Digital Transformation

Software Product For Hospital Industry by Girish Koppar @KopparGirish


Before we talk about software product for hospital industry lets understand how the Hospitals are broadly classified

– Based on the legal entity ( Private , Trust or Corporate)
– Based on specialty ( Super specialty, Multi-specialty, Single specialty)
– Based on bed strength ( Larger hospitals and Nursing Homes)


Hospital Industry is unique as compared to BFSI and FMCG industry as there is minimal or almost no standardization in the Processes/Operations between hospitals of similar nature, for example “Admission, Discharge and Billing Processes may vary from hospital to hospital. One more major difference is about the employment of Doctor’s. In some hospitals Doctors are Consultants and in some hospitals they are employees or on the payroll of that hospital. 

Due to above factors it’s very difficult to build and implement a global product for hospital industry. Although many companies have attempted to build a global product for the hospital industry they have not been very successful. 

The software product developed by the vendors may be technically sound for the hospital industry. However, most of the vendors face major implementation challenges as they are not aware of the practical scenarios in different hospitals since the nature of the hospitals and processes in every hospitals vary as mentioned above. 

Hence the customization percentage is very high and the stability of the product becomes an issue. As the degree of customization various from hospital to hospital, the customized product becomes local to that hospital and it becomes difficult for the vendor to maintain and give support to a particular hospital. The other major challenge faced by the vendors is to implement a software product/solution in a brown field project (running hospital), where the processes are set, hence there is a resistance to change by the users to implement a new software. In case of a green field (new hospital) it is not very difficult to implement a software solution as there are no preset processes.  

Now let’s see the major software applications used in hospital industry.
–   HMS (Hospital Management System).
–   RIS (Radiology Information System) and 
–   PACS (Picture Archival and Communication Systems).
–   DMS (Document Management System).
–   Mobility Apps.

HMS is the core application or like the ERP used in hospital industry. It mainly contains modules like Admission, Discharge, Transfers, Billing, In Patients, etc. Since it has the mentioned modules like Admission and Billing, it’s difficult to develop a global HMS application as the variation in processes across hospitals. Other modules like Finance, Inventory, PACS are standard in nature and may or may not be a part of HMS. These modules can be separately developed and seamlessly integrated with the HMS application. Most of the hospitals have adopted the practice of having HMS with only the core Billing and Admission modules and build & integrate other modules around HMS.

Mobile apps & BI tools have helped Vendors to build standard applications wherein they have to fetch the data from HMS and other modules and display it in the app. Unlike HMS application which is dependent on the processes of that particular hospital, mobile apps & BI tools are not process dependent and just fetch data from HMS and other modules to be displayed to the top management for analysis of Business process and making key decisions.

Lot of vendors are now focusing on capturing clinical data and converting the same into EMR/EHR. Although there are various solutions available for capturing clinical data adoption of such software is still an issue. Since most of the hospitals have started capturing clinical data, the next logical step is to use the data to develop applications that can assist doctors in their diagnosis and treatment. CDSS (Clinical Decision Support System) and Artificial Intelligence will be the focus of the vendors which will bring a revolution in the Healthcare ecosystem. These applications will be widely used by Doctors not only for preventive health to diagnose and treat their patients, but also will be used to predict the health of a patient depending on the amount of data that has been captured.


The article was first published in the CIO Insider Magazine, here. The article has been republished here with the authors’ permission.
Author
Girish Koppar

Experience of managing IT for Lilavati Hospital and Research Centre for over a decade, and an overall experience of 25 years

Committee Member of HIMSS (Healthcare Information and Management Systems Society) Asia Pacific Chapter and International Member of CHIME (College of Health Information Management Executives).

Secretary & Principal founder of Hospital Information Technology Association
(http://www.hospitaltech.in/) connecting IT personnel across various hospitals pan India. HIT Association is a non-profit association registered under the Bombay Port Trust Act which aims to “Provide Transformational and Visionary Leadership for successful adoption of Digital Technologies in Hospitals.

Board Member and Co-Founder of Medical and Health Information Management Association (MaHIMA) http://www.mahima.org.in/MaHIMA is accredited by Maharashtra Medical Council (MMC) for conducting Continues Medical Education.

