#DIGITALHEALTH

Regulatory Essentials for e-Health in India by Dr. Milind Antani @milindantani


A doctor should not give any advice over electronic media that would ordinarily require the physical examination of the patient.
» The Supreme Court has noted that prescriptions should generally not be given out without actual examination.
» It has also stated that prescriptions should not be given over the telephone, except in case of emergency.


Ensure that your doctors/healthcare service providers are duly registered with the relevant state medical councils.
» Keep in mind that certain states require the doctor to be registered in the relevant state where the advice is being provided/patient is situated.

Obtain informed consent from the patient before providing advice over telemedicine. Consent should have declarations that patient:
» has attained the legal age of majority;
» is voluntarily providing personal and medical information;
» has read the privacy policy, terms of use and other documentation;
» consents to the provider intimating public authorities about results and findings during the course of services, if required by law;
» understands the inherent risks related to the provision of telemedicine and other related services;
» is aware that s/he may withdraw consent at any time; and
» can inspect and modify personal information provided at any time.

Make sure that the patient has read about the inherent limitations of telemedicine that arise due to absence of physical contact between the doctor and the patient.
» Ensure that the patient is aware that the issuance of a prescription is not guaranteed.

Make it clear to the patient that telemedicine services are not for emergencies.
» Build in disclaimers that state that telemedicine services should not be used in case of an emergency.
» However, in case of one, please do not shy away from providing whatever assistance that you can.

Ensure that no one other than the doctor is privy to the consultation, as it may result in breach of the patient’s privacy. Have a privacy policy in place. It should lay down:
» whose personal information is being collected;
» for what purpose;
» until when; and
» whether it will be disclosed/transferred to a third party or not.

Have a terms of use of service in place and clearly identify:
» limitation of liability;
» indemnity; and
» the jurisdiction of courts.

Bear in mind that e-prescriptions require digital signature of the doctor.
» A prescription carrying a picture of the doctor’s signature may not be a valid prescription.
» A scanned copy of a physical prescription may also not be considered valid.
 Maintain records of the consultation to the extent possible.
» The period of limitation for civil cases is 3 years. Maintaining records for this period at the minimum would help mitigate risk.
» The government is contemplating making it mandatory to maintain records of OPD patients.

Always request patients to share contact information of a person who may be reached in case of an emergency during consultation. There are inherent limitations of operating a platform model versus a service model.
» In the platform model, the service provider cannot monitor quality beyond a point, else it will lose the status of a platform provider.
» In the service model, the quality can be monitored to a great extent. 

However, there is a risk of litigation against the service provider for any deficiency in service rendered by the doctor.

Documentation is key! Make sure you have all the required documents in place to mitigate risk.
» Proper documentation will help in clearly demarcating roles and responsibilities, which becomes essential in ascertaining liability.

What are the changes you invisage in the legal framework governing Telemedicine services in india? 

Dr. Milind Antani: I would consider e-Health more relevant than Telemedicine as e-Health has broader scope of activities. India has been witnessing significant upward surge in e-Health recently. However, regulations have not evolved completely or not matching the pace.

However I am envisaging the following changes/new laws in near future

·       Electronic Healthcare Data Privacy legislation
·       E-Prescription guideline/ amendment to allow e-prescription
·       Amendment to allow e-Pharmacy
·       Telemedicine Act ( may not happen in near future but required)
·       Amendment in MCI Code to allow Audio Video consultation for doctors
·       Central license by MCI to practice in every state of India




The article has been authored by Dr. Milind Antani. 

Author
Dr. Milind Antani

Represents clients in matters including corporate mergers and acquisitions, investments, regulatory and transactional matters, intellectual property prosecution and litigation, joint ventures and formation of new companies. Focuses on Pharmaceutical, Life Sciences, Healthcare, Social Sector, Intellectual Property and Medical Devices

#DigitalHealth as a tool to Protect the National Health Protection Scheme by Dr. Oommen John @oommen_john


Author: Dr. Oommen John, Date: 12/02/2018

Digital Health would have a pivotal role towards efficient implementation of the National Health Protection Scheme announced in the #budget2018.


Healthcare related costs is one of the leading cause of impoverishment in India. In recent times, there has been a growing “trust deficit” between the consumers of healthcare services and the care providers.


The Budget 2018 announcement of ” #Ayushman Bharat ” aimed at financial risk protection from catastrophic healthcare expenses is a clearly articulated strategy towards providing Universal Health Coverage and India’s march towards achieving the UN sustainable development goals #SDGs.
Government sponsored health insurance schemes in India have run into the risk of becoming scams in the past, where the availability of insurance cover have been an incentive to perform investigations and procedures that were perhaps clinically unnecessary and in some cases physiologically impossible, such as males having their uterus removed ( procedure called hysterectomy, when one thinks of a male undergoing the same would roll hysterically !) and worse still these procedures being reimbursed by the insurance providers under the government sponsored schemes. 
There is an urgent need to empower the citizens to make informed choices and participate in shared decision making process. The National Health Portal has a wealth of information around health conditions and tools that aim to empower the citizens towards informed choices around health, there has also been concerted effort to make these available in regional languages.
Also, since a significant provision of secondary and tertiary care is in availed in the private sector, seamless referral mechanisms between the primary healthcare systems (which are mostly in the public sector and closer to where majority of the rural communities live) and the specialized private healthcare establishments would be fundamental to the successful implementation of the National Health Protection Scheme #NHPS.
The frontline healthcare workers empowered with #electronic health records of the populations they serve and using #clinical decision support tools could serve as the gatekeepers to triage and refer those needing higher level services into the healthcare delivery institutions. #electronic tracking of the referral would not only ensure that the healthcare delivery systems are not overwhelmed with sudden influx of a large number of patients wanting specialized services that the current healthsystems are ill-equipped to deliver but also serve as a regulatory mechanism for these well intended schemes from being misused and protect the vulnerable citizens from being exploited and their organs being sacrificed at the alters of greed (akin to the killing of the golden goose). Any well intended scheme is a potential scam unless robust mechanisms prevent them from being misused.
Health Systems generated Electronic health records or better still patient held electronic health records such as MyHealthRecord as envisaged by the ministry of health and family welfare along with functional regional and central health information exchanges would be the backbone for the national health protection scheme to be efficiently operationalized.
Currently, most insurance linked health care provision is administrated through third party agencies, while few of the government insurance schemes are cashless, Ayushman Bharat is an immediate opportunity to scale up #digitalhealth based real-time health insurance handshakes that enable citizens to avail the benefits of this scheme without being pulverized in bureaucratic pain in addition to their physical pain from undue delays for “preauthorization” before they can avail essential healthcare services.
The implementation plan of the #NationalHealthProtectionScheme is an opportunity to leverage #designthinking concepts and establish thought leadership towards integrated people centered healthcare systems
While we have several islands of excellence in #mhealth, many of them still at national level pilot stag , a national Digital Health Platform would also help connect these islands and help navigate through the muddy waters towards a well-functioning digital health ecosystem with an aim to ensure a level playing field for all the stakeholders in the healthcare delivery space, thereby paving the path for more efficient and transparent healthcare delivery.
More over a national digital health platform / grid backed by a robust health information exchange would also create an enabling environment for “start up entrepreneurs” to plug in and contribute to the transformative vision articulated by the government towards achieving universal health coverage for all Indians.

The article was first published in Dr. Oommen John’s LinkedIn Pulse page, its been re-published here with the authors’ permission

Author
Dr. Oommen John

is a Consultant Physician, Public Health Research and Policy Expert. He is the current President of the Indian Association for Medical Informatics and a Senior Research Fellow at the George Institute for Global Health

<!– Place this data between the tags of your website –>
#DIGITALHEALTH AS A TOOL TO PROTECT THE NATIONAL HEALTH PROTECTION SCHEME BY DR. OOMMEN JOHN @OOMMEN_JOHN


Health Information Technology: A Longer ROI for Higher ROI? by Dr.Ujjwal Rao @DrUjjwalRao


Recently I gave a talk at the Revolutionizing Healthcare with IT Conference in Mumbai around ROI of Health IT. Here’s the gist!


Before I delve any deeper, let’s understand what ROI is.

ROI can mean different things to different people. To nurses and infection control teams, ROI means ‘Risk of Infection’. To most of us burdened by home loans, car loans and education loans, ROI means ‘Rate of Interest’. To the CEO who makes gut-wrenching investments and wants to make money back, ROI means ‘Return on Investment’. As for me, the emergency physician in me wants to take ROI at its face value, but the clinical informaticist in me thinks of ROI as the ‘Radius of Information’.


Let me illustrate what this means. Think about the “radius of information” as a measure of the circle of knowledge, i.e. the super-set of all that we know in medicine (Fig 1). From all this knowledge, there are things that you know and things that you don’t know i.e., you know what you know and you know what you don’t know. However, with an explosion in the rate of medical information growth coupled with the slow adoption of research findings into clinical practice, more often than not, physicians don’t know what they don’t know. This is what is known as knowledge variability. No two doctors, no two nurses have the same amount of knowledge, and that is at the core of knowledge-based medical errors.

Figure 1
The other fundamental cause of medical errors is operational variability. Operational variability arises, for example, when a physician’s handwriting results in a prescription error. Similarly, there are many categories of operational lapses that result in medical errors.

Reducing operational variability is usually the mainstay of most quality programs and health IT is often deployed to yield returns from operational optimization. But, the question remains, what about knowledge-based errors, where care providers at best fail to provide high-value care and, at worst, cause preventable medical errors and deaths due their knowledge gaps? Knowledge variability is hardly ever addressed by health IT.

Knowledge variability stems from the “Knowledge Dilemma” (Fig 2) posed by two determinants of medical knowledge – Diffusion Time and Doubling Time. On one hand, it takes, on an average, 17 years for research to move into day-to-day clinical practice and on the other hand, medical knowledge will soon double every 73 days!

Figure 2

Now, with this disastrous collision of realities, is the practice of medicine no longer “humanly” possible? How can we avoid variability in patient care while keeping current? And how can we optimize ROI of health IT?

In order to truly address new challenges appearing as our entire healthcare delivery model evolves, technology needs to be evidence-adaptive i.e., to have a knowledge-base that continually reflects current evidence so that it can bring the right information to physicians at the right time, at the point-of-care. Clinical Decision Support Systems (CDSS) are the most pertinent answer to the vast and destructive problem of variability in care delivery. Evidence-adaptive CDSS from authoritative sources have proven to reduce spending on unnecessary tests and procedures as well as avoid costly adverse events (and in many systems, malpractice litigation claims). Although at present evidence-adaptive platforms require human intervention, we are now beginning to see the inclusion of artificial neural networks (deep learning), Bayesian networks, reinforcement learning, and other artificial intelligence techniques for synthesizing evidence relevant to patient data in real-time, with potentially unprecedented insights for clinicians.

Intelligence Augmentation (IA) with evidence-adaptive CDSS, where technology amplifies the decision-making capabilities of humans, links healthcare providers to vast amounts of patient data in the Electronic Health Record (EHR) with relevant clinical knowledge, in real-time, at the point-of-care. This can dramatically increase clinicians’ ROI – radius of information, thereby improving clinical outcomes and consequently increasing the healthcare organization’s ROI – return on investment. Indeed, a longer ROI for a higher ROI!

End note: Wondering if you should build evidence-adaptive CDSS in-house or opt for a third-party solution? In my latest whitepaper, I weigh the pros and cons of each option. You can read more about it: http://bit.ly/2AXR6h9


Author
Dr. Ujjwal Rao

Dr. Ujjwal Rao is Senior Clinical Specialist in Integrated Decision Support Solutions, and is based in New Delhi, India. He provides strategic counsel to health providers on designing world-class clinical decision support systems with Elsevier’s comprehensive suite of current and evidence-based information solutions that can improve the quality and efficient delivery of healthcare.

An experienced emergency physician, executive, clinical informaticist and technology evangelist, Dr. Rao has a decade of experience serving in trust and corporate hospitals in various roles ranging from clinical administration, hospital operations to quality & accreditation. In his former positions, Dr. Rao led EHR implementations for large hospital groups and designed bespoke healthcare analytic solutions to raise profitability.

