which needs to be highlighted, is that automation of systems plays a major role in reducing medical errors particularly in areas like patient identification, medication delivery, transcription of patient notes etc. All this adds up to drive efficiencies across the system, lowering costs, increasing patient satisfaction, increasing patient safety and getting better outcomes. What are the direct/indirect benefits being enjoyed by Wockhardt after implementing HIMS solutions? Which solution providers and IT vendors are you currently working with?

We have implemented WIPRO HISRePS Ver 2.0 that has over 30 operational modules. All modules are fully integrated. This system has eliminated the need of data capture redundancies that were prevalent in older versions of HIS with standalone modules. Also, all modules were designed

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to be ‘patient centric’ rather than ‘Billing centric’. We have implemented ORACLE APPS (AR, AP & GL modules) being globally acknowledged best of the breed Financial Solution in Mumbai that integrates with WIPRO HIS at all hospital locations. Also all Diagnostic equipment in the LAB are interfaced to HIS where technology permits. Information within the HIS, such as LAB results, is available real time at the ‘POINT_OF_CARE’ to all users based on their assigned security roles and rights. We have been able to generate operational efficiencies resulting into minimum waiting time for patients at each service location. Being among the finest and advanced hospitals of the country, Wockhardt may have introduced the practice of Electronic Health Records (EHR) & PACS in its chain of hospitals across the country. Kindly elucidate on solutions and standards that are being followed, along with benefits and challenges that you may have experienced while transiting from traditional paper-based system to electronic system.

We have not moved completely to a paperless system as far as EMR is concerned for lack of India specific standards and we do not see immediate need for the same taking into consideration statutory requirements and patient mix, as we believe that in our environment a physical copy of the inpatient medical records will be needed when the doctor visits the bedside of the patient. Presently, keeping in mind IT infrastructures at the hospitals in India and the healthcare setup, it may not be economically viable to have palm tops or computers at every patient bedside. As and when technological advances reach a price point where inpatient medical records are accessible by the bed side that are of diagnostic quality, we shall endeavour to go paperless. Hence, we have consciously adopted a judicious mix of EMR and physical records. One of the challenges faced on a daily basis is to get senior clinicians to change their mindset and adopt paperless EMR. What is your estimation of growth potential for private healthcare

January 2008

market in India over next 5 years, considering both domestic and international patients? How critical is the adoption of EHR & EMR standards used in developed countries, to be able to provide seamless care for overseas patients?

We expect healthcare to grow at about 15% per annum for the next five years. Hence, it should double in size over the next 5 years from its current size of about 45 billion dollars. We intend to adopt those standards of EMR, which are applicable to our environment and will adopt the same standards for domestic and international

“Automation of systems plays a major role in reducing medical errors particularly in areas like patient identification, medication delivery, transcription of patient notes etc.” patients. Since all our hospitals are aiming for international accreditation we adopt required international standards related to patient confidentiality and privacy. Has the Wockhardt Minimal Access Surgery Hospital in Mumbai introduced any state-of-the-art electronic applications in its surgical operations during the recent times for conducting precision surgery?

Our minimally invasive program is using computer assisted navigation tools quite extensively and effectively for doing specialized surgery of the brain,

spine and joints. We are also doing a lot of Video assisted thoracic work. Recently, Wockhardt-Bangalore had carried out the world’s first awake coronary bypass surgery along with aortic valve replacement. Kindly tell us something about this achievement. Did technology play a crucial role in achieving this goal?

Our Cardiac Surgery team at Bangalore already has one of the largest series of “awake coronary artery surgery” in the world. They have now extended the skills learnt, to even more complex cardiac surgery, which includes carrying out dual procedures and open-heart procedures. The biggest advantage of these technology advances is that patients who earlier were considered inoperable, since they were not fit candidates to undergo anesthesia, can now undergo highly complex cardiac surgery while they are conscious. Does Wockhardt Hospital’s association with Harvard Medical International, USA facilitate tech-transfer and/or best practices in medical care? Kindly elaborate how Wockhardt value-adds out of this association.

The mission of Harvard Medical International is “One World One Medicine.” We constantly interact with the team from HMI and get many inputs in developing new clinical programs, nursing development, and facility design. We also do a lot of work with them in the area of Quality and accreditation. Does Wockhardt hospital chain make any contribution to the telemedicine scenario in India? Do you think, India, given its present state of healthcare infrastructure, is in a position to reap the benefits of telemedicine?

We do have a few telemedicine facilities operational at our hospitals but going forward, there is a definite move and intention to expand this network to take care of the needs of the domestic as well as international patients.

Health IT & HIS

Emerging markets are driving new models of care, which can only be achieved through IT

Healthcare and medical industry can be considered amongst the most information-intensive and data-critical fields of practice that directly impacts ‘human life’. Despite this fact, why do think this sector has been lagging (compared to manufacturing, finance, banking and others) in terms of IT adoption and technological maturity?

Dr. Brian Cohen Chief Technology Officer, IBA Health

January 2008

Health information technology (HIT) projects and the health industry is often compared with the commercial world, more often to provide examples of limited progress. As a generalisation, many of these comments do not take into account specific areas of HIT adoption, nor do they give credence to the substantial improvements in the quality of care and lives saved through the use of health information technology. The success of technology in the commercial world is still based around departmental solutions like finance and purchasing. The health industry has many similar successful examples. There are very few successful examples of company wide or national ERPs or CRMs available to compare with health’s holy grail – the Electronic Health Record.

The commercial world does not have to take into account the complex social, political and funding environment that envelopes health. Nor do they have to deal with the complex requirements of responsibly dealing with a patients personal health information whilst at the same time making information freely available to multiple enquirers at multi locations. The adoption and the benefits of an EHR in the broader community still has limited understanding as is the eventual financial return. A commercial bank does not have to deal with opt in / opt out policies or with the rights of its customers to choose. Whilst the adoption and benefits of a CRM for a commercial bank is implemented unquestioned.

What range of solutions are currently offered by your company for healthcare providers across private and public sector? We are one of the few health information technology companies that delivers solutions to all sectors of health, namely • • •

The other main impediment to the widespread implementation of clinical systems is the nature of the staff and how they are expected to use it. To create effective clinical data it should be captured at the point of care by the healthcare professionals involved. In particular, doctors are extremely busy and focused around patient care and direct interaction with their patients and their supporting staff. Effective computer systems must contribute to improve this process and not detract from it. Till date, it has been very difficult to design and develop user interfaces that are as efficient and easy to use for note taking, charting and diagramming as pen and paper. If healthcare professionals do not see any benefit in spending more time documenting the consultation process, they will not use these technologies. The financial and social returns from investing in health technology are enormous. In heath, the providers of finance and the beneficiaries of returns are usually different groups of people. Whereas, in the commercial world this is not the case, which is perhaps why HIT spending lags at sub 2% and commercial IT spending tends to be over 5% of revenues. In my view these generalized comparisons don’t stand-up to scrutiny. IBA Health is known to be a world-class health IT company with impressive market credentials and considerable achievements to its credit. What has been the corporate philosophy and focus along the path towards achieving this level of excellence? I would suggest there are 3 key elements to this success •

• •

Focusing on quality, recruitment and retainment of people who understand and know how to deliver health information technology and implementing this technology as close to the end-user as possible. Aligning this capability with an acquisitive growth strategy that has added quality products and customers to our existing portfolio. Building capacity to execute on our plans and deliver on the commitments we have made to our clients

• •

Primary care – the local GP and corporatised GP’s working in multi doctor, multi locations and ancillary providers like physiotherapist, podiatrist etc. Secondary Care – day surgeries, community hospitals, complex acute teaching hospitals Aged and Community Care – institutional care and care at home Mental Health – institutional care and care in the community Electronic Payments and Claiming – point-of-care claiming

This product set reinforces our ability to meet the future demand of a healthcare system that needs to make health information available from multiple providers, operating in multiple disciplines, across multiple locations. Among the various technological innovations of the company, what according to you has been the most remarkable in terms of setting industry benchmarks and developing a leading-edge in the healthcare IT market? The adaption and take up of the Internet has educated a community of health professionals and the public to not accept barriers to access or dissemination of information. This new demand is driving the take-up of electronic health records, and the development of cost effective departmental solutions that provides data to the EHR. This has driven the take up of Internet and web technology like Java and Microsoft tools to deliver the new applications. We have utilized these technologies and developed much more familiar, user friendly interfaces for data entry and display of critical information at the right time and place. For busy professionals it is important that the most relevant and important information is represented clearly and at the right time, so that they don’t need to wade through a massive amount of information, unless by exception, they wish to drill down to the details. This in conjunction with filtered protocols and care pathways helps healthcare professionals to do their job smarter and faster. Despite appreciable market share among top-of-line service providers across Australia, New Zealand, AsiaPacific and Middle-East, IBA Health seems to be keeping out of US and European markets. Is there a strategic angle to it? If not, when and how do you plan to venture in those markets? The US market whilst massive, is very complex, very www.ehealthonline.org

competitive and very expensive to enter. Itâ&#x20AC;&#x2122;s a market place which demands a very different product set which is based around the very unique funding and delivery model in the US.

capability and extend our health expertise and our capacity to cost effectively develop product for the global health market.

Today we have extensive health domain expertise in the markets we have chosen to operate in. For the time being we will to continue to focus on these markets.

Supporting our R&D team based in India is a capacity to cost effectively localise and implement our products in the region through regional deployment centers. This ensures that we develop and use local skills with local language capability and a clear understanding of the local cultural issues.

What has been your experience in doing business in India, and setting up the R&D Center-of-Excellence in Bangalore? What do you think are the main challenges and opportunities in this market?

How do you foresee the future growth of the company in emerging markets like India, vis-a-vis global markets?

We acquired our R&D Centre through an acquisition. The acquisition brought with it a team of over 200 dedicated and experienced health information technologists. So we started with a highly skilled team of professionals. Whereas, many others entering India have to build this expertise and at great cost. We supplemented this expertise as we migrated our core R&D capability to India ensuring we kept our domain expertise in health. With the iSOFT acquisition we will now expand our

Our strategy to grow our Centres of Excellence in India along with the deployment of product locally is key to our ability to engage in the emerging markets of the world. We are one of the few health technology companies in the world that has embraced the delivery of products into the primary care, hospital and aged and community care markets. The populous and emerging markets are driving new models of care focused on preventative and person-centred health systems, which can only be achieved through proper use of IT. The IBA Health Group is one of the few companies capable of partnering and delivering this new model of delivery.

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WORLD

San Francisco Medical Center tracks equipment in real-time The University of California San Francisco Medical Center’s project team has implemented a real-time location system to track the location, status and movement of the center’s medical equipment. UCSF Medical Center’s project team performed an evaluation of six proposals from different vendors before making the decision to install San Diego-based Awarepoint’s real-time awareness solution. UCSF Medical Center, part of the University of California, ranks among the top 10 of the nation’s premier academic medical centers. Awarepoint’s RTLS needs no hard-wiring or fixed infrastructure due to wireless sensors, which plug into electrical outlets. Assets are attached with small, battery-powered tags, which are tracked using the Web-based Searchpoint search engine. Long delays looking for unique items such as MRI-compatible equipment will be eliminated and the ability to rapidly find difficult incubation carts and other urgently needed items will be greatly enhanced. In addition, clinical engineering will be able to identify maintenance issues pro-actively; rentals will be tracked and logged for return and equipment conflicts will be minimized.

BT pilots N3 VoIP service for NHS, London NHS trusts in London are being offered free connections to the N3 Local Gateway Service (LGS) as part of a major city-wide pilot. The N3 LGS provides an interface between a local telephone switch and the N3 Voice Core Services Central platform. It enables cost free telephone calls to be placed over the N3 network and grants access to the central mobile gateway, enabling reduced calls rate to mobile phones. Costs to trusts are limited to a signalling interface card to connect to the N3 gateway, software configuration charges and a monthly management fee. Currently 21 trusts in London have joined the pilot, which has been running for a couple of months. The pilot follows BT’s announcement in July that the N3 network has been enhanced to carry phone calls using voice over internet protocol technology (VoIP), meaning NHS trusts can make free IP phone calls using the N3 LGS. The pilot will also help to explore whether the N3 network can support new technologies. NHS ‘Connecting for Health’ has part-funded the pilot with BT to explore the benefits of the N3 Local Gateway Service across a large scale community. The outcomes are expected to influence the uptake of services in other regions, and BT wants as many trusts as possible to take up the funding opportunity before it expires. London trusts have been involved in roadshows at the BT Tower and are enthusiastic about the benefits N3 LGS is providing.

ICW aides five hospitals in Germany share patient data Medical staff at Heidelberg University Hospital, Germany, and the hospitals of the Health Centers Rhine-Neckar will soon routinely exchange comprehensive patient data. Driving the seamless exchange of information between facilities and care providers is the hospital connectivity solution Professional Exchange Server (PXS), from the eHealth specialist InterComponentWare AG (ICW). The scope of the Rhine-Neckar project is similar to Health Information Exchange (HIE) initiatives being launched in the United States. In total, the undertaking involves five hospitals, including Heidelberg, which is one of Germany’s largest comprehensive care facilities. Information is fed to the new inter-facility electronic patient record from existing IT and imaging systems in the facilities. A highperformance Master Patient Index (MPI) is utilized to reliably and safely identify patients and enable access to medical information. Phase two of the project will network office-based physicians with patients via LifeSensor(R), ICW’s Web-based, patient-centric personal health record that collects and communicates patient information. Use of LifeSensor is intended to improve the quality of care and support disease management programs. It will also enable the citizens to improve their personal health and wellness efforts. ICW has established a subsidiary in the United States to deliver its eHealth solutions to healthcare providers, payers and consumers in this country.

January 2008

Telemedicine Centre Inaugurated in Cameroon In the health sector ICTs have proven to be a significant factor for an effective and comprehensive planning, management and estimation of healthcare. The increased development of and use of ICTs in health delivery systems in the industrialised countries led to an improvement of the quality of service, security as well as cost reduction for patients. For this reason the centre for Francophone African Network for Telemedicine (RAFT UNFM) was inaugurated at the Yaounde central Hospital recently. The ceremony equally marked the launching of the Cameroonian First Day of Medical Informatics known by its French acronym as (JCIM). Organised by the Yaounde Central Hospital, under the patronage of the Ministry of Public Health, the event brought together representatives of partner ministries, the diplomatic corps as well as directors and provincial delegates of Public Health in the country. Out of 11 countries, Cameroon was chosen to host the headquarters of the network for telemedicine in the Central African sub region and to enter into the international numerical world.

AMA Delegates endorse healthcare IT tax credit The American Medical Association’s House of Delegates recently recommended that physicians receive a full, refundable tax credit to help them buy and use healthcare information technology. The Delegates want such a credit to apply to technology like electronic medical records and e-prescribing systems. The Delegates passed their resolution in the wake of an AMA survey about 2007 Interim Meeting resolutions, in which 79 percent of responding physicians endorsed the idea of an EMR tax credit. American Medical News also reports that delegates directed the AMA to develop contracting guidelines to help physicians stay within the Federal State regulations that allow physicians to accept healthcare IT from hospitals. 37

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The healthcare IT market as

compared to 10 years back has grown

200 â&#x20AC;&#x201C; 300% Akhil Systems, known to be among the oldest healthcare IT companies in India, offers solutions to a large number of hospitals as well as pharmaceutical companies in India and abroad. eHEALTH in conversation with Sanjay Jain, Managing Director Akhil Systems Pvt. Ltd. traces the phenomenal growth of the healthcare IT market with the industry veteran.

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Akhil Systems is known to be among the oldest healthcare IT companies in India. When and how did you start, and what was your experience in the initial days? After studying the critical requirement of integrated software in healthcare industry, we started developing a HIS software with a small team and implemented in few hospitals of south India. These hospitals gave us live experience of actual requirements and process flows followed in the healthcare industry. Following this, in the year 1994 officially we launched Akhil Systems Pvt. Ltd. with the first version of HIS being tested and implemented in many hospitals across the country. In the initial days, people were not having complete exposure to use the fully online software and they were using different software for computerisation of different departments. Duplication of data and simultaneous maintenance of manual records were strenuous for the staff working in the hospital. No instant MIS was produced for the top management for decision making. Our software provided a solution to this industry, as to how a fully online, integrated software can be used in healthcare industry to automate operations. No doubt we faced lot of problems to convince the hospitals for computerising their functions and implement HIS. This was primarily because of untrained staff who didnâ&#x20AC;&#x2122;t know how to operate the systems and were against computerisation, out of the fear of losing their job. Training such professionals was a real challenge ! Sanjay Jain Managing Director, Akhil Systems Pvt. Ltd.

January 2008

However, with our own efforts and zeal to implement, and with some help from senior management of the hospitals we successfully implemented the systems - across large, medium and small sized institutions.

What products and solutions are currently offered by your company for the healthcare industry? We are offering complete range of products and solutions for the healthcare and pharmaceutical industry. Our HIS is an ERP solution for paperless automation of all departments of large and medium size hospitals. In addition, we have products for small hospitals and private clinics. We are also offering products to computerize large diagnostic centres (laboratory and radiology centres) pharmacy centres and retail outlets. What is your opinion about the current healthcare IT market in India? As the overall industry growth in India is going through an upward trend (by 10-15%) so is the healthcare industry. There is lot of demand for good hospitals with modern facilities. People are also getting aware of latest healthcare facilities and becoming more conscious about health issues. This is creating a lot of demand for good and specialised hospitals. The healthcare IT market as compared to 10 years back has grown 200 â&#x20AC;&#x201C; 300%. How do you see the Indian healthcare industry with regard to IT maturity? What has been the change over the last few years? Earlier, we had to invest a lot of time in explaining how hospitals can computerise their functions and what benefits they will enjoy after investing in IT. Currently, every hospital owner knows the importance and benefits of computerised systems. They plan from the project stage itself as to what type of system they would like to implement in their hospital and also plan the type of investment required. What do you conclude as the main reason for a relatively high rate of failure in IT implementation initiatives in Indian hospitals? Firstly, it is due to lack of standardisation of various documents and terminologies used in this industry. Secondly, every hospital wants the software to be customised just to computerise their manual process without proper refinement in the policy and procedures. Finally, in most cases there are no proper implementation methodologies that are followed to make the management aware about time and efforts required for successful computerisation. In order to ensure better results, any computerisation exercise should be preceded by a detailed process study and refinement strategy. The success or failure of any IT implementation depends equally on the hospital and software provider - itâ&#x20AC;&#x2122;s a joint

team effort. Unfortunately, most of the hospitals perceive that success of computerisation is the sole responsibility of the software company. Such an approach leads to unsatisfaction and finally implementation failure. What challenges are faced by the industry due to nonexistence of standards in patient data capturing, data sharing and clinical practices? Due to non-existence of standards in this industry, every hospital IT system is customised / developed as per individual understanding and different process flows followed at different places. Hence, if we try to connect two different hospitals to share patient medical records, in case of any emergency, it is almost impossible. In addition, further scalability of the software to another level or to a new version becomes difficult. What initiatives should be taken by the government and private healthcare providers in order to create an enabling environment for connected healthcare infrastructure in India? Government should call upon organisations like IMA, CII, etc. to come forward and make a new body which will work exclusively for standardisation of documents, processes, data capturing and data sharing methodologies. Healthcare IT companies should also be a part of this organisation to give their inputs as per their experience in this industry. What is the current client base of your company in India and abroad? Which are your most successful installations and Why? Akhil Systems has grown at the rate of 30% over the last 3 years. We are providing solutions across 4 countries, and in India we are in 12 states and 28 cities. 98% of our total installations till date are successful. Some of our successful installations are - Apollo Hospitals Dhaka, Bangladesh; Apollo Hospitals, Bangalore; Paras Hospitals, Gurgaon; Jehangir Apollo Hospitals, Pune; Apollo Hospitals, Ranchi and Moolchand Hospital, Delhi. We rate Apollo Hospitals Dhaka as our most successful installation because of complete EMR implementation and creation of a paperless environment for all the departments. The high point is that with the touch of a button complete patient records and treatment details are available for the doctors and administrative staff across all departments and payment counters. What do you attribute as the biggest strength of your company in providing IT solutions for the healthcare industry? Commitment, extensive domain knowledge, concentration on one single product and the will to go that extra mile for our clients are our biggest strengths. This is the reason Akhil

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systems has successful client base for more than a decade and still continuing the research for offering best to this industry. What is the current market share of your company in India and how do you foresee your growth performance over the next five years? We understand our self as a major player in healthcare IT market. We are one among the very few companies or perhaps the only company which is fully focused on healthcare IT. We attribute major share in North India and we already have a good number of installations in south India as well. With the blessings of GOD we have major plans for expansion in next five years to make this company as one of the biggest company in India to offer healthcare IT solutions.