On the advisory board of the following companies as a Healthcare Subject Matter Expert (Honorary)
https://www.lemarksolutions.com/mentors
http://findyourfit.in/?page_id=1235

Almighty Data or Hype? By INDERJITH DAVALUR @INDERDAVALUR

DIGITAL TRANSFORMATION AND THE PLACE FOR DATA


Mea Culpa, I am one of those who is guilty of getting on and staying on the Big Data wagon for the wrong reasons. “Data is the new oil” is an oft-repeated phrase. I am about to commit a “virtual” suicide by proclaiming that it is not so. Data has its place and it is not at the top of the digital food chain. I feel that we have crowned the half-naked prince, Emperor in haste.

For the sake of clarity, when I say data, I will be referring to digital data throughout this piece. Data is a by-product of any activity. Therefore, creating data is as natural as breathing. So we have data. A lot of data. So what? Accumulating data, structuring it, storing it, analyzing it are a natural progression from that point onwards. How and what we do with the data is more important. Software. 

The magic that is software, to me, is more transfixing. Consider the prospect of a language written in a semantic that is alien to our natural human language. A cryptic command, logic, condition, trigger – anything at all – that is magically read, understood and acted upon by silicon. Hardware that contains baked-in code that can parse and carry out complex instructions at blazing speeds. Pieces of such chips soldered on a board and communicating through ‘roadways’ of circuits laid out on a board. The miracle of hardware coupled with the magic that is software is what gets my adrenalin pumping. How can such a marvel not be exciting?

Even the awesomeness of hardware pales in comparison to software. Hardware is more or less static. It is confined to physical and functional dimensions. Software, however, is supreme. It can use the same hardware (with some limitations of course) and carry out simple tasks, entertain with games, or perform wildly complex calculations at very very high rates of speed, accurately all the time. And it can do this million million times with alacrity. This is just the beginning of what software can do. But wait, there’s more!

Consider intelligence in software. It suddenly becomes a living, breathing, dynamic being. Almost. Software can learn and teach itself. Crunching data and spitting out patterns and actionable analysis suddenly becomes mundane, banal almost pedestrian. No. I am not against data or big data. By itself, big data is just that. A monstrosity. Sometimes, big data actually gets in the way. Misleads us in making decisions quickly. Software breathes life into data. 

Take any software language or tool. Examine it. Study its flow, the eloquence, the nuance and its brilliance. Brevity in software coding is revered by programming perfectionists. There is elegance in a well-written piece of code that executes beautifully, perfectly, every time. Anyone that can find literary melody in Shakespeare or Milton can certainly begin to enjoy the harmony in a beautifully crafted software application code. So, my appeal goes out to all those who are worshipping big data to take a moment to reflect upon the joy that software brings to our daily lives. After all, the future is software!

Author
Inder Davalur

Inderjith Davalur is a healthcare technology specialist, speaker, writer and utopian dreamer.
Inder works with hospitals committed to transforming the healthcare paradigm with the aid of new innovative technologies. His primary area of interest lies in using data analytics and technologies such as Deep Learning to shift the current physician-driven healthcare model to a patient-driven market dynamic.
Inder focuses on the manifold ways in which data crunching and machine learning can lead to better diagnoses that can not only be made at the time of illness, but predicted way before any symptoms surface. The path ahead in the sector, he believes, lies in the deployment of evolving technologies that immensely influence both diagnostic and therapeutic aspects of healthcare, delivering real patient-driven, data-enabled, informed healthcare.
Inder currently works as the Group CIO at KIMS Hospitals Private Limited, Hyderabad and has previously assumed leadership roles at leading hospitals and companies, in India and the United States of America.

4 hints to get started with #AI in your company by Devesh Rajadhyax @deveshrajadhyax

Most companies are working on Digital Transformation today, and Artificial Intelligence is a critical part of that transformation.

Two questions immediately present themselves-
1.    What is Digital Transformation and how it is different from the IT/ICT transformation that is happening since for than four decades?
2.    Why is AI a critical part of this transformation?

Let me take the first question.