His passion to see transformation through technology led him to volunteer as a quality consultant with the United Nations. He also currently serves as an Assessor on the Panel of the Quality Council of India for the National Healthcare Accreditation Standards body, NABH.

Dr. Rao obtained his degree in Medicine and then specialized in Hospital and Health Systems Management, Medical Law and Ethics before completing his PhD in Quality and Medical Informatics.

India aims to be a Global Leader in #DigitalHealth by Rajendra Pratap Gupta @rajendragupta

The Article was first published in Mr. Rajendra Pratap Gupta’s LinkedIn Pulse, the Article is republished here with the authors permission


In May this year, India had tabled a resolution at WHO for mHealth, which was supported by over 30 nations. This clearly signals India intent to be a global leader in Digital Health.

Digital Health has the potential to revolutionize how populations interact with national health services and also strengthen health systems and will play an important role in preventive , promotive and curative health. India is now embarking on a futuristic journey to bridge the healthcare divide between have’s and have-nots using digital health tools. We have a number of projects that will extensively deploy technology .


The Ministry of Health & Family Welfare has been taking several impactful initiatives in the field of Digital Health. Our Hon’ble Prime Minister has envisioned for Digital Platform & Electronic Health to be optimally leveraged, so as to meet the key challenges posed to us in health sector e.g. shortage of health human resource, accessibility of healthcare infrastructure, affordability of healthcare services etc. Electronic Health Records (EHRs) of citizens are envisaged to be created for ensuring continuity of care and other associated benefits. Delivery of services to citizens through “online mode” is at core of the overall electronic health ecosystem being talked about.

Major I.T. initiatives by Ministry include various mHealth initiatives for improving efficiency and efficacy of public healthcare across the country under the Digital  India Programme. Some of the initiatives are:

Mobile applications

Various mobile apps have been launched

Vaccine Tracker mobile application support parents in tracking immunization status of their children and helps them in ensuring complete and timely vaccination.

The India Fights Dengue mobile application provides interactive information on identification of symptoms of Dengue and links users to nearest hospitals and blood banks

The swasth Bharat ( Health India ) mobile application provides detailed information on healthy lifestyle, disease conditions and their symptoms, treatment options, first aid and public health alerts.

Ministry recently launched the Stress management app – ‘NO MORE TENSION’ on google / IOS.

Mobile Academy

Mobile Academy is a free audio training course designed to expand and refresh the knowledge base of ASHAs and improve their communication skills. Approximately 170,000 ASHAs of Jharkhand, Madhya Pradesh, Rajasthan and Uttarakhand are expected to benefit from Mobile Academy. As of 31 Aug 2016 more than 45,000 ASHAs have started the course and out of which more than 40,000 have completed it successfully.

Kilkari

Kilkari delivers free, weekly, time-appropriate 72 audio messages about pregnancy, child birth and child care delivery to families’ mobile phones. Approximately 1.9 Million pregnant women and children in Jharkhand, Odisha, Uttar Pradesh, Uttarakhand and High Priority Districts (HPDs) of Madhya Pradesh and Rajasthan have been reached by the service in Phase 1 as of 31 Aug, 2016.

Tobacco Cessation Programme

Programme launched on 15th January 2016. Ministry of Health & Family Welfare, in partnership with World Health Organisation and the International Telecommunications Union, started an initiative for utilising mobile technology for tobacco cessation. Currently, more than 1900,000 users registered for mCessation on Tobacco.

mDiabetes Program

An initiative for prevention and care of diabetes, launched on 22nd , June 2016 on ‘World Diabetes Day’. It is based on proven algorithms for diabetes prevention and care, and builds on previous international experiences in using mobile technologies to deliver these interventions. Using constant text messaging on mobile phones. Currently more than 100,000 users registered for mDiabetes

Nikshay for Tuberculosis Control Programme

To monitor and track services and status relating to screening, diagnosis, treatment and follow-up of Tuberculosis cases. NIKSHAY was launched in 2012 and has been implemented across all States, and has 6 million registered users

Online registration System (ORS)

Launched in July 2015, ORS is a system to link various hospitals across the country for online registration, appointment and for providing patient centric services like viewing Lab reports, blood availability status etc. As on date, 48 hospitals covering over around 500 departments across 18 States/UTs are offering services through ORS and over 4,00,000 appointments have been transacted online till date.

These initiatives are ensuing remarkable improvement in healthcare delivery and management.

MyGov

A discussion group viz. ‘Healthy India’ has been created by MoHFW under the “MyGov” portal and seven discussion areas covering various issues have already been hosted so far. https://www.mygov.in/

National Health Portal (NHP)

Launched on 14.11.2014, serves as a single point access for authenticated health information for citizens. (http://www.nhp.gov.in).

NHP Voice Portal

Toll free national number 1800-180-1104 for providing information related to health, diseases, lifestyle, first aid, directory services, health programs etc.

National Healthcare Innovations Portal

(www.nhinp.org)- An online portal for documenting innovations taken up by states, NGOs and other private sector organizations.

National Identification Number (NIN) Portal

put in place for allocation of NIN to all health Facilities in India. As of 10th October 2016, 2,14,340 facilities were allocated NIN. Out of these 1,88,841 public health facilities (88%) facilities were verified by the states.

HMIS-MCTS Facility master mapping has been completed for all states and states are currently verifying the mapping to match health facilities in both systems. Incorporation of other hospitals of MoHFW and other ministries in NIN Portal is in progress

National Health Resource Repository (NHRR)

NHRR envisages creating a single gateway of authentic, standardized, updated public and private healthcare resource intelligence and develop user friendly system with utility to serve as a decision making tool for varied categories of health system stakeholders. The pilot of the survey was completed and the soon the pan-India survey will be initiated to collect health resources data. This data will be placed online for easy access to all stakeholders.

eHospital@NIC

6 modules available on eHospital Cloud version; other modules to be made available by Dec’16 by NIC. Over 30 large hospitals are using eHospital and 7 hospitals are using cloud version of eHospital

EHR Standards

were first notified in 2013. The EHR standards are meant to facilitate semantic interoperability between different EMR /EHR systems. EHR Standards include SNOMED CT standards for providing consistent terminology across all health care domains. India became member of International Health Terminology Standards Development Organization (IHTSDO), effective from 1st April, 2014.

Notification of revised EHR Standards (2016) is under process and will be released shortly. CDAC, Pune has been nominated as interim National Release Center (NRC) for SNOMED CT. As of now 140 SNOMED CT affiliate licenses are issued by iNRC.

Mother and Child Tracking System/ RCH System

Implemented across all the States & UTs, approximately 3.00 crore pregnant women and 2.72 crore children are expected to be covered annually under MCTS and RCH application combined. 1,16 million pregnant women and 994,000 children were registered in MCTS and RCH portal combined as on 20th September, 2016.

Missed Call Centre for reaching unreached TB patients

A dedicated toll free number with a call centre that is currently available in the States of Punjab, Haryana, Chandigarh and Delhi. Around 30,899 calls have been made till date.

National AIDS Control Organization (NACO)- Strategic Information Management Information System (SIMS)

has over 20,000 reporting units across the country. Centralized Project Financial Management System (CPFMS)- details of allocation, expenditure of budget disbursed at Central and state level are monitored.

Inventory Management System (IMS)

for tracking inventory at every point of supply chain to establish a robust supply chain Management,

India HIV/AIDS Resource Centre (IHRC)

A Digital Resource Centre (www.indiahivinfo.naco.gov.in ) which is one stop shop for resources available on HIV and related issues, and get an average of 2000 calls per month and covers 60 districts in 10 States (Bihar, Haryana, Punjab, Rajasthan, Karnataka, Maharashtra, Uttarakhand, Uttar Pradesh, Chhattisgarh, Jharkhand)

Rashtriya Swasthya Bima Yojana

RSBY uses IT platform for enrolment of beneficiaries, smart card for beneficiary authentication, cashless transactions, grievance management, has over 41 million (41,331,073 ) smart Cards : and has handled over 11 million (11,841,283 ) hospitalisation Cases : as on date: 31/03/16 .This scheme is likely to be the template for the National Health Protection Scheme

‘Mera Aspataal’ (Patient Feedback System)

To empower the patient to give his / her views on quality of services rendered by a healthcare facility, MoHFW has designed an ICT-based Patient Satisfaction System (PSS) for implementation in public and empanelled private hospitals. During the pilot phase 117 State / Central government hospitals are being considered where feedback will be collected from more than 1,00,000 patients per day. 37 hospitals were sharing data with My Hospital as on 19th September, 2016.

eRakt Kosh

Launched on 7th April 2016, eRakt Kosh application is a centralized blood bank management system. eRakt Kosh is being rolled out for all the licensed blood banks in public and private health facilities in States / UTs. Presently eRakt Kosh is running in 4 blood banks of Madhya Pradesh, 5 blood banks of West Bengal and blood bank of national HQ of Indian Red Cross Society in Delhi. The application is going to be initiated in some blood banks of Gujarat, Jharkhand, Telangana and Uttar Pradesh shortly.

National Organ & Tissue Transplant Orgnaization (NOTTO)

(http://notto.nic.in)- (Launched in 2015). There are two registries in place under this program-

1. Online Registration for Organ/Tissue Transplantation or Retrieval– Total registration- 1721

2. Online pledge registry by citizen for organ donation: Total registration-23695

National Cancer Registry Program

(http://www.ncrpindia.org/)- National Cancer Registry Program being run by ICMR collects data on cancer patients across country. The registry data is used to compile cancer atlas which provide details about cancer incidences, types underlying causative agents and risk factor details

Central Drugs Standard Control Organization (CDSCO)

“SUGAM” for processing of applications for import and registration of drugs and permits for import of small quantities of drugs for personal use. System Launched in November 2015.  Total Firms registered for import of drug (2089), medical devices (1076) and cosmetics (116). 

FSSAI

The system facilitates online License to the Food Business Operators falling under central license-; online clearance mechanism for imported food items; online system for product approval of food items which are not standardised under the Food Safety and Standards Act & Regulations made there under.

Total Bill Of Entries filed: 26997 for 34235 food items.

32597 food Items granted No Objection (NOC) whereas 292 items were rejected

NOC generation for 1346 items is under process

Food Licensing and Registration system:

Total application received online till date for central license : 28461

License issued till date : 28027

Total renewal application received : 13705

Total renewal done : 13649

ERMED (Electronic Resource in Medicine) Consortium

National Medical Library’s ERMED Consortium is an initiative taken by the MOHFW to develop nationwide electronic information resources in the field of medicine . The consortium is coordinated through its headquarter set up at the NML since 2008.

At present, 70 state and centrally funded Government Institutions (including all AIIMS) from 24 states are selected as its members

One of the advantages of ERMED consortium is that it not only provides current issue of Journals from leading publishers , but also facilitates its users with the archival issues (print as well as electronic) for example, British Medical Journal, an International peer reviewed Medical journal is fully searchable, with an archival backup since 1840. National Medical Library have a distinction of having BMJ since 1840 in print format. Print archive available since Oct 1840 to Dec 1993, and online archive available Jan 1994 to till date, and The BJU International is available since 1929 with full-text archive. One of the biggest strength of NML is its vast collection of 7.5 lakh volumes of books, reports, bound volume of journals and other literature, and adds latest books and journals every year. It also subscribes to 1500 current periodicals. The library has good collection of 19th century medical literature.

National Medical College network

Under National Medical College Network (NMCN), scheme , 50 Govt. Medical Colleges  are being inter-linked with the purpose of Tele-education, e-Learning and Online Medical Consultation by utilising the connectivity provided by National Knowledge Network (NKN). Under this imitative, a virtual layer of Specialty/ Super Specialty doctors from these Medical colleges would also be created  for providing “Online Medical Consultation” facility to citizens which will be similar to OPD facility but in a virtual way through a web-portal. This will help patients from rural, remote and urban areas to access doctors and specialists easily even from their home location through their Smart Phones, through Government healthcare institutions (PHC/CHC) and through Common Service Centers (CSCs). 

