Healthcare-IT Business Strategy

Tuesday, November 3, 2015

INDIA'S HEALTHCARE IS FRAGMENTED - NEEDS TO BE FIXED





India's Healthcare System is Fragmented = Fuzzy Boundaries for eGovernance.
900K Doctors in India
50% in 4 large metros
40% in Tier 1 and Tier 2 cities
10% in semi-urban and rural India below that
There are Only 5000 Seats for Specialist Doctors every year.
Majority of Doctors go into Primary and Secondary Care.
Women and Child Health remains main focus because 
India adds 1 Australia to its Population every Year.

India has 1 Bed to 1000 Population
WHO recommends 1 Bed to 300 Population
5% are >150 bed facilities
5% are 50-150 beds facilities concentrated in Tier 1 and Tier 2 cities.
90% beds are in small Clinics and medium size Nursing Homes < 50 Beds.

Over 100,000 Labs
60% are Unorganised small and medium size Labs
<20% are Organised Labs
20% are Hospital based Labs
Only 1% of the Labs are Accredited by NABL
Total market size between INR 40-60K Cr.

65K Stockists and 750K to 1M Retail Pharmacies
6% of the total Sales come from Organised Pharmacies
6% of the total Sales come from Hospital Pharmacies


#IndiaHealthcare Ranks 154 Among 195 Countries in Healthcare Index: According to the Global Burden of Disease Study (GBD) published in the medical journal The Lancet, India ranks 154th among 195 countries on the healthcare index.

Healthcare is a state subject. Centre govt funds 85% of most public health programs. However all the regulation and execution authority is with States. The states are free to accept or totally reject any healthcare ruling from the center. India is too diverse to expect a single Healthcare solution across all States. Unity in diversity is elusive.

MoHFW regulates the public health only. That too most of it is done by respective Directorates under the various Disease Control Programs. Rest of Healthcare eludes MoHFW.

Pharma sector is governed by DCGI which is an independent body. It has dotted line reporting to the Min. of Chemicals. It has no direct connection to MoHFW.

Health Insurance is governed by IRDA which is an independent body. It has no direct connection to MoHFW.

Hospitals standards are defined by NABH. Lab standards are defined by NABL. NABH and NABL are part of QCI which is an independent body but it has no teeth to enforce.

Building new Govt Hospitals e.g. AIIMS and Govt Medical Colleges is given to independent bodies like HLL/HITES or HSCC, again with no direct connection to MoHFW.

Doctors practices, medical education and Primary care comes under MCI. This is an independent body. It has no direct connection to MoHFW.

Out of 40K Doctors coming out of Medical Colleges every year only about 5K get into MD/MS/PG Specialty courses. The rest remain in the rat race to get into that limited Specialty seats. Some of the gap is filled up by DNB Specialty seats, but MCI keeps DNB at arms length and doesnt want to give it the deserved recognition. Rest of the new Doctors don't want to serve in Private practice but would rather serve as RMO in secondary /tertiary Hospitals. Primary Healthcare is breaking down in this country. These Doctors are concentrated in Tier 1 cities and some Tier 2 cities. Cant find much qualified Doctors below the District and rare to find any at Tehsil/Taluka level towns. Obviously the gap is filled by quacks or quasi medical professionals.

Clinical establishment bill has been pending for discussion in parliament for ever. National Identification Number [NIN HFI] for Healthcare Facilities of India hasn't been implemented across public and private as yet.

Radiology centers are controlled by BARC, which is an independent body which comes under Dept. of Atomic Energy. It has no connection to MoHFW.

There is no regulatory control over - Emergency support, Technicians, GDAs etc. The National Paramedical and Auxiliary medical staff Councils are still elusive.

Almost all Pvt. Medical Collages openly flout MCI standards as they enjoy political patronage.

I didn't even go into other areas e.g. medical research.

Tuesday, March 17, 2015

Indo-French Dialogue on Telemedicine in Healthcare





Embassy of France in India, January 22, 2015, 


On the occasion of the India visit of French trainee-superintendents of hospitals, the Embassy of France, in collaboration with the Federation of Indian Chambers of Commerce and Industry, organized an Indo-French dialogue between experts from the health sector to share their experiences and the growing potential of Health IT.

The goal of this workshop was to exchange ideas about telemedicine as a means to improve the efficiency and quality of healthcare in India.
Telemedicine is not a separate medical specialty; rather it is a tool that can be used by health providers to extend the traditional practice of medicine outside the walls of conventional medical practice. Telemedicine in India has a potential of 80-90% of financial savings and enjoys a high acceptability ratio among its rural communities. In France, following the successful implementation of several pilot projects, the Government recently cleared 300 telemedicine projects supported by the public sector.
A healthcare scenario, which uses IT and communications as an enabler, improves access and provides better preventive measures ensuring treatment in time to the urban as well as the rural population. In France and India many telemedicine programmes have been actively supported by the government and medical community. However, the telemedicine segment is still at a stage where a defined framework for Health Information Technology is yet to be set up.
Panel:
Dr K Ganapathy - President, Apollo Telemedicine Networking Foundation (ATNF)Dr Vijay Agarwal – Executive Director, Pushpanjali Crosslay Hospital
Dr Pankaj Gupta – Partner, Taurus Glocal Consulting Services Pvt. Ltd.
Mr Christophe Saint Martin - Institute of High Studies in Public Health, France 
Ms Shobha Mishra Ghosh - Senior Manager, Health Department, FICCI
See the event Details on French Embassy website

I am posting the background notes I had prepared. I hope this helps. 