January 2008

â&#x20AC;&#x153;Akhil Systems has grown at the rate of 30% over last 3 yearsâ&#x20AC;?

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INDIA

ICICI Venture plans to float healthcare holding firm ICICI Venture is planning to float a company that will buy mediumsized hospitals and pharmacy chains and act as a holding company for the fund’s investments in the booming healthcare sector. Temporarily called I-Ven Medicare, the company will be the lead vehicle for all ICICI Venture’s investments and buyouts in the healthcare space. ICICI Venture is in talks with four hospitals in different parts of the country for a complete buyout. They are also examining proposals from other small and medium-sized hospitals across the country who need funds.

A CII-McKinsey study estimated that India will spend USD 45.6 billion on health in the next five years. ICICI Venture wants to build a healthcare platform that will control a variety of healthcare players. The company hopes to use its large balance sheet and size to buy equipment, help the hospitals raise money and hire doctors. The new company proposes to list itself on the stock exchanges in a few years.

AIIMS to provide air ambulance service

Bangalore’s Vitage Tech signs deal with TTK Healthcare

India’s premier medical institute, AIIMS, is set to become the first government hospital in the country to get a helipad and start an air ambulance service to deliver urgent medical attention to critically ill patients. An application by AIIMS is being processed by the ministry of civil aviation and permission has been sought to construct a helipad. Senior doctors say close to 50% of critical patients in India die on their way to hospital. Though the expense involved in airlifting patients will have to be underwritten and the service won’t come cheap. Transferring a patient, say from Chandigarh to Delhi, could cost close to INR 1.5 lakh. The helicopter ambulance will have paramedic staff and a doctor trained to handle critical patients. The staff on board and on the ground will be given special training on transporting patients in these choppers. The service will be available at the AIIMS trauma centre which has been operational for the past 10 months though it is yet to be formally inaugurated. While some private hospitals across the country and in Delhi already have air ambulance service, AIIMS is the first government hospital in the country to provide the services.

Nimhans, Mysore hospital connect for telemedicine NIMHANS, Bangalore and Mysore based KR Hospital has established connectivity for their telemedcine project in collaboration with Larsen & Toubro Ltd in Bangalore. L&T has gifted telemedicine solutions and equipment worth INR 6 lakh to both the medical centres, as part of a private-public participation programme. Initially, neurology and neuro-radiology departments of the KR Hospital will be linked with NIMHANS and later on neuro-psychiatry, cardiology and surgery departments will also be linked. The telemedicine project will also upgrade teaching programmes and interaction between doctors, besides treating patients.

Bangalore based Vitage Technologies, a business service management company, has signed an agreement with TTK Healthcare Services Pvt Ltd, part of the TTK Group, to handle their IT operations as the managed services partner. Vitage will be managing TTK’s data centre, applications, network and the service desk on a 24x7 basis. Vitage will also provide direct support in Chennai, Mumbai, Hyderabad, Delhi and 15 more locations across the country. Upgrading the IT infrastructure is expected to help TTK Healthcare improve its customer service through service efficiency. TTK Healthcare along with the Vitage team has already implemented some of the base processess and a centralized service desk as well as completed the knowledge transfer activities. The tie up is expected to upgrade TTKs IT process maturity and bring closer alignment of IT with business.

Thermo Fisher Scientific expands with new facility in India Thermo Fisher Scientific Inc, has set up a new USD 17 million facility in Ahmadabad, India, to support growing demand for biopharma services in that country. The facility will focus on packaging, global distribution and logistics management of tightly regulated pharmaceutical samples to patients participating in clinical trials across the globe. It will complement existing clinical services operations in the U.S., Europe and Asia. The company expects to open the new 100,000-square-foot facility by spring of 2008, and add approximately 100 employees in the first year of operation. Thermo Fisher Scientific has taken significant steps over the past few years to increase its overall presence in India, adding sales and manufacturing facilities to support growing markets, including biopharma services and biospecimen storage, life sciences research and industrial processing. The company recently acquired Qualigens Fine Chemicals, a former division of GlaxoSmithKline Pharmaceuticals Ltd. (GSK India) based in Mumbai. Qualigens is India’s largest laboratory chemical manufacturer and supplier, serving customers in a variety of industries, including pharmaceutical, petrochemical, and food and beverage. Thermo Fisher also has a state-of-the-art demonstration laboratory in Mumbai that offers customers hands-on experience with its range of laboratory solutions.

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Bangalore telemedicine co chosen ‘technology pioneer’ by WEF

Union minister promises more funds for healthcare;health smart card in schools

Bangalore-based Neurosynaptics Communications Pvt. Ltd, has received recognition with the World Economic Forum (WEF) for its ReMeDi (Remote Medical Diagnostics) range of products. Neurosynaptic’s product, a portable medical diagnostic kit the size of a boom box is priced at an estimated USD 300. The kit performs five key tests, including blood pressure, temperature, and even an electrocardiogram, and relays the information from rural settings to top city hospitals via computer. The cost per exam: anywhere from 38¢ to 63¢, compared with USD 5 for an electrocardiogram alone from a doctor in town. The patients visit local multimedia kiosks- which are proliferating across Indian villages- where the tests are performed and the results transmitted to an affiliated doctor or a city hospital via a computer connected to the Internet. The doctor then diagnoses the problems and recommends medication via video conferencing, all at the kiosk. So far, 70 kits have been distributed globally, in India, seven of the kits are already in use in villages in Tamil Nadu and Maharashtra. Developing markets like the Philippines, Tanzania and Latin America are natural customers for these “virtual clinic” kits. The company will now involve pharmaceutical companies and health-care service providers. It is also looking for venture capital and private equity funding. It has set itself an aggressive target of installing its products and services in 10,000 centres by 2010.

The government will allocate INR 1,360 billion (USD 34.50 billion) for healthcare in the 11th Five-Year Plan (2007-12), up from INR 450 billion in the previous plan, said Union Health Minister Anbumani Ramadoss. He also said that the government will introduce a ‘health smart card’ under the National School Health Programme for every school-going child. The child will be screened annually for health problems relating to vision, hearing, heart, diabetes and anaemia and other parameters. The information will be fed into the smart card database. This programme he said will be a public-private partnership. Ramadoss announced that INR 15 billion will be earmarked for the National Blindness Control Programme under the 11th Plan.

Hospitals may need to comply to quality standards soon The Quality Council of India is planning to ask corporate houses to make quality certification mandatory before empanelling hospitals for providing medical benefits to their respective employees. This move is aimed at spreading awareness about the importance of hospital accreditation and for getting more hospitals certified by the National Accreditation Board for Hospitals & Healthcare Providers (NABH), a constituent board of QCI. At present, about 95% hospitals in India, including the bigger ones such as Breach Candy, Jaslok Hospital, P D Hinduja Hospital in Mumbai and S L Gangaram in New Delhi, do not have NABH accreditation. Not having a certification may hamper the inflow of patients from big companies and affect the reputation of the hospital. As of now, there are only 10 NABH certified hospitals in the country and QCI expects to add another 15 by 2009-end. Accreditation is slowly becoming mandatory for hospitals, who are targeting more clients, both Indian and foreign, and if QCI’s proposed model becomes a government policy, hospitals will definitely have to take heed. QCI also plans to reach out to the tier 2 and tier 3 cities. It has already roped in associations like CII, FICCI and Assocham to conduct awareness programmes. QCI will then in the last phase approach the consumer bodies to reach out to the last segment of the chain-the patient.

January 2008

LIC’s health product gets IRDA nod Life Insurance Corporation of India has got the Insurance Regulatory and Development Authority’s (IRDA) nod for its health insurance product- LIC Health Plus. The corporation now plans to launch the product in the market in the first week of January. The product would be on the lines of floater plan, which would give the policyholders the option to take health insurance cover for their immediate family. The product will not be based on the cashless transaction model, as many hospitals do not accept such a facility, and it was found that in many cases the hospitals charge more if a patient has an insurance cover that offers cashless treatment. LIC is targeting to provide health cover to close to one crore families in the first year of the launch of the product and expects over INR 5,000 crore of revenues. It is also learnt that the company has tied up with eight third-party administrators (TPAs) to manage claims under the policy and has tied up with Syndicate Bank, Axis Bank and Bank of America for the settlements. The TPA would first advise the company on the permissibility of the claim who would in turn instruct the bankers to issue the claim cheque to its health insurance policyholders. This will help settle the claims in a much faster way than what is happening in the market at the moment. The target is to issue the claims cheques within 24 hours of the approval.

Govt brings out Indian Pharmacopoeia, 2007 In an effort to control the quality of medicinal products, the government has brought out the Indian Pharmacopoeia, 2007, which lays down the standards for drugs produced or marketed in India. The standards of this pharmacopoeia are authoritative, legally enforceable and intended to help in the inspection and licensing of manufacturing and distribution of drugs and pharmaceuticals. It has been prepared in accordance with the principles and designed plan decided by the scientific body of the Indian Pharmacopoeia Commission. In addition to the past practices of requesting for comments, the contents of revised appendices and monographs have been publicised on the website of the commission for collecting comments from various institutions and organisations. All the feedback and inputs have been reviewed by the relevant expert committee to ensure the feasibility and practicability of the standards and methods revised in this edition of the Pharmacopoeia, as well as the principle of openness, justice and fairness. It is said that it would also play a vital role in initiating new prospective for improving the quality of medicines and accelerate development of pharma sector in India. 43

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Perception

IT in Hospitals About

Has Come A long Way... Prakash S Kamat, Managing Director, SoftLink International (B.Tech., Computer Science and Engineering, IIT, Mumbai) Recepient of several awards while working at fortune 500 companies, Prakash Kamat founded SoftLink International in 1997. He has since been working in the capacity of Chairman and Managing Director of the company.

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What are the flagship products and solutions of SoftLink for medical and healthcare industry?

In a short span, it has come to be installed in many centers in India, UAE, Kuwait and Saudi Arabia.

‘HeartCare Plus’ has been the flagship product of the company in cardiology. Over the years it has evolved into a complete Cardiology Information System (CIS), with interfaces to many invasive and non-invasive equipments in the cardiology department. It allows reporting, electronic record keeping, research and advanced analysis. It also facilitates collating of data for national and international registries.

How do you think IT solutions like HIS & PACS give a differential advantage for hospitals in terms of improving clinical operations, productivity and business returns?

Today, SoftLink offers healthcare IT solutions in hospital automation, radiology and cardiology with equipment interfaces for direct acquisition of data.

HIS is primarily a workflow solution that helps a hospital to assimilate and aggregate information related to patient’s care cycle across various departments and decision makers to cut down waiting times and errors in reporting. It guards against accidental loss of clinical information in paper format; and helps track accuracy of clinical information and outcomes. From hospitals’

“digitisation” cycle and have a long way to go before they can match the level in the developed countries. The “perception” of role of IT in hospitals has come a long way but the decisions on IT budgets are still not a reality in many hospitals! Major OEMs are now shipping equipment that are compliant to standards such as DICOM and HL7. They are also sharing information with the industry, but hospitals need to deploy IT solutions that make information and images portable across various stake holders within and outside the hospitals such as doctors, administrators, paramedics, insurance providers etc.

“The perception about IT in hospitals has come a long way but the decisions on IT budgets are still not a reality in many hospitals”

HCP DICOM Net is a cardiac imaging network product that was launched in 2000 and has an impressive foortprint in more than 120 hospitals across 12 countries. It has a varied client list that spans from large university hospitals in US to small cardiac institutes in various cities and towns in India, demonstrating that it is flexible enough to address everyone’s needs. ‘Panacea’ is an enterprise class Hospital Information System (HIS) product that spans across hospital campus and provides various modules to capture patient and procedure information for the entire “patient care cycle from admission to discharge”. It offers backoffice modules such as Finance, HRMS, Stores, Blood Bank, Pharmacy etc. to complete the automation needs of the entire hospital. ‘Imagine’ is an enterprise class multimodality RIS, PACS, Web Viewing and 3-D information and image management product suite that addresses the needs of the diagnostic centers as well as large institutional/university hospitals. January 2008

perspective they can utilise their critical resources at a higher level; and capture lost revenue for unbilled services and material due to paper movement across various departments for billing! PACS allows hospitals to improve accuracy and efficiency of patient reporting of diagnostic images, cuts down waiting times with integrated RIS and ensures higher utilisation of costly resources such as CT, MRI and cathlabs. It provides platform for collaborative medicine by sharing images across network, allowing clinical debates and cuts short patient stays within hospitals. It reduces the usage of films leading to tremendous cost savings over the years as well as makes the hospital “environment friendly” by reducing film and chemical usage for film development.

Even today, some of the major hospitals across India have “islands” of information that can not be interconnected resulting in manual transportation of data diluting efficacy of automation. It will be another 5-7 years before we start seeing hospitals that are well equipped as well as well connected in terms of accessibility and availability of information and images on demand. Which are your prominent clients among public and private sector service providers in India and overseas?

Drawing from your international and overseas experience, what is your perception about the level of technological maturity of Indian healthcare sector at present?

Amongst our top clients in India we have the teaching hospitals like Christian Medical College, Vellore, Sri Jaydeva Institute of Cardiology, Bangalore and Satya Sai Institute of Higher Medical Sciences, Bangalore. In the private sector we have clients like Apollo Group, Max HealthCare, New Delhi, Ruby Hall Clinic, Pune, and Nanavati Hosptial, Mumbai.

Indian healthcare enterprises are beginning to embark on their

We enjoy impressive clientèle in cardiac imaging in the U.S. such as 45

Mount Sinai Hospital & School of Medicine NYU, New York; University of Michigan, Ann Arbor; University of North Carolina, Chapel Hill and University Mississippi, Jackson et al.

as well as in radiology PACS. Our goal will be to deploy one of our products or solutions in 1 out of every 5 hospitals across the country by 2012. What are your future growth plans in terms of bringing new solutions or products for the healthcare industry?

In terms of percentage share, our export revenue constitutes 67% and domestic revenue is around 33%.

What is the current share of your overseas and domestic business (in percentage of revenue)? SoftLink has been focusing on building products that conform to global standards and has been exporting them right from the 2nd year of its inception. In terms of percentage share, our export revenue constitutes 67% and domestic revenue is around 33%. The differential is primarily due to better product prices in overseas markets due to higher salaries and wages for employees in healthcare sector resulting into higher level of automation in healthcare industry. What percentage of healthcare IT market share do you currently hold in India and what are your expectations for the US$ 300 million projected health IT market in India by 2012? SoftLink has been a focused player in healthcare IT segment and already enjoys about 33% market share in cardiology. In the last 3 years SoftLink has built HIS and RIS/PACS products and is fast gaining ground in HIS/HIMS

There used to be a time when upon requirement for speciality surgical procedures and treatments, Indians were travelling overseas, followed by people coming to metros for similar treatments. Now tier-2 and tier-3 cities are gaining ground and super-speciality hospitals are coming across the country and major healthcare providers such as Apollo, Fortis, Wockhardt, Max, Care have big plans to setup hospitals in various corners of India. This is going to provide tremendous opportunities to companies like SoftLink that have solutions across information and image management spectrum. New opportunities for technological solutions will be created due to “collaborative” nature of patient care cycle that is fast evolving. SoftLink plans to remodel some of its products and add new dimensions to address this principal shift. Next generation of our products will have integrated approach to multi-center information and image management, primary capture of data through device interfaces, telemedicine, remote consultations and many such evolving concepts will be facilitated.

“Our goal will be to deploy one of our products or solutions in 1 out of every 5 hospitals across the country by 2012.”

Patients will get to enjoy multitude of choices, differential service levels and facilities that have not been offered before, such as cashless settlements, free health check ups and ambulance pick up to name a few. All this is going to create tremendous competition amongst healthcare enterprises and eventually lead to survival of the best. We firmly believe that time has come for Indian healthcare enterprises to improve processes, efficiency and overall experience of patient care cycle.

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SMB hospitals are more challenging than the larger hospitals

Dinesh Samudra Director & COO

SEED Healthcare Solutionsâ&#x20AC;&#x2122; Director and COO, Dinesh Samudra, in conversation with eHEALTH shares his views on the challenges and opportunities of catering to the SMB segment. 48

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What are the major products and solutions that you are currently offering for the healthcare industry? CareDynamixTM – Hospital Information Management system • Gold / Premium • Diabetic • Dental • IVF • ed • Skin • Psychiatry • Polyclinic • Medical College DicomPACS® - an image processing system that digitally enables you to save and centrally administer your entire patient information. OnTimeTM - An intranet based Time and Attendance Monitoring System

Due to non-standardization, healthcare systems are immensely complicated, both in terms of organization and technologies.

compared to the larger hospitals. The mid and small segments look forward to improve the quality and effectiveness of health care through moderate costs. Their expectations are high in terms of fostering innovation through minimal financial accountability. What level of difference do you observe in terms of understanding and acceptance of IT-based systems implementation among doctors, nurses, administrators and decision makers of healthcare institutions? Computerization is not still on the top priority in the hospitals in India. The mindset of hospitals on the whole is not receptive to Information Technology. Yet it can be seen that the understanding and acceptance is more among the administrators and decision makers and lesser among doctors whereas least among nurses. In future, hospitals are not only expected to become paperless and filmless, they are also said to become intelligent, networked and mobile. What are your plans in terms of new product or solution development, to cater to this next generation hospitals? Due to non-standardization, healthcare systems are immensely complicated, both in terms of organization and technologies. To cater to the basic as well as future intelligent needs of the next generation hospitals, we have already planned a new product called CareDynamix Premium and beta version which will be launched in June ‘08.