Digital Transformation is actually a cognitive revolution. It is a more humanlike way of making sense of the world around. And this is our clue to the most important difference between IT and Digital-
IT systems are not humanlike. They don’t try to make sense of the world around them. They create a small world of their own and everyone follows the rules of that world. The input has to be given in the way they demand and output will be available in forms that they prefer. You better fall in line.
Digital, or Cognitive systems would want to fit into the world they find themselves. To understand this, see how we humans manage our operations. We take in all the signals from the real world. We see, hear, feel, smell and then speak, show, move and push at the world around us. That’s what Digital systems aim to do. They want to process all the available inputs and then interact in a natural way. That’s why they hope to solve problems much closer to our life.’
Now let’s turn to the second question, why AI is so critical in this transformation.
I think the above distinction must have given you an intuitive answer. Because we are aiming for a humanlike way of interacting with the world, we need AI to do the processing. We also need sensors (IoT) and motors (Robotics), displays (VR) and so on. You can see how well the various Digital Technologies fit in this paradigm.
But even before AI, there is a big big factor that drives this whole transformation, and that factor is Data.
Since we are talking about real world data, we are talking huge huge volumes in forms that we never processed before. Vision, audio, waveforms, text, handwriting and many more types of data need to be captured (again IoT), stored and processed (Cloud, Big Data) and managed (Blockchain). But if you are the one responsible for planning and implementing systems, this central importance of data means a fundamental change for you.
When you plan classical IT systems, you start with the objectives of the company. Accordingly, you define the requirements. Analysis and design are further carried out on the requirements. Data is an outcome of this process.
Fig 1: Planning for classical IT systems
In Digital systems, however, data drives the system planning. This is again somewhat like like humans. We cannot demand more data from the world. We work out our affairs in such a way that we can manage with whatever data the world gives us. And we have become very good at extracting as much meaning from that data as possible.
So the new paradigm will be:
Fig 2: Planning for Digital systems
As we can see, we are now thrown in a more uncertain and complex world. The existing data indicates possibilities of what can be done. These possibilities have to be mapped on the organizational objectives to decide the Digital Transformation plan.
There are more complexities in the Digital paradigm that shown in the diagram. But for the purpose of this article I would like to present a simple view, leaving the complexities for a future and longer article.
This immediately leads us to the four most important points that can help us to get started with AI. This framework does not consider AI in isolation, but the whole Digital Transformation.
The four hints are:
1.    The data that you have: Identify all the data that your company owns. The data can be put into three major buckets:
  • Structured Data: This is the easiest data to identify. It will be found in all the IT systems that you have implemented so far. Also look for the countless excel sheets that your employees have created.
  • Unstructured data: This will be typically text that has no fixed format. Emails, proposals, invoices, challans, vouchers and so on. Hint- even if you might have some of this data in your IT system, there may be ‘left-over’ data. For example, while some part of an invoice is entered in your AP system, there may be some that is not entered. This left-over might contain interesting possibilities.
  • Dark data: This is that part of your data that you never really thought about. In fact, it may not be being captured today. Photos that can take, vibrations that you can record, video that you can capture – these possibilities are endless. No wonder that IBM put the volume of dark data at 80% of all data.
2.    Objectives of your company: There is a whole load of literature on how to identify objectives of your organization and I am definitely not qualified to comment on it, but broadly they will fall in two buckets:
  • Aspirations: what you would like to happen – improvements, new initiatives, lead over competitors and so on.
  • Pain points: what you would like to remove – delays, leakages, inefficiencies.
There will be various areas of your business that will have their own objectives – customer experience, process efficiency, employee satisfaction, innovation, leadership and so on. I will write no more – you are the best judge.
3.    Applications (or Possibilities): The applications of data are of course endless, but since we are developing a framework, let’s again put them in the biggest buckets:
  • Automation: Essentially replacing human efforts by machine. This not only saves cost, but improves accuracy and speed. In most cases, human effort can be diverted to higher cognitive tasks, giving further advantage to the organization.
  • Analytics: Again lots of material is available on this topic, generally categorized in four types:
                    i.    Descriptive
                    ii.    Prescriptive
                    iii.    Diagnostic
                   iv.    Predictive
The most valuable use of analytics is in decision support, for which it has to be combined with Knowledge (see below).
  • Knowledge: The third and often ignored use of data, is also the most difficult to achieve. Combined with automation and analytics this can give rise to spectacular applications. The currently popular use case of chatbots is an example of the Knowledge possibility.
4.    Existing systems: The fourth hint for getting started with AI is studying your existing IT systems. Most of the above possibilities give best results when interfaced with one of the existing system.
I will now try and put these four things in the framework together with help of a simple example.
Let’s say you have an invoice management module in your existing Accounts Payable (AP) system. The scanned copies of incoming invoices are entered in the system by your employees. These scanned documents are the unstructured data.
The possibility this data presents is that of process automation, along with many others. Now, your company has a defined objective of improving process efficiency, and automation of invoice management fits well with that. Since you already have a AP system in place, the forth criterion is also met.
It seems that automation of invoice management is the right problem statement for your company to get started with AI. There will be a few startups and experienced companies who will be able to help you to get started.
The article was first published on the author’s linkedin pulse page, its been re-published here with the author’s permission. 
Author
Devesh Rajadhyax

