Healthcare-IT Business Strategy

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.


Sunday, February 2, 2014

Knowledge Currency

There are 3 kinds of powers in this world - muscle power, money power and knowledge power.  The currency for muscle power was the Hours of manual work done that was used in the agriculture or green revolution. The person or organisation with strongest  muscle power would rule in that era. The currency for money power is Dollars or Euro or Rupees etc. Money currency has been a predominant force that built the industrial revolution. The individual or corporation with highest money pool have been ruling the markets.

There is no currency for Knowledge as yet. People measure knowledge in terms of Dollars/Hour, which is a flawed way because you cant really put a value to the task that is done in minutes but may have taken months/years of preparation/study/experience.

Knowledge is considered as the highest form of power. Countries have collapsed because they couldn't control the spread of knowledge due to Fax machines. Today's social media is another example of knowledge power that has capacity to go viral and generate value beyond imagination of yester generation. It is flattening the hierarchy and Govts find it hard to fathom what is happening. 

Someday a knowledge currency will emerge somewhere in the world and lead to a paradigm shift which is unprecedented and will lead to sweeping economic and political changes across the globe. I am waiting to see it happen.. 

Dilemma of Procedure Code Sets!

TG team faced the Dilemma of Procedure Code Sets while working on Healthcare-IT standards! Given below is a good analysis about lack of opensource procedure code sets globally. A classic example of how developed economies of the world hold emerging economies to ransom!

-- Reproduced from FAQs of MDDS Health Domain Draft Standard --

The mandate of the MDDS was to look for open standards that are currently in use globally. For diagnosis the MDDS has used ICD-10 codes, these codes are map able with the SNOMED.

The Health Domain MDDS Committee reviewed ICD-10-PCS and CPT as a procedure code set options: ICD-10-PCS is an American standard for in-patient procedure codes developed by US Centers for Medicare & Medicaid Services [CMS] not by the WHO. This is an up-gradation from ICD-9-Vol 3, which is also a US standard for in-patient procedures currently in use. USA is set to adopt ICD-10-PCS in Oct/2014 and the licensing terms for ICD-10-PCS will be determined by USA at the time of its adoption in Oct/2014. Also ICD-10-PCS is not a complete procedure coding reference across in-patient and out-patient settings. USA is set to use ICD-10-PCS for in-patient procedure codes, whereas USA uses CPT for out-patient procedure coding. CPT® codes are owned by the American Medical Association [AMA]. The AMA holds copyright on CPT and use or reprinting of CPT in any product or publication requires a license. 

The Committee then reached out to WHO looking for open standard procedure code sets.  The Committee found that WHO is still in the process of developing the initial version of international classification of Health Intervention [ICHI].  WHO says that ICHI is being adapted based on the Australian standards - earlier ICD-10-AM now after the third revision is called Australian Classification of Health Interventions [ACHI].  Quoting the WHO official site:  “In recent years, the Network of WHO Collaborating Centres for the Family of International Classifications has promoted the development of a short list of health Interventions for international use, based on the Australian Modification of the International Classification of Diseases, 10th revision (ICD-10-AM) It is intended to be used in countries that do not, as yet, have their own classification of interventions.  An initial ICHI version is being adapted to meet present day conformance criteria with recognized standards. In particular, the multiple application areas of such a classification calls for a multiaxial capture of the underlying knowledge.” 

For the usage of ACHI the matter was pursued with the concerned Australian dept and the committee was informed that “a country within which you are located must be licensed for the AR-DRG Classification System before being able to purchase any of its materials, including the ACHI”

The Committee then reviewed the Canadian procedure coding standard – Canadian Classification of Health Interventions [CCI] as an alternative. CCI is an open standard and is from a well recognized source which is currently in use. As per CCI code directory: “Contents of this publication may be reproduced in whole or in part for internal, non-commercial use only provided that full acknowledgement is given to the Canadian Institute for Health Information.”

Purpose of coding standards in US such as CPT and ICD is primarily for insurance reimbursement. Whereas purpose of Canadian (CCI), Australian (ACHI) and WHO (ICHI) standards is semantic standardization for analytics, research and policy. ICHI contains approximately 600 codes. However the CCI provides additional level of detail and has more than 17,000 codes.

Considering the complete analysis across – ICD-10-PCS, CPT, ICHI, ACHI and CCI - The Committee found CCI as the only currently used open standard procedure code sets, suitable in Indian context and thus referenced CCI for procedure code sets.

Committee can review the decision in case WHO comes out with a detailed procedure code set under ICHI.