What is your current market share in India and what growth level are you targeting over next few years?

It is based on Microsoft Dot Net Platform and uses service oriented architecture.

SEED Healthcare being just a year old company, it is at present difficult to comment upon its market share, growth would be 100% compounding.

Our new product will address the following key issues: 1. Multiplicity of platform, location, language, capability and credentials

What are the USPs of your products and solutions against that of your competitors – considering technology, performance, flexibility and pricing?

2. Identity Management

SEED Healthcare Solutions, in little time has formed a large customer base, with live implementations of CareDynamixTM in India as well as abroad, giving fruitful results, ensuring customer delight. CareDynamixTM running successfully, is customized as per the requirements of the customer at a competitive price.

4. Flexibility and Agility

Like most solution providers, do you find the mid and small segment hospitals to be more challenging, particularly in terms of bringing them in confidence regarding ROI, business value and service quality improvement? Yes, mid and small segment hospitals are more challenging as

January 2008

3. Integration of Challenges

5. Security 6. Scalability, Performance and Availability

Read more expert interviews at www.ehealthonline.org/interview/ index.asp 49

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In Conversation

THERE IS ROOM FOR

NICHE

INITIATIVES LIKE OURS

Dr. E. S. Rajendran, MD New Steth Diagnostic Solutions Pvt. Ltd. What are the IT solutions/products offered by your company for medical professionals and service provider segment? We have products for doctors and individual and chain hospitals. Doctors’ reference software is “eClinician” with wide reference data on 4500 diseases and patent pending differential diagnosis model from signs and symptoms. We also provide easy system examination and clinic management system in this solution. “Cortex” is the hospital management solution, which has been recently updated to a web based solution.

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What are the unique technical and functional features of each of your solutions as compared to similar others available in the market? eClinician is a unique product in the sense that there is no other product in the market offering quality reference data on a large number of diseases in the Indian market. Our model of differential diagnosis allows users to reach diagnosis from signs and symptoms with nearly 90% accuracy. Cortex on the other hand, is built as a web based solution which can function in the intranet or internet environment. We cater to the entire spectrum of hospital administration

â&#x20AC;&#x153;Cortex has been developed with a vision to cater to users with minimum software knowledge, and is ideal for users with no prior software usage practice.â&#x20AC;? needs- from patient care, inventory, finance and the doctors reference. Globally we are the only providers with doctors reference system in HMS. Cost for IT-based automation seems to be the biggest concern for most healthcare institutions and service providers. How do you address this issue in your pricing strategy? We offer free installations to hospitals. The hospital has to pay Rs.10 for new patient registration and Rs.2 for revisits. IP cases will be charged from Rs.50 to Rs.100 per patient. So there is no investment required for software. This amount may also be charged to patients, which will not burden them when the hospital is able to provide faster and quicker service. We do free software updates and maintenance, so the hospital will actually save lot of money in the long term as well. eClinician is available at a very affordable price of Rs.7500/only. Lack of IT-friendliness among Indian doctors and absence of structured IT-curriculum in medical courses are often identified as bottlenecks in automation of healthcare institutions. What is your take on this? How did you address this critical issue in your product development and business strategy? IT friendliness per se need not require detailed curriculum. It can be achieved with some attitude to accept and learn new developments. Most doctors have started to use computer systems for making effective presentations, capture procedures

January 2008

etc. We are already seeing the younger generation of doctors use computers, and this trend will only increase. eClinician as well as Cortex have been developed with a highly user-friendly interface and can be operated by anyone with little or no IT background. Training to use eClinician can be achieved in less than 30 minutes for a physician even if he has no IT knowledge. Cortex has also been developed with a vision to cater to users with minimum software knowledge and is ideal for users with no prior software usage practice. What has been the response and uptake rate for your solutions in the Indian market? Who are your present clients and what is their feedback about these solutions? We have excellent response in Metros in India with sales of over 3000 units. Our customers include faculty and students at all major medical colleges. In our recent survey we find

eClinician is a unique product. It can potentially reach 5% of doctors in the next 5 years. With close to a million medical practitioners in India, we have hardly touched the tip of the iceberg. that 95% of our users are highly satisfied with Clinician, and we propose to upgrade them soon to eClincian. In the overseas markets we are receiving much better response and we plan to tap them this year by appointing more dealers. Cortex has a history of 11 years and all the customers are highly satisfied with the performance. We are aiming to reach 100+ hospitals by the end of 2008 in India, directly and through franchisees. In the overseas markets we are offering franchise rights to business associates. We are targeting Middle East and African market this year. What is your perception on the growth trend of healthcare IT market in India in last few years and how do you foresee the same in next 3-5 years? If you consider the HMS market, it is far from saturated and there is room for niche initiatives like ours; where we focus on small and medium hospitals from 25-300 beds. eClinician is a unique product. It can potentially reach 5% of doctors in the next 5 years. With close to a million medical practitioners in India, we have hardly touched the tip of the iceberg.

news review

BUSINESS

Pfizer considers outsourcing manufacturing to India, China US-based pharmaceutical giant, Pfizer, is looking to cut costs by outsourcing as much as 30 per cent of its manufacturing to facilities in Asia, particularly in India and China. Pfizer now outsources about 15% of its manufacturing capabilities. The company aims to double that figure, as part of cost-cutting measures. The drug major while announcing the plan also said it would expand its research and development investments in China, India, Japan and South Korea. The company, which has major operations in New Jersey, announced earlier this year it would save USD 2 bn by cutting its global work force by 10%, or about 10,000 jobs. The company also believes that Asia was key to the company because the region’s pharmaceutical market would grow to USD 200 bn by 2017. Pfizer, which spent USD 7.6 bn on research and development last year, currently has 80 research studies under way in Asia. The outsourcing plans follow Pfizer’s announcement at the beginning of the year that it would close manufacturing sites in Brooklyn, New York and Omaha, Nebraska and sell a third manufacturing site in Feucht, Germany.

IBM eyes USD 2 bn pharma, health services market IBM is targeting multi-billion dollar health business opportunities in India. The company has plans to tap opportunities worth USD 1 billion each in the Indian pharmaceuticals and health service segments over the next 3-4 years. It is looking at providing a range of IT solutions for patient record management and creating a vault of information for doctors, patients, nurses and insurers as well. In India, the integration of health information and data security itself constitutes almost 50% of the business opportunity in health services. This will also mean providing integration of small clinics with larger hospitals. The company is also working on a separate track for developing markets like India where there is a lack of proper networking in the health set up. For this, IBM is working on a mobile technology to enable wireless connectivity through personal digital assistants (PDAs) and laptops for all hospital personnel. They are also developing censors, where it will be possible to trace any error while administering dosages to patients. In US alone, about USD 3-4 billion is lost due to errors in administering health care. On the pharmaceuticals front, about 30-40% of the billion-dollar opportunity lies in the clinical trials and contract research space, he said. Another 30% of the pie can be attributed to supply chain management issues. These include developing specific software to track packages and detect spurious drugs.

MindTree to venture into medical electronics FIT and R&D services provider MindTree Consulting, which announced a major organisational restructuring recently, plans to expand its business line to tap new markets especially medical electronics, avionics and defense. The R&D services, so far addressed industries like data networks, cellular networks, voice networks, telecom solutions, computing and storage systems, consumer appliances and industry systems. The company, whose topline was INR 590.35 crore last fiscal, derives close to 75% of its revenue from the IT services with the balance coming from the R&D services. In the IT services, the company specialises in domains such as capital markets, manufacturing, financial services and travel and transportation. MindTree is targeting USD 1 billion in revenue. Given an annual growth rate of 38 per cent, the target may be reached by 2014. The company is also keen on acquisitions. MindTree, which was listed on the BSE and NSE earlier this year, has a revenue target of $178 million to $180 million for the current fiscal, a growth of 36 per cent at the higher end. About 41.48 per cent of its shares are held by a clutch of financial institutions and VC firms.

AIG, J P Morgan to invest INR 400 cr in Narayana Hrudayalaya Global financial institutions American International Group (AIG) and J P Morgan are reportedly to invest a total of INR 400 crore in Bangalore based Narayana Hrudayalaya for a 25% stake in this cardiac hospital chain, valuing it at INR 1,600 crore. Incidentally, Narayana Hrudayalaya is looking to expand to around six other Indian cities after establishing in Bangalore and Kolkata. The chain specialises in cardiology and paediatric care and is among the world’s largest in the segment. The hospital also offers treatments in the area of paediatrics, neurology, gastroenterology and with the help of ISRO, Narayana Hrudayalaya has played a pioneering role in telemedicine. According to industry information, Narayana Hrudayalaya is set to expand with the onset of Phase 2, which will sprawl over 100 acres. The structure will accommodate 780 beds, 30 operating rooms to perform 75 heart surgeries every day. It will also accommodate a teaching institute for cardiologists, cardiac surgeons, cardiac anaesthetists, nurses, health technicians and healthcare specialists. Once completed, the project ‘Health City’, will have 5,000 beds with specialty hospitals for every disease.

Red Hat enters healthcare sector Red Hat Software Services, provider of Linux and open source technologies, is foraying into the Indian healthcare sector. Red Hat plans to facilitate the sharing of patients’ data and history within various hospitals to promote better healthcare services. They have joined hands with a number of government and private hospitals in Maharashtra. Most of these hospitals are in the early stages of digitisation of patients records and medical history. In collaboration with HP, they plan to make this data available to every hospital connected through our platform. Banks, financial institutions and companies in the insurance sector have adopted open source technologies for quite some time now. The government establishments, telecom sector and institutes in healthcare are yet to adapt to this kind of work culture. They are catering to hospitals in Maharashtra during the initial phase followed by hospitals in other states. The programme would provide various case histories and it would work as a knowledge and information platform for all the hospitals.

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Apollo Hospitals plans to invest INR 600 cr in tier II cities Apollo Hospitals plans a massive INR 600-crore expansion plan to make its presence felt in tier II cities, with about 10 hospitals. The company would come up with 150 to 200 bed capacity hospitals in tier II cities across the length and breadth of the country and is under the process of identifying locations for the proposed hospitals. The management would invest INR 50-60 crore in each of its hospitals. Apollo had appointed a US-based consultant company specialising in healthcare projects for drafting the nitty-gritty of its plans. The funding would be a mix of equity and debt. However, the ratio is still being worked out.

BT considering expanding health business in middle east A world-class IT services organisation, having made successful delivery of large-scale contracts for the National Health Service (NHS) in the UK, British Telecommunications plc (BT) is now accelerating its investment in the Middle East and Africa (MEA) in recognition of the fact that this is one of the fastest growing ICT markets in the world. Under this programme, BT is delivering three contracts worth more than USD 4 billion, comprising N3, a broadband network with more than 20,000 secure connections between hospitals and doctors throughout England; the Spine, one of the world’s biggest transactional databases and messaging systems containing more than 50 million records; and in greater London it is delivering a large-scale upgrade to the IT across all care settings in 74 health trusts to enable the creation of an integrated care record for more than 7.5 million patients. Internationally BT is also delivering a contract to improve the exchange of information between hospitals, outpatient clinics and general practitioners with consortia representing three of the least developed regions of Hungary.

Pharma companies to scale up Romania operations With Romania recently becoming a member of the European Union, it has become a gateway for Indian drug makers to over 30 markets in the region. Having a subsidiary in Romania will help Indian companies to expedite the distribution process rather than importing from India. Ranbaxy Laboratories which acquired Terapia for USD 321 million last year is shifting the production of some of the drugs from India to its Terapia facility and plans to make the country a hub for its European markets. The Gurgaon-based company is also investing USD 10 million in Terapia. For the quarter ended September, 2007 Romania posted a revenue of USD 23 million, which is about one-third of the company’s total European sales of USD 73 million. Three Indian companies, Shreya Lifesciences, Lupin and Dr Reddy’s Laboratories are reportedly in a race to acquire LaborMed, a Romania based generic manufacturer. In a bid to encourage domestic manufacturing, the local government has proposed to cap prices of drugs imported in the country at the lowest price of the similar brand in key 12 European markets.

Wockhardt to consolidate global operations; push to healthcare biz With three acquisitions undertaken in little over a year across Europe and the US, Wockhardt Ltd is in the process of consolidating its global pharmaceutical operations. It had acquired five companies in Europe, the last being France’s Negma Laboratories in May, and is now in the process of implementing the integration process, which includes “enhancement of product usage”, reduction of some manpower and further investments. Bain and Company, the consultant for the integration of operations in Europe, has completed the task say sources from Wockhardt. Products will be rationalised across different operations in Europe. The first phase of this has been completed and the second phase will be completed in the first six months of 2008. Meanwhile, Wockhardt will also invest £5 million at the sterile and injectibles plant there over the next 18 months. In October, Wockhardt had acquired Morton Grove in the US and efforts are on to improve the topline and reduce costs, there too. Wockhardt Hospitals is also set for growth, with plans for new hospitals in metros and “brown-field” managed hospitals in tier-II cities. The hospital-chain, from the same promoter-family, looks to raise between INR 800 crore and 1,000 crore through an IPO. The IPO will hit the market in the first quarter of 2008. Wockhardt Hospitals looks to dilute a little less than 30 per cent say sources.

Britain to move EU over India’s medical outsourcing call Britain has agreed to take up with its European partners, India’s strong and persistent objections to a rule that discourages healthcare outsourcing to India. Current European Union regulations limit referrals to hospitals within three hours of flying time - in other words, a doctor referring a European patient to a hospital for subsidised treatment has to make sure that it is located within three hours of flying time. Any destination beyond three hours means the patient will have to pay for the treatment. Mr. Kamal Nath, Indian Union Minister had urged the EU to amend the law, arguing it is a protectionist measure that is damaging trade and harms patients’ interests. ‘Britain recognises the strength of feeling on the Indian side, but we cannot unilaterally resolve the problem. It is something that has to be resolved via Brussels,’ Andrew Cahn, Chief Executive of UK Trade and Investment, told IANS after a conference of Indian and British business leaders in London Thursday. ‘We will certainly be raising the issue in Brussels,’ he added. India’s burgeoning private healthcare sector today offers attractive and cheap packages to foreign patients in an industry dubbed as ‘medical tourism’ - combining treatment with tourism, health retreats and yoga. The prices however are unbeatable, a heart bypass surgery in India costs around 4,300 pounds, compared to 15,000 pounds in Britain and a cataract operation around 650 pounds compared to 3,000 pounds in Britain.

January 2008

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Healthcare segment today is witnessing a move from point solutions to an enterprise-wide solution Wipro Healthcare ITâ&#x20AC;&#x2122;s Head- Business Operations, Prasenjit Lahiri, in conversation with eHEALTH shares his views on the increasing IT adoption in healthcare facilities accross public and private sectors.

Prasenjit Lahiri Head - Business Operations Wipro HealthCare IT Ltd. 54

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What is your opinion regarding current state of IT adoption in public and private healthcare facilities in India? How the domestic healthcare industry is fairing in terms of elevating their efficiency through IT implementation?

has enabled all the functions of each hospital in the last 12 months. Currently we are integrating patient records across these hospitals thus enabling uniform records at citizen level.

IT adoption in healthcare facilities is seeing an upswing with more and more companies investing in enterprisewide solutions. The first phase of IT enablement in these organizations was with a view to enable operations and hence was more in terms of point solutions. However in the recent years organizations are looking at IT solutions that can enable their growth engine both from planning and execution of the growth initiatives as well as providing better and consistent care on a larger scale as the organization sets up more and more units across the country.

Often the primary concern for small and medium service providers pertains to relatively longer time frame for realising RoI on IT investment (primarily due to their smaller scale of operations). What solutions are on offer from Wipro to cater to this segment and address the need?

IT adoption in healthcare facilities is seeing an upswing So we have organizations evincing interest in IT solutions like a integrated Hospital Information System which not only automates but also optimizes and standardizes transaction and clinical processes across multiple locations based on industry best practices; Healthcare providers are also looking at integrating patient records in a intra and inter hospital scenario through browser based EMR solutions which further enhances their promise of highest quality of care across the chain. Integration of IT solutions and lab equipments is another area of interest for the segment. To summarize, today the healthcare segment is witnessing a move from point solutions to a approach where organizations look at a integrated solution including software applications, infrastructure products and services and maintenance of the same. Although large corporate healthcare providers have gone ahead in automating their operations, most government hospitals are still lacking basic IT facilities. Do you attribute this gap to financial constraints of government hospitals or is it due to a lack of understanding and/or initiative of decision-makers in the government? There is a realization of the criticality of IT enablement in the public health space. So a large number of projects are in the anvil. However the execution and rollout of these projects needs a strong focus in the coming years. Wipro has been involved in the execution of a integrated HIS for six hospitals of Municipal Corporation of Delhi and

January 2008

We in Wipro have given a lot of thought to this both in terms of the potential of this segment and their uniqueness of needs. The segment is big in India with more than 800 new hospitals being set up every year and most of them are in the SMB segment. This segmentâ&#x20AC;&#x2122;s IT initiatives have been restricted to automation of point areas like billing, pharmacy etc with no integration, no automation of clinical side and no integration across multiple sites for orgs with more than 1 hospital/nursing home. The reason for this has been two-fold: lack of availability of solutions catering to their needs and price points and second a lack of fast track implementation process. We have come up with a solution the Wipro HIS Lite which was launched in June this year which addresses these issues both in terms of the breadth of the product and its price and in terms of a fast track well thought out 4-6 week implementation process. We have got 10 customers in the last 3 months across the country and see this as the start point for a huge upswing. What is the current market share of Wipro Healthcare in India and that in Asia, Middle East, Europe & US? What is your expectation in terms of market capitalisation in India over the next two years? Wipro has a strong leadership presence in the healthcare provider space in India and Middle East. Wipro has more than 75 healthcare providers as its customers in this geography and is growing at more than 30% on year-on-year basis. Considering the lack of basic healthcare infrastructure and severe paucity of trained referral personnel in rural India, how can the benefits of ICT effectively address the challenges faced by rural population? High penetration and availability of bandwidth, telemedicine, remote diagnostics etc can help in reaching out expert advice and care to people in remote areas and can mitigate the paucity of trained personnel.