Founder and CEO, Cere Labs, AI, Machine Learning, Deep Learning

Why should standalone Hospitals in India focus on IT enabled productivity by Tirupathi Karthik, @TirupathiKarthi CEO at @NapierHealthit


Fresh out of HIMSS India’s inaugural Digital Healthcare Summit, (2015) in Gurgaon, I lamented over the state of healthcare IT in the country. At the time, we were showcasing our hospital information system and launching our telehealth and patient referral management solutions. I should have been proud to be a part of the innovation on display at the event, and understandably so. But what struck me harder than pride at the event and left me with a lingering sense of disappointment was something else. And that was just how far some parts of India lagged behind the rest of the developed world in terms of healthcare delivery and quality.

Napier Healthcare is a global company headquartered in Singapore, where it manages the development of technologies to world-class standards. My other point of reference is the US. So whenever I consider the industry in India, I am invariably piqued by its difference from the industry in Singapore and the US. Especially the US, since it is a democracy like India and has similar health problems on a large scale.

In the time that has passed since HIMSS India, I have thought through some options that the Indian healthcare should seriously consider moving forward. 
EMR Enforced By Law

The most obvious difference I see between India and the US is in their standards and certification environments. We do business in the US and have to be certain that our solutions meet that market’s most stringent regulatory and certification requirements. They include HIPAA and a few others, but more significantly in the case of hospital information systems, the Meaningful Use Stage 2 (MU2) compliance certification. These certifications create significant entry barriers for non-serious players, and make certain that healthcare IT (HIT) quality is maintained in the market.

The policy framework in the US sees to it that EHRs (Electronic Health Records) are sold with certain features that ensure nearly zero medical errors, well-supported transitions of care and ultimately higher quality care delivery.
India has been working on a national EHR standard since 2013, when the Ministry of Health & Family Welfare (MoH&FW) announced its first set of requirements. The MoH&FW has subsequently made continual enhancements of this set of standards. Translating policy intent into effective outcomes still remains a distant goal in most states as software vendors have an option, not a mandate, to comply with this EHR standard.
I must admit, though, that for a large country such as India, executing that would take quite a few years. Even then it would most likely reach only those under some form of formal insurance, and that too only in the metros and some larger cities. As a result, the majority of the population in the semi-urban and rural sector would be excluded from this. 

Automation to Level the Playing Field

The World Bank tells us that private hospitals account for 67 percent of total healthcare expenditure in India. World Bank numbers also tell us that in 2014, citizens paid for 89.2 percent of their healthcare expenses out of their own pockets[1]. These figures have been rising constantly since 1995, and they clearly show two major trends.
One is that private healthcare is enjoying explosive growth in India, with larger private healthcare providers, such as Fortis and Apollo, gaining the lion’s share of the market, and smaller private hospitals being edged out of reckoning slowly but surely. The other is that healthcare is becoming an increasingly heavier burden on Indian citizens. And on poorer households in India, that only drives them deeper into poverty.
My recommendation is for < 100 bedded hospitals to focus on quality rather than volume, and to leverage HIT and automation in their efforts. Automation helps  improve patient-care coordination and ensure the consistency of patient care across facilities, and foster patients’ (and their families’) engagement in their own care. This all adds up to better care and lower costs of delivery for hospitals, and better health outcomes for patients. Today most healthcare providers think of Billing and Inventory as the key areas for automation to the exclusion of everything else. This myopic vision leaves a lot of value gaps that goes un-leveraged and un-monetised.
From the industry standpoint, smaller private healthcare providers who leverage HIT effectively ensure their survival and success, help bring about a more competitive provider market, and ultimately offer better quality care at lower costs.

