10030241144_Prof Apoorva K_Dissertation PPR-II

8/3/2019 10030241144_Prof Apoorva K_Dissertation PPR-II

http://slidepdf.com/reader/full/10030241144prof-apoorva-kdissertation-ppr-ii 1/27

apoorva

[Pick the date]

Second Progress Report on

³An empirical study on healthcare industry in India and the usage andimpact of IT in healthcare in India.´

Submitted by

APOORVA SRIVASTAVA

PRN: 10030241144

MBA-ITBM

(JUNE 2010-12)



TABLE OF CONTENTS

LIST OF FIGURES ...................................................................................................................................... 2

LIST OF TABLES ........................................................................................................................................ 2

LIST OF ABBREVIATIONS .......................................................................................................................... 2

CHAPTER 1-- Healthcare Industry- An Overview .................................................... ...................... ............. 3

1.1 Healthcare in India ......................................................................................................................... 3

1.2 Analysis of Existing Trends in Market.............................................................................................. 4

1.2.1 Based on Geographical Diversity.............................................................................................. 4

1.3 Growth of the Healthcare market ........................... ................................ ...................... .................. 5

1.3.1 Indian Healthcare Sector structure / Market size ................................................. .................... 5

1.3.2 Average healthcare spend of Indian population ............................ ....................... .................... 6

1.3.3 Current Healthcare Landscape- 2010 ........................................................ ...................... ......... 7

1.3.4 Key finndings of current private spending- 2010 ................................ ....................... ............... 8

1.3.5 Road Ahead 2012 ................................................................................................................. 9

1.5 Analysis of challenges faced ........................ ................................ ...................... ............................ 9

1.7 Long term growth opportunity for private players ................................ ...................... .................. 10

CHAPTER 2 -- IT in healthcare................................................................................................................. 11

2.1 IT in Healthcare ............................................................................................................................ 11

2.2 Drivers for Adoption of ICT in Healthcare ..................................................................................... 12

2.3 Areas of healthcare where IT is used ............................................................................................ 12

2.3 Current trends of applications and technologies used ......................................... ....................... .. 14

2.3.1 Commonly Used Applications................................................................................................. 15

2.3.2 Telemedecine and E-healthcare ............................................................................................. 17

2.3.3 Social Networking in healthcare ............................................................................................ 17

2.3.5 Cloud Services in Healthcare .................................................................................................. 20

CHAPTER 3 -- Focus For Next Deliverable ............................................................................................... 26



LIST OF FIGURES

Figure 1 : Inter-zonal Dynamics of Healthcare in India

Figure 2 : Statistics for Hospitalization/1000

Figure 3 : Break-up of expenditure on healthcare by an Indian family

Figure 4 : Healthcare landscape- 2010

Figure 5 : Indian Government Budget allocation for healthcare

LIST OF TABLES

Table 1: Distance a family is willing to travel for healthcare facility

Table 2: Applications used by health care organizations

LIST OF ABBREVIATIONS

PACS -- Picture Archiving and Communication Systems

RFID -- Radio Frequency Identification

CDSS -- Clinical Decision Support Systems

EMR -- Electronic Medical Record

DIACOM -- Digital Imaging and Communication in Medicine



CHAPTER 1-- Healthcare Industry- An Overview

1.1 Healthcare in India

Growing population, increasing affordability, comparative cheaper treatment costs as

opposed to the west and medical tourism thereof, increased health insurance penetration,increased patient awareness, out-of-the-box unconventional thinking by the healthcare

players for better operations, government opening up its arms to PPP and even providing

tax holidays will be the key factors to look out for which would drive the future of

healthcare in India, according to Dr Akash S Rajpal, Head, Consultancy Services, HOSMAC

India Pvt Ltd

As per various studies including a report by IDFC, and Mc Kinsey, Indian Healthcare

industry will be worth $125 billion in the next five years. Public spending is likely to

increase beyond 20 per cent, there is room for everyone in the organised private healthcare

sector.

India presently has a bed deficit of approximately 30 lakh beds as per the WHO

recommendation of four beds per 1000 population. Considering even a 250 bedded

hospital on an average, the country would need 12000 hospitals in the near future. As

almost 80 per cent of this would be fulfilled by the private players, a huge rise in IPO's and

premium commanding players in the arena would flutter bringing in interesting times for

the healthcare industry.

As the density of population varies across the Indian states, the geographical area coveredper medical institution also varies greatly. Among the low-density states, while Madhya

Pradesh has one medical institution per 220 square kilometers, West Bengal has one per 35

square kilometers. Among the high-density states, Kerala has one medical institution per 8

square kilometers while Maharashtra has one per 23 square kilometers. (Kerela)

( Source: Centre for Development Studies Kerala)

K ey Segments in Healthcare

y Pharmaceutical US$10 billion growing at 12% despite global economic pressures

y Hospitals/Nursing Homes $12 billion growing at 20%

y Medical Equipment $2 billion, growing at 15%

y Clinical Lab Diagnostics US$2 billion growing at 30%

y Imaging Diagnostics US$1 billion growing at 30%



y Other Services (includes Training & Education; Aesthetics & Weight loss; Retail

Pharmacy; etc. US$2 billion growing at 40%

1.2 Analysis of Existing Trends in Market

1.2.1 Based on Geographical Diversity

Indian states are highly diverse with respect to their economic conditions, infrastructure

and social development . Similarly, the dynamics of healthcare also vary widely across the

states.