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Anantharaman Iyer Regional Director (India) TrakHealth

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TrakCare brings you ePR benefits from inception... What do you consider the most remarkable and differentiating factor of TrakHealth in the overall vendor market for healthcare IT across the globe? The TrakCare difference is that it is built on powerful object integration technologies that deliver breakthrough speedto-care results. This means that Electronic Patient Record (ePR) benefits are realized from deployment of the very first TrakCare module, not at the end of a long and massive implementation efforts common with other systems. Implementing Web-based TrakCare using it’s “FastTrak to ePR” approach gets you there - quickly. The result is rapid delivery of the rich, always available information environment needed for a giant leap in patient care. While others promise ePR benefits eventually, TrakCare delivers them quickly. All systems today seek to provide patient-centric care. That said, alternative solutions use a system-centric approach – you must build a complete system, or “rip-and-replace” existing systems before you start seeing ePR benefits. Built on an integration platform, TrakCare brings you ePR benefits from inception, leveraging a wide range of systems and data sources, both within and outside your institution, whether internally developed applications or products from other vendors. January 2008

By embracing data and processes from such a wide range of sources, TrakCare helps organizations leverage their current investments and offers freedom of choice, as well as futureproofing against changes in systems and standards. Its powerful database engine can hold the large volumes of data generated as part of healthcare transactions, enabling very efficient search and retrieval with little or no degradation in speed, as the volume of data grows. TrakHealth is considered the pioneer of web-based HIS solution. What are the business critical advantages that a web based HIS delivers for a hospital? The main advantage of a web-based application is that one can lower the cost of scaling up quite drastically, by installing low end computers with browser capabilities. The client-toserver interaction model in web applications is usually light, and enables you to efficiently move information between the client and the server. Alternate client-server interactions models are heavier, and tend to consume more resources on the client and/or server as also on the network. Another advantage is that a web based model allows you to have distributed users; but reduces the maintenance task to a group of web servers, application servers or database servers 57

in one room, as opposed to being spread out over the hospital campus. Hence, the downtime is dramatically reduced and the task is more manageable. With the lines between phones and computers being blurred with each new generation of cell-phones, and the convergence of technologies, web-based applications also open up opportunities in terms of delivering very powerful HIS applications on devices with a very small form-factor. What were the business logic or reasons for the acquisition of TrakHealth by InterSystems? What kind of technological and market strengths are both the companies enjoying because of the move? The best way to answer this is via the following quotes: “This union of InterSystems and TrakHealth will increase our global prominence and open up major new sales opportunities in international markets. TrakHealth’s success in Asia and Latin America will enable InterSystems to accelerate our

growth in emerging markets which hold over 70% of the world’s population.” Terry Ragon, InterSystems CEO “With the financial strength of InterSystems behind us, we are better positioned to win and deliver the large-scale projects that are redefining healthcare delivery at the community, regional and national levels in many countries. This is a great move for both organizations and for the customers we serve worldwide.” Chris Chapman, TrakHealth COO What will be the status of both companies? Though they will continue to be two separate entities, they will be as one in terms of vision and style of operations. TrakHealth proudly states on its website that they are an InterSystems Group company and has a link to the InterSystems website. Likewise, the InterSystems web-site and collateral now lists the following product offerings

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It is not a stretch to see how the need to create patientcentric health records that span the continuum of care across all areas of care delivery, across hospital boundaries, will push the envelope in terms of patient record portability and interoperability, shifting focus from departmental information systems to systems that manage patient care locally, regionally, nationally and even internationally. Customers and Partners Like the telecom boom, only stand to benefit that took us from the back from the acquisition. All of the pack to being a leader “web-based applications also TrakHealth competitors, in the space in terms of both who are InterSystems’ consumption and innovation open up opportunities in terms partners will continue to in terms of offerings, I am receive full commitment fairly certain that India could of delivering very powerful HIS from all of us at InterSytems possibly emerge as a leader in and TrakHealth. Though Healthcare. applications on devices with a we would like our clients These are exciting times, to select TrakCare, we and though we have a long very small form-factor” are happy to have them way to go in terms of adoption as InterSystems clients of world-class IT systems, through TrakCare or one of standards, and processes, and our partners’ products. building seamless national patient-health records, the Which regions of the world are the stronghold of seeds of change have definitely taken root. TrakHealth in terms of market share and number of As a nation of consumers we are demanding more - in terms clients/installations? of healthcare, and healthcare professionals, organizations and the government are responding to the call at a continually In the past, the sales efforts have been focused on a small accelerating pace. number of large and prestigious clients in the selected territories. Most developing countries and emerging economies Asia and Latin America have traditionally been places like India are considered to be highly price-sensitive where TrakHealth has had success, but there are marquee markets. Do you have specific pricing strategies for customers around the globe, for example winning over competition in these markets? • Brazilian Federal Government (Brazil) It is true that markets like India are price-sensitive and • The Royal Infirmary of Edinburgh (Scotland) very demanding in terms of functionality and performance. • Molinette Hospital (Italy) However, they are also huge in terms of numbers -both in • Grupo Português de Saude (Portugal) terms of number of users and numbers of patients affected • Bangkok General Hospital (Thailand) by the systems. • St. George’s Hospital (Australia) Given that the application is highly modular in nature, it Closer home we are proud to list groups like Fortis and is possible to buy the application in totality or any subset Manipal, and large charitable hospitals like Sir Gangaram of modules calculated to leverage existing IT investments, Hospital (Delhi), as our clients. reduce upfront costs, or to drive adoption in a phased manner by the organization. What is your perception and expectation about the TrakCare sells a concurrent-user license that is priced based Indian market? What has been the level of success uptil on the modules that are purchased. Support and Upgrades now? are paid for on an annual basis and entitle our clients to unlimited support tickets, and to call on our expertise, in There are many signs that the Indian Healthcare Market is set addition to patches and upgrades of the software. to grow at an incredible pace. A booming economy, increasing It is possible to pay the license cost upfront, or elect to pay percentage of literacy and heightened awareness of medical a monthly rental fee per user that includes all costs (including conditions and possible treatments, rising costs of healthcare, support and upgrades). the advent/growth of Healthcare insurance, Medical Tourism, TrakCare is a good robust application that has stood the world-class healthcare facilities and doctors. test of time, as well as the “trial by fire” of implementations, The signs abound, and already there is a demand for better ranging from small clinics to large hospital groups, around the IT systems in hospitals and hospital chains, who are no globe. The functionality and flexibility of the application in longer satisfied with “billing solutions” passing themselves conjunction with the pricing options, makes us an attractive off as HIS’. option and give us a winning edge over the competition. • • • •

Cache – The High-performance object database Ensemble – The rapid integration platform HealthShare – The health information network platform TrakCare – The patient-centric healthcare information system

January 2008

news review

WORLD

NoemaLife launches Galileo e-health platform

SAP to release integrated solution in December

NoemaLife has launched a new eHealth application platform called Galileo, designed to help exchange information and share resources across the healthcare industry. Galileo’s eHealth application platform has been developed to provide healthcare organisations with a flexible and powerful platform to exchange information among the many people involved in patient care processes. The new solution is based on technology developed by the Berlin-based GMD and already successfully used in over 100 hospitals in Germany, Italy and Latin America. Galileo is designed to help deal with the increasingly complex healthcare processes, including advancements in the medical science and the need to control costs. Using web technology it makes it possible to manage the most complex inter-sector, multi-site and multi-actor processes in a seamless way. NoemaLife’s current clients include Sana-Kliniken, one of the largest private healthcare organisations in Germany, who used Galileo in combination with Oracle Fusion Middleware technology to implement its eFA (elektronische Fallakte) project, a nation-wide clinical data and

Germany’s largest software company SAP and its partner Accenture will reortedly release an integrated care solution, called the Collaborative Health Network, in December 2007. The new solution will then be tested in pilot projects in several European countries, including Germany, Austria, Switzerland, the Netherlands and Belgium. With the CHN solution, SAP/Accenture will compete with a number of other big players in the health IT-business, among them Siemens with its solution Soarian Integrated Care, Microsoft with EHIP, and TSystem with eHealth.connect. Siemens and T-Systems are close allies of SAP in the field of IT solutions for hospitals. After the release of CHN in December ‘07, pilot projects will start quickly. At the moment, they are in talks with hospitals in Germany, Austria, Switzerland, the Netherlands and Belgium. The goal will be to network these hospitals with rehab facilities, out patient departments, and doctors in private practice. Hospitals are SAP’s key customers in the health IT business. In spite of CHN, SAP was not planning to offer an own hospital information system with clinical modules but to leave this part to its partners.

Bilcare to use nanotech to counter drug counterfeiting A pharma packaging company Bilcare Research of Pune (India) has launched a product to help check the menace of counterfeit drugs. The product has a label with a unique bar code made out of nanotechnology and fingerprinting which can be swiped in the scanner or at select ATMs to verify the authenticity of the drug. Bilcare has a dedicated R&D section for packaging research, material research, analytical research, drug sensitivity studies and package design. It also has a flexo printing machine and a state-of-the-art pilot plant. About 10-25% of the drugs available in India are counterfeit. Counterfeit drugs also put patient safety, brand image and the nation’s credibility at stake. The USD 100-million Bilcare got a patent for the product in 22 months. The company claims that this technology is very cost-effective compared to RFID technology currently used in the US. The labels will be produced at Singapore. Manufacturing is slated to begin from the first quarter of the next calendar year and the commercial launch will be in June or July.

Healthcare groups partner on common health information security framework AMajor organizations from across the health care and employer spectrum have united to participate in the development of the first-ever common security framework for the protection of health information. Over the next year, Health Information Trust Alliance (HITRUST), which is spearheading the development of the security framework, and the common security framework founding participants - CVS Caremark, Cisco Systems, Highmark Inc., Hospital Corporation of America, Humana, Johnson & Johnson, Philips Healthcare, and Pitney Bowes will bring together a representative group of health care stakeholders across all segments of the industry. The purpose is to develop a common security framework that will provide the industry with an actionable set of standardized practices. Also participating in the development of the common security framework is PricewaterhouseCoopers, a professional services firm currently engaged in the assessment and implementation of information security infrastructures. The Health Information Trust Alliance (HITRUST), a private, independent company was created to establish a common security framework that will allow for more effective and secure access, storage and exchange of personal health information.

US group calls for national patient IDs America’s National Alliance for Health Information Technology has called for a national voluntary system of unique patient identification numbers to be established. Under the proposals, patients would choose to subscribe to the voluntary system, which would assign them a unique ID for them and their medical information. The Alliance, an industry grouping advocating adoption of IT and supporting policies to improve the US healthcare system, argues that the current statistical processes for matching patients to their records based on such attributes as name, address and birth date are too unreliable. It believes a national patient ID system would be more secure, accurate and reliable in matching patients with their medical records in distributed networks. The Health Insurance Portability and Accountability Act of 1996 called for the Department of Health and Human Services to issue unique ID numbers for Americans’ medical information, but Congress subsequently reversed itself and forbade HHS to do so. The Alliance’s position paper, ‘Safety in Numbers: Resolving shortcomings in the matching of patients with their electronic records’, does not specify which organization would issue the numbers, referring to it only as “an operating agency”. As part of the consensus-building process, the Alliance is seeking comments on unique patient identifiers on its web site at www.nahit.org.

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PACS (Picture Archiving & Communication System)

Indian PACS Market â&#x20AC;&#x201C; Changing Dynamics Anurag Dubey Industry Analyst, Healthcare Practice Frost & Sullivan

Definition Picture archiving and communications systems (PACS) is a rapidly evolving technology that is being adopted by healthcare facilities, as part of an ongoing trend to maximize efficiency in the acquisition, storage, distribution, and interpretation of diagnostic images through the digitization of these functions. In the broadest sense, PACS is often understood as a system that is used in the digital management of medical images.

January 2008

From a market perspective, PACS is best defined as an integrated set of information technology (IT) system designed to provide a complete solution for image management in a film-less radiology department. According to Frost & Sullivan, PACS solution includes dedicated display and review workstations with their associated servers, viewing and image distribution software, database servers, web servers, and archive servers, archiving software solutions, as well as all necessary additional software and any implementation or integration efforts, which incur costs. The segmentation of the PACS solution is as follows: • •

Enterprise PACS – A Complete turnkey PACS with filmless operation Modality PACS – Single-modality PACS such as ultrasound PACS, mammography PACS, Cardiology PACS etc.

Key Features Some of the key features of PACS includes:• • • • • • • • • • •

Teaching repository Automated offline centralized mechanism Automated offline indexing Disaster recovery functionality Modality perform procedure steps (MPPS) Medical grade display Central archiving Interoperability with other hospitals information systems Teleradiology support Interoperability with DICOM / Non-DICOM compliant modalities Scalable architecture

Prerequisites When introducing PACS to the hospital environment, it is critical to establish a Hospital Information System (HIS) or Radiology Information System (RIS) before a PACS. Often a retrospective merger of the PACS database lends itself to higher costs and data entry inconsistencies. All components of HIS or RIS and PACS must also be bi-directional and integrated fully with electronic patient records if present. If this is not coordinated, a hospital may find itself film-less in the radiology department, but resigned to copying images on costly laser film for other departments to use -an incredibly costly state of affairs.

• •

for success since these are likely to be frequently long term relationships Workflow capacities: ideally only full solution systems should be adopted Service and support provided by the vendor

The Technology According to Frost & Sullivan technical insights, interactions between picture archiving and communications systems (PACS) and radiology information systems (RIS) require compatible hardware, a common protocol for handling the data, and commensurate operational definitions. However, PACS and RIS are based on different protocols. PACS operates on the Diagnostic Imaging and Communications in Medicine (DICOM) standard, while RIS operates on Health Level Seven (HL7). DICOM is a transmission protocol that formats, stores, prints and transmits images to and from the imaging modalities and the PACS. HL7 is used to register patients, process orders, and store reports, but it cannot manage DICOM image data. In order for the PACS to do its job, it must be able to communicate with RIS. Therefore, interfaces are used to create an interface between the two systems. The interface (also known as a PACS “gateway” or “broker”) is a hardware- and/or software-based module that allow PACS to communicate with the RIS. However, it has its drawbacks, including added cost to the PACS, and a potential point of failure that may result in orphaned studies (studies that are “lost” or inaccessible to the data system). Although the leading vendors continue to support RIS/ PACS integration through the standard HL7 interface, current developments in image management technology are leaning towards a completely integrated RIS-PACS solution that manages all radiology-related numerical and imaging data from a single database. This is known as the fully integrated RIS-PACS. Although a number of current systems use the embedded or internal PACS broker and call them “brokerless,” a truly integrated RIS-PACS is one in which both types of data are indexed in a common database allowing immediate interaction of both types of data within the complete RISPACS system Trends

The following are among the other major concerns that a PACS team should also consider:

PACS implementation is slowly catching up in India with more hospitals aiming towards a paper-less environment. The Indian PACS market is estimated to be $5.5 - 6 Million and is expected to grow at a compound annual growth rate of 27 percent from 2007 – 2011.

The order of implementation of technology The sales team of the chosen vendor: a good fit is crucial

Corporate hospitals are the front-runners with some of the mid-size and Government hospitals following suit.

• •

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Private hospitals are opting for PACS to provide services efficiently and have an edge over their competitors, whereas, Government hospitals use it to help in keeping patient records, reduce the number of films used, and also the cost of record maintenance.

•

Radiologists are using it even for Tele-radiology services to provide consultation and second opinion to remote areas in India as well as abroad.

•

Technology savvy doctors are providing consultation and opinion even when away from healthcare facilities by accessing the records online from the comforts of their home or clinics. Major Players Some of the major foreign PACS application providers in India include • • • • • •

Agfa Carestream Health (earlier Kodak) Fuji GE Siemens Vepro

Local players include – • • • • • • • • •

21st Century Healthcare solutions Amrita Medvision Ashva Technologies Karishma Software Perfint Technologies Sobha Renaissance IT Ltd. (SRIT) Softlink International Srishti Software Matrixview

Drivers, Restraints and Challenges Market Drivers For the Indian PACS market the key market drivers are:• • • • • • • • •

The need for film-less environment Cost savings Better workflow through accessibility and availability Centralized storage Entry of local players Teleradiology services Increase in Medical tourism Increasing competition amongst hospitals Increasing awareness and demand for quality healthcare

Low penetration of DICOM compliant modalities

Challenges Faced The low growth of the PACS market is attributed to

• • • •

High cost of installation (that is, cost of required software and hardware) Low IT budgets of healthcare facilities Demand for films by patients and referral doctors No clear ROI (perceived) Attitude towards adoption of IT

Benefits of PACS • • • • • • •

Easy accessibility and availability of images Teleradiology services Cost reduction due to Film reduction Increased productivity Faster transcription Reduced rates of repeated imaging

The Work done so far Major PACS implementations in India are at: • • • • • • • • • • • • • • • • • • • • • • • • • •

Aditya Birla Memorial Hospital, Pune Amrita Institute of Medical Sciences, Coimbatore Apollo Hospital, Chennai Christian Medical College, Vellore Deenanath Mangeshkar Hospital, Pune Dr Shyama Prasad Mukherjee Hospital, Delhi Fortis Hospital, Mohali and Delhi G Kuppuswamy Naidu Memorial Hospital, Coimbatore Indraprastha Apollo Hospital, Delhi Jehangir Hospital, Pune Kidwai Memorial Hospital, Bangalore KIMS, Bangalore LNJP Hospital, Delhi M S Ramaiah Memorial Hospital, Bangalore Max Devki Devi Hospital, Delhi Madras Medical Mission, Chennai NIMHANS, Bangalore P D Hinduja Hospital, Mumbai Rajiv Gandhi Cancer Institute, Delhi Ruby Hall Clinic, Pune Sahyadari Hospital, Pune Sree Chitra Tirunal Institute of Medical Sciences, Trivandrum Tata Memorial Hospital, Mumbai Vallabhbhai Patel Chest Institute, Delhi Vikram Hospital, Mysore Wockhardt Hospital, Bangalore

Market Restraints •

Inadequate IT infrastructure (at referral doctors’ level)

January 2008

(References: Frost & Sullivan Technical Insights and reports)

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New Advancements in Electrophoresis Technology Fully Automated, Walk Away Electrophoresis System with Advanced Capillary Electrophoresis Technology CAPILLARYS 2 & MINICAP . Conventionally, Electrophoresis testing is considered as difficult and time testing. Now things have certainly changed with availability of advanced hardware, software and reagent systems from SEBIA, France. SEBIA Capillarys simplifies classic electrophoresis testing providing substantial labor and cost savings. Capillarys utilizes liquid flow electrophoresis through very narrow capillary tubes. Capillarys provides complete walk-away automation from bar-coded primary sample tube to final result with simpler operations. Able to accommodate any size and type of workload, Capillarys provide all benefits of electrophoresis with full automation, but with more Improved Reproducibility, Enhanced Resolution, Increased Sensitivity and Unsurpassed Convenience. Capillarys requires minimal attention offering maximum time saving. Capillarys can perform electrophoresis testing and interpretation in few minutes only. No staining is required in Capillarys. Direct detection at a precise wavelength enhances precision and accuracy. Also no densitometer or scanner is required. Capillarys results and Quantitation is Real Time - on-line. Unlimited menu expansion is now possible through the addition of a gradient technology, which allows protein detection at wavelengths ranging from 200600 nm. Capillarys menu offers Protein, Immunotyping, High resolution Protein, Carbohydrate Deficient Transferrin (CDT – new marker for alcohol consumption) and most important – Hemoglobin. In Future Capillarys menu will be extended to many more Special proteins. The Capillarys Hemoglobin assay provide complete automation. Direct analysis is performed from the bar-coded, primary tube on packed, unwashed red blood cells. Red cell hemolysate is automatically prepared on the instrument; sample migration occurs; and relative quantification & identification of the hemoglobin fractions take place all with a throughput of 34 samples per hour. Multiple capillaries functioning in parallel, yet independently, allow seven simultaneous analyses. The Capillarys Hemoglobin assay gives easy to interpret, clean result curves without extraneous peaks, Enhanced resolution & focalization in the separation of variants. This facilitates accurate quantification of Hb A2, F, and S with impressive correlation with HPLC technology. Capillarys is much better than HPLC for separation of Hb E from A2 fraction and allows identification and quantitation of this fraction. Capillarys also separates Hb variants like Hb H, Bart and Punjab. Generally electrophoresis results require experience for interpretation. Capillarys software provides on line assistance for interpretation. Software is easy to use. Both the gel image and curve are displayed and included on the report for easy editing, interpretation and complete reporting. Complete patient demographic identification is available including free fields for customization purposes. A comprehensive patient report can be produced. Capillarys also has Bi-directional interface (LIS) capability. Capillarys is a Fourth Generation Electrophoresis System with advanced technology and features as per the requirements of today’s Diagnostics laboratories. Capillarys is available in two models : 1. Capillarys 2 : With 8 Capillarys where 8 samples can be processed simultaneously, suitable for big volume labs. 2. Minicap : With 2 Capillarys where 2 samples can be processed simultaneously, suitable for small volume labs.