National Telemedicine Network (NTN)

In the first phase of National Telemedicine Network project, it is proposed to connect 500 PHC/CHC/SDH at remote/rural locations with 50 District Hospitals. These District hospitals will be networked with 50 Medical Colleges.

Telemedicine by using Space Technology

Establishment of SATCOM based telemedicine centres at Chardhams and other important places of pilgrimage in collaboration with DoS (ISRO).

Integrated Health Information Platform (IHIP)

In order to augment the overall Electronic Health ecosystem further, the Ministry has envisaged setting up IHIP. This is a major step in the direction of addressing the existing situation of ‘electronic silos’ in health system. Interoperability and data exchange amongst Health IT Systems is almost lacking.

IHIP is expected to address various key issues and challenges such as fragmented information systems, accessibility & quality of data, duplicate information systems and most important lack of common EHR System. Today, most of the patient records get trapped in multiple silos. IHIP would work in the direction to enable the EHRs of citizens to be made available nationwide with the help of Health Information Exchange.

IHIP would in due course facilitate better health services to citizens and improve efficiency of healthcare services and programmes through optimal utilization of resources, availability of information for better decision and reduction in medical errors etc. With help of EHRs, cost reduction in medical cost is expected as requirement of redundant medical tests would be checked.

Citizens would be empowered through online access to IHIP to view their health records and also to upload other medical records in order to create and maintain personal health record.

In line with Startup India initiative, IHIP would also provide an opportunity to Health IT start-ups to host their innovative solutions for use by different stakeholders. 

States and Union Territories (UTs) are being supported for implementation of hospital information system at hospitals and health centres for facilitating creation of EHRs.

Ministry has already started the process for setting up IHIP and it is expected to be ready for pilot in select States/UTs early next financial year. The platform will by then be ready for progressive roll-out all over the country. 

National Digital Health Authority

Setting up of the National Digital Health Authority (NDHA) is another milestone for Indian Healthcare IT. The various regulatory aspects of digital health deployent like privacy, security, access, disclosure, exchange. would be taken care of by National Digital Health Authority (NDHA) proposed to be set up by MoHFW. The work on the same is already on , and this will institutionalize the support for digital health.

National Health Helpline

The Ministry is working on setting up of the health helplines . We want to ensure that people have the information they need, and on time 24 x7 in the remotest and inaccessible areas . This project should roll out by early next year . National Health Helpline  is envisioned to be offering its services in 16 regional language including reliable medical information with a doctor/an expert by harnessing the high number of mobile connections in India (in almost every household). This health helpline facility will help rural population save money and time on visits to doctor in a large number of cases

India Health Information Network (IHIN)

The Ministry of Health & Family Welfare , Government of India has initiated IHIN – A think tank of private and public sector to advice the Government on Digital Health.

Ministry is committed to financially support all the digital initiatives, and looks forward to multi-stakeholder engagement, and private public partnerships to scale up these initiatives

Update: 
CHANGING THE PARADIGM OF #DIGITALHEALTH IN INDIA REPORT 5TH GOVERNMENT INDUSTRY DIALOGUE by @rajendragupta 
http://governmentindustrydialogue.org/documents/pdf/5th-gid-report.pdf 




Rajendra Pratap Gupta is the Advisor to the Union Minister of Health & Family Welfare , Government of India . Views are personal. 

Author
Rajendra Pratap Gupta

Rajendra Pratap Gupta (Rajendra) is an original thinker and an innovator and one of the most influential and sought after public policy expert in the country. He has worked with some of the largest organizations across the world and was nominated to the Global Agenda Council of the World Economic Forum for 2012-2014 in recognition of his work.

He was conferred; ‘Global Healthcare Leader of the Year’ award in 2012 by the sheriff of Los Angeles; named the ‘Thought Leader of the Year’ three years in a row by ICT Post; Featured amongst the ’25 living Legends of Healthcare in India’ and is listed amongst the “100 Most Impactful Healthcare Leaders”.

Enactment of Healthcare Reforms, Including PPCA, Drives the HCIT Solutions Market by Deepa Tatkare

According to the Bureau of Labor Statistics in the U.S., about 1.2 million vacancies would be available for registered nurses from 2014 to 2022. 

The demand of home healthcare is expected to increase and drive the healthcare IT solutions & services such as telehealth, telemedicine, and mHealth during the forecast period to meet the demand-supply gap


Enactment of Healthcare Reforms Including Patient Protection and Affordable Care Act (PPACA) Drives the Healthcare Information Technology (HCIT) Solutions Market 


Healthcare information technology (HCIT) deals in creation, design, development, and maintenance of information systems for healthcare organizations. It is expected to improve medical care, curb costs, minimize manual errors, and enable the optimization of reimbursement for ambulatory and inpatient healthcare providers.

Many government healthcare policies promote the use of both non-clinical and clinical solutions, especially electronic medical/health records (EMR/EHR), mHealth, and telehealth. While, EHRs benefit healthcare organizations by curbing treatment costs; mHealth utilizes mobile phones and communication devices to provide immediate care to patients. Increasing number of patients have adopted mHealth, as it is economical, and provides insights on preventive health care services, chronic disease management, disease surveillance, epidemic treatment support, outbreak tracking, and reducing overall healthcare cost. 

Patient Protection and Affordable Care Act (PPACA), commonly termed as Obama’s Health Care, is one of the most important healthcare policies that has affected the adoption of HCIT solutions. 

This law is effective in promoting enrollment of uninsured population, boosting use of HCIT solutions & services, and stimulating the adoption of electronic medical/health records. There are nine major separate legislative titles under PPACA, which include:

  • Affordable health care for all Americans
  • The role of public programs for the implementation of this act
  • Improving the quality and efficiency of health care facilities
  • Prevention of chronic diseases
  • Organized management of healthcare workforce
  • Transparency and program integrity
  • Improving access to innovative medical therapies
  • Community living assistance services and support
  • Revenue provision

For complimentary access to more information on this research: https://www.alliedmarketresearch.com/healthcare-information-technology-market

Some key sections of PPACA that are expected to impact healthcare information technology market are:

Section 2401: 

offers home- and community-based medical services for qualified individuals. These services assist patients to accomplish regular life activities and ensure continuous care for them. This section will have a direct impact on the HCIT industry, as it guides patients on their health status via telehealth or mHealth, enabling them to be in real–time communication with their doctors. 

Consequently, the demand for such services has significantly increased, which stimulates the adoption of telehealth and mhealth market. In fact, Telehealth segment is expected to grow at a CAGR of 33.27% during the analysis period.

Section 2703: 

provides home-based medical services for patients with chronic diseases such as cardiac condition, cancer, diabetes, and others. This section promotes the use of IT–based care management systems and stimulates the integration of IT in healthcare industry. 

The subdomains of healthcare include laboratory management, practice management, financial management, patient, and billing management, payment management, and others. Increasing incidence of chronic disorders among individuals has posed a key challenge to healthcare organizations. 

Hence, different management solutions are available for different levels in the market. This act stimulates the demand for healthcare management solutions & services, thereby driving the market growth.

Section 10410: 

establishes national center’s for treating depression. It is anticipated that EHRs would be used. It also promotes the use of telemedicine.

Section 4103: 

mandates medicare patients to have an annual wellness visit. It is expected that these visits would encourage patients to self-manage their medical problems. Moreover, they would be trained in self-management through the use of healthcare IT.

Section 2717: 

aims to establish quality reporting for both group and individual health insurers. This section focuses on regular reporting of healthcare insurance companies about their performance, and promotes the implementation of different healthcare payer solutions such as claim management, fraud management, and others. Stringent government rules for proper and timely reporting of healthcare-related financial documents have fuelled the demand for IT-based payer solutions.

These sections would propel the growth of EHR market in North America; affecting the world HCIT market. Moreover, dearth of skilled medical staff in healthcare facilities has hampered the market growth in the region. 

For instance, according to the Bureau of Labor Statistics in the U.S., about 1.2 million vacancies would be available for registered nurses from 2014 to 2022. 

The demand of home healthcare is expected to increase and drive the healthcare IT solutions & services such as telehealth, telemedicine, and mHealth during the forecast period to meet the demand-supply gap.

The article has been published with the Author’s permission
Author
Deepa Tatkare

Deepa Tatkare, has an experience of more than 3.5 years in market assessments and forecasts in healthcare & medical device industry. She is actively involved in providing critical insights on business research to clients with her subject matter expertize. Her profile includes planning, commissioning, and executing syndicate as well as customized research projects. She has successfully analyzed and presented data for studies related to medical devices, biotechnology, and pharmaceutical domains

What 2017 has in Store for Physicians? by Aiden Spencer, @aidenspencer15

The coming year is going to be tough if you’re a physician. There are several things that are going to change. It is important to be prepared about the coming changes in regulations, and what is required from a practice. This article will provide a brief summary about the coming changes, and what you can expect from 2017.


Before 2017

The year hasn’t completed ended yet but the healthcare industry has been bombarded with changes. The recent ending of the ICD-10 grace period has been the first major change leading into 2017. It has effected many practices in a number of different ways. It should be remembered that in the long run going electronic will benefit the entire industry. 


The possibilities are endless in the future, collaborative studies using patient data, the entire industry coming together to create something that could very well change the way the industry has worked for many years. 

Of course in the short run there will be certain problems especially as practices get used to the changes. Many physicians have even expressed concerned over productivity dropping because of all the regulations that have been imposed. These are minor setbacks in the grand scheme of things, and productivity is bound to rise in the long run.

Conclusion of Grace Period

The ICD-10 changes are something that every practice needs to know about. There have been almost around 3000 code changes starting October 1st. The biggest problem for practices is how to deal with the advent of these new codes. It is important to have a medical billing software to get through the paperwork. Whether your service provider has complied with the recent updates is a good question to ask. However if there hasn’t been an automatic update than you need to think about changing your service provider.

There are practices which still do not use a medical billing software, and it is important for them to know which family of codes has been changed and whether the changes affect your practice. The practices that aren’t totally electronic yet are going against the tide, and it is recommended that they shift if they wish to keep afloat in the long run especially with Medicare Incentive Payment System, and the changes that will entail. 

Claim Denials

The new ICD-10 codes, and the end of the grace period means that a practice can no longer use unspecified codes. This many have said will increase claim denials in the short run, and this could upset the budgeting of many practices. However practices that have medical billing software from reliable companies and vendors will not have to worry about claim denials going drastically up. Practices that aren’t using a software, should make sure they know the code changes especially the ones that effect their practice.

Elections

There are other changes that a practice needs to be aware about. The upcoming elections will truly decide the fate of the healthcare industry. Both the candidates are going in different directions. While Hillary Clinton wants to ‘tweak’ the Affordable Care Act (ACA), and keep going in the same direction, the Republican nominee Donald Trump wants to repeal the ACA. 

It is imperative that a practice be prepared for both outcomes. Whether that means more regulations, or less. In a Trump presidency, not only will the ACA be repealed, but insurance would be sold across state lines. This could potentially open up companies to more competition. Whereas a Hillary Clinton presidency would support state-based public option, and even limit covered consumers out of pocket liability.

Both the parties have disagreed on a problem of fundamentals. The future of healthcare industry hinges on the basic problem of how much spending should be done on federal level? The republicans have the view that there is too much spending currently on healthcare and not enough revenue. They plan to fix this by relying on the private market, which through competition would reduce costs.

The Democratic Party suggests that the amount of spending is not too much, it is however a problem of extracting revenue. This could be done according to the democrats by improving current government programs.     

What does this mean for a Physician?

For a practicing physician there isn’t much of a change as far as the elections are concerned. This is because it is important to first see the results of the elections. However one rule of thumb that we can go with is that there will always be regulations. This would mean that a practice should have meaningful use and HIPPA compliance. There are many Electronic Health Records (EHR) software that have integrated all updates, including the changes in the ICD-10 codes.

With the addition of Medicare Incentive Payment System, or MIPS, there will be a significant increase in transparency since reporting on performance measures will begin in 2017. Although the composite performance score (CPS) will be calculated and posted in 2019 it is important that all practices pace themselves along with these changes. The future of the healthcare industry is electronic, and regulated. Thus physicians should prepare accordingly. However after November 8th we will have a clearer picture as to which direction the healthcare industry is going towards. 