For example, Kerala with an exceptionally advanced healthcare system has one hospital

bed for every 325 persons which is also an indication of a high proportion of people

receiving hospitalized treatment in the state. On the other hand, poor accessibility of

healthcare facilities in states like UP, Bihar & Jharkhand limit the utilization of medicalservices.

Fig 1: Interzonal Dynamics of healthcare in India (Phillips Healthcare India, 2011)

Such inter-state disparity in availability and utilization of healthcare services and

manpower are distinctly marked across the country. Geographical access in low income

states is further limited by poor healthcare financing, dysfunctional infrastructure and

inadequate human capital.



Fig: 2 Hospitalizations/1000 (Technopak Analysis)

1.3 Growth of the Healthcare market

(masetti, 2010)

(www.

harneedi.

com- Article Written by Jairam Masetti Friday, 07 May 2010 19:56)

The Indian healthcare industry, unlike other industries, stands untouched by recession.

There had been a steady growth in this sector, revenues from the healthcare sector

accounts for 5.2% of the GDP, making it the third largest growing sector in India, and

further the healthcare sector is projected to grow to nearly 1,80,000 crores by year 2012

and a compounded annual growth rate (CAGR) of 15-17 percent for at least the next 7-10

years.

1.3.1 Indian Healthcare Sector structure / Market sizeThe sector comprises hospital and allied sectors that include:

(a) Medical care providers that includes physicians, specialist clinics, nursing homes and

hospitals

(b) Diagnostic service centers and pathology laboratories

(c) Medical equipment manufacturers

(d) Contract research organizations and pharmaceutical manufacturers

(e) Third party support service providers

In India, 80% of all the healthcare expenditure is borne by the patients.

Expenditure borneby the state is 12%. The expenditure covered by insurance claims is 3%. As a result the

price sensitivity is quite high. The high level healthcare facilities are out of reach for the

patients.

Among the top five therapeutic segments, gastro-intestinal and cardiac are experiencing



both high volume and value growth. Opthologicals, cardiovascular, anti-diabetic and

neurological drugs continue to top the growth list . The anti-infective, neurology,

cardiovascular and anti-diabetic segments have witnessed a high number of new product

launches in recent years.

1.3.2 Average healthcare spend of Indian populationIndia Healthcare Trends 2008

The eight Indian metro cities have health care delivery formats that can be compared to the

best institutions across the world. However this level of health care has not yet percolated

to the Tier II, III Cities and Rural India. One of the greatest concerns for the people residing

in Tier II, Tier III Cities and especially Rural India is the fact that they have to travel long

distances to access health care services. Though a large number of hospitals have been

commissioned in the smaller towns in last few years, 46% of patient volume of hospitals

comes from patients who travel more than 100kms.

On an average a patient spends Rs.9400 for an episode of hospitalisation, which includes

hospital bills, spends on drugs and diagnostic tests.

Table 1: Distance that patients are willing to travel(India Healthcare Trends 2008)

Over and above hospitalization expenditure, a middle-class patient incurs 30% of the

hospitalization cost on travel, lodging and other related costs.

Analyzing the break-up of the expenditure, we have-



Fig: 3 Break-up of the expenditure on healthcare by an Indian family (India HealthcareTrends 2008)

1.3.3 Current Healthcare Landscape- 2010

y Amount spent on healthcare - 103,000 crores / annum

y 86,000 crores is the Healthcare delivery market

y 17,000 crores is the Retail pharma market

Fig 4: Current Healthcare Landscape (Source: Self- Compiled)

0

20

40

60

80

100

120

Healthcare Total AmountHealthcare Delivery market Retail pharma market

Series 1



y 600,000 practicing physicians

y 15,000 hospitals

y 875,000 hospital beds

y 737,000 nurses

y 170 medical colleges

y 350,000 retail pharmacies

y 18,000 new doctors every year

y 50,000 pathology laboratories

MEDICAL CARE INFRASTRUCTURE (Source: ICRA)The medical care infrastructure in India includes overy 500,000 doctors,y 15,000 hospitalsy 875,000 beds.

In addition, semi urban and rural regions have overy 23,000 primary health centresy 132,000 sub-centres.

Despite an extensive public healthcare infrastructure, the private sector now dominates themarket .