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Dhanvantri HPMS+ / Prescription Pad 2.0 an unique integrated EMR, HIMS, PMS & Prescription Writing Software To help achieve the highest standards in health care using Artificial Intelligence & by adopting latest tools in technology for the specific requirement of users in health industry, CompuRx InfoTech, a Delhi based company under supervision of a very DHANVANTRI (Hospital & patient management software) A powerful ERP, flexible, User friendly Hospital & Patient Management Software ready to deliver conceivable benefits to big & small hospitals. Unique patients ID, Single Window service to all common tasks, user defined Multiple Tariff plans, incorporation of international standards like HL-7, DICOM, ICD, HIPAA etc, User defined formats for all the documents, barcode & biometric device enabled, 5 Level Security, online security checks & warnings, Unique Search Engine to Locate patient medical record & Other Medical & Administrative Informations, Various payment plan for Insurance / TPA Company, Credit / Debit card / Cash/ Cheque, Contracts etc. Product Components: Integrated System with more than 35 modules, option to choose, covering every task of Hospital & capable of working in an enterprise environment. Technical Specification:

MS SQL Server 2000/2005 & Microsoft .Net Framework 2.0 Highlights Detailed / Unique EMR System with online saving feature • Speech Recording & free hand writing possible. Barcode Enabled • EMR, Lab Reports, all Cards / Receipts / Requisitions Foolproof Prescription writing with Automatic Dose calculation, • dose warning Facility with full features of “PRESCRIPTION PAD” module Critical Care management system • Full customization for every doctor with their preferences & • unique password to protect settings. Can export Patient Data to other formats Consolidated Patient History from Multiple Departments to • view Commission / Incentive / Reward management system • Innovative Blood Bank module with Disease Handling System • Dynamic MIS system with unlimited Reports on Customizable • Criteria Graphical Presentation of Investigations & Other Comparative • Data Allows Adding / Editing of entire Master Data & system settings • Fully Customizable Formula Based / Fixed Calculations. (with • Facility to Add / Modify Defined Formulas) Customizable Code Generation i.e. On Daily Basis, Monthly • Basis, Yearly Basis etc. Having both Codeless / Coded Features Enable / Disable System Warnings, Checks, Features, interface or • Change the Software Behavior using Control Parameters Centralize / Separate Purchase System • Patient education material in multiple Languages • For details visit : www.dhanvantrihpms.com

PRESCRIPTION PAD 2.0 (Unique EMR & Prescription writing software) Technical Specification: Visual basic with Microsoft Access Highlights Detailed / Unique EMR System • First-rate, foolproof prescription writing facility which checks • for drug allergy, interactions, duplications & safety automatically regarding pregnancy, lactation, children, elderly, hepatic insufficiency, renal insufficiency, pulmonary insufficiency & warns you in case it is unsafe in a particular situation Checks for drug safety at individual disease level also, like in case • of G6PD, PORPHYRIA, HYPERTENSION etc. An intelligent, interactive software which gives out valuable tips • for treatment automatically while writing prescription Contains complete prescribing information of more than 25,000 • brands of Indian Pharmaceuticals with complete information about 2,000 drugs, 1200 common diseases with their latest treatment protocols Contains ICD10 codes, CPT codes & list of 3500 investigations • Vaccination schedule, all kinds of growth charts & mile stones • tables are available. Can calculate growth velocity with graphs Features to calculate cardiac risk factor , obesity & body mass • index & ideal weight & height for any patient Can store pt’s multiple photographs by digital or web cam & • documents, x-rays by scanning Every visits of individual patient is kept in chronological order • Every member of a family can be grouped under one family head • which may help in tracking familial diseases All kinds of lab reports, ledgers, financial reports or clinical • practice reports can be generated Hand out of various dietary advices, exercises, dos & don’t for • patient education in multiple languages Facility to download the more frequently encountered disease’s • prewritten prescriptions to avoid rewriting Equipped with Appointment / Task Diary to help you maintain • your personal appointments & important tasks Provision to change the Program Settings / Features / Prescription • Layout according to the User’s Requirement Fully customizable & simplified Searching Mechanism for fast • and accurate searching on user defined criteria Customizable / User defined formats for Documents, receipts etc • Provision to generate OPD card for various departments • Reception Entry Facility to enter patient & prescription • complaints for every visit of patient For details visit : www.prescriptionpad.in

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Health Insurance

Insurance Sector - Riding High on the Healthcare Boom Growth of health insurance increases the need for standardisation, regulation, interoperability and information exchange.

Health insurance was first introduced in India in the late 1980’s. However, according to a recent survey by the National Insurance Academy, as of date only 1.08% of the one billion odd Indians are covered under health insurance. Which means that in the last nearly three decades, health insurance has suffered from low penetration into a very vast market. Things however seem to be changing. Insurance companies have realised the immense potential this field holds within itself. India has in fact, recently seen the entry of two major stand-alone health insurance companies, namely, Star Health & Allied Insurers and Apollo DKV Health Insurance. This alongside other Life insurance companies who have now gone into over- drive promoting their stand-alone health insurance products.

medical care and treatment, which is beyond the reach of the common man. There is also a growing public awareness and desire to have better health care from private medical providers. In case of a medical emergency, cost of hospital room, doctor’s fees, medicines and related health services all add up to a huge sum. In such times, it is health insurance that provides the common man, financial relief.

Cygnus Business Consulting & Research, a firm specialising in business analysis and forecasting, estimates that health

Scope for Health Specific Insurance Products

insurance premia will touch US$ 856.83

Given the increased incidence of what is called ‘Lifestyle Disease,’ due to the hectic, stressful lifestyles of people in a booming economy, health insurance has become a necessity today. Especially when one considers the rise in cost of

million in 2007-08, up from US$ 659.1

January 2008

million in 2006-07 71

The huge population of the country also limits the state machinery from providing cheap health/medical care. In India, approximately 80% of the total health expenditure comes from self-paid category as against the governmentâ&#x20AC;&#x2122;s contribution of 20-30 %. A majority of private hospitals are expensive for a normal middle class family. The opening up of the insurance sector to private players and de-tarrifing is expected to give a shot in the arm of the healthcare industry. Health insurance it is hoped will make healthcare affordable to a large number of people. Currently, in India only 2 million people (0.2 % of total population of 1 billion), are covered under Mediclaim, whereas, in developed nations like USA about 75 % of the total population are covered under some insurance scheme. The health insurance market today requires varied and innovative products for the ever expanding list of disease, both pre-existing and newly diagnosed. Keeping in mind the age bracket of the target customers, which is mostly the middle aged and senior citizens.

the premia rates on health insurance policies if the claims ratio goes down. (Claims ratio is a metric of performance calculated as a ratio of overall claims to the total premium collected for a specified period.)

Indiaâ&#x20AC;&#x2122;s largest insurance company, Life Insurance Corporation (LIC), enters the health insurance business in a big way in 2008, with an ambitious target of INR 50 billion (US$1.3 billion) within three months. The first move the company made, to make way for the large returns it expects is, to have sent a notice requesting the parliamentary committee of the health ministry to consider a proposal to grade hospitals in the country to reduce The health insurance industry has been suffering from huge losses every year as the average claims ratio stands at 110 to 120 per cent. According to an industry estimate, the total premium collected under health insurance policies during 2006-07 was about INR 4,000 crore against overall claims of over INR 4,300 crore.

Limitations faced by health insurance Among the many hindrances to the growth of the health insurance industry in India include the 24% of below poverty line and 35 % of illiterate population as also shortage of hospitals and insurance providers, lack of co-ordination

As per the study undertaken by the WHO, insurance in India is mainly financed from out-of-pocket expenditure in comparison to all other countries involve in the study including China, Sri Lanka, Vietnam to mention a few between hospitals and insurance firms, coupled with peopleâ&#x20AC;&#x2122;s belief in destiny for good health or bad. Also, the care delivery infrastructure needs to be overhauled and the government has an important role to play here; by taking action on demands such as health insurers have been making for hospitals and nursing homes to be graded in an effort to reduce the high claims ratio on the risk covers they sell, the government can play its role of facilitator. Grading of hospitals The initiative for a grading system for hospitals has two objectives: First, it will help policyholders get some idea about the healthcare they can expect; second, it will bring down

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Policy holders and health insurers are also peeved by the way some hospitals overcharge patients with medical insurance covers. It is suspected that they subject such patients to a battery of tests and medical investigations that are not relevant to the ailment, secure in the knowledge that the insurer will pick up the tab.

health insurance viable, there is a need to focus on eliminating or reducing fraudulent claims. Standardisation of policies The association of third-party administrators have long been campaigning for transparent guidelines for insurance companies dealing with TPAs.

The hospitals’ practice of overcharging not only consumes the insured’s maximum limit faster but also raises the insurers’ overall claims amount. A grading system will reduce TPAs maintain databases of policyholders and handle losses in the health insurance industry by 20 to 25 per cent. all post-policy issues, including claim settlements. They Once a grading system were introduced by comes in, the insurer the insurance regulator will be in a better to speed up what was It is claimed the Indian health insurance position to judge the typically a very longmarket is estimated to be INR 3,000 crore, actual prices of various drawn-out settlement treatments in the procedure for claims filed but has a potential to grow to INR 15,000 given set of hospitals. by individuals, as with crore in the near-term. And in terms This will also help the TPAs, policyholders can insurer in specifying use their insurance ID card of wealth, the health insurance sector the maximum limit of at authorized hospitals to stands at just 3 % of the insurance sector claims that could be get cashless treatment. made by a hospital for a given ailment. However, here too issues relating to sensitive maters It is also expected that health insurance premium will go such as patient records, information exchange, have created down once a hospital grading system is in place, since it will problems; especially since the industry has not been brought allow health insurers to design policies with lower premium under any stringent, cohesive policy, which might lay down rates, depending on the category of hospitals selected by the rules and specifications regarding collection, storage and policyholder in his health cover. exchange of data between hospitals, TPAs and insurers. Frauds in Health Insurance The Way Forward The estimated number Health Information of false claims in Indian Exchange India’s insurance penetration has inhealthcare industry is estimated at around India is a low-income creased from about 2.3% in 2000 to 4.8% 10-15% of total claims. country with 26% in 2007, nearly doubling over the last Fraud in insurance not population living only creates a hole in the below the poverty line, seven years. Insurance density has iminsurance companies’ and 35% illiterate proved from about US$10 (Rs 394) in 2000 pocket, but affects all population with skewed to about US$38 the stakeholders. (It health risks, coupled not only invites higher with that, currently, premiums, but also there is insufficient leads to restricted benefits, higher insurance co-payments, and inadequate information about the market tastes and potential of denial for future coverage, higher service taxes requirements and various schemes available. Also, the and also impacts on the quality of care.) growth of the health insurance industry increases the need for licensing and regulating private health providers and It is estimated that 4 – 10 % of medical insurance claims developing specific criteria for appropriate services and fees. may be fraudulent or exaggerated in some ways in Australia and the US. Insurance companies in the US lose over US$30 Health insurance can improve access to good quality healthcare billion each year to healthcare insurance frauds. only if it is able to provide for healthcare institutions with adequate facilities and skilled personnel at affordable cost. In India too, the statistics are alarming. A report suggests Given this scenario, the challenge, then, for the industry and that the healthcare industry in India is losing approximately policy-makers is to find ways to improve upon the existing INR 600 crore on false claims every year. Health insurance situation in the health sector and to make equitable, affordable is anyway a sector with very high claims ratio. So, to make and quality healthcare accessible to the population.

January 2008

An important agenda for this is that hospitals, different service centres and diagnostic centres be accredited and graded, and there be brought some policy shifts both within the government and the healthcare as well as the insurance industry, to mandate some standardisation of processes, data collection and storage, keeping in mind the secrity issues; so as to bring about some parity in the data collected by various stakeholders, and its easier for the stakeholders of the healthcare industry to share information.

potential loss due to non-sharing of data, and if implemented soon and rightly across the board, it can turn in large profits in the shape of savings. Sharing of data will also help the industry keep an eye on the pulse of the market.

Sharing of information has already become necessary given the

Susan Thomas, eHEALTH, susan@ehealthonline.org

India has a huge population base; there is immense potential for the industry to grow in future. While the government is already working on the regulatory issues on one hand, the private sector is looking at insurance expertise and product design.

Indiaâ&#x20AC;&#x2122;s first stand alone health insurance company Anand Roy

AVP Marketing and Sales, STAR Health & Allied Insurance Company Ltd. Currently, STAR Health and Allied Insurance Co. Ltd, is among the very few to offer independent health insurance products. Do you think you have been able to tap the first-mover advantage? Most definitely. We have made our mark in the health insurance space and our products and services are very well received in the market. It has been claimed that the Indian health insurance market is estimated to be INR 3,000 crore, but has a potential to grow to INR 15,000 crore in the near-term. How have you planned to maximise your reach and benefits from this enormous potential? To tap this vast potential we have introduced many innovative products at very competitive premium that cater to all the segments of the society such as: a)Policy for HIV+ persons b) Senior Citizens Policy c) A long term cash back Policy d)Policy benefiting dependents of NRIs e) Policy for diabetics etc. We also have a large network of over 110 offices supported by a large agency force.

So far there has been no retail focused health insurance player. What is your strategy as regards this market trend? Our focus is on the retail segment via the agency distribution model. Also unlike many other insurance 74

companies, we have our own claims servicing mechanism, and do not depend on a third party for this crucial activity. We have a proprietary network of over 3200 hospitals across India to provide cashless facility to our customers. A 24 X 7 toll free call centre is also at the disposal of our customers. All our claims are handled in-house and we ensure to visit each and every policyholder in the hospital, whenever a claim is reported.

What are your views on the possibility of India developing a National Health Information Exchange? How would it impact the insurance industry? It would be a welcome move and definitely help health insurance companies in product development and pricing. How do you foresee the future of health insurance in India? What policy shifts and innovations would you like to see? And what role do you see STAR Health play in it? It is common knowledge that health insurance is indeed going to be the key revenue driver for insurance companies in the near future. We realized this potential early and are geared to lead from the front in this space. www.ehealthonline.org

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Insurance sector to get healthier â&#x20AC;&#x153;IRDA expects the health insurance business to be the second-largest premium earner for insurance companies after motor insurance within the next three yearsâ&#x20AC;?

K. C. Mishra, Director National Insurance Academy, Pune

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National Insurance Academy (NIA), Pune

What is NIAâ&#x20AC;&#x2122;s main focus with respect to its training, consultancy and research activities?

NIA promotes, develops and nurtures research and consultancy activities on an institutional and individual basis. Areas of study include accounting, life insurance, general insurance, healthcare management, reinsurance, business economics, banking, investment, turnaround management, financial controls, risk management, regulatory provisions, human resource and organizational behavior, information system, marketing, operation & technology management and strategy & organization. NIA follows an interventionist approach to help influence practice through its consulting and research. The conference, workshops, seminars and training programmes provide NIA opportunity to update the concepts. This helps NIA to offer the latest solution package to organizations. Apart from NIAâ&#x20AC;&#x2DC;s own in-house publications like Bimaquest, Dnyanajyoti Research Series (DJRS), research monograms and working papers, NIA encourages its faculty members to undertake various research studies. NIA encourages its faculty members January 2008

and research associates to undertake commercially viable, stand alone or institutional action research projects, publish them in referred journals and present the concepts at national and international seminars. NIA has a cadre of research associates, two thirds of them drawn from the insurance industry and one-third from NIAâ&#x20AC;&#x2122;s own core professionals. Research and consultancy are components of faculty performance benchmark. National Insurance Academy was established with the objective of promoting & providing education and training in insurance and allied subjects to persons employed in insurance sector. The Academy endeavours to achieve this core objective by designing & conducting relevant and need-based programmes for officers of insurance industry. The curricula of these programmes are meant to impart not only insurance knowledge but also to develop managerial skills, self-development & the ability to face challenges. How does India compare with the rest of the world in terms of health insurance coverage?

India has mostly short-term health indemnity product. In the far east, they

have return linked insurance product (RLIP), which helps in arresting moral hazard, scales up fast and the idea of a return makes it a quasi-investment product. In the USA and other western countries, they have cashless and managed-care products. The method of coverage is Pay for Performance (P4P). In Europe, the method is care management; the products here are mostly for long term care and wellness centred. India is experimenting a hybrid system. Most products are indemnity driven. Life Insurers in particular are experimenting with long term care products. Micro-insurers are following a maxim of Pa4aP rather than P4P. Pa4aP stands for Physical assistance for affordable Premium. What is the size and scope of the health insurance industry in India and what do you think of the need and scope of micro-insurance for health specifically?

Current premium volume of Health Insurance is around INR 3500 crore for short-term policies. This excludes term indemnity policies sold by Life Insurers, which is insignificant at this point of time. The Insurance Regulatory and Development Authority (IRDA) expects the health insurance business 77

policy of the type envisaged in Medicaid plus choice program in USA. What measures do you think should be undertaken by the government to bring more people under the ambit of insurance cover?

to be the second-largest premium earner for insurance companies after motor insurance within the next three years. IRDA expects the sector to grow larger than fire insurance business after complete de-tariffing on 1st January 2008. Until now only two companies have been operating in the segment on a stand-alone basis. Experts vary in opinion about potential size of Health Insurance market. To attain world average of Health expenditure, India needs 80 billion USD of health allocation. Assuming 20% of the expenditure is the potential allocation for ex-ante preparedness through insurance route, Indian Health Insurance volume measured in terms of premium should be targeted at INR 64000 crore. But there is need for substantial structural changes to achieve this desirable magnitude of performance. Estimation suggests only 1% of the market has been tapped so far. In the medium term of three years, even with present effort the market may reach INR 15000 crore. In the past, growth of health insurance has been very sluggish, right from its formal introduction in the eighties. But in the last few years the cumulative average growth rate attained has been 37%. Micro-insurance in health sector should be best done as a providercentred model, but the current attempt is full service model, which is not cost effective and highly fraught with moral hazard. Micro-insurance has not assumed any significant volume at present but going by IRDA norms, the

companies should have a short term target of INR 300 crores and medium term target of INR 2500 crores by scaling up rapidly in next three years. How has the entry of private companies altered the health insurance landscape in the country?