You can read it here



Digital Advantage for Doctors

Presentation/Publication is focused on mHealth platforms for Physicians. Sponsored by www.gp-india.com. Progress in Medicine contains the scientific proceedings of CME program of APCON-2015 held at Gurgaon during 19-22 Feb 2015. http://www.apicon2015.com/. Progress in Medicine Vol. XXIX 2015, Association of Physicians of India, Indian College of Physicians.

Monday, March 16, 2015

Improving Process Standards in Healthcare



Published on Sep 25, 2014: 

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See Dr Pankaj Gupta speak on improving process standards in healthcare, broadcast on September 24, 2014. Replay it here: Improving Process Standards in Healthcare
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Topics include:
- Lean process thinking,
- CPOE - computerized physician order entry,
- eMAR - Bar code medication administration,
- CDSS,
- Key performance indicators, Trends,
- Evidence based medicine;
- and other workflow considerations.
https://youtu.be/dELeEbY8Sfk

Thursday, February 19, 2015

Speaking about mHealth @ APICON 2015

Date: 19/Feb/2015.
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See Dr Pankaj Gupta @ APICON 2015 speaking on 19/Feb/2015 in Gurgaon. https://youtu.be/NPQ-cshfLdQ
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Dr Pankaj Gupta spoke about mHealth @ the APICON 2015 www.apicon2015.com. Topic: Digital Advantage for Doctors.

Thursday, October 16, 2014

Shortage of Teachers! - Higher Education System Suffers

Indian education system has severe shortage of teachers. This is because of archaic divide and rule policy - Govt/UGC/Board rules deliberately create a divide between academia and industry. 

For higher education the teachers are supposed to have PhD and teaching experience in Govt/UGC/AICTE/MCI recognized university/institute. Industry experience is not given the same weightage as teaching experience! Obviously the teacher who has been away from the reality of industry will not be able to impart knowledge about the industry. Hence the divide by design where the students are not directly employable by the industry. The industry has to spend extra to train the students after recruitment.

The compensation model as per Govt/UGC/AICTE/MCI norms is far lower than the industry average. Hence it is hard for any industry expert to devote time for education sector. Obviously the academic knowledge remains far behind and removed from the industry pace.

The curricula norms designed by Govt/UGC/AICTE/MCI are so stringent that the education system teaches subjects/topics which are essentially useless for the industry. We end up creating a human resource capacity crisis in pretty much every sector in India.

 Once a person is out in the field the education system castigates and debars that person from lateral entry into the education mainstream. If a professional learns the skill at his or her own efforts and wants to get certified and recognized - our education system provides no mainstream methods to enable such self initiatives. Rather it is discouraged by design. S[He] has to start again from the bottom of the education system without getting any credits for on the job knowledge/expertise he has gained over the years in the field.

It is time for India to re-look at Education System and remodel it completely to build seamless bridges between academia-industry. The generation born in the British Raj era and upto 10 years after that firmly believed the legacy system is good and doesn't need to be changed. I have spoken to deaf ears for decades. Is anyone listening now?

Also read my Blog: Innovation: http://healthcareitstrategy.blogspot.in/2012/02/innovation.html

Wednesday, April 23, 2014

Why All Indian Hospitals IT is in Bad Shape

Recently I got a call from a Board member of a leading Hospital chain. I have known him for many years now. He asked me "Which Hospital has the best IT System"; to which I responded that "everyone is suffering...everyone is in the same boat". Then he asked me to give top 3 reasons "Why All Indian Hospitals IT is in Bad Shape". Here is what I told him:

Policy - India lacks a healthcare policy. Therefore there is no incentive for any stakeholder to improve process or technology. Therefore Process and IT are seen as a marketing fad rather than a business need. 

Tangible - No CFO pays of intangible things such as process and technology. All expenses on the process and IT are seen on the liability side but it doesn't add anything to the Asset side. Obviously CFO will have a problem with this intangible model.
Pay out of pocket - There is no Healthcare Financing model. 85-90% of market is pay-out-of-pocket. Therefore the question is 'How much can you load the patient's pocket?'. Obviously it becomes an extremely price sensitive market. All this makes it a breeding ground for local, low-cost, no-quality fly-by-night HIS/EMR software vendors. They aim to solve only the immediate issues but none has delivered on the promises.

Vacuum - Large Healthcare-IT vendors have exited the market. Either they lost interest and exited or got bought out e.g. TrakHealth, iSoft. Also the market is moving from client-server to cloud and from Capex to Opex models. New cloud based players are small in size and yet to reach enterprise class. Existing players are not able to shift out to cloud because of their longterm negotiated contracts in client-server model. However the time is not far off when full conversion of Enterprise class to cloud will happen anyways.

Techno-Functional Skills: Last but not the least. I have harped a lot on this issue earlier - the implementation team has to be techno-functional in the same brain. It doesn't work by putting a technical person together with a functional person.