India Leads the Way in Digital Health

 

India is in the midst of what some have dubbed the “world’s biggest healthcare overhaul.” In addition to recently launching one of the world’s largest publicly funded health insurance programs, set to cover some 500 million people living in poverty, the government has also been working diligently to develop a new digital health strategy for the nation.

The work on the strategy began more than five years ago, when the Ministry of Health and Family Welfare and the Ministry of Communication and Technologies developed a new set a metadata and data standards for health – essentially a common set of standards for the collection, creation, and coding of all health data that can be easily transferred across computers and information systems anywhere in the country. The standards were based on global best practices but adapted to better serve the local context. Previous to its work on data standards, the government also developed a system to allow it to issue a National Identification Number to all healthcare facilities in India.

These efforts have now put the government of India in a position to launch a new National Digital Health Blueprint. The blueprint, which is now open for public comments and consultations, validates the six pillar strategy that ACCESS Health has advocated for, namely:

1. A governance methodology and framework to help the digital health blueprint bring balance between patient privacy and scale.
2. Highlight the value and role of standards-based system design, including meta data and data standards for health, the health data dictionary, and registries.
3. A Health Delivery Information System to better manage healthcare provider operations, including software for patients medical records.
4. A Health Insurance Information Platform to provide better underwriting support for government schemes and to manage fraud and risks.
5. Electronic Health Records and a Health Information Exchange to provide citizens access to their health records and allow policy experts to understand disease burdens patterns.
6. Information and communications technology for infrastructure and capacity building to support digital health transformation.

A number of key members now on the ACCESS Health Digital Health team previously worked on the metadata and data standards initiative and on developing the national identification numbers. Their work was carried forward in the national blueprint.

In addition to its impact in India, the work the government has undertaken is likely to become a model for other emerging nations. The blueprint highlights some of the key points that ACCESS Health believes should be a part of any national digital health strategy. These include:

The need for federated governance and technology models to reflect the healthcare system, given that healthcare in India is a state-related subject;

The need to shift focus to more preventive medicine via a focus on strengthening the primary healthcare system and promoting alternative schools of medicine;

The importance of issuing of a personal health identification number that allows consent-based identification and portability of medical records across the continuum of care;

The importance of a mobile-first design approach that recognizes the growing penetration of telecommunication links on the back of low data tariffs;

The need for a data-driven approach to health policy making that recognizes the role of disease registries for accurate capturing of health burden; and

Recognition that there’s a need for keeping citizens healthy and productive to achieve economic growth as sick citizens become a burden on the system.

ACCESS Health Digital team looks forward to supporting the Government of India in its ongoing efforts to develop and implement this critical new strategy to improve health in the country.

https://accessh.org/india-leads-the-way-in-digital-health/

MAXimising Benefits

Max Healthcare IT Transformation Cover Story in Ehealth Magazine Eletsonline. Perot systems corporation Total ITO. Largest VistA EHR implementation outside the Veterans Health Administration (VHA) - U.S. Department of Veterans Affairs and outside the USA. The institutional memory of the grand success was lost in the merger of Perotsystems with Dell Services further merged with NTT Data. Though the success achieved in Max is unprecedented and still largely unmatched. Lot of firsts here. First Indian Hospital chain to go on a private cloud. All Hospitals working from the same HIS/EHR/LIS with common IDs for Patients, Doctors, Facilities. Records having Diagnosis, Procedure, Lab Standard Code Sets.