Star Health and Allied Insurance has been in the business for some time and now the latest entrant is Apollo DKV Health Insurance. There is a host of new products with unique classification features thanks to the innovation of new companies. The products are rationalized depending on market dynamics. Loss prevention measures are augmented as in diabetic products recently introduced by ICICI concern. Even public sector companies have repositioned their products to be more sustainable. Do you foresee some possibilities of public private partnerships (PPPs) in the health insurance sector?

Public Private Partnership is already happening in most health plans. Of the four major constituents of health insurance namely health insurers, physical service providers, Third Party Administrators and most importantly the target group, which is potentially almost universal, there is intuitive appeal of PPP. Whether the target group is individualized or institutionalized, the other three constituents can have several permutations and combinations in the absence of any national combination

Government as facilitator and regulator with developmental responsibilities has to disperse the physical provider network, particular to rural recesses. There has to be inter-regulator coordination. At present there is no coordination between IRDA, Medical and paramedical councils, health ministry and Hospital regulators or drug controllers. The government has to also facilitate in areas like creating standard operating protocols for treatment, health awareness, tele-medicine, coding and classification of diseases, morbidity investigation, cleaning the data by a system of medical informatics and use of multiple imputation of lapse IT packages.

In the medium term of three years, even with present effort the market may reach INR 15000 crore. Development of a national health data bank and information exchange for payers and providers is often considered as a pre-requisite to standardise health insurance sector. What has been the move from government and/or industry towards such facility?

IRDA is making slow but steady effort to create a morbidity investigation bureau. There is still slower and reasonably unsteady effort to scale up the data bank. This area needs attention by augmenting the supervisory expertise. Data infrastructure is one of the biggest obstacles, but unfortunately, this is a man-made obstacle as India has several channels for data harnessing. Only there is lack of hard work and devotion for completion of the job on hand.

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25 – 28 February 2008 • Crowne Plaza Mutiara Kuala Lumpur • Malaysia

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NEW! CEO Talk Show - Conversations with CEOs leading the march in medical travel Talk Show Host Co-Host

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CEO Panelists Curtis Schroeder CEO Bumrungrad Hospital

Richard Larison Managing Director Apollo Hospitals

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Dr. Ming-Yen Wu CEO Taiwan Medical Travel Task Force

Stuart Rowley CEO Prince Court Medical Centre

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How can your hospital attract, vet and retain international medical travel? Creating successful market positioning for market leadership in Medical Tourism Working with third-party partners Perspectives on Growing Medical Travel Investments, Infrastructure & Internal Processes to Support the Sector Attracting & Catering to Islamic Patients & Special Needs International Patients How to Attract Americans to Your Hospital. Exploring Key Strategies Developing the Hospital & Insurer Relationship Healthcare Insurance - Building Hospital and Physician Networks What do Arab patients look for in medical services in and outside Middle East? How Hospitals can Leverage the Power of Media to Launch their Services to a World Market

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INNOVATIVE PRODUCTS IN

Health Insurance To achieve the countryâ&#x20AC;&#x2122;s health care objectives, the approach has to be inclusive of the ability to reach out to the bottom of the pyramid. Rural India is exposed to fundamental financial risks and has limited access to risk management solutions.

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the pyramid. Rural India is exposed to fundamental financial risks and has limited access to risk management solutions. The challenge for insurance companies is to develop relevant solutions at the right price with cost effective distribution. Efficient claims servicing over dispersed geographies will be the key to build customer confidence. ICICI Lombard is working closely with the Central and State Governments to build models of mass health insurance that will achieve these objectives. Health insurers have been rallying for hospitals and nursing homes to be graded so as to reduce the high claims ratio on the risk covers they sell. With respect to this, what might be your view on a possible national policy on standardisation and data-sharing among healthcare providers, payers and TPAs, perhaps something on the lines of HIPAA in the US? The claims ratio is a function of the rating approach followed by the insurance company, involving claims incidence and average claims size. Claims size is determined by the administered treatment and overall cost of the procedures. Data standardisation and data sharing will help in managing these aspects. Ritesh Kumar, Head Retail, Rural and Reinsurance ICICI Lombard

Do you see Health Insurance as a key driver in the insurance sector in the next 10 years in India? Health insurance contributes to just about 2% of the total health care spend in the country. Higher incidence of lifestyle diseases, rising medical costs and increasing awareness of the benefits of health cover will drive the growth of the category. The entry of new players in the category will lead to a wider range of product, pricing and service options for the customer. What progress has been made with the premium-refund health insurance products proposed by ICICI Lombard? What other innovations do you propose to bring to the health insurance market? Penetration of health insurance will be driven by innovative products targeted at specific customer segments and addressing unmet customer needs. Some of the customer needs are in the area of comprehensive health coverage, long terms plans, health funds, cost effective senior citizen plans etc. What kind of focus do you suggest for increasing the reach of health insurance to the masses of India? You have of course promised to roll out special packages targeting particular sections, such as the weaver community; do you think such customisation makes a big difference? To achieve the countryâ&#x20AC;&#x2122;s health care objectives, the approach has to be inclusive of the ability to reach out to the bottom of

January 2008

â&#x20AC;&#x153;The challenge for insurance companies is to develop relevant solutions at the right price with cost effective distribution, and efficient claims servicing over dispersed geographies. ICICI Lombard is working closely with the Central and State Governments to build models of mass health insurance that will achieve these objectivesâ&#x20AC;?

How do you see the future of health insurance in India in the short and long term perspective? And what role do you see ICICI Lombard play in it? It is expected that health insurance will contribute to at least 10% of health care costs in the country over the next five years and will become a significant contributor to overall insurance premiums. The heightened activity and focus on this category will lead to a widening and deepening of health insurance penetration. ICICI Lombard will continue to focus on product innovation, efficient distribution and effective customer servicing supported by a robust technology architecture to increase our customer franchise.

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PREMIUM PRODUCTS Health Insurance In the short term perspective health insurance industry is expected to grow at a rate of 25% annually till 2010, while in the long term, it is expected to grow at a rate of 5% annually thereafter.

Ivan Chak Head, Life Profit Centre and Accident & Health division, Tata AIG Life Insurance Company Ltd.

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According to a recent study by the National Insurance Academy (NIA) the health insurance cover in India stands at a meager 1.08%. Does it give a perception of opportunity or does it indicate a daunting business challenge necessitating a paradigm shift in public perception? The health care market in India offers a tremendous opportunity for health insurance both in the rural and urban areas. A large proportion of the population is still unable to access quality health care, therefore, it gives us the opportunity to provide affordable, accessible, available and quality care to the population. We can provide these facilities by: • • • • •

Creating awareness of the importance of health insurance and providing adequate information and education of the product to the masses. Providing products that are cost effective and fulfill the needs of the individual. Creating innovative Channels of distribution. Providing good quality services thereby building the faith of the consumers. Providing simplified products and Claim services.

What has been the strategy of major health insurance players such as Tata-AIG Life to benefit from this enormous untapped potential? Tata AIG Life was the pioneer in launching the first health product in the country way back in 2003. We have recently got an IRDA approval for a critical illness return of premium product. •

•

We are now going to introduce products targeting the masses and in particular, specific niches like women, children and elderly citizens. The aim of products should be to help individuals maintain their lifestyles come what may. As per the McKinsey report, the health care spending

of flexibility/ risk / return depending which will suit the appetite of the customers. What public policy interventions would you recommend for popularising health insurance in India? How differently would you deal with the rural and urban Indian market? Widely perceived to be inequitable, expensive, over indulgent in clinical procedures, and without standards of quality, the private sector is also seen to be easily accessible, better managed and more efficient than its public counterpart. Given the overwhelming presence of private sector in health, there is a need to regulate and involve the private sector in an appropriate public-private mix for providing comprehensive and universal primary health care to all. There has to be a differentiation in product coverage and pricing based on Urban and Rural locations. For the Rural market, the need is an affordable product, offering basic coverages along with quality care. The Urban market demands augmented services besides just getting quality core product/services. Health insurers have been rallying for hospitals and nursing homes to be graded so as to reduce the high claims ratio on the risk covers they sell. What is your comment on this particular need of the industry and what are the predictive business benefits of such a grading system? There is a massive difference in private spending on health care services between different states in different levels of hospitals. It is to be noted that in India, nearly eighty per cent of the healthcare delivery system is handled by the private sector and the rest by government. Hospital Gradation Scheme is one of the schemes that IMA has announced as a very positive and pro-active scheme, which will help improve the healthcare delivery system of the country in the long run, and bring forth a considerable degree of transparency in the

“Hospital Gradation Scheme is one of the schemes that IMA has announced as a very positive and pro-active scheme, which will help improve the healthcare delivery system of the country”

•

will be primarily on lifestyle diseases, especially cancer, cardiovascular diseases, diabetes and chronic respiratory diseases. Products based on lifestyle diseases will be introduced in the market. Introduction of innovative products offering a right mix

January 2008

working of the medical profession. There will be specifications on technology, manpower availability in the hospital and related medical services like X-ray, diagnostic laboratory, hospital infection control, biomedical waste management, etc. Standardised procedures and pricing among different

levels of hospital will help us in having a benchmark for Claims processing throughout the country. What is your view on a possible national policy mandating data-sharing among healthcare providers, payers and TPAs, perhaps something on the lines of HIPAA in the US? State governmental health agencies collect and maintain a wealth of data to help them identify health problems, develop and evaluate interventions, and make decisions about purchase or delivery of health services. By linking and sharing data among the healthcare providers we will be able to move beyond traditional ways of looking at health services and develop an understanding of how each of us can play an important role in improving and assuring the public’s health. Also we will need to address the security and privacy of health data as these standards are meant to improve the efficiency and effectiveness of the nation’s health care. What are your views on the possibility of India developing a National Health Information Exchange? How would it impact the insurance industry? The health informatics market in India is on the verge of a rapid growth phase. Health information technologies can be tools that help individuals maintain their health through better management of their health information. Health IT will help consumers gather all of their health information in one place so they can thoroughly understand it and share it securely with their health care providers so they get the care that best fits their individual needs. Health information technology (Health IT) allows comprehensive management of medical information and its secure exchange between health care consumers and providers. Broad use of health IT will: • Improve health care quality; • Prevent medical errors; • Reduce health care costs; • Increase administrative efficiencies; • Decrease paperwork; and • Expand access to affordable care. The insurance industry can use data warehousing, management and mining to gauge the profitability and potential of various customer and product segments. Understanding the customer better will allow insurance companies to design appropriate and customized products, determine pricing correctly and increase profitability. What are your expectations from the government regulators in terms of standardisation of clinical procedures and pricing models in the healthcare industry? The fragmented nature of healthcare sector in India makes pricing very critical, since it varies widely depending on the provider and the location. As per classification of city and grading of hospitals, insurance companies are classifying 84

“The insurance industry can use data warehousing, management and mining to gauge the profitability and potential of various customer and product segments.”

hospital packages into standardised slabs. TPAs are pursuing this scheme of standardisation. There is a need for uniformity in standards and a comparable price structure among healthcare centres offering similar services in the absence of which Insurance Industry cannot take off. This domestic accreditation system along with a code of ethics, besides ensuring a uniform price band is expected to go a long way in ensuring a set standard of services. The government needs to work towards setting up an accreditation standard and give it a statutory status. How do you see the future of health insurance in India in the short and long term perspective? In the short term perspective the health insurance industry is expected to grow at a rate of 25% annually till 2010. In the long term perspective, it is expected to grow at a rate of 5% annually thereafter. McKinsey estimates that the health care spending in India will increase from Rs 86,000 crore in 2000-2001 to over Rs 200,000 crore by 2012. Hence, health insurance would see significant growth as it will be seen as a viable option for Health Care financing. www.ehealthonline.org

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Challenges for Health Insurers & TPAs Data enhancement and information sharing in the health insurance sector

Alam Singh Assistant Managing Director Milliman

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he issue of data has presented several challenges to all the health insurance industry stakeholders. Till a couple of years ago, the primary challenge was that the data requirements and uses of data was not always fully understood by some critical stakeholders. As the industry matured, the awareness about utility of data in building rating structures, product design and flexible pricing systems increased, however, the industry did not transfer this knowledge to action. This was partly due to the fact that the data was hard to use, it was frequently of poor quality and incomplete. In addition, each TPA captured different data in different formats, thus making data aggregation and analysis at the insurer’s end a very daunting task. As early as 2005 some TPA’s tried to differentiate themselves by providing value added services built around data analytics for specific insurers. Since health insurance was an insignificant part of many general insurer’s portfolio, this value added service was embraced by only a few insurers. Till then none of the insurers had given data analysis much importance, very few of them even had a dedicated person responsible for health insurance. Health insurance premium growth in excess of 30% for FY ‘05-’06 significantly changed the complacent attitude many insurers had adopted towards their health portfolio. As health became close to 20% of the total business handled by a leading private insurer, the industry started to pay closer attention to health. The advent of detariffication in the general insurance industry has increased the importance of data collection and data analysis especially in the health insurance industry. There is an additional need for more effective analysis in the new competitive regime of pricing without any cross subsidy across classes. Proper data analysis is also necessitated by new regulations of the IRDA such as IBNR (Incurred but not Reported) estimation and Product Filing Requirements. It is also important to create industry wide benchmarks to enable an insurer to compare its own performance and rates with industry standards.

As the industry developed awareness about data usage, other critical events were occurring which would impact the current awareness level about data pertaining to health insurance. IRDA appointed DVS Sastry, to look at general insurance data issues. In addition, the process of strengthening and preparing the Tariff Advisory Committee (TAC) for functioning in a detariffied industry started, based on the vision that in the detariffied industry TAC would function as a data warehouse, supporting the industry. Among the first steps that TAC did towards this goal was to collect data from TPA’s and start some initial analysis. The data collection process required that all data be submitted in a standardised format. However since standards which had been proposed earlier were not adopted, this was a capacity that TPA’s & insurers will need to develop as per data reporting guidelines proposed by TAC.

January 2008

Knowledge and awareness about data standards has existed in India for quite a while. The Ministry of Communication & Information Technology (MoCIT) constituted a working group to prepare the ground for the Information Technology Infrastructure for Healthcare (ITIH) in India in coordination with Apollo Health Street Ltd in October, 2002. In January, 2004, the working group recommended standards to be followed for capturing and exchanging health information. The standards covered detailed formats for Healthcare identifiers, Data elements, Messaging standards, Clinical Terminology, Minimum Data Sets and Billing Formats. Another committee formed by the Insurance Regulatory Development Authority (IRDA) and coordinated by Bearing Point made recommendations for data formats and data collections from TPAs. However, industry adoption of these standards was weak. Although the TPA systems do have many common fields, and almost all capture those which can be defined as critical, variance is still significant. In addition, as anyone who has had the opportunity to study a large volume of data from multiple TPA’s would testify, the main shortcoming in the data has been adherence to quality parameters during the data capturing stage. From my own experience of large volume analysis of an insurer’s data from multiple TPA’s, I have observed that although data quality is getting progressively better, many elementary errors are still common. The good news is that most of these errors can be eliminated easily be introducing validation checks and drop downs. In addition, training of the data entry staff can easily enhance data quality.

Since each TPA captures data differently, TAC has now prescribed current formats of health insurance data collection. Data is currently segrated into the following structure: •

Policy Data (Table A): The policy level information is contained in this table. Ithas details such as the total number of people covered under a policy, policy premium, start date and end date of policy.

•

Member data (Table B): This table contains information about the individual members covered under the policy. The details include the age or date of birth of member, sum insured, gender and relationship with the insured.

•

Claims Data (Table C): Information on claims made by the covered members is contained in this table. The details include the date of admission and discharge, diagnosis description and code, name of the hospital, amount paid as well as claimed and the date of payment.

•

Outstanding Claims Data: This table shows the outstanding claim amount at the beginning and close of each financial year as well as the total amount paid during the year in aggregate.

The chart below shows the list of important fields contained in Tables A, B and C. The challenges in data quality can be subdivided into 3 distinct issues: Data accuracy, data completeness and data standardization:

To standardize data collection, the TAC has published a Health Insurance Data Reporting Manual which contains detailed instructions on acceptable data structures. Adoption Data Accuracy: of this manual will be the first step in generating quality data. This initiative can then be expanded upon by adding It is of utmost importance that data fields to enhance data depth and resultant analytics. Data fields as Table A Table B presented in the current structure of policy, members and claims datasets, TPA Code TPA Code which is recommended by TAC, has Insurer Code Insurer Code been found to be adequate for most U/W Office Code Policy Number types of analysis. Awareness about Policy Number Member Referance Key quality however is critical, therefore, the State Date Date of Birth first section of the document discusses End Date Age of Insured how the quality can be improved, the Product Type Sex second section discusses benefits and Type of Cover Occupation mechanisms for data sharing. Group Size Relationship of Insured Policy Premium Sum Insured Data Quality: Pre-existing Diesease Cover Baby cover as part of Maternity The TPA’s have been regarded as the Maternity Cover traditional custodians of enrollment Floater application and claims data. They manage the policyholders details through the readily Floater amount available tailor-made softwares for such purposes. The data provided by different TPAs showed significant variation in terms of quality and consistency. 88

the data be largely accurate.

Table C TPA Code Insurer Code Member Referance Key Claim Number Diagnosis Description Diagnosis Code Procedure Description Name of the Hospital Date of Admission Date of Discharge Total Amount Claimed Room & Nursing Charges Surgery Charges Consultation Charges Invistigation Charges Medicine Charges Miscellaneous Charges Total Claim Paid

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A high volume of inaccurate data undermines the reliability of any analysis. The several common shortcomings in the current data with respect to data accuracy are: 1) Reasonability Checks: Reasonability checks is the most important step to understand and demonstrate data quality. They are very useful from data analysis perspective as they give an early indication of which analyses can be viably done. Frequently they also indicate which other elements of data pre-processing be included in initial data enhancement efforts. This includes, but is not limited to, data cleaning, re-categorization, sorting, grouping, and calculating new variables by utilizing existing variables and reformatting. The following reasonability checks have to be undertaken on the data due to it’s current poor quality: • • • • • • •

Negative policy period; i.e. end date of a policy before its start date Length of stay less than zero; i.e. date of admission after the date of discharge Date of admission before the start date of its policy Date of admission after the end date of its policy Claim paid more than the corresponding amount claimed Inconsistency in age of Insured Policy premium less than zero

categories including Room & Nursing, Surgery, Investigation, Medicine and Miscellaneous charges as per the prescribed format. However, the figures for Miscellaneous charges were unusually high for some TPAs. It might be due to the fact that some of the TPAs do not classify the total claimed amount into the various sub-categories efficiently. Such classification, if provided, can facilitate analysis of the payment patterns for different benefits. Data Completeness: Completeness of data is pre-requisite for effective analysis. The variables provided in the data set should be sufficiently populated for accurate analysis. Any error or incompleteness in the data would lead to inaccurate results. Some examples of common fields which have completeness issues and the impact thereof: 1)Age/Date of Birth: The likelihood of a claim, and therefore the required premium, is affected by the age of insured. The lack of accurate date of birth or age of insured undermines the ability to do any meaningful analysis based on age. 2)Occupation: The occupation information helps in better understanding of the risk profile of the insured. The field for “Occupation” is usually blank in most TPA records.

