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IT in healthcare

IT can boost the growth of the healthcare industry and at the same time improve the overall experience. By Varun Aggarwal

The healthcare industry is one of the biggest spenders on IT across the globe. However, the same is not true in the Indian scenario. The Indian healthcare industry has confined its use of IT to billing, inventory and other peripheral functions. Only a few hospitals and healthcare centres in India have gone ahead and implemented IT to support clinical functions. This implies a vast scope that IT can seek in this industry as the healthcare industry is gradually awakening to the IT revolution.

Small and mid-sized hospitals face a number of challenges in competing with large hospitals. Providing similar facilities without increasing expenditure is one such challenge. Software vendors claim that IT can drive mid-sized hospital business and help them compete with the giants. Anurag Dubey, Sr. Research Analyst, Healthcare Practice, Frost & Sullivan–South Asia & Middle East, points out, “A mid-sized hospital spends less than 1.5 percent of its turnover on IT (new investments plus the annual maintenance) while a large hospital spends less than two percent of turnover on IT (new investments plus the annual maintenance).” He predicts that the growth rate of IT in healthcare is going to be 15 to 20 percent CAGR.

The total domestic IT-BPO market was estimated to be $13.2 billion in 2006, of which healthcare sector accounted for only three percent, according to a NASSCOM report. That said, the projected numbers indicate that the healthcare industry is becoming more focussed on IT and is realising the difference that technology can make in terms of productivity, controlling expenses and a better experience.

Problems with HIS/HIMS

If IT spending in hospitals across the world are so high, then why is that Indian hospitals are lagging behind? The answer to this could be the high failure rates of HIMS (Hospital Infrastructure Management Services) projects. Some of the most common functional areas which are automated are accounts, billing, front office, laboratory, inventory & purchase, payroll & personnel, pharmacy, MIS and radiology reporting. However, in most cases, the software applications for the functional areas are standalone applications bought from different vendors. Such a thing makes overall IT infrastructure management difficult leading to inconsistency.

Companies have started looking at return on investment while going for IT deployments. However, most IT companies find it difficult to determine RoI in the healthcare sector. As deployments like ERP, HIMS and PACS take a long time before their returns are visible; a lot of small and medium hospitals decide to skip the same.

Dr. Vijay Singh, IT head and medical officer, healthcare relations and telemedicine, Narayana Hrudayala Hospital explains, “It is very difficult to convince doctors to use IT, which poses a challenge for IT deployments in hospitals, though these days a number of doctors are becoming technology savvy.”

Suprabhat Chatterjee- National Business Development Head- Cisco India & SAARC says, “Like in other industries, rising costs, inefficiencies, and labour shortages continue to plague physicians, clinics, and hospitals. The healthcare industry is constantly looking to reduce the cost of doing business. With a focus on operational excellence, healthcare firms are increasingly waking up to the benefits of IP communication solutions. These solutions provide near real-time access to information through wireless networking, nurse call, and location-based services. Organisations that deploy advanced applications can improve patient care, streamline operations, and contain costs.”

At the same time, IT companies are working to improve the quality of medical care; healthcare players are establishing ways to give customers easy access to pertinent information and pharmaceutical companies are moving to speed development and delivery of new drugs. Utilising the Internet as the platform for integrating and automating a wide range of clinical, customer-facing, and back-end applications, hospitals are constantly looking to reduce medical errors. Companies are saving substantially with Internet-based claims management and customer-facing Web portals. Pharmaceutical companies are going online to shorten the development and approval cycle of new drugs. IT has thus become a crucial component for the success of healthcare companies and vendors are focusing on providing customised solutions for the healthcare sector.

Replacing legacy systems

Healthcare firms are seeking every advantage that new information technology can offer. Organisations are now moving to use IP based mobile applications, using the proven ability of wireless IT applications to improve treatment at the point of care and to support clinical decisions by providing instant access to medical records, healthcare organisations have been able to improve responsiveness and treatment accuracy and to save lives as well as millions of dollars.