Published in eHealth Magazine : 01 October, 2010, Read the details

The IT outsourcing deal puts Max Healthcare on the roadmap for becoming the best IT-enabled hospital chain in the country The Indian healthcare system has recently realised the potential of information and communication technologies in completely transforming care delivery at hospitals. The industry witnessed its first complete IT infrastructure technology outsourcing deal in September 2009, when Max Healthcare and Dell Services (formerly Perot Systems) partnered for developing IT operations at all Max Hospitals. The cost of the deal, Rs 90 crore (excluding infrastructure cost), is an indicator of the increased priority that is now being given by Indian hospitals to IT, which is an extremely positive sign. As per the agreement, the deal will last for ten years, out of which one year has already passed, and a lot of positive transformation has already been noticed. The unique partnership is not only expected to provide a lot of value to Max Healthcare in terms of enhancing the quality of services and reducing treatment costs, but it will also be a great learning experience for Dell, which marked its entry into the Indian healthcare market with this deal.Status update Post its inception in September 2009, the ITO deal will last for 10 years and which, according to Dell, will comprise of three major phases – transition, improving productivity and optimisation.

As one year has passed, the transition phase is almost over. During this phase Dell installed the entire IT infrastructure for Max, by migrating the already existing IT infrastructure to a modern infrastructure. The entire data centre of Max, which was housed in their Okhla office, was migrated to the Dell facility in Noida. To reduce hassles, the shifting work was done during off hours on weekends, so that the work at the hospitals does not get affected. The entire process lasted for a couple of months and currently all Max Hospitals are running from the data centre housed in the Dell facility in Noida. The servers and network devices have been installed with monitoring devices that generate alerts in case a problem arises. There is also a situation management process in place to ensure that even the problems of highest criticality get resolved within a definite period of time.

Original publication for Reference: http://ehealth.eletsonline.com/2010/10/11436/

Summary of outcomes beyond the published article: Max Healthcare was the largest ever full ITO and Clinical Transformation Account of Perotsystems International. $20M deal across multiple years. Total Business Transformation done including technology, process, people and business. This includes Enterprise Architecture, Operations and Projects:

Phase I: Infrastructure Upgrade completed

1. Centralized Service Desk for L1 support and triage to L2 and L3 teams
2. Converted the P2P network to a MPLS private cloud
3. HIS and all other software applications of 7 Max hospitals are now running from the Dell data centre
4. HIS re-engineered and stabilized to take the load of new environment
5. Physical, Network and Data level security established
6. Operations management as per SLAs
7. Governance process for decision making
8. Integration with Medical Devices - ICU, ECG, EEG, LIMS, Lab Analysers, CT, MRI, Modalities, RIS, PACS, Surgery, Scopes etc.
9. Bar Code, Medication Administration and Nursing Devices
10. Computer on Wheels, Mobile CPOE Orders Devices
11. Retail Pharmacy, CRM, Physician Mobile, Remote Monitoring Devices

Phase II:

1. Customization of Opensource VistA Electronic Health Record System. Max Healthcare is the largest VistA implementation outside the VA and anywhere outside the USA.
2. Implementation of CPOE, CDSS, BCMA, ePrescription
3. Developed standard master data e.g. Service master, Lab master, Drug master, etc.
4. Order sets, Notes Templates
5. HL7 based Enterprise Application Integration using Mirth.
6. Clinical transformation as per ADOPTS methodology

Business Benefits realized by Max Healthcare:

1. Private Cloud IT Infrastructure: plug-n-play environment for new facilities
2. Business downtime due to infrastructure and HIS outages is history
3. Process Re-Engineering -- 1000 beds in 7 Hospitals; expanded to 1500 beds in 11 Hospitals.
4. Standardized operations without disruptions reduced the waste and improved the topline.
5. Near paper-less, > 95% Adoption in Clinical.
6. Achieved full NABH and HIMSS Stage 6 accreditations later.
7. Hospital was able to attract FDI investments.

The institutional memory of the grand success was lost in the merger of Perotsystems with Dell Services further merged with NTT Data. Though the success achieved in Max is unprecedented and still largely unmatched.

