There is no Market for EMR in India

India is a very price sensitive market. The Maruti/Suzuki advertisement - 'kitna deti hai?' is an epitome of the reality. The big success of the mobile/telecom in India is because of it gave an instant gratification to the users. The Sabjiwala vendor keeps a mobile because of free incoming, such that he can be called by the customers for home delivery and he gets an instant boost to business - instant gratification.  

Likewise in the Healthcare the hospitals have a 2-5% budget for IT and give a step motherly treatment to IT. All because IT is considered as a support function and not a direct business benefit. Most of this budget is spent in areas that give tangible business benefits and/or instant gratification - e.g. HIS and in that for Billing, Material Management, Procurement, Lab and Pharmacy. The EMR is an after thought and that too almost never for clinical reasons; rather EMR is used as a point-of-use application for material management. 

The current Healthcare Financing model is to blame for this. Every cost gets passed on to the patient. >80% is pay-out-of-pocket. Therefore the hospital must ask the question at every stage - After all how much can the hospital load the patient's bill? Almost 2% of the Indian population falls below the poverty line every year because of medical expenses; for which they have to sell their land and assets.

Bottomline - Indian Healthcare-IT market is very small and almost negligible for EMR, until new models of Healthcare financing emerge - e.g. Govt's Universal Healthcare, 49% FDI in Health Insurance, Micro Finance etc.    

IT Planning in Hospital Planning!

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Read TG Hospital Planning Framework on slideshare: https://www.slideshare.net/PankajGupta9/tgi-hospital-planning 
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Yesterday I had a meeting with a hospital planner who is planning the expansion of a super specialty Govt hospital in Delhi.

He wanted to get a consultant to plan the cables/routers/switches/LAN/WAN for the hospital. I lost the battle of convincing him that - the cable/router/switch/LAN/WAN design depends on the hardware infrastructure requirements, that in turn depends on the medical devices and software application portfolio. In other words Hospital IT portfolio is extremely inter-dependent and it is self-defeating to plan the Hospital's cables/routers/switches/LAN/WAN components in isolation.

He couldnt understand that the Lab, Radiology, Cath lab, Oncology, Laproscopic OT etc will need redundancy and additional capacity in terms of cables/routers/switches. We need to calculate the average and peak load for each Dept. and then design the cables/routers/switches/LAN/WAN as per that. Whereas typical cable vendors dont know how to calculate transaction loads in Hospitals. For example bulk uploading of Lab results needs a network capacity that is far beyond the regular. LAN/WAN design will also depend on weather you want any wi-fi in wards and selected patient areas or whole hospital. 

Someone needs to decide if all the servers will will be located locally or in a remote data centre. Considering the performance issues, it is better to have the imaging servers located locally. Need to plan for a local server room and network cabinets on every floor because Smart hubs/switches/routers need a server room environment. Further someone needs to have a back-up and disaster recovery plan. The cables/routers/switches/LAN/WAN design is dependent on many such considerations. It is never a cake walk as he assumed it to be!

The industry doesnt have any single vendor that has all the consultants in one team. The only way is to have a Healthcare-IT 'Principle Consultant' that can assemble a team of functional, software, hardware infrastructure and cabling consultants for planning the entire IT Roadmap for the Hospital.

I have seen some hospitals in GCC region [without taking names] that have very high adoption of IT systems by the end-users coupled with JCI Accreditation with minimal non-compliance. These are an indication of IT integrated into Hospital process and design.