PUBLIC HEALTHCARE INFRASTRUCTURE

(Source: ICRA)

UrbanTertiary Medical Colleges & Hospitals 117ESI and PSU Hospitals 1200Urban Health Posts 1500

Rural District and Taluk Hospitals 4400Community Health Centres 2400Primary Health Centres 23,000Sub Centres 132,000

1.3.4 Key finndings of current private spending- 2010

y Private spending on healthcare delivery 69,000 crores

y 61 % of this is spent on OPD services, 44,000 crores Indicates low levels of affordability

and a disease pattern dominated by infections

y 39 % on IPD services = 25,000 crores



y 85 % of IPD spend is in 5 areas : cardio, cancer, accidents, infections and maternity

1.3.5 Road Ahead 2012

y Private spending on healthcare delivery 156,000 crores because of an increase in

population will lead to increase treatmentsy Change in socio-economic mix will lead to 8 % increase in treatment rate and 30 %

increase in avg. price paid

y Change in prices 26 % increase in price per treatment

y Change in mix of diseases 50 % increase in prevalence of lifestyle diseases will lead to

12% increase in treatment rate & 7 % in price and this would lead to a change in GDP from

5.2%to 6.2%

y Richest 15% will account for 50% of all private healthcare spending & 60% of inpatient

spend

y Private spending would increase by another 39,000 crores if the insurance is likely toimpact on middle-income households approx. 350 million in 2012, leading to achieving

GDP spending to 7.5% and private spending on healthcare delivery to 195,000 cr.

1.5 Analysis of challenges faced

y High capital costs: Depending on the region and real estate costs, an average hospital

requires capital infusion of Rs 40 lakhs to a crore per bed (& even more).

Industryestimates suggest that any hospital with capital costs of more than 50 lakhs per bed has

high gestation period and even may be unviable . Land and building together account for

almost 40 per cent of the total project cost and affects the viability depending on the

resulting per bed cost .

y Medical equipment: Contributing to almost 40 per cent costs in a tertiary setup, the

medical equipment though cutting edge at the time of purchase poses the threat of

inevitable obsolescence within five to seven years of setup. This problem is

compounded by the fact the most of such equipment is imported and very few local

reputed manufacturers exist . This will lead to apportioning to higher treatment costs

and will further lead to lesser competitive edges and low utilization rates resulting in an

undesired operating margins.

y Human resources: As Dr Prathap Reddy puts it, "the biggest challenge for him and

Apollo is filling the void of human resources". The fast-expanding domestic healthcare



industry is the third largest employer, but is severely short of manpower, according to

him. As per ministry of health, there is a shortage of approximately half a million

doctors, a million nurses and the deficit needs to be filled in the next five years . Such

shortage will lead to exponential salary hike demands, and further lead to high patient

care costs. With organised sector being the preferred choice now, there will be a huge

demand even for the skilled and quailed health administrators to run the show.

Considering one skilled and qualified administrator is required for every 50 employees,

there would be a requirement of almost 50000 such healthcare professionals in the

near future. Highly regulated environment and unrealistic stringent norms and

restriction of entry to the private entities in the field of medical education has led to

further deficiencies in terms of number of skilled professionals being released for intake

by various hospitals.

1.7 Long term growth opportunity for private playersWhile the government budgetary allocation on healthcare has increased at 26% CAGR

between FY06-FY11, it is not sufficient to meet the demand for healthcare infrastructure .

By 2013, an about 350,000 additional hospital beds are required to meet demand

requirements, which would involve an investment of almost Rs873B. Over the next 15-17

years, about Rs5000B of cumulative investments are needed for setting up hospital beds to

cater to the growing demand. This demand can not be met by government investments

alone and will need to be funded by private investments. Thus, a significant opportunity

exists for the private sector to participate in the healthcare delivery market .



Fig5 : Indian government budgetary allocations on healthcare (Govt . of India budget

documents)

CHAPTER 2 -- IT in healthcare

2.1 IT in Healthcare

Information Technology (IT) has tremendous potential to improve the quality, safety, and

efficiency of health care. Globally, healthcare has been receiving significant amount of R&D

focus to improve diagnostic and therapeutic solutions. The use of ICT to meet non-clinical/

administrative challenges within the healthcare sector has been prevalent in the developed

economies and is largely driven by industry complexity and government mandates. The

need for interaction and information sharing between various participants (hospitals,

doctors, labs, insurance providers and the government) and greater use of clinical tools

with digital outputs has made Information Technology ubiquitous in Healthcare

Administration.

Gartner estimates that US Healthcare providers spend approximately4.2% of Operating Expenses on Information Technology Initiatives1

. As a result, healthcare

providers have adopted the digitization of medical records such as patient information,

diagnoses, prescription and diagnostic images.

The use of Information Technology (IT) can play a very important role in enhancing the

healthcare delivery mechanisms. While IT applications in the healthcare space have been

increasing in India, they are still quite limited when compared with developed countries.

Some areas where technology is being applied are hospital management systems, decision

support systems that improve diagnosis and treatment, telemedicine and PictureArchiving and Communication System (PACS).

Use of IT in healthcare improves patient care by enabling systems and processes to be

introduced and monitored repeatedly. However, lack of standardization and regulations in

the sector have been the major roadblocks in adopting IT solutions. Also, the fragmented

nature of the Indian healthcare system has considerably slowed down the adoption of IT in

the sector

In India, information archival, retrieval and sharing has been largely paper based as the

healthcare sector is predominantly unorganized and the enforcement of government

mandates lax. However, there is a rapid change in the Indian landscape and healthcare

providers are turning to technology for improving administration challenges. Indian

healthcare providers are rapidly adopting Patient Scheduling, Hospital Information

Systems (HIS), Electronic Medical Records (EMRs), electronic Picture Archiving and

1Gartner IT Spending and Staffing Report, 2008 - ID Number: G00154809



Communication Systems ( PACS), Radio Frequency Identification ( RFID), Bar Codes, Clinical

Decision Support Systems ( CDSS) and Telemedicine technologies.

