IT in Healthcare: Welcome to the world of opportunities!
Introduction of Information Technology (IT) in healthcare sector has helped in maintaining medical records and hospital management along with increased customer satisfaction. Besides, it plays a crucial role in computers-assisted surgeries, robotic surgeries, teleradiology and telesurgery, simplifying the life of both the healthcare professional and patient. But has ‘IT’ penetrated rural India?
Dr Asma Mohd Yousuf
IT has evolved Indian healthcare sector in the recent past, especially in the areas of medical technology and health management information. IT has helped the Indian healthcare industry keep pace with technological advancements in developed countries. Today, most of the major players from the West are eyeing the Indian healthcare sector due to its large customer base.
Discussing the acceptance and adoption of IT in the Western countries in comparison to that in India, Mahesh Shinde, Deputy Director, IT and Telecom, Hinduja Hospital, Mumbai, says, “Doctors in the West are trained in hospitals with advanced Hospital Information System (HIS) solutions, hence the aptitude for IT is inculcated in the initial stages of their career. Whereas Indian doctors lack any form of IT training during the early stages of their career, thus, the late adoption and change in the management becomes difficult.” Moreover, he adds, “Since most healthcare consumers in the West are sponsored by insurance policies, cost of increasing healthcare is never a concern. Hence, the adoption of technology has been commensurate with latest advancements, research and development.”
It is worth observing how India faces a contrast of the situation in this case. Some figures are rather astonishing. As Shinde informs, “Due to constraints such as R&D expenditure, the available software and hardware in India do not match with those of the Western countries. The estimated IT budget for Indian hospitals is capped at about 5-10 per cent of the gross revenue, while that for Western hospitals are estimated to be about 40 per cent.” He explains, “In India, since over 80 per cent of healthcare expenditure is borne by the patients, price sensitivity is quite high and high-level healthcare facilities are not within the reach of the patient. Therefore, Indian hospitals do not generally invest in high-end IT infrastructure.”
Simplifying doctor’s life
With the range of solutions it provides, IT has pleased several professionals in the industry. As Avinash Chander, Assistant Manager – Medical Operations, S L Raheja (a Fortis associate) Hospital, Mumbai, says, “Role of IT is multi-faceted. At one end, it helps in retention of medical records and patient demographics aiding the healthcare professionals in better care provision, and on the other hand, it helps administrators and healthcare facility planners in better planning in order to meet the needs of the population. As it is often said ‘people die, but records do not.’ The documentation and storage of information has become so easy for the providers with minimum need to maintain paper-based records.”
However, doctor’s inclination towards adopting these new techniques also plays a major role. Also, with time, the medical fraternity is seeing the benefits, and is eager to adopt the same. Says Chander, “We still find nearly 70-80 per cent doctors struggling to utilise the capabilities of HIS. However, the accuracy of medical equipment, prevention of human errors due to erroneous transcriptions, and legibility of communication and notes are just a few benefits of IT-based solutions. Instead of boggling their heads into yellowed, crumpled and illegible documentations from the past, doctors can now go through systematic and sensibly arranged legible records of the patients in less than one tenth of the time taken before.”
Avers Dr Neena Pahuja, Chief Information Officer, Max Healthcare Institute Ltd, New Delhi, “Systems with alerts and notifications provisions have helped ensure availability of knowledge management systems to the doctors. Second opinion and collaboration for a patient along with clinical prognosis is now possible with IT systems across the globe.”
Today, with IT advancements, availability of Clinical Decision Support System (CDSS) with past Electronic Medical
Records (EMR) has ensured adherence to principles of evidence-based medicine that has helped in reinforcing patient’s credibility towards the doctor and trust in the treatment.
The power of computerisation
Computerisation improves the accuracy of diagnostic and treatment procedures and gives options to save, edit, mark, measure and take snapshots along with various other options so as to make the investigation or procedure meaningful. Chander explains, “Computerisation has helped in operating the equipment at any point/location and transferring the data through simple Local Area Network (LAN) cables to the server. Systems like Laboratory Information System (LIS) and Radiology Information System (RIS) help in relating the orders to the actual investigations, thereby preventing human errors, and also linking the orders with the results/reports along with an instant remote viewing option.”
The ultimate aim of any new technology is to make human life more convenient. To this effect, computerisation helps the hospitals with proper storage, organisation, management, analysis, on-demand prompt retrieval and use of data like images and EMR.
Agrees Dr Vishal Goyal, Chief Operating Officer, BGS Global Hospitals, Bengaluru, “EMR is yet to be legally accepted in India. But software/enablers are already available and used by the service providers to some extent in the country. Earlier the gap of launching advanced technology in India compared with the world was high, but with increased demand and paying capacity, now it is made available pretty soon.”
In this information age, there is hardly any new research that does not use computerised analysis. Shinde elaborates, “New research involves use of stem cells for treating paraplegics, coral in the treatment of non-union fractures and other pharmaceutical advancements are carried out with the aim of making human life better and more convenient. Robotic surgery facilitates complex surgeries using the remote access route, while enhancing precision in certain surgeries, like microvascular and neuro surgeries. Minimal Access Surgeries (MAS) have been possible with the use of the lumen camera relaying images to the screen that guides the surgeons. These archived images also serve as a basis for evidence-based medicine and can come in handy in case of a medico-legal negligence.”