The article has been published here with the Authors permission. 

Author
Aiden Spencer

Aiden Spencer is a health IT researcher and writer at CureMD who focuses on various engaging and informative topics related to the health IT industry. He loves to research and write about topics such as Affordable Care Act, electronic health records, Medical Practice management and patient health data.

Reducing Leakage in Admissions, Pharmacy and Diagnostics at Hospitals by Baljit Singh, @mtatva

Typical advised diagnostics in OPD in hospitals ranges from 20% to up to 50% depending on specialty and month of the year. You really need to see how many of these are being lost to competition nearby


Hospitals have two big challenges to stay profitable. First, they have to continuously work to get new patients to discover their hospital. Second, most important aspect, is to get as much revenue from each patient visit. The second one drives both top-line and bottom-line significantly, but is also the least understood process due to inherent limitations.


Many hospitals achieve great OPD inflow but very little sales in IP, diagnostics and pharmacy. If you are facing this problem, then this article is for you!


Typical advised diagnostics in OPD in hospitals ranges from 20% to up to 50% depending on specialty and month of the year. You really need to see how many of these are being lost to competition nearby.

Understanding patient flow at hospital


For multi-specialty hospitals, OPD is like a landing place where patients first land. Based on the treatment advised on OPD records (mostly prescriptions), patients can either use pharmacy, diagnostics or IP services inside the hospital or from other providers outside. For example, a patient coming to OPD with chronic pain would need to get scanning, medicines, surgical belts and physiotherapy. Patient could do these either inside the hospital or outside hospital.

Typical Patient Flow at a Hospital and Revenue Loss

Hospital would like patients to avail facilities inside the hospitals rather than outside. Hospital management is always worried about the losses due to patient going out of the hospital for follow-on diagnostics, pharmacy or procedures.

Need to measure leakage

Unfortunately with current set of tools available with hospitals, they cannot measure this leakage effectively and continuously. Although hospitals know very well on who is landing on their pharmacy, lab and admissions, they do not know who were advised one of these but chose to go out for fulfillment. If somehow their OPD records became digital they could measure this easily. But this does not happen and hence the fallout. 

What they actually need is digitization of their OPD records. The only option available to hospitals is using EMR which is very costly in terms of allocating resources or equivalent cost of doctor’s time for electronic-entry. Nor are the specialists and super-specialists inclined to do it.

The benefits of digitizing OPD records are obvious but how can this be achieved efficiently? How can this be done with no changes to current work-flows for the hospital and the doctors?

Proposed solution to reduce leakage

Do hospitals need to live with this till EMR becomes a reality? No! There is a solution.


Stop Admissions, Diagnostics and Pharmacy Leakage

Health-PIE service available as of now can digitize OPD records cost effectively. This solution uses artificial intelligence based technology to reduce cost. Also gives direct benefits of digitization to patients as well. Realizing hospitals are already overburdened, the solution comes with zero need of training to hospital staff or any major change in workflows.

Health-PIE helps hospital understand their OPD patients and flow, helping hospital with measurement of leakages and analysis. Health-PIE will also uses artificial intelligence to continuously communicate with patients through their treatment creating stickiness. This stickiness helps increase OP to IP conversion. This double-pronged approach of Health-PIE is a killer solution which can increase top line as well as bottom line of any hospital!

Author
Baljit Singh, CEO, mTatva

Baljit Singh having more than a decade experience in variety of roles in Technology, business, strategy and management. He worked with multiple companies including one of top semiconductor companies as well as startups. Baljit is passionate to work in healthcare IT industry to solve some of key issues in primary healthcare. He also started SPOG

Steps to Performance Transformation by Ritesh Dogra @Ritesh_Medium

Take a step back and think on the fundamental question – ‘Have I created enough value in my current business model?’


Since the last year, we undertook quite a few ‘Performance Transformation’ projects. This was a pleasant change – existing healthcare providers trying to transform themselves and this had nothing to do with increasing bed occupancy either! So what is performance transformation?

Simply stating, Performance Transformation is Creating Value in Existing Infrastructure which will differentiate an existing set up in the market. To understand this, lets step back and reflect on a familiar concept, the S-Curve.


Redefining the S-Curve
Quite often, a business model in its maturity reaches a stable state. The revenue and margins become stagnant and at this time the promoter is faced with a fundamental question – What Next? This is followed by expression of interest from investors to scale up or providers evaluate new business models. It is at this point of time healthcare providers should take a step back and think – Is this real or perceived S-Curve? And on going deeper, the answers can actually redefine the ‘maturity state’. It is our inherent biases and preexisting knowledge that prohibits us from doing this. In the following section, I will try to elaborate the key steps which can actually help an existing organization transform itself.


1.Start with Immersion and Eliminate the Structure
We are all familiar with the term micromanagers, how about creating new creed of people who we call ‘micro-observers’ and ‘micro-listeners’? Even the best of managers fail to observe and listen to real patient problems and quite a bit of this is attributed to our ability to structure every element of our life– right from structured feedback to structured questionnaire to structured problem solving. Structure is great but never works when you need to understand your customer! Let’s start with unlearning all structures and just immerse ourself, spending our valuable time sitting in lobbies and corridors to understand our customers and break preexisting notions. This will throw up a lot of questions and answers!

2. Stop Gossiping and Start Talking
Our employees right from frontline staff to executives are in midst of action everyday. In fact, few other industries would offer the type of action that healthcare does. Let’s start listening to them and avoid side gossips, else soon we could be competing with Facebook! Spending time with employees to understand problems – their and customers, rather than skimming the surface, in my experience has been really helpful.

3. Identify Problems, Brainstorm and Lastly Don’t be a Super Hero!
While the first two steps will throw out problems and some indicative solutions, go ahead and dig deeper. Only super heroes in movies can save the world! In real life, understand the implications of problems followed by quantification of loss and the impact which solving them could mean for you. Prioritize problems, it always helps. And this is the stage where you can get into your familiar territory – structured problem solving!

4. Make Change Personal
Go ahead and implement solutions; align everyone in organization to your ultimate goals, make them a part of the larger cause, in fact create a mission. For any change to be effective to the core, it has to be personal. Create sub parts of larger solutions and assign everyone an implementation agenda and plan. You will gradually notice a change in your organizational culture, a change for good. And for this to be effective, never create incentives for culture change- it can be suicidal; only offer incentives for results which come unexpected.

5. Create Value and Monitor the ROI
After all, we started with the S-Curve. Start monitoring the impact and you will notice a shift in the S-Curve. And this is the time when you should make a shift to communicating the change – to your employees, target segment, investors and everyone in the ecosystem. More people should benefit from the change- shouldn’t they? And ultimately all of this will reflect in your financial metrics; Revenue, ROI and EBITDA.

So the next time you start thinking of larger than life problems such as trends shaping healthcare or attracting investors for scale, it would be worthwhile to take a step back and think on the fundamental question – ‘Have I created enough value in my current business model?’

Originally published in Healthcare Radius, March 2016: http://edition.pagesuite-professional.co.uk//launch.aspx?eid=fe8b4971-300f-4a9b-b0a7-58ebb835c206

Author
Ritesh Dogra

Ritesh has been a member of the Founding Team at Medium Healthcare Consulting. He has led a number of engagements in areas as diverse as market expansion strategy for a Fortune 500 medical equipment manufacturer to planning and commissioning of novel healthcare concepts to performance transformation of a leading hospital chains in South and East India. He has received numerous accolades from clients for his rare insights and extraordinary commitment.

The Current Status of 8 Future Technologies on Healthcare by @msharmas

It’s mid-2016, and here is a look at the current status of 8 Future Technologies that might be having a significant impact on Healthcare


Most if not all these technologies will make an impact on Healthcare, and hence it is important to understand the various scenarios and the stories detailing how the experts from across the world are incorporating these technologies in healthcare


1 Internet of Things

By 2020, there are expected to be 50B IoT devices with a total economic impact of $3.9Trillion – $11.0Trillion across all the industries, out of which $1.6 trillion impact in the “Human” segment.

Experts have identified the various areas in Healthcare, where IoT-based solutions can be implemented in healthcare. 

  • IoT refers to any physical object embedded with technology capable of exchanging data and is pegged to create a more efficient healthcare system in terms of time, energy and cost.
  • Dr. Vikram in his article on how IoT can transform healthcare opined the benefits of remote patient monitoring in emergency cases
  • Dr. Pankaj Gupta, noted in his article for IoT-based solutions to be aggregators of healthcare data from primary, secondary and supporting care market will begin to be aggregated. It will be in the interest of Insurance, Pharma and Govt to support IoT driven Healthcare Market Aggregation
Digital Health startups are working on the following categories as showcased in The Map of Healthcare IoT

  • Clinical efficiency, 
  • clinical grade biometric sensors/ wearables, 
  • consumer home monitoring, 
  • brain sensors/ neurotechnology, 
  • fitness wearables, 
  • sleep monitoring and infant monitoring

IoT platforms need to be created to ensure the utilization of data being generated by the IoT devices deployed in healthcare. Absence of platforms to aggregate IoT device data will result in loss of meaningful and contextual insights being drawn for the patients’ conditions.
 
Here is an Infographic, by Team HCITExperts, IoT in Healthcare, Types of Opportunities

2 Augmented Reality

Pokemon Go happened and augmented reality has triggered the imaginations of the innovators to work on bringing the technology to Healthcare

By 2020, an IDC report states AR – VR revenue will hit $162Billion by offering major applications for healthcare and product design.

In a recently concluded Intel developer conference, Microsoft’s Windows chief Terry Myerson announced a partnership with the chip maker that will make all future Windows 10 PCs able to support mixed reality applications.

For instance, Live 3D imaging is one of the hottest topics in optics today, transforming medical imaging capabilities and delivering the immersive experience behind augmented and virtual reality.  

Tim Cook in a recent interview indicated Augmented Reality to be a bigger market than virtual reality.

3 Virtual Reality

With VR technology projections reaching $3.8Billion by 2020, there will be an increase in the use of VR technologies in Healthcare

Virtual reality has an increasing number of implementation opportunities in Healthcare for education, training and patient treatment.

While the cost of using VR in healthcare is still something that needs to be dealt with, partnerships like the one with Intel and Microsoft only bodes well for bringing the technology mainstream and be cost effective.

VR tech is currently being used to 

  • virtually zoom around the patient’s brain to pinpoint an aneurism before the operation. 
  • 3D virtual renderings of the patient’s anatomy lets physicians get a very real experience before operating on the patient
  • the Virtual Reality is being used to present the patient a virtual human agent that replicates a Doctor & Patient communication, where patients can get their questions answered in an environment free from judgement
  • train surgeons how to use new or unfamiliar devices
  • presenting medical images such CT-Scans and MRIs as 3D renderings for improved accuracy of diagnosis 
  • and as an alternative treatment for seniors

4 Blockchain 
Interoperability in Healthcare is a big topic for debate and a sore unsolved puzzle. With the US HHS and ONC seeking research on Blockchain for Healthcare, there seems to be growing interest in the technology. 

For instance, “By combining the blockchain with the peer-to-peer business model, this creates the potential for a near-autonomous self-regulated insurance business model for managing policy and claims. No single entity would control the network. Policyholders could “equally” control the network on a pro-rata basis” 
– Cyrus Maaghul in Why out of hospital Blockchains matter

Blockchain technology is being researched to be the super secure healthcare data aggregator of EHR data and IoT devices data

Blockchain technology is supposed to benefit healthcare 

  • in population health and clinical studies, 
  • interoperability, 
  • patient centricity, 
  • security,
  • supply chain management 
  • Merck has already announced its exploring the use of Blockchain technology for clinical trials. For instance, if a patient is enrolled for multiple clinical trials, a single blood test common to all the clinical trials needs to be done only once and can be shared across the clinical trial studies the patient has enrolled for.
  • In a recently concluded challenge, ONC in the US announced 15 winners for the use of Blockchain in Healthcare

5 Artificial Intelligence
Artificial Intelligence has been a topic of research all these years, but with the advent of the Data Age, Artificial Intelligence is fast moving mainstream and presents a viable business opportunity. 

