CXO Accent

Information technology in healthcare

Dr Karanvir Singh

There are several benefits following the introduction of IT in administrative areas. However, in a healthcare set-up, the benefits of IT are supposed to be in patient care, and not just easy billing or patient registration

There are few spheres of everyday life that have not been affected by the IT boom. In most businesses nowadays, the use of information technology is becoming a critical success factor. Today, the ability of any given organisation to evolve its telecommunication and information technologies is one of the main elements that distinguish a successful company from a second-rate one. Not surprisingly, the healthcare industry has also tried to reap the benefits.

IT first entered healthcare where the benefits were immediately tangible. Reduction in the cost of carrying inventory following computerisation was apparent. The introduction of IT in these areas has followed the same trend in healthcare and other industries.

Similarly, the benefits of the introduction of IT in administrative areas were clearly visible. In India, most large hospitals, and quite a few smaller ones, have some software for managing these functions. Often, these are the only functions that are computerised in these hospitals.

However, in a healthcare set-up, the benefits of IT are supposed to be in patient care, and not just easy billing or patient registration. Direct healthcare benefits, including a direct effect on reduction of medical errors, and improvements in the quality of patient care and safety, have accrued mostly from computerisation of medical records. Although this has been the most difficult part, it has been the Holy Grail of medical computerisation for a long time. Clinical IT applications are increasingly supporting evidence-based medicine and patient-centric technologies, including monitoring patient outcomes and adverse events, as well as informing and empowering doctors to work for better outcomes. The combination of increased availability of patient-centric information, in the form of automatic alerts regarding allergies and drug interactions, and the increased availability of medical reference data, in the form of online drug prescription data and decision-support expert systems, has seen a reduction in medical adverse reactions in most studies worldwide. Other IT-related factors that have improved patient care include software-imposed enforcement of clinical guidelines and protocols, maintenance (and availability) of electronic medical records, and improved doctor-doctor communication via e-mail and the Internet.

But it has not been a success story all the way. Electronic medical records have been the most difficult to implement, the principal reason being the non-availability of appropriate technology. Doctors are willing to embrace IT as long as it does not interfere with their daily routine of patient care. In a hospital setting, doctors tend to be mobile, and computers tend to limit this ability. Mobile computing (laptops, PDAs) has reduced this problem, as have improvements in software technology, which allow a clinician to have a vast amount of clinical data relating to the patient in his mobile device. Although in India most software used in hospitals is developed locally—often in-house—it is only the recent availability of specialist Hospital Information Systems (HIS) software in India which is announcing this revolution. Leading in this field are HIS by TrakHeath (Australia), SISL (Bangalore) and Wipro (Bangalore). MedTrak by TrakHealth, which uses the power of Cache, a post relational database management system, has been implemented on an enterprise-wide scale at many hospitals in the country.

IT software can be expensive, but the costs associated with not being IT-enabled are too high nowadays. IT helps a hospital reduce the cost of insurance and malpractice, along with the legal costs, by countering errors and omissions. The savings incurred in these areas are themselves enough to justify the IT investments.

We can also look at stock-related issues and find out how IT applications help healthcare institutions handle several issues.

Stock Control

• Every single medicine consumed is recorded, so it directly affects stocks.
• At one end is a full clinical record, while at the other there is complete stock control.
• IT creates a definite possibility for the hospital to supply the medication required by the patient—stock-out situations become outdated.
• Even in case of stocks not being available, information regarding alternative medication and stocks is available immediately.
• Pharmacies in many hospitals are the highest revenue contributors, for example at Bangkok General Hospital.
• Clinical care regarding medication, drug-to-drug allergy interaction and drug-to-allergy interaction with respect to each patient are available with a pharmacist in advance.
• Inventory carrying costs are reduced.

In most hospitals, the need for IT applications was felt long back. With the HIS ERP implementation, all departments have been automated. The system is stable and Web-enabled, so it gives a two-way communication for many patient-related queries. Having laid a fully-automated HIS using Cache, it is easy for hospitals to grow into paperless ones. The interface between billing and the financial management system has been developed. The entire lab results are captured via Labtrak; users enter core data and doctors enter the most important information to create a full ERP system. As the use of this system grows, more features and functionality need to be added. In most cases, hospitals are able to add features after they deploy an application, which indicates that the system is easy to maintain.

We can now state with conviction that the use of the Internet will act as a catalyst for healthcare providers (both physicians and hospitals) to embrace IT. It will assist in the use of the Web for reference libraries for patient care. Web-based applications for staying in touch with patients, even remotely, will only increase in popularity from here.

The author is Consultant Surgeon In Charge, HIS Implementation, Sir Ganga Ram Hospital, New Delhi