Private hospitals are also realising economies of scale by targeting specific services such as

maternity care, and by making heavy use of the sort of information technology that many

Western countries are struggling to introduce.

2.2 Drivers for Adoption of ICT in Healthcare

y Arrival of new players with international partners brining international practices

y Aware and demanding consumers, asking for second opinions

y Transition of diagnostic tools to network aware and with digital outputs

y Greater acceptance of Health Insurance

y Efficiency improvement in Asset Management

y Government initiatives

2.3 Areas of healthcare where IT is used

Management of Supplies and Equipment

y Advanced information technology (IT) systems are needed for ordering, inventory

control, finding and distributing supplies

y Cost control and avoidance of theft and waste

y Use of Radio Frequency Identification Tags (RFID) and bar coding for locating and

keeping track of supplies and equipment y Business Process Improvement systems; improvement of quality of delivery of

services

EMR and Patient Information

y Electronic Medical Records (EMR)

y Importance of access and accuracy of medical history of patients

y Privacy issues regarding storage and access to information

y Diagnosis, treatment and potentially detrimental other information being accessed by

patient or others (e.g., sexually transmitted disease, genetic disease or DNA disease

susceptibility analysis information)

Patient Information

y Clinical Information Systems for patient charting

y Use of wireless personal digital assistant devices (PDA) for access to and updating of

EMR



y Potential for patients to have personal card, RFID device, implanted device containing

blood type, disease, and other EMR information

y Treatment information to be generated and stored for later reference in EMR

y Tie in of EMR treatment and prescription information to pharmacy for providing

appropriate medicines and dosages for patients

Prescriptions and Medications

y Computerized generation of prescription to avoid errors

y Computerized generation of labels; drug ingestion or use instructions; warnings

y Computerized cross checking of prescription against patient information on allergic

reactions, drug interactions, appropriate dosage levels

Management of Patient Treatment

y Specialized information technology systems to manage appropriate treatment tied

into diagnostic databases, patient personal information and diagnosed conditiony Use of IT systems to manage and avoid errors in special care environments such as

operating rooms, emergency rooms, pediatric care and intensive care wards

y Use of IT systems to aid nurses in providing proper treatment (Nursing Informatic

Systems), monitoring patients with sensory equipment for vital signs

y Use of local robotic delivery systems to provide equipment, medications, and

nutrition

y Wireless communication for doctors and nurses to avoid pagers and delays in

providing information regarding patients and treatment

y Use of distance diagnosis and treatment with high speed digital communications

links; transmission of charts, monitoring information, x-rays and scans

y Patient access to doctors and medical information over Internet

Staff Development and Training

y Use of Internet based training to maintain best practices and skills for hospital or

other healthcare institutional staff

Billing and Collection Information

y Particular importance in US because of lack of national healthcare delivery and

insurance systemy Computerized monitoring of use of proper medications, medical equipment,

treatment procedures for cost control

y Determination of proper codes for treatment and billing for services used by private

insurers to make payments to providers of care

y Development of national databases for tracking illnesses, treatment methods and

effectiveness of medications and treatments used



Medical Research

y Tracking of methodologies used, compliance with government reporting and safety

requirements

y Specialized IT systems to track information and provide reports in form necessary for

government approval of new drugs

Interactions with Health Insurance Providers

y Most developments in the IT space for Indian health insurance took place in the last

decade

y Arrival of Private insurers and TPAs led to investments in claim processing systems-

steadily evolving into Business Intelligence tools and MIS applications

y IRDA Data Working Group led to early adoption of ICD-10 as the diagnosis standard

in 2004, while TAC reporting formats emphasized standardization and compilation of

data across the industry. Data repository (now IIB) has compiled millions of records

since 2004.

y Arrival of mass government HI schemes brought new expectations and capabilities-

smart cards for offline authorizations, paperless claim submissions, VPNs and CUGs,

expectations of 100% cashless authorization, specific data analytics- and this is just

the beginning.

y Experiments with mobile phone payments, handheld devices, prepaid insurance kits,

prepaid pharmacy cards, e-vouchers for physician consultation are already underway.

2.3 Current trends of applications and technologies used

The health care organizations are today dependent upon software applications which

provide the platform through which various medical functions are performed such as

health care management, HIS, image processing, MRI scan, etc.

As per current market analysis we can see upsurge in usage of IT Systems in healthcare

sector because of various factors such as:

1. Cost-effective recurring subscription and service fee models

2.

Growing Communication & IT Infrastructure3. Domain Specific Consulting and Technology solutions

The main aim of any hospitals or healthcare provider is to:

1. Improve patient and staff satisfaction

2. Improve financial performance



3. Improve revenue cycle and reduce cost

Nation and Region Wide Electronic Health Records are being deployed in several countries

around the world to enable sharing the care records within the organization and between

different organizations. Healthcare industry providers are under pressure to integrate data

across the entire continuum of care while building the patient loyalty.

Healthcare industry solutions should be provided in such a way that that it meets the needs

of smallest clinic to the largest health organization.

