Feature

A shot of hospital information systems

Competition has forced hospitals to adopt technology, and private sector hospitals are taking the lead, says Sushma Naik.

It may be a while before you get a prescription to correct your heartbeat via your mobile phone, but Indian hospitals are initiating steps on this journey by implementing hospital information systems (HIS). HIS are evolving from order entry systems, administrative systems and departmental subsystems to one solution which is the hospital’s ERP.

Hospitals in India are in various stages of implementing HIS. “We are a multi-location hospital and nearly 70 to 80 percent of the hospital’s activities are covered by the HIS. It is difficult to say that we have arrived with an implementation such as this,” says Sunil Kapoor, Corporate IT Head, Fortis Hospitals. Some of the modules that are present in HIS are registration, emergency, OPD, wards, laboratory, billing, help desk, purchase and pharmacy. “Our HIS encompasses most of the functions and work flows of a hospital such as billing, material, administrative, clinical back office and MIS integrated as one system,” says Suresh Shenoy, VP, IT, Wockhardt Hospitals. The trend is catching on rapidly, and most hospitals have already started this process in the last decade.

Long-term benefits

Hospitals are of the opinion that deploying HIS will not make healthcare more expensive. Currently, corporate hospitals are deploying HIS as they are in a position to sustain the huge investment. Healthcare in India is just beginning to realise the importance of integrated, configurable systems. “It will take a couple of years to reach a level of maturity. With stress on international quality standards and best practices, an attempt has been made to imbibe the same in IT systems,” adds Shenoy.

Medical tourism is not a major factor for technology implementation in Indian hospitals. The greater chunk of such tourism comes from India and its neighbouring countries. Having said that, if systems are in place, it might just boost tourism. “Patients are the same whether national or international; however, the expectations of foreign patients are usually a little higher,” comments Mahesh Shinde, CIO of Hinduja Hospital in Mumbai.

The central Ministry of IT has created a sourcebook, A Proposed Framework for IT Infrastructure for Healthcare in India. The document speaks of being an initiative towards standardising and seamlessly integrating the various sectors of healthcare on common platforms to bring in economies of scale. Its implementation is, however, yet to see daylight. The healthcare industry in India is also trying to bridge the gap between technology and medical needs.

The Medical Computer Society of India (MCSI) believes that some medical institutions in the west have already spent millions of dollars only to later realise that some systems do not suit their purposes. They fear that a similar scenario of haphazard deployment of medical software systems is going to follow in our country as well. To avoid such a situation, the institute co-ordinates the expertise of specialised doctors who have an interest in bringing technology to healthcare.

A team effort

Hospitals which have deployed HIS have solutions from different vendors with the in-house IT department building a lot of the modules. A case in point is Fortis. “We had tried to deploy the European system, but that did not work out. The Indian medical system is largely private as opposed to the European system. Hence we were left with no choice but to develop our own,” says Kapoor.

Others such as Wockhardt have worked with vendors. Wipro developed a core ERP called HIS Version 2.0 with inputs from Wockhardt and Harvard Medical International, US. The local IT team developed some tools and MIS around an ERP. Much of the automated lab equipment and EPABX systems interact with the HIS, ensuring the data flow, and avoiding duplication and error. This medical equipment and related software is sourced from different vendors, says Shenoy.

This system is being deployed in Mumbai and Nagpur, and is based on Microsoft Windows Server with modules that cater to all functions—from administration and marketing to billing and health check-ups.

An integrated system

Having an integrated system obviously helps ensure smooth functioning. Hospitals have a critical environment, and improving efficiency can mean saving lives. According to Kapoor, by having the HIS connected to front-office systems, patients could be informed well in advance of requirements such as not consuming any food for an hour or two before a particular medical test.

HIS supports complicated packages to be defined, administered and billed. Confusion in package billing is a major source of revenue loss the world over, believe experts. Inventory control gets better as every item is tracked from purchase to consumption.

Departmental stock is also tracked. Any number of stock points can be created in HIS, from material inflow following indent to acknowledgement with receipts. Reduction of time in various patient-care processes such as registration, lab results and billing can be achieved. Integration of various system components (all modules of stock/billing/ registration/clinical/ward/pharmacy) helps in the natural workflow and in maintaining consistent information.

Shenoy says that OPD appointments can be scheduled on the phone based on a doctor’s availability. This information is entered into the system which enables the doctor to plan his visit better based on the actual number of patients who have registered to meet him. The dose advised can be issued to pharmacy directly and the pharmacy in turn can respond to it.

So how much are hospitals investing in IT? IT investment may generally be 3 to 7 percent of the overall hospital infrastructure budgets, say CIOs. Hinduja Hospital has spent about Rs 2.5 crore in phases over a decade to deploy HIS. “Over a period of two years and above, the realisation on investments boosts the bottom line. Also, one has to remember the value addition in the quality of care delivered to patients,” says Shenoy.

Though it was earlier a challenge to get doctors to use the system, Kapoor says that of late they are excited about the integration of medicine and IT, and often encourage the IT team to expand the deployment to address more areas.

Our HIS encompasses most of the functions and work flows of a hospital such as billing, material, administrative, clinical back office and MIS integrated as one system Suresh Shenoy VP, IT Wockhardt Hospitals	Patients are the same whether national or international. However,the expectations of foreign patients are usually a little higher Mahesh Shinde CIO Hinduja Hospital

PACS is next

The next system that most Indian hospitals are looking to deploy is Picture Archiving and Communication Systems (PACS) that is used to capture, store, distribute and display medical images. Electronic images and reports are transmitted digitally via PACS, eliminating the need to manually file, retrieve and transport film jackets.

A PACS system comprises four principal components: imaging such as CT and MRI, a network for the transmission of patient information, workstations for interpreting and reviewing images, and long- and short-term archives for retrieving images and reports. Combined with the emerging Web technology, PACS has the ability to deliver timely access to images, interpretations and related data. PACS breaks down the physical and time barriers associated with traditional film-based image retrieval, distribution and display.

“In the next phase, there is a plan to integrate PDAs, tablet PCs and cell phones,” says Shenoy. The Internet holds much potential. Tele-communication between a central hospital and a satellite clinic or hospital can be enabled especially when a physician consults with domain experts in other hospitals concerning a patient’s case.

HIS combined with the Internet can enhance personal communication among healthcare staff using e-mail, transfer clinical information about patients between two hospitals or clinics for consultation or decision support, retrieve up-to-date medical information from the Web, and initiate discussion among healthcare providers and researchers by using e-mail lists, real-time video chat systems and various electronic textbooks.

While this is being realised abroad, it may take some time for such automation to come in India. However, the process has begun, and the efforts of the Indian healthcare industry are currently to integrate their systems and and get them to work efficiently before bringing other technology benefits to patients.

sushma@expresscomputeronline.com