2) Duplicate records: Duplicate records are usually found in both Policy table A and Member table B of all TPAs. This duplication leads to multiple records when an attempt is made to create a master exposure dataset containing policy as well as member details. This limitation makes it difficult to evaluate the true risk profile of the lives covered under a policy. Further, there is a lack of a standard format to assign a unique policy number to each policy record. There were similar format issues with member records as well. Some TPAs used the same policy numbers for group as well as individual policies.

3)ICD Codes: ICD (International Classification of Diseases) is a standard disease based code prescribed by WHO (World Health Organization) and used across the world. A unique three digit ICD-10 code is assigned to each of the diagnosis groupings of the claimant. The claims data is grouped by these codes for analysis purposes. This coding is largely unavailable or inaccurate in many cases. The lack of prescribed ICD-10 Codes can be a major shortcoming in the analysis of the data. Some TPAs provided broad level code ranges rather than a unique three digit ICD-10 code.

3) Missing policy data: Policy data was missing for certain claims paid by most TPAs. The percentage of missing records can be as high as 30% for some TPAs. Such a gap undermines the entire purpose of the loss ratio analysis by different parameters.

4)Diagnosis and Procedure Descriptions: Diagnosis descriptions are useful to verify the ICD codes assigned to the claims and to populate the ICD codes, in case it is unavailable. The procedure description is used to analyze whether it is medically appropriate for the diagnosis. There was a high degree of variability in the diagnosis and procedure descriptions generated by different TPAs. Some of the inconsistencies observed were:

4) Segregation of expenses into different benefits: The claimed amount needs to be segregated into different

January 2008

Diagnosis descriptions are restricted to a text limit by many TPA softwares. This leads to incomplete diagnosis descriptions. Data in the field was difficult to comprehend due to syntax errors or broad descriptions such as “Conservative Surgery”. Some TPAs provide an additional column titled “OPINION”, frequently this contains a combined descriptive and procedural information for some records. Most TPAs did not provide procedure descriptions at all, while others only recorded drug names. Occasionally, diagnosis and procedure descriptions are provided interchangeably by some TPAs. Data Standardization: Inconsistency and variation among industry stakeholders for populating certain fields highlights the need for a standard terminology to facilitate data collection. Lack of a structured mechanism for population common fields causes problems while creating a single dataset for all insurers or TPAs. Some fields which can easily be represented in a uniform manner by all stakeholders to enhance data usability are: gender, relationship of patient with primary policy holder, hospital and city names, unique identifier for hospitals, type of cover – group / individual. By adopting a uniform structure to represent each of these fields, the industry will lay the foundation for comprehensive analysis. This will also ensure that future initiatives based on pooling or sharing of data succeed. Level of Aggregation and Compliance with IRDA standards: Some of the fields prescribed in the Data Reporting Manual are not always populated by TPAs. These fields are important from the point of view of data analysis and require more attention. They include- date of intimation to TPA, new / renewal status, pre-hospitalization and post-hospitalization expenses and date of issue of card. The above discussion highlights the fact that any analyses undertaken prior to a significant improvement in the data quality will be seriously compromised. Undoubtedly, the lack of adequate and accurate data must be the foremost concern for health insurers in the near future.

Data Recommendations In the following section, we discuss some simple solutions to the data inadequacies discussed above. Most of these can be easily rectified by the use of simple validation checks adopted by the TPAs and minor technological enhancements to their data reporting systems. Data Completeness: Inadequate data is useless data in most cases. To ensure that the data is complete and accurate, certain validation features need to be introduced into the TPAs’ front end business application. The data must be submitted in a standardized format with mandatory fields completely filled in. Insurance

companies can design a training program for all TPAs and assist the TPAs in conducting this training. This program should highlight the benefits of complete data as well. Data Accuracy: As far as possible, the TPAs must use drop-down menus containing only the prescribed options for entering data in different columns. Validation features must be inbuilt in the system to avoid errors discussed under “Reasonability Checks” previously: • End Date of Policy must be after the Start Date. • Date of Admission must lie between the Policy Start and End Dates. • Date of Discharge must be after the Date of Admission. Data Standardization: To ensure that the data is consistent across a spectrum of data sources, a data field standardization document such as one developed by TAC, should be adopted by all insurers and TPAs within a specific time frame. In addition, companies must guide the various TPAs in achieving this standardization. This may entail conducting an audit of the TPAs current IT system, developing a gap analysis document and assisting the TPA in developing software upgradation strategy. Data Efficiency: It was observed that duplicate records existed for all TPAs in Policy Table A and Member Table B. It is our opinion that if a standard protocol for linking edited records with the original record were followed, the number of duplicate records would become negligible. Further it must be noted that the lack of indicative change in the policy number on renewals led to duplication of records. A unique numeric reference key for each policy (new or renewed) in Table A will ensure that data is assessed accurately. This unique key can be used subsequently in Tables B and C so as to correctly map the data. Master Tables: A consolidated member table with premium information after combining Table A (Policy data) and Table B (Member details) would result in better data analysis by reducing data duplication. This would enable some additional analysis such as profitability by age. Overall, it was observed that there is wide variation in the quality of data maintained by different TPAs. There is a need to take steps to standardize the process of data coding across the industry. Further, steps should be taken to improve the degree of compliance with the fields marked as not fully populated as of now. The availability of complete and accurate data is also necessitated by the fact that due to insufficient mortality and morbidity data in India, the past experience of insurers gains utmost importance for rating purposes.

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Medical Tourism

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MEDICAL VALUE TRAVEL AN AMALGAM FOR ANALYSIS

When a new industry starts to flourish, we start analysing the whys and wherefores, and the learning that comes out of it most often is- when there is a demand somewhere, chances are that it will meet with supply in India- a country full of resources. Could the IT success have been replicated?

Dr. Naresh Trehan examines Mr. Melvin J FROM MICHIGAN, at Apollo Hospital, New Delhi

Healthbase customer, Melvin J of Michigan was diagnosed with aortic aneurysm and some blockage in his arteries a few months ago. He was prescribed 3 surgeries to treat them- aneurysm repair, heart catheterization, and stents or cardiac bypass(es). Being uninsured, he could not afford to have the surgeries in the U.S.A. Thus, he explored other options, and with the help of Healthbase, U.S.A., came to India to be treated by Dr. Naresh Trehan at the Apollo Hospital, New Delhi. US hospitals had quoted $450,000 for the surgeries, doctors fees and tests. In India, they re-evaluated his problems and determined he did not need stents or cardiac bypass(es). So when he received his final bill, it was $14,000. “The people I met - the hospital staff, the people at Healthbase, were all very helpful, and I am grateful for their assistance. If a need were to arise I would go back for medical treatment (to India). I hope to return someday for some sightseeing!”, Says Melvin.

he new phenomenon, the new industry we are talking about is Medical Value Travel or Medical Tourism, as it has popularly come to be known now. Until some time ago we were concerned about ‘brain-drain’. The best of doctors would leave for best of facilities and offers outside of India. We are also just beginning to grapple with the shortage of nurses 92

here, for the same reason. As a country which is infamous for Delhi belly, we are still coming to terms with the fact that people from developed countries would purposefully come to India to get treated. How odd it must be, to get vaccine shots before breathing in the Indian air, where one is going to get medical treatment. eHEALTH team asked the industry players themselves, www.ehealthonline.org

what has caused this dramatic turn-around. Following are some interesting facts that were thrown up. The participants of this interesting questionnaire are some of the most successful service providers such as Col. Manesh Masand, CEO, Jaslok Hospital, Mumbai; Ms. Saroja Mohanasundaram, CEO Healthbase, U.S.A; Dr. Azimuddin, India4Health.com, India & U.S.A.; Ms. B. Makharia CEO, Yogashramrishikesh.com, Mumbai; Dr. Rajkrishnan, CEO, Rajkrishnan’s Dental Clinic, Kerala; and D. Arun Kumar, CEO, Mediescapes, Delhi. According to Dr. Rajkrishnan, CEO Rajkrishnan’s Dental Clinic, Kerala, “Dental tourism by itself has started to occupy a major share of medical tourism.” He pointed out that, “Dental specialty can be coupled with tourism very well as the dental procedures are less complex and do not need much follow up. Most of the dental procedures are done in multiple sittings and are managed on an outpatient basis. This ensures that the hospitality industry also benefits from dental tourism as the patients don’t have

Dr. Rajkrishnan, CEO, Rajkrishnan’s Dental Clinic, Kerala

What is the quantum of International patients served by you in a year? Where do your clients mostly come from? Col. Masand, CEO Jaslok Hospital: Out of all visitors, Domestic patients would be 80% and International patients 20%. Most of our patients come from Middle East and African Countries. Rest of them come from Europe, U.S.A. and Canada. MS. SAROJA M, CEO HEALTHBASE: We are helping several hundred people from U.S.A., Canada, U.K. and other countries, to receive high quality, low cost medical treatment abroad. Dr. Azimuddin, India4Health.com: We have a few hundred patients every year contacting us for their medical travel needs. Most of the patients are from the US, UK and Middle east countries. Ms. B. Makharia, CEO Yogashramrishikesh.com: in numbers we could say around 200 a year. They are generally from U.S.A., U.K., Europe, Middle East and Australia. We also serve quite a few NRIs Col. Masand CEO Jaslok Hospital (Non Resident Indians). What kind of infrastructure do you have in order to provide medical/advisory services? Col. Masand, CEO Jaslok Hospital: Jaslok has a very strong infrastructure in order to cope with increasing numbers. At present, bed capacity is restricted to 360 beds. We propose to increase it to 400 beds in the next 2 years. Each department has state-of-art equipment. For instance our Radiology Department has 3 Testla MRI and 64 slices CT; Oncology has IGRT, IMRT, Linear Accelerator; Nuclear Medicine Department has PET CT; Cardiology has the latest Cath Labs; Urology has the latest 180 watt Laser for prostate; and Orthopedic department has a Navigation system for Orthopedic surgeries. Dr. Azimuddin, India4Health.com: We have a network of India’s best hospitals and doctors who together help cater to International Patients. We have offices operating in Delhi and Bangalore, from where the effort is driven. We have our network in other Asian countries like Singpaore, Thailand and Israel also, where we refer our International patients. MS. B. MAKHARIA, CEO YOGASHRAMRISHIKESH.COM: We have a doctors specialty based site where world class doctors provide advice to our clients. We have tie-ups with state-of-the-art hospitals in Mumbai like Hinduja Hospital, Saifee Hospital, Lilavati Hospital, Hiranandani Hospital etc. What are the service levels or certifications that you think hospitals in India require for servicing globally? Col. Masand, CEO Jaslok Hospital: Jaslok has applied for NABH accreditation and we are waiting for the inspection team to arrive. Ms. Saroja M, CEO Healthbase: For our American customers, JCI (Joint Commission International, USA) accreditation is a big draw. But, there are some very good hospitals which are not JCI accredited. Besides accreditation, the more transparent the hospitals are in terms of quality outcome data, success rates, doctor credentials, etc., the better they can serve the international market. Dr. Azimuddin, India4Health.com: ISO certifications and JCI accreditation are required to service globally. Indian hospitals will have to strive for setting very high ethical, quality and infrastructural standards. Just having good doctors is not enough. This industry is bound to grow by word-of-mouth. So, just having the right certifcations will not be good enough either. In the long run the focus will have to be in ‘delivering as promised and beating customer expectations’. Only once the first patient goes back to his home country smiling, will more follow suit. Hospitals need to focus less on promotional ads and more on improving their standards. January 2008

What kind of strategies do you adopt in order to advise patients on Hospitals which may provide expected high levels of service? Ms. Saroja M, CEO Healthbase: Before bringing an international health care provider on-board, we look at their accreditations and collect various facts about their facility. We empower our patients with a wealth of information related to medical tourism such as details of international health care facilities, doctors, procedures, logistics, and so on, so that they can make a well-educated decision on which provider will best satisfy their needs. Additionally, we also collect feedback from our customers about the hospitals when they return after their surgery. Dr. Azimuddin, India4Health.com: “Affordable world class medical services with a human touch”.. That is our motto. MS. B. MAKHARIA, CEO YOGASHRAMRISHIKESH.COM: Since we are a doctor based service provider we give our clients the advice on hospitals as per their requirements proposed by our doctors. What kind of collaborations do you expect from Insurance firms? Col. Masand, CEO Jaslok Hospital: Insurance Companies can be a great help as far as bringing patients from abroad is concerned. They can have tie-ups with us and we can work out packages for various treatments and procedures. Ms. Saroja M, CEO Healthbase: Before insurance firms start offering the option of overseas treatment to clients as one of their plans, there are a few major issues in this industry that need to be sorted out like, liability, follow-up care, and so on. Dr. Azimuddin, India4Health.com: Insurance companies provide a seamless intergration of their services with our provider hospitals and our patients. Medical insurance is still in the nascent stages in India. It has few players and limited penetration. They still have a long way to go. MS. B. MAKHARIA, CEO YOGASHRAMRISHIKESH.COM: Unfortunately medical tourism has a very poor support from any of the faculties in India like the government, the insurance companies and other sectors. So the concept is taking off very slowly and is rather unorganized. What do you expect from the Government? Dr. Azimuddin, India4Health.com: Any initiative provided by the Government will be an added

B. Makharia CEO Yogashramrishikesh.com

boon. The Government should play the act of an able regulator to maintain standards of medical services and delivery. There should be ethical and quality benchmarks set by the state for the Hospitals. Hospitals and doctors should be held accountable for the treatment they provide to international patients. Ms. B. Makharia, CEO Yogashramrishikesh.com: We require substantial support both from the Central as well as State Government for organized services; and also from tourism departments, to promote medical tourism companies abroad. The combination of medical and hospitality services go hand in hand and for that we need a lot of promotion and marketing which has to be taken up by the public sectors.

to linger in hospitals during the dental treatments, but have to stay at a hotel or resort. “The increase in awareness about the facilities here has come through participation of our dental clinics in national and international expos. Organizations like the Confederation of Indian Industries (CII) together with Government tourism department are working hard to make full use of our potential.” “Accreditation of dental clinics is a major move in this direction, which will definitely go a long way in improving and standardizing the facilities.” On the question of provisions for any legal issues that may crop up, between the patient and foreign hospital, Ms. Saroja M., CEO Healthbase, Canada, replied that they have not had any bad experiences so far. She clarified, “Currently, the patients need to work with the hospital and court system in the country where they obtain their services. She further advised that the issues can be mitigated by doing thorough research

Patient undergoing treatement Rajkrishnan’s Dental Clinic, Kerala

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“One main issue in India regarding medical tourism is that when patients come to India, their primary reason is low cost and no waiting list. They like to go to high quality facilities with experienced doctors; and we have excellent facilities and great doctors in India. However, most of the patients need to stay in a nearby hotel, resort, service apartment or guest house for a week to a month depending on their procedure, before returning home. But it is increasingly becoming difficult to get good hotels at affordable cost in a good neighborhood. We are looking for accommodations of around $60 per night, but the current cost (in a good hotel) is 3 to 5 times more” Ms. Saroja M, CEO Healthbase, U.S.A.

Interesting facts about SingHealth Group: Each year, more than 200,000 people from around the world, travel to Singapore for quality healthcare. SingHealth Group, as the second cluster serves 50 % of those. Following a major reorganisation of the public healthcare services initiated by the Ministry of Health, Singapore Health Services Pte Ltd, or SingHealth was incorporated in March 2000. SingHealth has 3 Hospitals, 5 Specialty centres, 42 Specialties, 1000 Internationally qualified Doctors and 3.7 million patient visits per year. SingHealth’s International Medical Services (IMS) team provides a wide spectrum of services, like an end-to-end package, to patients from overseas and their family members, ensuring them of a pleasant and comfortable experience throughout their stay.

about the destination, health care facility, doctors, etc. before actually going there.” Ms. Saroja said, “Healthbase works only with high quality hospitals and empowers customers with every detail they need regarding their treatment so as to minimise the chances of complications from occurring.” We can sum up this discussion with the strong comments from Mr. D. Arun Kumar, CEO Mediescapes. He says, “While India strives to emulate the success of Thailand, Singapore or Turkey, there also exist a number of drawbacks to consider; such as, overall hygiene levels in India’s International patient arrival gateway cities, poor infrastructure at international airports and a bureaucratic approach to issuing medical visas. “Hospitals should concentrate on uniform price range for various medical treatments in different hospitals across the country and make it public, to establish transparency, in order to facilitate the entry of more foreign tourists seeking medical treatment. Facilities in Hospitals seeking foreign patients need to be market driven. Every hospital should have a dedicated international patient-care centre and should be able to provide language assistance and state-of-the-art communication facilities for patients. A well developed marketing department in the hospital is a necessity for intense marketing and publicity of medical facilities. The west is more likely than not largely ignorant

January 2008

about hospitals in Asia and there is therefore, a huge psychological hurdle. “Last, but not the least, understanding the different cultural backgrounds of medical tourists is of paramount importance because the topic of healthcare is very personal and means different things to different cultures.” The healthcare industry must tackle all these issues to continue inching closer to becoming the leader in medical tourism. Medical value travel, more popularly termed ‘Medical Tourism’, was discussed at length, as the next big window of opportunity at a recent conference organized by the Confederation of Indian Industries (CII) in association with Indian Healthcare Federation(IHCF) in New Delhi. It saw the release of a new brand ‘Experience Indian Healthcare,’ geared toward facilitating India’s competition in the global healthcare market. Smt. Ambika Soni Minister of Tourism and Shri. Anbumani Ramadoss Minister of Health & Family Welfare expressed their support to the initiative at the conference. Healthcare Revolution might just have begun! Dolly Ahuja Research Associate (eHEALTH Group) dolly@ehealthonline.org

> >

Customer Relationship Management â&#x20AC;&#x201C; The Key Differentiator in High-end Healthcare

Ruth Connolly, General Manager Microsoft Dynamics, Asia Pacific

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n the past decade, an emerging trend in global tourism has been ‘Medical Tourism’. This new phenomenon brings patients from the more developed countries, where treatment costs have skyrocketed to Asian countries, which provide low-cost medical treatment alongside being popular tourist destinations.

The concept seems fairly simple and ordinary, combining medical treatment and a holiday overseas, but the economics and sheer magnitude of growth in this trend has made Medical Tourism an important new industry in Asia.

“IT plays a crucial role in establishing a competitive advantage for hospitals looking to compete for the medical tourism dollar.”