2.3.1 Commonly Used Applications

EMR: An electronic medical record (EMR) is a medical record in digital format . It is an

important factor for interoperability (ability of different information technology and

software applications to communicate to exchange data accurately) to share data between

practicing physicians, pharmacies and hospitals.

It has several features as mentioned abovein the last page. There are some features like insurance record, alert system, electronic -fax-

to-e-form which are developed by selected vendors only. Also there are some common

features like patient dashboard and medical history.

PACS: In medical imaging, picture archiving and communication systems (PACS) are

computers or networks dedicated to storage, retrieval, distribution and presentation of

images. The medical images are stored in an independent format . The most common

format is DIACOM (Digital Imaging and Communication in Medicine). It has two main uses

1. Hard copy replacement

2. Remote access

Features like Mammography report, Biometrics Devices are limited in case of PACS. Major

features like Lab Information, RFID are common in PACS.

PIM: Patient Information Management is most commonly used information system in

healthcare industry. It contains features which are generally used like registration, critical

patient care and patient records. Quality and Control Management is a feature which is

developed by few software vendors.

PIS: Physician Information System details about the physician list and there correspondingpatients. It gives all the details about the physician timings and their patients records .

Features like emergency patients information are developed by few software firms.

LIS: Laboratory Information system is mostly used in every healthcare organization.

Pathology, blood bank and microbiology are most commonly used features in healthcare



industry. Pathology and blood bank are commonly developed by software firms but

features related to microbiology are developed by large companies like Wipro.

Vendors and their applications

COMPANY APPLICATIO

N

Business Partners

WIPRO y Wipro HIRePS-HIS,

y Wipro HIRePS-Mini

y Wipro HIRePS-LIS

y Wipro HIRePS-MMS

y MCD Hospitalsy ESIC

SriShti

Software

y CPOE Module

y RIS Module

y Pharmacy Module

y Support Services

Module

y LIS Module

y PAS

y CRM module,

y Integrated HER

module

y Rajiv Gandhi CancerInstitute

y Jayadeva

Sobha

RenaissanceInformation

Technology

y xTransEDI

y PharmIT

y

SEED heathcare y PALASHy dicomPACSy emPower

y B.K.L.Walawalkar Hospitaly Inamdar Multispeciality

Hospital

Mediff

Technologies

y InstaRad

y InstaPACS

y InstaCath

y Enterprise InstaRad

y Enterprise InstaPACS

y InstaNM

y Shri Vinoba Bhave CivilHospital

y Apollo Hospital (bangalore)



Table 2: Various applications by vendors (Whitepaper Software Applications in Global

Healthcare Industry)

2.3.2 Telemedecine and E-healthcare

Telemedicine, which is the use of IT for delivering health services and information over

distances, has a substantial scope for growth in India. The use of telemedicine can greatly

aid in dealing with the shortage of healthcare staff and improving the penetration of

healthcare infrastructure and resources in the underserved semi- urban and particularly

rural areas. Various private hospitals have adopted telemedicine services while some have

also developed PPPs for the same; these include Apollo, AIIMS, Arvind Hospitals, etc.

Organizations such as Asian Heart Institute (AHI) and Indian Space Research Organization

(ISRO) have plans in this space . However, the current healthcare scenario in the country

calls for the implementation of a large scale / nationwide telemedicine programme with a

specific focus on the underserved states.

For e-healthcare and telemedicine to emerge as a viable alternative modality for delivering

medical care and expertise there are a few preconditions that are to be met . Some of these

are:

y Adaptation of Information technology by hospitals especially in terms of

networking and Hospital Management systems.

y Increasing awareness on IT among medical professionals.

y Better Internet access; possibility the advent of broadband in India that can

transfer video files faster.

y Standardization of various protocols (like DICOM in teleradiology) and

acceptance of these protocols by the relevant equipment manufacturers.

y Decline in the cost of telemedicine hardware to make it more financially viable.

2.3.3 Social Networking in healthcare

The raising health awareness and consciousness of the public combined with theimproving economic status of the people has contributed much to this growth . In otherwords, it's almost like a social networking site, as an example Facebook or Friendster,with the exception that it accommodates users who need healthcare. This technology



allows a consumer to touch base with their doctor through the internet using specializedsoftware, effectively establishing and improving their relationship at the same time.

This "health information technology" allows consumers and healthcare providers to haveinteraction together online, providing a handy and efficient way so that they cancommunicate to one another outside of the healthcare establishment . This technologypermits them to do things such as share medical information together, form onlinecommunities, as well as may even be employed to manage information comparable toprescriptions and medical appointments. This sort of health technology isn't merelylimited by a provider-patient relationship. This can also be used by end users to speak aspartners to supply a good quality support

Hospitals in India have started adopting social media as a tool to grow their business. Super-specialty hospital chains such as Apollo Hospitals, Fortis Healthcare and MaxHealthcare have aggressively pursued social media marketing. On the otherhand, Columbia Asia and Manipal Hospitals are yet to take up active social mediamarketing. Max Healthcare has 125 video uploads on its official YouTube channel whichincludes testimonials from patients and the channel targets mainly international patients

.