“By 2025, AI systems could be involved in everything from population health management, to digital avatars capable of answering specific patient queries.” — Harpreet Singh Buttar, analyst at Frost & Sullivan.

In a recently published report, AI adoption by enterprises is imminent. 38% of respondents are already using AI, another 28% will adopt it by 2018. 

The AI ecosystem is projected to be worth $5.5Billion by 2020

Artificial Intelligence ecosystem consists of:

  • Deep Learning
  • Evidence Based
  • Machine Learning Systems
  • Prescriptive Analytics
  • Natural Language Generation
  • NLP/ Text Mining
  • Predictive Analytics
  • Recommendation Engines

Artificial Intelligence has already started making its way into healthcare, with 90+ AI startups getting funding to deliver solutions like; 

  • helping the oncologist define the best treatment plan specific to each patient
  • a virtual nursing assistants, to follow-up with patients post discharge
  • drug discovery platforms, for new therapies
  • Medical Imaging and diagnostics 
  • The use of AI in diagnosing diseases, patient education and reducing hospital costs
  • You can also find a great discussion on machine learning, wherein how machine learning could replace/ augment doctors via the health standards podcast with Fred Trotter.

Some of the other areas where AI is being implemented in Healthcare. Microsoft, Apple, IBM and other major players are all looking to AI help in curing people. And they are forming a group that creates the standard of ethics for the development of AI.

Finally have a look at the AI in healthcare: Category Heatmap

Source: CBINSIGHTS


6 3D Printing 
3D Printing in Healthcare is making fast inroads in many disruptive ways. The projected market size for 3D Printing in Healthcare as suggested in the IDC report:

“Global revenues for the 3D printing market are expected to reach $US35.4 Billion by 2020, more than double the %US15.9 Billion in revenues forecast for 2016.

This represents a compound annual growth rate (CAGR) of 24.1 percent over the 2015-2020 forecast period, IDC research reports that while 3D printers and materials will represent nearly half the total worldwide revenues throughout the forecast, software and related services will also experience significant growth”

Gartner expanded the number of profiles from 16 in 2014, to 37 technology and service profiles in their latest Hype Cycle for 3D Printing 

3D Printing in Healthcare is being used in the following ways: 

  • 3D Printing and Surgery. All surgical and interventional procedures with complex pathology, extensive resection and/or extensive reconstructions could benefit from this technology: Orthopedics, Cardiovascular, Otorhinolaryngology, Abdominal, Oncology and Neurosurgery.
  • A bespoke 3D Printed model of the patient’s forearm changed the standard course of a 4 hour surgery to a 30 min less evasive soft tissue procedure
  • Affordable prosthetics
  • the FDA has touted the use of 3D Printing in personalised medicine, ans has already cleared 85 medical devices and one prescription drug manufactured by 3D Printing.

Researchers are also exploring the use of 3D Printing which could come mainstream in the future such as Printing prescription drugs at home, Synthetic skin, 3D Printing and replacing body parts.

7 Drones

Last year in a conference a researcher proposed the use of Drones for delivering healthcare in much the same way Katniss receives medicine in the Hunger Games movie or for that matter in the movie Bourne Legacy, UAVs are shown to retrieve the blood samples of Jeremy Renner.

The worldwide market for drones is $6.8 billion anticipated to reach $36.9 billion by 2022

Similarly, there is an active interest in the use of drones to be monitoring traffic, to delivering pizza and products ordered online. 

In context of Healthcare, UAVs are being field tested for transporting samples and blood supplies, medical drone manufacturer Vayu is using UAVs to deliver cutting edge medical technology in Madagascar. In Rwanda, estimated 325 pregnant women per 100,000 die each year, often from postpartum hemorrhage. Many of these deaths are preventable if they receive transfusion via drone delivery in a timely manner. 

In India, Fortis hospital plans on using drones during Heart Transplants, to cut the travel time and save lives. An estimated 500, 000 are in need for organ transplants in a year in India.

Drones & UAVs are also being tested for delivering emergency medical supplies during accidents and natural disasters.

8 Robotics

Robotics in healthcare has been used for sometime now, for instance the Da Vinci surgery system is being used for a myriad of surgeries. 

Just the other day i came across an article on robots being used for some of the tasks at the reception of the hospital.

“Cloud robotics can be viewed as a convergence of information, learned processes, and intelligent motion or activities with the help of the cloud,” the report explains. “It allows to move the locus of ‘intelligence’ from onboard to a remote service.”Frost and Sullivan report on Cloud Robotics.

The overall world market for robotics in healthcare will reach $3,058m in 2015, and expand further to 2025.

The global robotics industry will expand from $34.1 billion in 2016 to $226.2 billion by 2021, representing a compound annual growth rate (CAGR) of 46%.

I was reviewing the articles on Robotics in Healthcare and came across this very comprehensive article Robots/ Robotics in Healthcare by Dr. Bernadette Keefe, MD which provides a comprehensive look at the current and future trends.

Other areas robots are being used in healthcare in addition to the above scenarios are: 

Forrester’s Top Emerging Technologies To Watch: 2017-2021 http://bit.ly/2dmVRkZ  via @GilPress

And there you go, we look forward to you sharing your experiences and thoughts regarding these Future Technologies and share them with our community of readers. 

We appreciate you considering sharing your knowledge via The HCITExpert Blog

Suggested Reading

  1. The Future of Healthcare Is Arriving—8 Exciting Areas to Watch | Daniel Kraft, MD | Pulse | LinkedIn http://ow.ly/KrGS304kGjs
  2. Why the A.I. euphoria is doomed to fail | VentureBeat | Bots | by Evgeny Chereshnev, Kaspersky Lab http://ow.ly/CMKu304kGyU
  3. Looking Back At Today’s Healthcare In 2050The Medical Futurist http://ow.ly/4Dl6304kVZZ
  4. Incisionless robotic surgery offers cancer patients better chances of survival: StudyTech2 http://ow.ly/gpMS304l3wq 
  5. Robots/Robotics in Healthcare | Bernadette Keefe MD http://ow.ly/wRbb304lz44
  6. By 2020, 43% of IT budgets will be spent on #IoT: Jim Morrish, Machina ResearchThe Economic Times http://ow.ly/VKuT304lFi9  
  7. Forrester’s Top Emerging Technologies To Watch: 2017-2021 http://bit.ly/2dmVRkZ  via @GilPress
  8. Are killer bots about to do away with smartphone apps? – http://www.bbc.com/news/technology-37154519 
  9. Where machines could replace humans–and where they can’t (yet) | McKinsey & Company http://ow.ly/v9BY100dNn6 
  10. 2016’s hottest emerging technologies | World Economic Forum http://ow.ly/Jq2R100m4AS 
  11. The Top 10 Emerging Technologies 2016list, compiled by the Forum and published in collaboration with Scientific Americanhttp://www3.weforum.org/docs/GAC16_Top10_Emerging_Technologies_2016_report.pdf 
  12. Rwanda’s hospitals will use drones to deliver medical supplies http://money.cnn.com/2016/10/13/technology/rwanda-drone-hospital/index.html?iid=hp-toplead-intl 
  13. 4 Trends Shaping The Future Of Medical Events https://t.co/rUUUJ7oqkK #digitalhealth #hcsm https://t.co/KuPgGW4k9Z 
  14. Post-PC Tech Rules at Intel Developer Forum 2016 https://lnkd.in/fKux3Ek 
  15. House MD vs Doctor #AI- Who will turn out to be the better by @RoshiniBR http://ow.ly/elXy304mYpv

    Author

    [tab]
    [content title=”About Manish Sharma” icon=”fa-heart”]

    Manish Sharma

    Founder HCITExpert.com, Digital Health Entrepreneur

    Connect with me via any of my Social Media Channels

    [/content]
    [content title=”Latest Articles”]

    [/content] [/tab]

    How to create a winner marketing plan to your hospital by Dr. Hesham Dabah

    Healthcare’s facility directors and top executives who are in charge of the execution of hospitals and health services are confronting a test of how to get their facilities more profitable and make them more productive


    The article was first published in Dr. Hesham Dabah’s LinkedIn Pulse page (link below). The article is published here with the authors’ permission.

    Acquiring new patients to the practice is the lord of administrative practices,  pulling in more individuals requiring your service is what all health care business administrators should consider at into their daily operating systems.



    In a perfect world talking, every single utilized specialist should run in beneficial status , be oriented with the expenses of their workplaces and practices. If not, we need to take an approach to make utilized doctors to move from the comfort zone to the dynamic one.  

    Marketing is of course known to have positive benefits for enterprises of all kinds, including health care. It may even be an essential driver for some of the hospital’s prestige services and big revenue generators, such as open heart surgeries and liver transplantation, etc

    It may, however, be less well understood that marketing can also be implemented in a way to have a direct influence on the patient choice and hospital branding as well.  

    In fact, marketing can be highly effective in this way, contributing to the improved profitability of all services while also increasing market share in the health system and growing referrals to the hospital 

    It’s never been an easy process, the Marketing team responsible for that file in hospital, having a hard time competing in the market with other well established hospitals in the nearby neighbors. 

    What’s more, the marketing department additionally seeking association’s with different offices, and the middle management managers and supervisors in charge of the productivity of these hospitals, are not completely mindful of the maximum capacity of viable, vital integration of the marketing efforts with other departments in the hospital  to specifically pull in new patients to these specialties . 

    However, they know the potential, yet they don’t have the enough knowledge about the how a strategic marketing plan component ! 

    Making the challenge even greater is the common scenario of un-specialized hospital marketing departments, which have to support all hospital service lines. Taking an example of the pharmaceutical industry, they realized too early the necessity of developing different lines of marketing teams for different line of production, make it more efficient and easy to follow cost with the results.  

    Unfortunately, the hospital managers and top executives overlooked that , using the same old way of thinking and hospital marketing is often at or near the bottom of their list of competing priorities and internal constituencies. A piece of the issue is that the chiefs of other administration lines in the  hospitals have a “louder voice” when seeking resources, but it is expected from the marketing department to come up with results !  

    Another thought is that hospital marketing team is usually less capable and non-experienced in branding the doctors in practices and the health service lines. 

    Eventually, numerous hospital executives and directors who are in charge today of the day by day hospital operations unwittingly wrong determined by general spending plans of marketing not indicating each service expense. How would you enhance execution without sufficient promoting assets, there is a difference bt. mastery and clear technique! 

    • What would you like to wind up with ? 
    • What’s more, where would you like to go? 

    Basically answer these 2 questions and you will discover it is not an advanced science to make sense of your marketing strategy to begin a winner one. 

    The first step is to find a common definition of marketing in your hospital setting. For this, marketing should be defined as the process of  communicating the value of your services in-order to increase its profitability. At the same time, this kind of marketing requires identifying, anticipating and satisfying patient expectations.  

    Your operation role in  this, marketing strategy ought to be characterized as the procedure of integration of all your administration’s power together to get the results you want. 

    To develop your strategic plan for the marketing, simply first apply the The 5 Ps of the marketing techniques to develop your marketing strategy that meets your requirements.

    The 5 P’s of Product Marketing

    • Product – In this case, it’s the hospital services being sold.
    • Place – In healthcare, refers to the Hospital facility.
    • Price – Competitive? Expensive? Affordable? We think of that as an end value the patient will receive when pays for it.
    • Promotion – The choices in messaging and communication channels to deliver a clear message to target clients.
    • People – All people in the organization, especially those in direct contact with patients and patient’ families (and other “clients,” including hospitals, doctors, insurers, regulators etc.)

    In this way, marketing is more than just exposure of the facility.it’s comprehension of procedures and duties for me and my association.  

    I should understand that successful marketing does not just drive business. It also drives reputation and branding to my facility. This is why it is called a marketing strategic plan.

    Identify my position in the market

    Every situation is unique and should be considered on a case-by-case basis. We need to determine and define our position within the marketplace. 

    Clearly, well-identify our value proposition, develop a single statement that will serve as the guiding theme for my efforts. This positioning statement should be clear , memorable, unique and — most of all — TRUE. 