In addition, recent improvements in wireless infrastructure security and advanced applications, such as location-based tracking and voice over WLAN, have provided further gains in productivity and patient care. Dubey feels that IT can improve customer satisfaction by making processes more efficient, lowering cost (purchase, inventory, billing etc.), providing better MIS, clinical benefits, plugging seepage of revenues, enabling faster and quicker record search, reducing pilferage, bringing about transparency and ethical practices, better manpower utilisation, better control and act as a driver for business growth.

Prasenjit Lahiri, Head Business Operations - Wipro HealthCare IT Ltd. opines,” The trend is towards the replacement of legacy standalone HIS applications with end-to-end comprehensive solutions that address the all round needs of hospitals labs to wards, patients to doctors, leverage on the Web to reach out to patients and suppliers, integration with lab equipments, alerts and notifications—-leading to a digital hospital concept.”

Next generation technologies

One of the most promising technologies is Picture Archival and Communications System that is better known as PACS. It enables images from various modalities such as ultrasonography, magnetic resonance imaging (MRI), endoscopy, mammography and radiology to be stored electronically. Lahiri explains, “PACS helps coordinate all aspects of digital imaging in the hospital or clinic. This includes capturing images from DICOM complaint imaging modalities and video sources, storing this clinical information in a secure environment, and distributing and displaying both clinical images and corresponding diagnostic information. Integration of the PACS with the HIS helps in the PACS data being visible to the consultants and doctors along with the patient medical records and helps in the diagnostic processes and also reduces delay due to non availability of the picture reports on-time. It also helps patient getting their reports faster and synchronised with their appointments.”

Although this technology is not really new, it’s still at a nascent stage in India creating a tremendous market for IT vendors to exploit. PACS is poised to replace the age-old method of storing medical images as hard copy or on film. PACS consists of four major components: the imaging modalities such as CT and MRI, a secured network for transmission of patient information, workstations for interpreting and reviewing images, and long and short-term archives for the storage and retrieval of images and reports.

Images from different modalities come into the PACS station simultaneously. Typically, the storage capacity of a PACS server varies between 1.5 to 2 terabytes for a 100-bed hospital. Experts also suggest that the time duration for storage of images should be rule-based.

Combined with available and emerging Web technology, PACS has the ability to deliver timely and efficient 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.

If implemented and used well, PACS also becomes a potential source of saving revenue for the management. Monetarily, the returns may not be immediate, but it is a one-time investment, as in the long run, films work out to be more expensive than establishing a PACS network.

Telemedicine

Tele-consultation and remote-patient-monitoring is taking a big leap in India to integrate the fragmented healthcare industry. The technology of treating patients while the patient and doctor are geographically distant is best suited for the Indian healthcare scenario, where cost and accessibility of quality care for a section of society is still a big question.

Dr Singh explains, “In a number of medical cases, for instance in case of an epileptic patient, where direct contact with the specialist is not required, telemedicine can ensure the treatment of the patient in a remote location with a regular doctor as a mediator between the patient and the specialist. With more than 60 to 70 percent of India’s population residing in rural villages and 90 percent of specialists and super specialists residing in urban areas, telemedicine can revolutionise the way we treat patients in remote areas.”

Telemedicine is now an integral part of healthcare services in many countries. Once the virtual presence of a specialist is acknowledged, a patient can access resources in a tertiary referral centre without the constraint of distance. Ambulance drivers using a GPS in a palmtop can quickly reach an accident site. Automated voice message (AVM) systems could be used as an adjunct to primary care for diabetic patients. An AVM monitoring protocol can inquire about a patient’s glucose, diet and medication. Patients have the option to listen to health promotion messages. Hand-held Simputers are being used by midwives and public health nurses in pilot projects in India.

With technology’s position changing from being a support crutch to a business driver, healthcare has a lot to gain. If all organisations in this field realise this fact, India will soon be among the best in terms of healthcare services.