It also makes proper use of hash-tags in Twitter and it has been using the medium forgiving valuable information about healthcare and for promoting its services. FortisHealthcare boasts of 1402 followers on its Twitter handle. Apollo Hospitals has awhopping 37,651 Facebook Fans and it is very active in engaging with fans.

Super specialty hospitals are not an exception either. For instance, NarayanaNethralaya which is a super specialty eye hospital in Bangalore and which has beenadjudged as among the top 5 Best multi-speciality hospital in Ophthalmology by TheWeek/HANSA research survey 2011 has been adopting social media actively. It has 5,273Facebook fans and has been using Facebook to promote campaigns such as Eye Donation

campaign and events such as Ophthalmology CME for pediatrician, etc.

It also reinforcesits leadership in the industry by posting an update on debunking the contact lens mythwhich spread like wildfire on Facebook . The post got 32 shares by public and receivedpositive feedback from people who got scared about the contact lens myth. The hospital isalso one of the few hospitals in India maintaining a blog.

Narayana Nethralaya Foundation funds KIDROP as a part of her social responsibility inkeeping with the hospital principle that no child must go blind for want of financialresources. KIDROP is also present in Facebook and it uses the channel to createawareness about Retinopathy of Prematurity (ROP) which is the leading cause of Infant Blindness in the World.

Chronic Disease Specific Communities

Communities can be created within social networking sites for people suffering fromchronic diseases such as diabetes. These can be promoted through organizations such asthe American Diabetes Association and can provide information specific to better livingconditions of patients. For example, people can share specific diet plans, common exerciseoptions, and other lifestyle traits that will help in controlling the disease. Members can



also share their own experiences with treatments and the long-term impacts that they arefacing. New research and findings regarding such diseases can gain publicity through thesite.

For example, the website PatientsLikeMe gives consumers a way to track diseaseprogress, access disease information and learn from the real-world experiences of otherpatients with the same medical condition and to share their findings with patients, healthcare professionals and industry organizations that are trying to treat the disease . Otherconsumer-directed sites include MedHelp which, in addition to being a social network,offers a number of tracking tools for pain, weight and other chronic conditions;CureTogether, which helps people anonymously track and compare health data to betterunderstand their bodies, make more informed treatment decisions and contribute data toresearch; DailyStrength, which allows patients and caregivers to give and receive support;Inspire, which hosts different communities, some of which are co-sponsored by non-profit foundations, to educate and offer support; and FacetoFace Health, a social network that uses a proprietary algorithm to match people with similar diagnoses .

Analysis of Challenges to be consider with social networking

While the idea sounds promising, several challenges need to be considered.

y There could be legal issues regarding the nature of comments posted by the participantsand so appropriate legal precautions and guidelines need to be incorporated into thesite. Any information or comment that could damage the reputation of a service providermay invite more legal challenges and lawsuits.

y Privacy and security concerns could also be discouraging factors for implementing theseideas.

y Another challenge is to attract the right kind of audience to this website. The socialmedia generation of today may not be too worried about health at this time and theolder generation may not be social media savvy.

By and large, information healthcare technology has created one way for the people to beable to live their lives better by helping them speak with each other conveniently and witha better measure of interaction.



2.3.5 Cloud Services in Healthcare

EVOLUTION OF CLOUD TECHNOLOGY

Technology has penetrated in human lives so much that it has started to become an

intrinsic part now. Mobile phones have brought in a revolution in the way we live. A

sample study of usage of Smartphones by US physicians in US is depicted in the figure

below. We increasingly look to social media to inform our personal and business

decisions. Our expectations on communications, data, content, and applications have

increased dramatically and we look for instantaneous and ubiquitous access to

information. anytime', 'anywhere' access to information has become a defacto

requirement in today's world.

The combination of rising expectations and a rapid rate of change, pose a challenge totraditional approaches for information technology (IT). A new approach is needed to free

individuals and organizations from the constraints of traditional IT. Cloud is a new

computing paradigm. In Cloud, IT resources and services are abstracted from the

underlying infrastructure and provided on-demand and at scale in a multi-tenant

environment . Cloud has several characteristics:

y IT, from infrastructure to applications, is delivered and consumed as a service over

the network

y Services operate consistently, regardless of the underlying systems

y Capacity and performance scale to meet demand and are invoiced by use

y Services are shared across multiple organizations, allowing the same under-lying

systems and applications to meet the demands of a variety of interests,

simultaneously and securely

y Applications, services, and data can be accessed through a wide range of con-nected

devices (e.g., smart phones, laptops, and other mobile internet devices)

Cloud Deployment Models

y Deployment of a cloud can be done in the following ways:

y Private clouds are operated solely for one organisation. They may be managed by

the organisation itself or by a third party, and they may reside on-premises or off it .



y Public clouds are open to the general public or a large industry group and are

owned and managed by a Cloud service provider.

y Hybrid clouds combine two or more clouds (private or public) that remain unique

entities but are bound together by technology that enables data and application

portability.

y Community clouds feature infrastructure that is shared by several organizations

and supports a specific community. They may be managed by the organizations or a

third party and may reside on-premises or off it .

In a CDW Cloud Adoption Poll, 47 per cent of IT managers say their organizations are

most likely to use a private cloud approach.