    Once positioning is born, the hospital manager and executive should consider many steps to help my marketers to get the results from their work:

    1. Develop my brand.
    2. Be there; on consumers’ comfort zones
    3. Answer all inquiries in no time
    4. Build a happy referral network
    5. Include your physician in your marketing strategy
    6. Hire thousands of agents in your city for free

    1 Develop my brand

    Be Disctinctive ! 

    An effective, consistent branding for healthcare organizations, particularly the private hospitals, is very critical. The organization should have a brand that represents who it is and what it stands for.  It is the sign on your building, the voice on the phone, the words said to patients, the quality of care and the level of service. 

    It’s the organization’s personality, presence, reputation,type of chairs, uniform of my team, style and smell when you walk in. It is very useful to think of branding as reputation by style, it’s a part of the overall organization’s brand, print outs and also different from the competitors, and vary from specialty to specialty and even clinic to clinic, but all have something in common which is the line of my organization’s brand. 

    Convey a clear and unique message, provide trustworthiness, connect with prospects psychologically, motivate the patient to come again and create loyalty

    2 Be there: on consumers’ comfort zones

    Go to your target clients when they don’t need you, don’t wait them till they come to you hospital should have a role in people life , a useful one,  present in daily needs and activities, not just banners on buses and yellow boards in building or paid articles in newspapers.  

    Be a part of their life, share with them their happy moments , add value to their life , let them come to ask about your promotions and then convert them to loyal customers! make to your hospital a permanent part of their life, not just a one time service utilized by a shopping client,, let them want you, follow you , fall in love with you  and always deliver the right message to them that you are there to meet their needs and always ready to take the extra mile to keep them happy, let them know that you are happy because they have a good health and happiness.  

    Always check, do I get the right target people? Did I address the right points? Did I succeed in developing my right branding? Am I Different from competitors? Ask them what could be my next service they need and can’t find anywhere else?

    3 Answer all requests in the blink of an eye

    Fill the need of the patients to know more about their sickness 

    Nowadays, Web advertising is crucial, an unavoidable source of information. And they are expanding utilizing it to settle on their health choices. So, they have questions about their illness and they want answers to feel better about themselves and their conditions.  

    In hospital strategic marketing plan , it’s extremely important to have all around well prepared office staff  that can answer questions, no big surprise, I saw one time on an IVF health care facility ” Adam Centers – in Cairo ” utilizing new graduated doctors as a part of the front office to listen precisely to patient inquiries and answer each and every one.  

    Staff individuals speak to your image with every connection, they must to be exceptionally very much arranged with my image and convey as a piece of their standard work in each collaboration with patients and their families. 

    The object of the strategic marketing campaign is to drive new patient request and reservations, and your front office staff is the individuals who will be doing that, undertaking and making the early introduction of your hospital to the new patients. 

    That impression will either fortify or undermine the first presentation testing your delivered message and the interchanges you got from your strategic plan. Business speaking,they will be the person who will turn a checker to a client. PERIOD. 

    Promoting, will make prompts you , yet changing over guests into new patient arrangements are of high importance. That is the reason it’s so imperative vital that front office staff are going to play an important role with my marketing team and up-to-speed and arranged to handle the stream either via telephone or face to face in the front office. 

    Staff should be prepared to a point of high transformation rate, which will just happen subsequent to giving staff individuals the instruments, training and abilities, including how to empower make a new patient reservation and adherence to a suggested script of answers is the key.   

    An extraordinary Client service is the first line of your association, and where you will see results if you invest on them appropriately

    4 Build a happy referral network

    Build a referral network 

    Build trust and associate with the doctors in your city , or go further on the off chance that you have an in number of doctors exceptionally well in their specialties and broaden your affiliations with specialists everywhere throughout the nation.  

    This is essentially imperative for your hospital. Business talking , drawing in doctor referrals is one solid reason doctor’s facilities and healthcare organizations have been purchasing little practice offices, bringing new doctors to their network , and one reason why pays rates of doctors hit the sky sometimes.  

    But, you got to know that building referral is not a 1-2-3 steps process to follow !  

    Because the existing referral arrangement is difficult to break, and new referral relationship is a harder job, require a significant amount of information to collect. Just keep in mind that like any other relations in life, it has peaks and bottoms. Any referral arrangement between the doctor you want to win and a competing hospital , will have a moment of tension or dissatisfaction from time to time, so your consistency and continuous presence with the right offer and solution in front of the doctor you want to attract will allow you to be at the right time to win the game with your competitor.  

    You need the help of your doctors in your facility to you build that network system, you can recognize how you will fortify yours to take a part in this procedure either in view of their dedication to your clinic or for whatever other thought process you can include in your marketing strategy. It works and it pays for its expense and this key cooperation can turn into a primary wellspring of your incomes in the event that you do it right.  

    A week ago I made a visit to a doctor’s facility that I’ve generally known about, however ever been there, the chairman and the CEO of of that hospital  ” Dar Al Shifa ” in Cairo – Egypt , has shared with me the inpatient log of that day,  incredibly he had patients referred to him from 8 different countries at his 44 ICU bed unit. They all had an open heart surgery in the hospital, all got through his effectively implanted referral system throughout the years.  

    You have to measure and estimate the association and union you need to put resources into , then need to create particular, viable strategies to convey properly to plainly set the win to win circumstance anticipated from that connection.  

    You can consider likewise the referral offices , not just doctors’ offices. Which happen to have a huge significance now for healthcare business.  

    The referral-building should be taken care of with a member team has a lot of perseverance, astounding correspondence , the abilities to follow up continuously , and has a great communication skills. With the right one to do it with the right abilities and character attributes for the assignment you can build a good one

    5 Include your physician in your marketing strategy

    Use the best people in your organization 

    They can be a vital vehicle in your marketing campaign, that incorporates likewise their engagement with your endeavors to help build your referral system with partnership specialists.  

    Truth be told, the doctor contact part is so essential to hospital business, you’re extremely well prepared group is your doctors, so utilize them whenever it is possible and appropriate.  

    They represent your image with their own fellows outside your work space with their families,and communities. They have the capacity to make you look different from different hospitals ,identify your abilities, style of administration and care and your ways to deal with making the additional move to fulfill a patient and win a good specialist to join your team. 

    You can know you succeeded when a well reputable specialist from a competing hospital  comes to you and request to join your team of doctors, at exactly that point you know you are destined for success. PERIOD.  

    It’s about persuading and inspiring them without much speaking,they are very smart and they will know whether you want to make their hospital a good one, or you only there to have a huge compensation at the each end of the month.  

    For that, you need to make sure that your physician not only know what to say about your efforts , but also well presented and have enough materials to leave behind and always be in the right place at the right time. Put a system to encourage every department to have some medical research to present in medical gathering , shows their accomplishment in meantime if new techniques they have applied in your facility to help more patients live healthy.  

    The right materials handled by doctors can have a great impact in the general population and fill the gap of information about it , empower intrigued referrals to come to you and ask how they can utilize your facility services.  

    These  materials can be in numerous structures, including business cards with the website address, data analyses,decent flyers,public relations team going with your specialist while he/she present a paper at a medical gathering ,,,and so on

    6 Hire thousands of agents in your city

    YES, as the old saying says “word of mouth ” 

    Your own patient population of your hospital are a treasure, their part is still under-assessed or undiscovered potential, unless a marketer has effectively worked in another industry than health facilities and know how to use.  

    Building up a key arrangement for inside advertising to existing patients been of awesome significance in numerous commercial ventures, for example, accommodation , restaurants , time share,credit card providers,,,,etc.  

    Unfortunately, most or lets say numerous health care executives did not experience these tremendous commercial ventures of transforming their customers into non paid agents to them without acknowledging they are helping you build your image and making more benefit and just for the expense of pennies.  

    Without a doubt numerous patients who need to get some medications still get some information about a decent one , from family members receive medical services frequently.  

    If we consider that the overall people who never came to my hospital, they don’t know much about me or what i can do to them.  

    In this way, by speaking reliably and keeping a good communication channel with my patients, will be the one who introduces my hospital’ services  to their families and companions.  

    Communicating with my patients can be very simple… yet very effective 

    Patients promoting methods that we can apply to our marketing strategy can be very simple, as basic as requesting that fulfilled patients refer their companions, sending birthday congrats with some informative print out , short SMS, ask offer some discounts to them that they can pass to anyone they want.  

    Much obliged to you for coming to that point and taking the time to read my article that I trust I had the capacity share with you some of my strategies that I tried myself and I know it lives up to expectations flawlessly.  

    My last word, it’s never been the marketers alone duty to bring you new business; and on the off chance that you quick to manufacture an unmistakable medicinal services office, you need to construct a good marketing strategy for your hospital, survey commonly with different departments till you totally fulfill with it, afterward demonstrate and help your marketing team to apply your strategic plan  

    Furthermore, most importantly to be an enthusiastic to succeed, bar any individual who says it can’t be done, in light of the fact that nothing is impossible in the event that we work right and make enough commitment to do it. 

    Thank you. 

    Thank you for reaching that point, please feel free to leave a comment , share your thoughts, start a discussion that can broaden our minds or share the article and invite your friends to read

    Author
    Dr. Hesham Dabah

    Healthcare & Hospital expertise – Entrepreneur. Dynamic, confident and professional healthcare leader with strong ability to engage people positively and motivate them to embrace and work toward the vision for the organization

    Booking a doctor appointment online – Whats the big deal? – @AshwinNaik


    This blog was first published in Dr. Ashwin Naik’s LinkedIn Pulse.  

    WOW!

    Now you can you book an appointment with a doctor online. I know, i know – not a big deal. 

    I meant, you can now book an appointment with a doctor in a government hospital online Or in a couple of years – you can book an appointment with a doctor in any government hospital in the country – online (http://ors.gov.in/copp/appointment.jsp) !


    Now that’s something. With a country of a billion+ people, mostly on mobile and with 1000s of government hospitals & clinics across the country – now this IS A BIG DEAL. 

    The government has silently launched the Online registration system (http://ors.gov.in/copp/) on which you can book appointments with government hospitals using your aadhar card. It early days, but since July 2015, close to quarter of a million appointments have been taken online. And multiple hospitals are now using the e-hospital system (with over 2 million appointments) 

    Now this is a really big deal.


    + has a mobile app. And portal to check availability of blood in the hospitals


    First – how this works

    If the patient provides Aadhaar number on his first visit to the hospital then he would be given same preference for online appointment as is given to the patient who stands in queue in the hospital and UHID will be provided to the patient. In future, patient would be able to print E-OPD card after making online payment.

    If patient is a follow up patient with hospital, then also he should try to link his Aadhaar with existing UHID which will facilitate in maintaining Electronic Health Record (EHR) in the hospital for better treatment.

    Patient’s UHID get linked to Aadhaar card so that EHR across the Hospitals can also be facilitated in future.

    In case patient has aadhaar number but mobile number is not registered with it, then name of the patient appearing in aadhaar card must be known. After verification, patient needs to enter other personal details.

    While this is a great technology and adoption achievement, i am excited that this has an even more incredible impact – transparency! If every government hospital data on appointment available and booked is captured in a single system along with reports from lab and pharmacy – boom – everything is out in the open. 

    Doctors who dont show up as per their appointment are up for scrutiny, medicines prescribed if not in the pharmacy show up, lab test which should have been done in house – now being diverted to private labs – stick out like sore thumb. 

    And that’s why i think this is a really big big big big deal.


    This blog was first published in Dr. Ashwin Naik’s LinkedIn Pulse.
    Author
    Dr. Ashwin Naik

    Founder – Vaatsalya, Ashoka Fellow & Young Global Leader of World Economic Forum

    C.A.U.S.E Methodology for Healthcare Organization Change Management by @pankajguptadr

    Please note: The Author of this article is Dr. Pankaj Gupta. The article was first published on Dr. Gupta’s blog.


    For Boot-Strapping Healthcare Organisation Change Management, I follow my proprietary CAUSE Methodology for managing change in people, process and technology. This has emerged out of our collective experience of managing change in healthcare organisations.