Today, mobile health (m-health) and telemedicine are making rounds in the medical world. Telemedicine is a rapidly developing application of clinical medicine. It helps in transferring medical data through interactive audio-visual media for the purpose of consulting, and sometimes remote medical procedures or examinations. Telecardiology, teleradiology, telepsychiatry, telepharmacy and telesurgery are some terms associated with telemedicine.
Expressing his views on the importance of teleradiology, Shinde says, “One of the various low-cost innovative technologies is the Trans-Telephonic Electrocardiogram (TTECG). TTECG makes use of the regular telephone landline for transmission of ECG signals from the remote outreach centres to nodal centres of excellence. Private and trust hospitals like Narayana Hrudalaya, Manipal Hospitals, Gangaram and Apollo Group of Hospitals have rural outreach programmes that connect remote areas accessed from fixed stations or mobile vans via Integrated Services Digital Network (ISDN)/broadband network to nodal centres. Since these rural outreach initiatives are not highly financially rewarding for the private hospitals, the need of the hour for the government is to explore, and hence, promote initiatives like these by using Public Private Partnerships (PPP).”
Private vs government hospitals: Are they IT’ed?
Most of rural India is still dependent on the government for their healthcare needs. Informs Dr Goyal, “Primary healthcare centres located in the rural areas are now getting funded by the government and will soon see a surge of new technology at basic level. Secondary healthcare centres will be getting equipped with advanced imaging and laboratory equipment.”
As per Chander, “So far, there is more development in the private sector. The initiation and development of an HIS requires inputs as well as efforts in customisation based upon the requirements of the organisation. May be this is a reason for the government hospitals to adopt the technology, as there is lack of initiative, complex approval procedures, and also, lack of interest by the senior users, who are possibly computer-phobic. Most of the unit, whether government or privately managed, are however using the technology for billing purposes so as to have accuracy in accounts and finance field.”
However, Shinde says, “A general perception is that only private hospitals have a good IT infrastructure. In reality, though private hospitals were first to jump on the IT bandwagon, the government, government aided, semi-government and autonomous hospitals were not much behind. For example, Tata Memorial Hospital, Christian Medical College (CMC) Hospital and All India Institute of Medical Sciences (AIIMS) were the pioneers to use IT in healthcare. Other government hospitals are also adopting the route of the state-wide Hospital Management Information System (HMIS) network such as the recent initiative by the state governments of Karnataka, Gujarat, Goa and Delhi.”
Rural and urban India
Further, discussing the developments that have taken place in urban and rural India, Shinde informs, “By undertaking Corporate Social Responsibility (CSR) initiatives, private sector is helping in the development of IT in the rural areas. Confederation of Indian Industry (CII) is in discussions with government machinery that plans to make CSR initiatives mandatory. Due to the success of various pilot studies and CSR initiatives, there are islands of excellence in terms of India’s rural IT infrastructure.”
However, he also admits that due to various reasons, the implementers of the pilot studies have failed to replicate the successful model to other geographies. But with the advent of nationwide Worldwide Interoperability for Microwave Access (WiMAX) services from Bharat Sanchar Nigam Ltd (BSNL), information inclusion is becoming a reality in the remotest parts of the country. General Packet Radio Service (GPRS) use on mobile phones is also increasing. These developments will be exploited by service organisations like banks and hospitals, thus ensuring inclusive growth and development of the country.
IT can be used as an engine to integrate and optimise the available resources in healthcare. “Today, even though India has IT-enabled hospitals and other tertiary healthcare services especially in the metros, a similar infrastructure is lacking in smaller towns and rural areas, thereby depriving the population in these areas of modern healthcare facilities. This gap can be bridged effectively by integrating healthcare services through a robust information technology network,” says Ajit Dixit, Vice President – IT, Metropolis Healthcare Ltd, Mumbai.
Soon, the healthcare industry will be moving in the direction of using IT for capturing and storing the patient information for indefinite periods for faster access to service provision in future and also to utilise the patient information in terms of better patient care planning and administration. Chander adds, “The next level will be healthcare at the door steps of the patients with the help of facilities like online patient portals as well as e-hospital, which will ultimately reduce the traffic at the healthcare delivery centres, except in case of critical care patients as treating them requires special infrastructure unique to healthcare centres.”
Also, India should adopt model as followed in the Western world that enables effective communication between different IT systems across locations through common protocol/specifications as defined by Integrating the Healthcare Enterprise (IHE), feels Dixit. Moreover, a lot of progress needs to take place in tele-health, m-health and home health scenario. Such advanced techniques will reduce hospital stay, and thus, hospital beds can be utilised for treatment of many more patients. Moreover, the data captured will provide effective analysis on the disease trends, clinical studies, disease profile and impact of various remedial measures. And thus, gradually, prevention will become a major focus area. However, no economy can cater to the needs of such a huge population as ours without appropriate healthcare policies. Therefore, government support is a must to make IT in the Indian healthcare set-up as competent as that in the developed countries.
With proper guidelines and adequate investments in terms of finance, research and manpower, IT has, and in the near future, will further reform the Indian healthcare scenario not just to find health solutions for medical tourists, but also for the common man residing in the remotest location of our country.