CLOUD TECHNOLOGY - ADDRESSING CHALLENGES IN HEALTHCARE

Healthcare lags most other verticals in the adoption of technology.

Most healthcareorganizations depend on workflows that consist of paper medical records, duplicate tests,

film-based radiological images, handwritten notes, fragmented IT systems, and silos of

information. Information sharing across providers is inefficient and data portability is

rare. Care providers rely on outdated technology for their communication needs.

Collaboration and coordination of care processes is a major challenge.

The Digital Divide: In major cities across India, we have some of the best hospitals in the

world in terms of adoption of technology and provision of high quality of healthcare

services. However, the scenario is completely different in rural hospitals, which lack even

basic infrastructure, let alone high end technological infrastructure.

This means that the

doctors, nurses, administrators, and other personnel working in the rural hospitals are

not exposed to technology at all, as opposed to their counterparts in the major cities.

There is a need for sustained efforts from both the Government and private sector to

create uniformity in healthcare technology adoption. The good news is that cloud

technology can make healthcare applications like EMRs, HIS, PACS, and others affordable

and easily accessible.

High cost of implementing and managing multiple diverse infrastructural

components: The general feeling is that traditional technology requires elaborate

infrastructure and manpower to run. For example the computer network requires a

separate infrastructure, as opposed to the telephony network . In addition, devices like

pagers, nurse call systems, public address systems, etc. requires a different set of

infrastructure. There is a need for a common integrated network infrastructure, which

can create the 'Foundation for Connected Health'. To capitalise on technology investments

now and in the future, hospitals need an integrated IT network that helps diverse entities



to collaborate and communicate effectively. The cloud can act as the foundation for

connected health to support a range of complex, disparate, and mission-critical

applications. The cloud helps the hospitals and healthcare providers to use the

applications, hardware, and services on a'pay per use' model, which allows them to avoid

heavy capital expenditure on buying and deploying expensive technology.

Data Centre Virtualisation for Healthcare The rapid adoption of electronic health

records: EMR, HIS, PACS, and other advanced clinical applications are creating a critical

need for more data storage, resulting in the expansion of the range of healthcare services,

and increased IT spending. Cloud technology provides the answer by ensuring that users

have access to the data and applications they need on demand and from any location .

These new advancements in cloud technology are fundamentally changing the way

healthcare providers operate their technological infrastructure. They are realising the

benefits of adopting cloud technology, instead of owning and maintaining huge data

centers that need massive investments in technology and human resources.

Concerns about patient data confidentiality and security issues are also weighing down

heavily on the adoption of cloud technology. As patient data will reside at a location

distant from their own facility, there is a concern about the possibility that sensitive data

could be lost, misused, or fall into the wrong hands. Technology vendors have to build

robust security and disaster recovery features into the cloud technology, to ensure that all

administrative and clinical data is securely and safely maintained.

Gaining confidence of all the stakeholders is also an enormous challenge. Gaining the buy-

in from both internal and external stakeholders is very crucial. Healthcare providers still

do not see the value of the cloud as an enabler of faster, safer, efficient, and more effective

healthcare.

Providers are often unwilling to make investments in cloud-based initiatives.

Hence it is important to take the entire ecosystem into confidence, before embarking on

any large-scale cloud initiative.

Training of the users also can be a significant challenge because of the'digital divide' .

Training of the users should be tailored according to the needs of the users and should

take into account their educational background, aptitude, and pace of learning . Training

may also need to be conducted in the local language.

Cultural Issues and Change Management : Implementing the cloud solution involves

significant changes in the processes being followed by the healthcare providers.

Healthcare facilities have been dependent on legacy systems and processes, many of

which are outdated and are not efficient . The infrastructure needs modernisation.

However healthcare providers tend to avoid modernising their IT infrastructure, because

of lack of funds and a tendency to avoid capital expenditure on new technology. Moreover

healthcare stakeholders have traditionally been very resistant to change . Hence

healthcare organizations require a significant amount of support from their technology



partners, to manage the change and ensure a smooth transition to the new system and

processes.

B enefits of cloud technology for healthcare - Transforming Service Delivery

The Yankee Group is observing the emergence of new business models based on anytime,

anywhere IT services, propelled by end-user creativity and expectations.

The YankeeGroup asserts that "anywhere IT" will be the largest technology-enabled transformation

in our lifetimes, potentially reaching two billion people by 2012. It believes that this trend

represents the convergence and synergy of cloud computing, application mobility, and

social media.1 At the center of this trend are the companies that design, aggregate, and

deliver IT services.

The keys to transforming service delivery through the cloud require the following:

y Reducing capital expenditure and leveraging existing assets

y Controlling ongoing development, delivery and operations costs

y Increasing the speed and flexibility of developing and providing new (differentiated)

services

y Efficiently managing the customer relationships over the cloud (e.g. billing)

y Such challenges illustrate the complex interdependencies required to provide cloud

services and currently no single service partner can deploy and manage all the

services that end customers are demanding.

HEALTHCARE ON CLOUD

More and more vendors are offering healthcare solutions and services such as

telemedicine, electronic medical records, medical imaging, and patient management that

can be consumed or integrated by healthcare providers, payers and customers over a

cloud.