    Consciousness of need to change: The people must be informed by the Head of the organization again and again until they are very clear in their mind about why the change in needed. There is no over communication for this. Treat the organization like an anxious child about to undergo a surgery and will need a lot of reassurance.
    Aspiration to support change: The organization must Aspire to support the changes. Since the organization is going through a transition this is an opportunity for the organization to redefine itself across the organization. The Aspiration must come from within not without.
    Understanding how to change: Once the organisation is conscious of the need to change and they aspire for the change from within then they are ready to be trained. Before this stage any trainings will be futile. Now train the team on new processes and technology extensively, again and again till it becomes second nature to them. Keep Checking for gaps in knowledge between expected and achieved.
    Strength to over come hurdles and implement change: It is important to realize that processes will break and problems will happen when such a major implementation is done. Trick is to recognize the problem areas before it is too late to avoid big failures. Top management should be ready to cope up with the hurdle and internal resistance and not buckle down under pressure.
    Ecosystem to support, sustain and adopt change: Lot of support is required in terms of hand holding and training till the change gets adopted by the users and is irreversibly embedded into the ecosystem. Unless you support the change till it becomes an ecosystem the change will not last. It will swing back to zero as an elastic and throw the organization into chaos.

    Dr. Pankaj Gupta’s experience spans Organization change management, Business transformation, Clinical transformation, Knowledge management, Transition management, eHealth Consulting, mHealth Consulting, Chronic Disease Management, Solution design, Implementations. Due to his background and experience he is interested in Healthcare Operations, Pharma, R&D Labs, Medical Devices, IoT, SMAC, next generation technology platforms for Digital Hospitals.

    CAUSE Methodology is an outcome of having done organization change management over and over again. Dr. Pankaj Gupta has successfully applied this framework to many healthcare organisations in terms of IT, Process, Quality and Management changes.
    Please note: The Author of this article is Dr. Pankaj Gupta. The article was first published on Dr. Gupta’s blog.

    Author

    Article By: Dr. Pankaj Gupta

    Digital Health Influencer & SMAC / IoT Speaker | Healthcare Business Executive, Chief Medical Informatics Officer at ProMed Network AG | Managing Partner at TAURUS GLOCAL CONSULTING | Director at Taurus Globalsourcing Inc.
    Additional Articles by the Author

    1. Top #DigitalHealth Trends to expect in 2016 by @pankajguptadr @AmandaShaffer14 http://ow.ly/uTSp300Bhyw
    2. New Healthcare Aggregators: SMAC and IoT by @pankajguptadr http://ow.ly/UCzO300BD7y

    Incorporation of Health Informatics in the curriculum for Healthcare Professionals by @Supten

    The  article was first published in Dr. Supten’s Blog. The article is published here with the authors permission.

    The art and science of processing “information” is informatics, where “information” is the processed “data” (anything that is observed and recorded). Just as we get information by “data processing”, using informatics tools, we condense information into “knowledge” that can be applied to real life situations 


    When the informatics tools are applied to the “biomedical” field, it is called “biomedical informatics” which is a very broad term encompassing the study and application of computer science, information science, informatics, cognitive science and human-computer interaction in the practice of biological research, biomedical science, medicine and healthcare. Other fields, including bioinformatics (proteomics, genomics, and drug design), clinical informatics (including clinical research informatics), public health informatics and medical informatics (including imaging informatics, nursing informatics, dental informatics, pharmacy informatics, consumer health informatics, healthcare management informatics and veterinary informatics) are commonly counted as sub-domains within biomedical informatics

    Health or Healthcare informatics is an alternative term that has been defined: “If physiology literally means ‘the logic of life’, and pathology is ‘the logic of disease’, then health informatics is the logic of healthcare. It is the rational study of the way we think about patients, and the way that treatments are defined, selected and evolved. It is the study of how clinical knowledge is created, shaped, shared and applied. Ultimately, it is the study of how we organize ourselves to create and run healthcare organizations.”It deals with the resources, devices, and methods necessary for optimizing the acquisition, storage, retrieval, and optimal use of information in health and biomedicine. The health informatics tools include not only computers but also clinical guidelines, formal medical terminologies, and information and communication technology (ICT)

    Biomedical / Health Informatics can be applied to diagnostic procedures, imaging, decision-support systems, patient records, financial and administrative systems, educational systems (for healthcare delivery students, practicing professionals and patients), patient monitoring (e.g., anaesthesia control), and accessing health knowledge

    The National eHealth Authority (NeHA) is in the process of being set up through an Act of Parliament. Under such circumstances, for the smooth adoption of eHealth throughout Digital India, there would be a tremendous requirement for formally trained health informatics professionals in India very soon. It will be prudent to incorporate health informatics as a part and also as a speciality for healthcare professionals in India. Ministry of Health and Family Welfare has notified Standards for Electronic Health Records since August 2013 and India has been a country member of IHTSDO that develops and maintains a terminology standards SNOMED-CT. It is essential to make healthcare professionals at all levels aware of such initiatives and adopt standards for health information exchange

    Source: Connectathon India – http://ow.ly/ve8t300Qa3M


    In the USA, all ABMS (American Board of Medical Specialties) member boards have agreed to allow their diplomates to take the clinical informatics subspecialty examination if they are otherwise eligible. The ABPM (American Board of Preventive Medicine) website provides information about eligibility for the exam and online application.Certification in Clinical Informatics is a joint and equal function of the ABP (American Board of Pathology) and the American Board of Preventive Medicine (ABPM)

    CDC, Atlanta, Georgia, USA, offers PHIFP (Public Health Informatics Fellowship Program) as a 2-year, competency-based training program in public health informatics. The fellowship provides a problem-based learning environment in which fellows apply information and computer sciences and information technology to solve public health problems

    They have the opportunity to: learn about informatics and public health in an applied setting work with teams involved in research and development of public health information systems lead an informatics project design, develop, implement, evaluate, and manage public health information system

    The  article was first published in Dr. Suptens’ Blog


    References

    1 Sarbadhikari SN, Medical Informatics: A Key Tool to Support Clinical Research and Evidence-based Medical Practice (Ch 15), In, Babu AN, Ed, Clinical Research Methodology and Evidence-based Medicine, 2nd Ed, 2015: 179-191. 
    2 Abdel-Hamid T, Ankel F,…Sarbadhikari SN, et al, Public and health professionals’ misconceptions about the dynamics of body weight gain/loss, Syst. Dyn. Rev. 30, 2014: 58–74 
    3 Ahmed Z, Sarbadhikari SN, et al., Using online social networks for increasing health literacy on oral health, Intl. J User Driven Health, 2013, 3: 51-58. 
    4 Karishma SH,…, and Sarbadhikari SN, Creating Awareness for Using a Wiki to Promote Collaborative Health Professional Education, Intl. J User Driven Health, 2012, 2:18-28. 
    5 Sarbadhikari SN, Unlearning and relearning in online health education, (Ch 21) In, Biswas R, and Martin C M, Ed, User Driven Healthcare and Narrative Medicine, IGI Global, Hershey, USA, 2011: 294 – 309. 
    6 Sarbadhikari SN, How to Make Healthcare Delivery in India More “Informed”, Education for Health, Volume 23(2), August 2010: 456. 
    7 Sarbadhikari SN and Gogia SB, An Overview of Education and Training of Medical Informatics in India, IMIA Yearbook of Medical Informatics, 2010: 106-108. 
    8 Sarbadhikari SN, Applying health care informatics to improve student learning, Really Good Stuff, Medical Education, 2008; 42: 1117–1118. 
    9 Sarbadhikari SN, How to design an effective e-learning course for medical education, Indian Journal of Medical Informatics. 2008; 3(1): 3: http://ijmi.org/index.php/ijmi/article/view/y08i1a3/15 
    10 Sarbadhikari SN, The State of Medical Informatics in India: A Roadmap for optimal organization, J. Medical Systems, 2005, 29: 125-141. 
    11 Sarbadhikari SN, Basic Medical Education must include Medical Informatics, Indian J Physiol. Pharamcol., 2004, 48(4): 395-408. 
    12 Sarbadhikari SN, Guest Editorial on “Medical Informatics — Are the Doctors Ready?”,J.Indian Med. Assoc. , 1995, 93: 165 – 166. 
    13 Mantas J,et al, Recommendations of the International Medical Informatics Association (IMIA) on Education in Biomedical and Health Informatics – 1stRevision, IMIA, 2009 
    14 Burnette MH, De Groote SL, Dorsch JL. Medical informatics in the curriculum: development and delivery of an online elective. Journal of the Medical Library Association : JMLA. 2012;100(1):61-63. doi:10.3163/1536-5050.100.1.011. 
    16 NHP, EHR Standards helpdesk: http://www.nhp.gov.in/ehr-standards-helpdesk_ms 
    17 IHTSDO, SNOMED-CT: http://www.ihtsdo.org/member/india 
    18 American Academy of Family Physicians, Recommended Curriculum Guidelines for Family Medicine Residents on Medical Informatics: http://www.aafp.org/dam/AAFP/documents/medical_education_residency/program_directors/Reprint288_Informatics.pdf 
    19 AMIA, ABPM, ABP, Clinical Informatics Subspecialty Board Examination: https://www.amia.org/clinical-informatics-board-review-course/board-exam 
    20 CDC, Public Health Informatics Fellowship Program:http://www.cdc.gov/PHIFP

    Author

    Dr. Supten Sarbadhikari

    Digital Health Influencer & Project Director at Centre for Health Informatics of the National Health Portal; President IAMI (2016)

    Strategies to Foray into Digital Health by @JPpattanaik

    Author: JP Pattanaik, Sr. Business Analyst & Akanksha Rajeev, Business Consultant

    in this article, provide an insight to various strategic options for Indian IT product-centered organisations to consider foraying into healthcare industry

    The article was first published in Express Healthcare, Feb 2016 Edition. The article is republished here with the authors’ permission
    24 Mar 2016, India



    Abstract 

    The lucrativeness offered by the healthcare IT industry has brought significant attention worldwide. Healthcare industry is considered ever green and healthcare IT has attracted the attention of global players for investments. There are a section of players who are pioneers in the industry and have recorded significant growth. At the same time there are laggards who want to build such capabilities and tap the untapped market following the recent industry trends and success stories. Healthcare IT organisations have to cope with transforming business model while adhering to strict regulatory demands of the industry. They need to carefully adopt strategies based on the organisational maturity, capital and the time they have for go-to-market. In pursuit of quick success, often organisations commit mistakes choosing the right approach while building potential health IT product capabilities. This article highlights different strategic options for Indian IT product-centered organisations thinking of foraying into the healthcare industry
    Global Healthcare and Healthcare IT spending trends

    According to industry estimates, the global healthcare spending is expected to grow at an average of 5.2 per cent year on year during 2014 – 2018 to a total of $9.3 trillion. In spite of its vastness, both developed and emerging nations are dealing with issues like ageing population, rising incidences of chronic diseases, rapidly increasing cost of healthcare, disparity in quality of care, infrastructural challenges, workforce shortage, non-uniform distribution of healthcare facilities across the community locations etc. The burden faced globally today has never been so challenging than ever it was.

    An estimate by the Economist Intelligence Unit (EIU) the regional healthcare spending during the year 2015 is expected to be as given in the table.
    Globally, most nations have been challenged to improve quality of care while reducing the cost of healthcare by means of inventing cost effective methods for an optimal outcome. The challenges described above have led to adoption of healthcare IT solutions such as Electronic Medical Records (EMR)/ Electronic Health Records (EHR) for safe storage of healthcare information and to make more informed decision.
    According to an estimate by MarketsandMarkets, a leading research organisation, the global healthcare IT market is estimated to reach $56.7 billion by 2017 — up from $40.4 billion in 2012 — due to the demand for clinical information technology, administrative solutions and services. Among the various healthcare IT solutions offered, EMR/ EHR segment dominates the sector.
    Gartner estimates healthcare providers in India are likely to spend $1.2 billion on healthcare IT products and services in 2015, a seven per cent growth over 2014. Software spending is likely to grow 6.2 per cent to reach $103 million in 2015, up from $97 million in 2014, led by growth in vertical specific software. An estimate by Frost & Sullivan, healthcare information technology market in India is expected to reach $1.45 billion in 2018 mainly due to fast adoption of technology by stake-holders. India being a developing nation, the health IT spending is still much less than that of the developed nations. The rest of the paper discusses various drivers for healthcare IT initiatives, its attractiveness and approaches for Indian health IT organisations for an effective go-to-market strategy.
    Drivers of Healthcare IT in India 

    Some of the major factors contributing to the growth of healthcare IT globally are listed below:

    • The continuously growing pressure to cut healthcare costs
    • Need for care coordination and management demanding integrated healthcare systems
    • High rate of return on investment in healthcare systems
    • Financial support and incentives from the government
    • Growth of medical tourism
    • Government initiatives, conducive policies for the sector
    • The rise in the ageing population
    • Growing demand of health IT products to reduce medication errors
    • Rise in incidences of chronic and lifestyle disorders
    • More informed and engaged patients.