One of the key growth drivers in medical tourism is the escalating demand for healthcare in the more developed countries – predominantly in North America, Europe and some parts of Asia. This increase in demand has resulted in extremely long queues even for simple medical procedures. Along with the spike in demand, the costs for medical treatment and procedures have also skyrocketed. Because of this, patients in need of some form of medical or aesthetics treatment – usually a costly surgical procedure back home – would fly to countries like the Philippines, Singapore or Thailand for the same treatment, where the cost of an offshore medical procedure can be significantly lower than that of a similar treatment in the United States or Europe. Uncompromised quality for a fraction of the cost Worries that lower costs in healthcare in Asian countries translate to a compromise in quality of treatment, facilities and services, are also unfounded. Many of the modern hospitals in these lower-cost countries that are designed to serve the affluent, international clientele, are often newer and have much better technology and equipment than hospitals in the more developed nations. They are typically staffed by Western doctors and surgeons trained in Western medicine; and they provide equal or greater quality surgical care than hospitals in the United States or Europe. While some patients are seeking significantly lower prices and relatively shorter waiting times by having their medical treatments done abroad, others choose to go abroad for treatments that are not yet available or widely practiced in their homeland. There are also individuals who head overseas for the personalized customer service that the high-end private hospitals deliver in order to attract an international clientele. Destination Asia As a result, the enormous cost savings, shorter waiting time, high quality of healthcare and the opportunity to take a holiday in a tropical paradise with some of the money saved, has made Asia an attractive destination for medical tourists. In fact, an estimated 150,000 North Americans and Europeans currently seek medical treatment overseas each year and their preferred destinations include India, Thailand, Singapore and Malaysia. Abacas International, a leading travel facilitator,

January 2008

reports that medical tourism to Asia could generate up to $4.4 billion by 2012. Key challenges for healthcare players in the region In this competitive high-growth landscape, healthcare players constantly face several key challenges in addition to the obvious need to provide reliable, world-class treatment and cutting-edge medical facilities.

In the early years of Asia’s rise as a destination for medical tourism, the costs involved in running a healthcare business would have been lower than they are today. But with the growth of the industry in Asia, the gap in the cost of human capital is narrowing. As a result, the cost of operations due to the rising cost of skilled labour, supplies and other overheads is rapidly increasing. This, along with a downward pressure on the treatment fees, makes it more difficult for hospitals to go on providing the same level of service at the same cost.

“The top medical organizations in Asia are already turning to technology to give them an upper edge in the bid to win the hearts of international patients.”

The IT Advantage To exploit the growth in medical tourism, deal with the increasing cost of providing medical services and to cope with the increasingly complex demands of more sophisticated customers in Asia and from all over the world, hospitals in the region need to use every advantage to get ahead. Spotting cutting-edge medical facilities and renowned doctors will not be sufficient.

Customer demands The most salient challenge that the hospitals, vying for a piece of the medical tourism pie, will face – is in satisfying customer demands and expectations. Consumers today, all across the world and in every industry, have increasingly high expectations of service industries. The healthcare industry is certainly no exception, especially since healthcare is a fundamentally more important need than that of most other services. The ever-increasing expectations that patrons will have of top-tier hospitals include more efficient appointment scheduling, increased responsiveness by physicians, nurses and other hospital support staff, access to personal medical information, online channels and services and other patient management tools. With customer expectations and demands set to go nowhere but up, hospitals will need to continually innovate to keep their customers satisfied with the quality of service. Competition from other hospitals The other challenge is that of direct competition, both within the region – as other Asian healthcare players (backed by government initiatives) make their bid for the medical tourism pie – and globally, as U.S. and European hospitals that have ceded market share attempt to re-capture some of it. Increasing operational cost Cost reduction is a third but important challenge for industry players. While delivering high-quality healthcare may be the key priority for healthcare providers, finding ways to reduce costs further has become the number one imperative. The key lies in finding ways to streamline processes, eliminate inefficiency, increase productivity, and improve decision-making.

As with the hospitality industry so with the medical industry, Information Technology (IT) plays a crucial role in establishing a competitive advantage for hospitals looking to compete for the medical tourism dollar. The top medical organizations in Asia are already turning to technology to give them an upper edge in the bid to win the hearts of international patients. Customer Relationship Management (CRM) tools as an enabler These hospitals have been extremely successful in attracting more international patients for an endless range of treatments, partly due to the cutting-edge medical expertise and equipment, but more so because of the customer service they provide. The hospitals are built like five-star hotels, and they have deployed customer relationship management technology to manage their growing list of international patients. Their ability to provide first-class customer service in addition to the best quality in medical treatment is what differentiates them from the rest of the competition. The service they provide, and the follow up all contribute to a growing number of patients returning for new treatments and follow up appointments. And with this technological edge to their approach to customer relationship management, the hospitals can maintain its lead in the premium healthcare range without resorting to a price-based strategy. Belo Medical Group, The Philippines Belo Medical Group, the largest and most popular cosmetic surgery center in the Philippines is expanding at a very rapid pace to cope with demands from patients coming from all over the world. The Group currently operates six branches, all of which serve an increasing number of patients every day. In order to provide a seamless experience across all branches, Belo uses Microsoft Dynamics GP and Microsoft Dynamics CRM to integrate patient records. This ensures that clients can walk into any branch after the initial visit

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without having to provide personal medical details all over again, and without having to wait for their medical records to be physically transferred from another branch. This not only enables Belo to provide superior customer service to its patients, but also manage its customer records in a more costefficient way. On top of that, the Group is also able to obtain business intelligence from all its customer records to better refine its marketing efforts. Belo Medical Group has established itself as a premier destination for medical tourism in Asia; and it is clear that first-class customer experience – starting even before patients check into the hospital and ending only after surgery and checking-out – is what differentiates this top-tier hospital from their competitors.

As worldwide demand for quality healthcare grows each year, the opportunities in medical tourism are endless. But in an industry that is increasingly competitive, it is important for serious players to employ the best-in-class IT tools to sharpen their edge against the competition in every area; and to satisfy the ever-increasing customer demand for a firstclass healthcare experience.

A central component to their customer experience strategy is in their deployment of Microsoft Dynamics CRM, enabling them to powerfully manage the large database of customers at a low cost. Microsoft Dynamics CRM was recognized in early 2007 by Forrester Research as a leader among customer record-centric products. The Forrester Wave Vendor Summary report published in the second quarter of this year (2007) credited Microsoft Dynamics for its comprehensive customer service capabilities, as well as its architecture, integration, usability, and business strategy. The report further claims that “the product shines in its ability to support agents through phone agent, blended agent, and agent collaboration tools — all of which sit on top of a solid workflow engine”. The importance of CRM solutions in healthcare It is clear that increased adoption in software such as CRM solutions will increase the overall quality of service rendered by hospitals and consequently, have a positive impact on the healthcare industry. But the inherent benefits extend beyond that. In an industry where human capital is a vital resource, a well-run hospital IT infrastructure can have a huge impact on cost control and patient care, as well as in increasing employee productivity and overall competitiveness. Conclusion Healthcare providers in this region, who want to step up onto the global stage as a prime destination for medical tourism, will have to find intelligent ways to harness the power of IT tools such as CRM to better manage the vital relationships with patients. These tools can also help the hospital optimize their operations by reducing administrative and operational costs, and improve access to patient and organizational information. And with automated information management systems, both healthcare staff and hospital management can easily access patient information necessary for clinical decisions and access the financial data required to drive business decisions. Together, these tools enable physicians, nurses, and administrators to work together as a single integrated team and establishing such an environment will also help in attracting the best in medical and healthcare talents.

January 2008

“In an industry where human capital is a vital resource, a well-run hospital IT infrastructure can have a huge impact on cost control and patient care, as well as in increasing employee productivity and overall competitiveness.”

Ruth Connolly General Manager Microsoft Dynamics, Asia Pacific

> >

Going the Sahara Way Medical Tourism â&#x20AC;&#x2DC;It is the Health Care Facilitators who make all the difference from a good medical procedure output to a really memorable experience of a complete wellness journeyâ&#x20AC;&#x2122;

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Mr. Murrey from Scotland visited India for his treatment of Vasectomy Reversal on 10th December 06. His treatment was successfully done at Apollo Hospitals, New Delhi. After the procedure, the patient along with his wife stayed in India for 7 days during which they shopped in Delhi and also visited the Taj Mahal. According to Mr. Murrey “We never thought there are such good hospitals available in this part of the world with latest technology and wonderful doctors, I along with my wife would like to thank Sahara Global for making all the necessary arrangements for them (Hospital , Hotel and Travel Arrangements). If we have a daughter I would like to name her India and would like to come back to India with my family for a visit. I would definitely recommend the services offered by Sahara Global to the people who wish to get medical treatment in India. Its cheap but its world class treatment-nothing less than what we have back at home.”

Mr. & Mrs.Murrey from Scotland

to an alternative like India, for world class treatment at 1/10th of price. For all the talk about aging baby boomers bankrupting the U.S. healthcare system, the real cost culprits may be tests and treatments available at sky rocketing prices. However, growth of this industry would not be possible only with technical expertise; it needs to be cushioned by personalized services by healthcare facilitators, making their role crucial and responsible. It is the Health Care Facilitators who make all the difference from a good medical procedure output to a really memorable experience of a complete wellness journey. With greater access to technology and the ease of travel and communications- health and wellness services have truly entered the global marketplace and the path healthcare outsourcing has taken them from “Globalization to Googalization”. Sahara adds significant credibility to the medical tourism industry by packaging all essential services such as travel, surgery, language, visa, and local tours and spiritual camps to ensure best customer experience. ‘Our attention to details towards foreign patients’ needs and customizing each medical trip accordingly is very unique in the industry and is a much needed services for people apprehensive of traveling to a foreign country for medical treatment’.

ahara Medical explores yet another rapidly expanding business opportunity around the worldMedical Tourism. By startling the world with a sustained high economic growth, poised to be one of the biggest economies and superpowers in the coming years, India has gained a lot of attention. From an image of the land of elephants and snake charmers, it has now become a land of hi-tech knowledge workers, world class medical facilities and innumerable opportunities. Along with state-of-the-art hospitals, sporting a legacy of thousands of years, with its Vedic “With greater access to technology and the knowledge and Ayurveda, India is truly emerging ease of travel and communications- health as a preferred destination for tourists who come for low cost high quality treatment with no waiting and wellness services have truly entered the time. It is a place to relax and rejuvenate their body, mind and soul while exploring the rich global marketplace” culture of the new dynamic, changing India. Medical Tourism presents concerns and challenges as well as opportunities. This trend will have We at Sahara Medical make sure that when a patient an impact on the healthcare landscape in industrialized & moves in Sahara’s safe network; and as the very meaning of developing countries around the world. Traveling overseas ‘SAHARA’ is to support, we hold our patient’s hand right for medical care was first embraced by consumers, now it is from the airport to the pre-booked hotel, to the scheduled being looked at by employers and health insurance companies hospital. Our ambassador even waits outside the ICU while for the simple reason of cost cutting. the surgery is in progress. He subsequently checks on the India’s medical tourism market is believed to be worth over patient while he recovers with holistic healing; follows up $ 300 million and is expected to rise to $ 2 billion by 2012. on his leisure trip in case he opts for one, till he is dropped Reports show that 1,20,000 overseas patients traveled to back at the airport to fly back home, after a complete wellness India in 2005 to receive private medical treatment. This figure trip. is expected to rise by 30% every year. The most common Not just that, Sahara also has alliances with the local medical treatments that patients seek are heart surgery, knee surgery, centers for the pre and post operative care. cosmetic surgery and dental care. Wishing you all a healthy & prosperous New Year! On the one hand in countries like the U.K., the waiting list is so long that a patient waiting for knee replacement might Madhuruchi Lamba just die in pain before his turn comes. On the other hand Head Sahara Medical www.saharamedicaltourism.com there are 50 million people in the U.S.A., either insured or uninsured, who as and when the need arises, have to turn

January 2008

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EVENTS DIARY

13 - 15 January, 2008 ICSR Conference on Clinical Care 2008 Mumbai, India

14 - 17 February, 2008

12 – 14 March, 2008

Holistic Health Asia ‘08 Philippines

SE Asian Healthcare Show 2008 Kualalumpur, Malaysia

15 - 17 February, 2008

12-14 March, 2008

International Conference on Medical & Community Genetics Chandigarh India

SALMED 2008 Poznan, Poland

http://www.gsmi.com.ph/gevents/hha/index.html

http://www.abcex.com/

http://www.iscr.org/Conferance/Page1.html

14 - 16 January, 2008 Health GIS 2008 Bangkok, Thailand

http://www.telemed.org.ua/Seminar/eng/2008e/ index_e.html

http://www.geneticsandpopulationhealth.com/ index.php/Main_Page

25 - 27 January, 2008

20 - 22 February, 2008

Medical Traveller Business Congress ‘08 Malta, Other

Canadian Critical Care Conference Whistler, BC Canada

http://www.gaiaint.com/gaia-international-eventmedical-travel-business-malta-2008.htm

28 - 31 January, 2008 ARAB HEALTH 2008 Dubai, United Arab Emirates

http://www.kallman.com/HealthShows/ arabhealth2008.htm

10 – 13 February, 2008 ARABLAB 2008 Dubai, U.A.E.

http://www.salmed.pl/

13 - 15 March 2008 Georgian International Healthcare Exhibition (GIHE) Tbilisi Georgia http://www.healthcare-events.com/gihe/

http://www.canadiancriticalcare.ca

14 - 16 March, 2008 25 - 28 February 2008 Medical Travel World Congress 2008 Kuala Lumpur, Malaysia

HOSPIMedica INDIA 2008 Mumbai India http://www.hospimedica-india.com/

http://www.magenta-global.com.sg/healthcare/

21 - 23 March, 2008 1 - 3 March, 2008 Meditec Clinika 08 Chennai, India

MEDEXPO East Africa 07 Nairobi Kenya

http://www.growexhibitions.com/kenya/medexpo/

www.meditec-clinika.com

http://www.arablab.com/

13 - 17 February, 2008

7 - 9 March, 2008

25 - 27 March, 2008 IV International Conference “Telemedicine- Experience@Prospects” Donetsk, Ukraine

CRITICARE-2008 Madhya Pradesh, India

52nd National Conference of Indian Public Health Association New Delhi, India http://www.iphaconference.mamc.ac.in

http://www.telemed.org.ua/Seminar/eng/2008e/ index_e.html

14 - 15 February, 2008

10 - 12 March, 2008

25 - 28 March, 2008

MedTech Investing Europe Conference Lausanne, Switzerland

Dubai International Pharmaceuticals & Technologies Conference & Exhibition Dubai

Medical Tourism Asia 2008 Singapore Singapore

http://www.criticare2008.org

http://www.campdenconferences.com/default. asp?page=conference&conference.id=18

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http://www.duphat.ae/

http://www.medicaltourism-asia.com/ibcsg/ medicaltourismasia/index.jsp

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EVENTS DIARY

16 - 18 April, 2008 Med-e-Tel Luxembourg Germany

http://www.medetel.lu/index.php

25 - 28 May, 2008 Geneva Health Forum: Towards Global Access to Health Geneva Switzerland http://www.genevahealthforum.org

26 - 29 March, 2008 World Congress of Health Professions Perth, Western Australia Australia

18 - 20 April, 2008 EVE SANTE 2008 Gurgaon (NCR Delhi), India http://www.evesante.com

http://www.worldhealthcongress.org/p

9 – 11 June, 2008 ICMCC Event 08 London UK http://2008.icmcc.org

27 - 30 March, 2008 MedicExpo Helliniko, Greece

http://www.medicexpo.com/

16 - 19 April, 2008 Health Care Dental Damascus, Syria http://www.arabiangroup.com/healthcare/n_ homepage.htm

18 - 22 June, 2008 Syrian Medicare 2008 Damascus Syria

http://www.syrianmedicare.com/

2 - 4 April, 2008

4 – 6 May, 2008

1st India Health Conclave Mumbai, India

EGYMEDICA 08 Cairo, Egypt

20 - 22 August, 2008

4 - 6 April, 2008

10 - 11 May, 2008

Conference on Biomedical Electronics & Informatics (BEBI ‘08) Rhodes (Rodos) Island Greece

IDEM 2008 Singapore

1st International Online Medical Conference (IOMC 2008) Online, India

http://indiahealthsummit.com/

http://www.idem-singapore.com/

http://www.egymedica.com/index.htm

http://www.wseas.org/conferences/2008/rodos/ bebi/

http://ala.ir/iomc2008/

9 - 11 April, 2008 RFID World Asia 2008 Singapore, Singapore

http://www.terrapinn.com/2008/rﬁd/index.stm

24 - 27 September 2008 13 – 15 May, 2008 HOSPIMedica Australia 2008 Sydney, Australia http://www.hospimedica-australia.com

11 - 13 April, 2008 Pharma Future Expo ‘08 Singapore Singapore

http://www.pharmafutureexpo.com/

14 - 17 May, 2008

Unite For Sight Health Conference Connecticut United States of America http://uniteforsight.org/conference/2008/ registration.php

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http://www.healthcare-events.com/bihe/index. html

Kazakhstan InternationalHealthcare Exhibition (KIHE) Almaty, Kazakhstan

30 September - 2 October, 2008

18 - 20 May, 2008

14 – 17 November, 2008

Symposium on Health Informatics and Bioinformatics, HIBIT ‘08 Ýstanbul, Turkey

TELEMEDCON ‘08 Chandigarh India

http://www.healthcare-events.com/kihe/

12 - 13 April, 2008

Azerbaijan International Healthcare Exhibition (BIHE) Baku Azerbaijan

http://fens.sabanciuniv.edu/hibit08/

Hospital / Pharmatsiya St. Petersburg, Russia

http://www.primexpo.ru/hospital/eng/

Mail: meenusingh4@rediffmail.com

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Opportunities for Digital India healthcare industry in India is growing at a phenomenol pace - so are the standards

INDIA

2008 29-31 July, 2008 Pragati Maidan, New Delhi

of service delivery. technology is redefining ways of care management, clinical processes and business pathways. be it providers, payers or patients ..everybody can be a winner when technology lends its magic wand and transforms the way we do healthcare. Join us to find it all for yourself !

High powered sessions and panel discussions would focus on • IT Innovations in Healthcare Delivery • EMR Best Practices & Standardisation • Network Infrastructure for Connected Healthcare • TeleHealth Applications and Service Delivery • Medical Imaging & Diagnostic Technologies

...the definitive event on

healthcare ICTs, technologies and applications

• Information Sharing & Regulation for Insurance Sector • Investment Landscape in Healthcare & Medical Technology Industry • Medical Tourism - Opportunities for Healthcare Industry

For Programme Enquiries Dipanjan Banerjee (dipanjan@ehealthonline.org; Mob: +91-9968251626)

For Sponsorship and Exhibition Enquiries

...BE A PART OF IT

Arpan Dasgupta (arpan@ehealthonline.org; Mob: +91-9911960753) Amitabh Mukherjee (amitabh@ehealthonline.org; Mob: +91-9871686548)