We expect majority of the larger healthcare players to set up their own'private' cloud in

the near future. The primary focus would be to offer IaaS to their internal stakeholders .

This will help healthcare organizations to reduce costs and increase its agility in

provisioning, orchestrating and managing the applications and the infrastructure.

Mid-

tier and smaller players are expected to move their administrative applications like

Registration, Billing, Scheduling, and Reimbursement, to the cloud. As the cloud adoption

in healthcare evolves, we expect a major chunk of healthcare services to move into cloud;

and this would let healthcare players focus on providing cost effective and efficient

healthcare services.



Service providers play a major role in adoption of cloud in any industry, and healthcare is

no exception. Cloud can enable service providers to rapidly and cost-effectively integrate

their applications, end points, and operations capabilities into a set of cloud services that

can be deployed to customers, be it providers, governments, payers, or patients, using a

wide range of network connections (fixed and mobile). In many cases these services can

be composed of existing applications, infrastructure, and workflows that may be located

anywhere in a cloud configuration (without requiring co-location) to a set of consumers

that can either be permanently or temporarily connected into the cloud. The service

connections can be provisioned for high levels of security and can be monitored to precise

endpoints (such as a device or user) to enable accurate billing, usage and metering

information for the individual services.

Increasing B usiness Agility

Healthcare service providers need to maximise their investments in IT assets, operations,

training, and management of their solutions to support the cost economics that drivehealthcare. An agile service delivery model is required to support the need to dynamically

scale services up or down to optimise availability of resources with minimal delay and

waste. Cloud computing can help them increase business agility.

Gartner predicts that 30 per cent of consulting and systems integration revenue will be

delivered through cloud computing by 2011.ii, Frost & Sullivan predicts that hosted

services will account for the majority of unified communications services revenues,

hovering just above the halfway point by 2014.1

KEY BENEFITS OF CLOUD TECHNOLOGY

Cloud transforms the economics of IT from capital-intensive to pay-as-you-go . Service

level agreements guarantee the capabilities needed, when needed. Costs are tiered and

metered to accurately reflect requirements and usage. All applications, including legacy,

run more efficiently and sustainably with greater utilisation of the underlying

infrastructure.

Cloud can improve information management and reduce operating risks: Coupled

with context-aware systems, Cloud protects sensitive information through automated

policy enforcement .

Additionally, the resilience of Cloud deployments increases uptimeand simplifies disaster recovery.Cloud accelerates business by allowing healthcare

organizations to transform ideas into new services, with greater speed . This allows

healthcare providers to scale up their operations, and launch new services quickly and

easily. Cloud can provide nearly limitless scalability, enabling businesses to grow, without

the investment in time and resource intensive technology infrastructure.



Cloud brings powerful IT resources to the healthcare providers: Healthcare

organizations of all sizes, across all geographies, can access information technology

resources that previously were out of reach. World-class applications and computing

infrastructure are available to all without considerable up-front investment .

Cloud makes new business models possible and unlocks revenue potential, for healthcare

entities. Hospitals and other healthcare providers can enter new markets, respond more

quickly to changing customer needs, collaborate more effectively to drive innovation and

business value, and execute on strategies that might not have been cost-effective in the

past

2.7 Information security regulation in healthcare

It has become increasingly clear that the daily functioning of a healthcare provider dependson the integrity and reliability of the provider's information systems. Patient care, research,operations, and finance all rely on highly available, trustworthy, and robust applications,

data, and infrastructure.

But at a time when hospital and physician dependence on healthcare IT has increased, thebar for security in healthcare IT also has been raised. The use of healthcare IT hasincreased significantly as more providers use electronic health records (EHRs) to support direct patient care. This dependence on the HER leaves the organization less able totolerate viruses and other malware threats that can make the EHR unusable. Meanwhile,the prevalence of mobile technologies and the sophistication of today's IT security threatsfurther erodes the ability of the provider to protect its healthcare IT systems. A provider'sability to ensure that its IT systems are there when they are needed can be threatened byhackers, viruses, and worms. And the confidentiality, integrity, and availability of patient,

personal, and business data can be threatened by phishing and the loss of portable devices.

Now more than ever, knowing the risks that healthcare IT systems could faceandincreasing the security of a hospital's and physician practice's information systems inresponse to these risksis critical.

Challenges Facing Healthcare IT Systems

Over the past several years, most providers have made great strides in ensuring that theirinformation system (IS) environment addresses security threats. But the need forincreased diligence regarding healthcare IT security has become critical as the challenges

to healthcare IT systems have become more complex and diverse and have continued toevolve rapidly. As HER use grows, so too does the number of EHR users . Busy cliniciansmay view security controls as impediments to patient care, and busy managers fall behindin managing user access rights.



CHAPTER 3 -- Focus For Next Deliverable

y Detailed research on telemedicine and e-healthcare in India

y Information Security in healthcare IT systems

y Mobile technology in healthcare in India

y Challenges to ICT adoption in India

10030241144_Prof Apoorva K_Dissertation PPR-II

Documents

Transcript of 10030241144_Prof Apoorva K_Dissertation PPR-II