    Why do more and more Indian IT organisations want to venture into Healthcare Industry?  
    Healthcare has a huge addressable market. India as a country has witnessed a rather steep growth trajectory only in the last decade with the advent of the private sector. The influence of technology has been an important growth driver, with healthcare models based on IT intervention now becoming a reality. The accessibility of healthcare today is more than it ever was, consequently increasing the opportunity for new players. Emergence of new delivery models which are scalable, less capital intensive and yet promise better earnings is one of the major reasons the healthcare sector has lured the investors. Diagnostic chains, single speciality clinics, wellness centres, primary care set-ups etc. are all emerging models of healthcare and it is still evolving. In a nutshell, healthcare industry provides array of opportunities for new experiments at a promising return on investments. The penetration of healthcare IT is still in its infancy providing ample opportunities to all competent healthcare IT solution providers. With increased importance to healthcare needs, the adoption of modern healthcare IT systems is bound to grow.


    Approaches for Go-to-Market  

    In order to tap the business opportunity presented by the IT enablement of healthcare institutions, the IT organisation should evaluate options and consider one that suits the best. A single approach may not fit all. In pursuit of quick success, often IT organisations opt for suboptimal options, which may not meet their long term objectives. Following are the three strategic options to realise the business opportunity presented by healthcare IT market:
    • Approach 1: MODIFY Enhancing an open source software
    • Approach 2: CREATE Building a greenfield system
    • Approach 3: ACQUIRE Acquiring a licensed product

    The table below provides the advantages and disadvantages associated with each of the approaches.
    An organisation should evaluate the functional, technical and business capabilities while prioritising a strategic approach. Each of the approaches can be evaluated based on the following parameters:

    Cost and effort
    Total cost of ownership (TCO): Total cost of ownership refers to the cost to the organisation for sustaining a product line. This includes the license fee for the product and cost of the application maintenance and support.
    Effort: This is the effort that needs to be put in by the organisation to meet the desired product criteria driven by Customer/ Market needs.
    Potential Revenue: This refers to the revenue that would be generated by the organisation on entering the market with the stated product.

    Market factors
    Time to market: This is the time taken to launch the product in the market for customers.
    Market acceptability risk: The risk that the product launched into the market is not accepted by the clients. This is particularly high for a new product launch.

    System related factors
    Customisability: The capability of a system to be easily customised for desired features. Creation of a greenfield system offers the highest amount of flexibility as it can be designed keeping product expansion in mind.
    Scalability: The capability of a system to be easily scalable for larger implementations. While a greenfield system can be designed to be scalable an open source or acquired product may have limitations.
    Skilled resource availability: The major constraint of a system is the technology stack that it is built on. Having technically sound resources trained exclusively on the same platform is one of the major factors for system selection.
    Legal/ IP Risk: Enhancing and commercialising existing open source systems would give rise to potential legal risks. Some systems are covered under various public licenses which prohibit the commercial use for profit.
    Security risk: With the ever growing population that is being catered through the IT enabled system, security of the healthcare data plays a vital role in the evaluation of a system. Many laws of the land mandate patient privacy and prohibit the transfer or usage of the healthcare data and thus require utmost authorisation and protection for the same. Any shortcomings in the system that compromises patient data security would pose a security risk.
    The evaluation of each of the approaches based on the above mentioned parameters are summarised in Figure 2.

    Key Considerations  

    A greenfield system though requires investments, is a safer approach as it minimises some the risks demonstrated in other two approaches. However, all organisations may not be in a position to have proprietary systems to exploit the immediate market opportunities presented. The pioneers always have the advantage to exploit the market opportunities with less competition. New players should carefully choose the market segment they want to make an entry. When an organisation lacks significant market presence and experience, it may be recommended that the organisation should take baby steps and stay profitable yet. A big bang approach may not support the ultimate objectives of the organisation. In this context it may be recommended to health IT vendors that the
    Approach –‘MODIFY’ can be considered as a short term strategy with an objective of learnings, small scale implementations and R&D.
    Approaches – ‘CREATE’ and ‘ACQUIRE’ can be considered as long term strategies with an objective of achieving the vision of the organisation.
    Approach – CREATE demands investment in terms of time and ensuring the product exceeds expectations than a competing product while 
    Approach – ACQUIRE enables the organisation a quicker go-to-market for realising the opportunities. However, the risks associated with the approach must be given due consideration.

    Conclusions  

    The lucrativeness of the healthcare IT market has received significant attention. It is an obvious choice to exploit the opportunities presented. The pioneers and the laggards are equally keen to make the best of the opportunities. An approach that works best for a pioneer may not be of same value to a beginner. In pursuit of quick success, organisations should not commit the mistakes of engaging in a wrong approach to make a foray in hurry. It has been rightly said, “There is no shortcut to success.” Organisations need to carry out a risk and return tradeoff before formulating and executing any strategies for the best possible outcome.

    References  

    i. 2015 Global Healthcare Outlook. Common Goals and Competing Priorities By Deloitte, Whitepaper, 2015.
    (http://www2.deloitte.com/content/dam/Deloitte/global/Documents/Life-Sciences-Health-Care/gx-lshc-2015-health-care-outlook-global.pdf)
    ii. Global healthcare IT market estimated to reach $56.7B by 2017 By Ashley Gold, News Article, FierceHealth IT, May 10, 2013.
    (http://www.fiercehealthit.com/story/global-healthcare-it-market-estimated-reach-567b-2017/2013-05-10)
    iii. 2014 Global health care outlook: Shared challenges, shared opportunities By Deloitte, Whitepaper, 2014.
    (http://www2.deloitte.com/content/dam/Deloitte/global/Documents/Life-Sciences-Health-Care/dttl-lshc-2014-global-health-care-sector-report.pdf)
    iv. Overview of International EMR/EHR Markets: Results from a Survey of Leading Health Care Companies By Accenture, Whitepaper, August 2010.
    (http://www.accenture.com/SiteCollectionDocuments/PDF/Accenture_EMR_Markets_Whitepaper_vfinal.pdf)
    v. Healthcare IT market in India may touch $1,454 million: Study
    (http://timesofindia.indiatimes.com/tech/tech-news/Healthcare-IT-market-in-India-may-touch-1454-million-Study/articleshow/24142487.cms)
    vi. IT spending by Indian healthcare providers may rise 7 per cent in 2015, Gartner says
    (http://timesofindia.indiatimes.com/business/india-business/IT-spending-by-Indian-healthcare-providers-may-rise-7-in-2015-Gartner-says/articleshow/47295710.cms)

    Disclaimer: The ideas and opinions shared in this article are personal views of the authors and have no bearing or impact on the official policy or position of United Health Group or its entities

    Authors

    JP Pattanaik

    Healthcare Management and IT Consulting
    Akanksha Rajeev

    Healthcare Management and IT Consulting

    Top #DigitalHealth Trends to expect in 2016 by @AmandaShaffer14 @pankajguptadr

    Author: Amanda Flowers & Dr. Pankaj Gupta


    The article was first published in Healthcare-IT Business Strategy. The article is republished here with the authors’ permission
    17 March.2016, India

    The 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.
    Authors

    Article By: Dr. Pankaj Gupta

    Digital Health Influencer & SMAC / IoT Speaker | Healthcare Business Executive, Chief Medical Informatics Officer at ProMed Network AG | Managing Partner at TAURUS GLOCAL CONSULTING | Director at Taurus Globalsourcing Inc.
    Amanda Flowers

    a graduate in Psychology, with minor in English Literature and Public Health. She draws on her knowledge of these subjects to create online content that addresses human needs in a simple way. Flowers is currently a freelance health blogger and working for Blue Cross Blue Shield of NC

    Revolution In Healthcare via @SelfCareGuru

    Author: Joao Bocas 

    Digital Health Influencer & Wearables / IoT Speaker
    10.Feb.2016, London, UK
    The emergence and increased severity of chronic illnesses around the world has grown to exponential heights in comparison to the last fifty years of medical analysis. The existence of chronic diseases are crushing the Healthcare sector and the resources therein, and subsequently creating socioeconomic issues within the diaspora as the government, patients and insurers are faced with the burden of paying higher costs for medical services. We have a major crisis on our hands, one which not only declines the population’s status of health, but also lowers the potential productivity of said populace. In light of the aforementioned, it is in the best interest of all to revolutionize the current Health Care systems in hopes of changing the trajectory of the potentially disastrous outcomes. 

    Around the world, unhealthy lifestyles and aging populations have strongly influenced the constant recurrence and prevalence of chronic diseases. This category of illnesses place a strain on healthcare providers and the healthcare system at large, due to the high volume of hospital visits and admissions by ailing patients. Strategically speaking, healthcare providers have what may be considered as a normal range of activity within which patients are anticipated to operate. However, those who require long and resource-intensive treatments undoubtedly use up intensive care resources that were initially set aside for the interest of other insured patients. This growing problem has led to the drastic reduction in available resources and the imposition of limitations in regard to certain treatments.

    Tactics employed to protect health care systems and their resources have sufficiently lessened the availability of the once prevalent resources, and in direct proportion, have increased the growth of people with chronic diseases. In the near future, it is clearly foreseeable that if no radical intervention is initiated, this downward spiral will only increase the intensity of the detrimental effects suffered by all involved. 

    Sadly, despite the wondrous advances in medicine and technology, health care continues to fail as it is unable to provide what its customers truly need. Regardless of the increasing complexity and best intentions of doctors and nurses involved, they can no longer guarantee the provision of the best care practices to ailing patients. Fixing health care will most definitely require a radical shift from current health care practices that are individual based, to a strategic approach that embraces a team-based way of work.  Although many physicians are anxious about the reduction of money, autonomy and respect; accepting new organizational structures, payment models and performance goals; could possibly create a level playing field for both insurers and patients. 

    To catapult this change, leaders from all sub-divisions of health care must draw on their reserves of courage, resilience and optimism; and stand up for what they believe in. They must make it a point of duty to be aware of the economics and social capital relations which define how they are paid, and be willing to cut ties with companies who are solely driven by monies acquired as opposed to the improvement of outcomes and efficiency of service.

    Conclusively, in the writings of sociologist and economist Max Weber, four major considerations of social action which have been adapted for healthcare improvement includes: shared purpose, self-interest, respect and tradition. These levers may be manipulated to bring about the changes, which the system so desperately needs
     

    (function(i,s,o,g,r,a,m){i[‘GoogleAnalyticsObject’]=r;i[r]=i[r]||function(){ (i[r].q=i[r].q||[]).push(arguments)},i[r].l=1*new Date();a=s.createElement(o), m=s.getElementsByTagName(o)[0];a.async=1;a.src=g;m.parentNode.insertBefore(a,m) })(window,document,’script’,’//www.google-analytics.com/analytics.js’,’ga’); ga(‘create’, ‘UA-73784175-1’, ‘auto’); ga(‘send’, ‘pageview’);

    Please note: The Author of this article is Mr. Joao Bocas. For resharing the article, please contact Mr. Joao Bocas or the HCITExpert Admin via our contact us page.

    Article By: Joao Bocas

    Digital Health Influencer & Wearables / IoT Speaker
    Scroll to Top
    Connect
    1
    👋 Hello
    Hello!! 👋 Manish here, Thanks for visiting The Healthcare IT Experts Blog !! How can i help you?