Read the details

Top Health IT Trends to Expect in 2016

Technology has transformed healthcare around the world at a faster rate in the last few years than at any other time in history. There are many exciting innovations poised to help improve patient outcomes and the landscape of healthcare as a whole over the next few years. For 2016, we can expect to see the following IT driven changes in India:

Expanding Telemedicine Services

The telemedicine market in India is expected to reach a valuation of about $18.7 million by 2017, according to Deloitte. Since telemedicine makes it possible to provide needed medical services from a distance, this may be particularly helpful for individuals in rural communities that do not have access to the larger hospitals and centralized facilities. Medical professionals can provide advice to patients and can even consult with patients about specific issues using video chat options.

Greater Integration of SMAC

SMAC, standing for Social, Mobile, Analytics, and Cloud technologies have transformed every business in India and around the world and healthcare is no exception. As medical facilities get on board with using social options, patients will be able to interact with their doctors and obtain information about their health and well being in new and convenient ways. Analytics in healthcare will allow information to be analyzed and cross referenced, assisting with research and outcome improvement.

Mobile integration puts health information at the patient’s fingertips in a way that was not possible in the past. This may help improve outcomes and communications between medical providers and patients in countless ways as the shift to mobile is embraced. The movement from client server to cloud is shifting the industry IT vendor landscape, with many smaller and newer vendors beginning to replace large vendors that have traditionally assisted with IT needs.

Increased Use of Medical Wearable Devices

The use of health and fitness wearables has increased substantially over the past few years and is expected to continue to increase at an ever-faster rate until about 2020. Start-up companies are experimenting with creating wearables featuring health IT features. We may see prototypes emerge this year that allow patients to instantly send remote information about biometric data that is obtained using sensors in various medical wearables. This could allow physicians to spot medical issues much faster.

Improved Mobile Access to Health Insurance

Private health insurance covers about three percent of India’s population. The government health plan covers about eight to nine percent of India’s population, while the rest is paid out of pocket. In 2015 the Parliament passed the Insurance Bill where the FDI in Insurance was raised to 49 percent and health insurance has been declared as a separate business. Also 100 percent FDI was allowed in medical devices. These two policy changes will bring a boom to the mHealth and health insurance market in 2016-2017.We predict Insurance support for mHealth solutions including outpatient visits and chronic disease management or non-communicable diseases [NCD] as it is called in India.

Many companies now also allow individuals to apply for health insurance using mobile apps. In 2016, we can expect to see even greater competition in the industry with more mobile access and improvements in automating the claims process.

More Complete Patient Histories with EHRs

EHR and MDDS for health domain standards were notified in September 2013 and approved in December 2013, respectively. As medical facilities adjust to using systems to keep electronic records, we can expect to see more complete patient histories begin to affect outcomes and standards of care. This is especially true across borders, as many developed nations are now employing the same standards for coding and keeping EHRs. We may see 2016 bring forth improved software that simplifies electronic record keeping, transitions of care, coding, and billing.

Widespread Adoption of Surgical Robots

India has been behind the ball in adopting surgical robots for some time now, but we may see many more robots flood the hospitals this year. Intuitive Surgical, the creator of the U.S. based da Vinci surgical systems, considers India an important market. The Vattikuti Foundation plans to increase the number of surgeons trained to perform robotic surgeries from about 147 currently to 300 by 2020.

IoT Revolutionizing Patient Care

The Internet of Things is an extremely beneficial addition to the medical industry. We expect IoT platforms to emerge that will enable integration of all healthcare applications, devices, and things. Health monitoring devices can track vital patient information such as blood pressure, heart rate, and blood sugar levels every single day and communicate this information to medical professionals. Pacemakers and other medical devices can also be connected so that information is transmitted daily and not just during doctor visits. Medical professionals can directly communicate when information is worrisome and can save time from running unnecessary tests when health signs are good.

CRM Improving Patient Relations

Customer relationship management has always been important, but is now easier than ever because of SMAC technologies and EHRs. Doctors can communicate more freely with patients and can track all interactions for future review. These options will help make doctor/patient relations more personalized. A personalized approach will improve patient satisfaction and may also help to improve outcomes.