Get Over Short Termism

Short-term thinking is holding back progress in the healthcare industry and preventing innovation among HIT vendors. Our studies have shown that hospitals  seldom spend more than 0.5 percent of their revenue on IT. Mostly they tend to source customized software solutions from small time players and the mindset seems to be—“cheap is good but free is better.”
Clearly, they do not see IT as a competitive differentiator that can help reduce cost and improve productivity. Small time IT players seldom invest in R&D and rarely provide yearly updates and upgrades. This means that hospitals need to re-implement every time they need to do a technology upgrade. But instead of seeing the potential loss of patient relationships and revenue opportunities that comes with every implementation, many hospitals stay fixated on just how cheap it is to get a new solution every time.

Compared to a global average of 2-2.5 percent of investments by hospitals, or 6-15 percent by other sectors in India itself,  hospitals are far behind their global peers in recognizing the value of good software. The impulse is always to invest for the quick ROI. For example, instead of investment in IT, many CEOs traditionally have wanted to invest in CT Scan or other equipment, which can generate revenue from the following morning itself.

By extension, this approach of managing the affairs of the hospital stifles innovation among IT vendors and limits their ability to invest in R&D for creating innovative IT solutions.
I strongly urge the healthcare leaders to change their mindset and start looking at generating productivity gains by setting up lean and mean operations. The skilled work force is increasingly hard to come by. Hospitals need such critical resources like Doctors and Nurses in abundance to support the opening of newer facilities and not having them will limit growth, like one of our customers in India is realizing very quickly. With abundant money supply Hospitals can easily raise capital today but not having good physicians and nurses will limit their growth for sure.
The only way to achieve sustainable growth is to focus on enhancing productivity rather than just adding to the labor force alone. And quite simply the most effective approach to enhancing productivity at any organization incorporates the innovative use of good technology.
So my key message here goes directly to senior executives of healthcare facilities:   is to view IT as a competitive differentiator rather than as a cost management tool. And recognize that the right software and other tools are essential to making those gains and sustaining your business growth. Continually benchmark your practices to hospitals globally and not just with peers locally.

Finally, Insurance is coming

Increasingly top hospitals are becoming aware that the Insurance reimbursements are a significant portion of their revenue and rising every year. DRG classifications and reporting are going to become commonplace as Insurer’s seek to reduce their cost by paying for “packages” rather than individual services. This means that Hospitals that won’t or can’t respond to the Insurer’s will be left to address private-pay market that will shrink slowly but surely. If one studies the evolution of the US system you will find a strong parallel to the trends in the Indian healthcare system. This will be an existential question for providers.

Like they say “the best way to predict the future is to invent it”. 


Conclusion

  • Healthcare providers need to implement software and other tools with a view to generate productivity gains – not just to generate bills
  • View IT as a competitive differentiator rather than as a cost management tool

The author is the CEO of Napier Healthcare, a Singapore based software provider of technologies such as HIS, EMR, Portals and revenue generating solutions such a Referral management and CRM. He has personally witnessed smaller Singapore healthcare providers with ~100 beds overcome manpower crunch by using technology.

The Article was first published on Mr. Tirupathi Karthik’s LinkedIn Pulse blog, here, and has been republished with the author’s permission.

Author
Tirupathi Karthik

A leader in the Healthcare IT space, Tirupathi Karthik has extensive business leadership experience across Asia, the Middle East and USA, particularly in the enterprise software space. He is a passionate advocate for the innovative use of technology that turns IT investments into competitive differentiators for their stakeholders rather than using IT as a pure cost containment initiative.

In various hospital implementations, he has been championing the use of Mobility as a pervasive information delivery channel. His vision led to the use of themFirst approach with the infusion of HTML5 and Apple’s mobility products across the Napier platform. Napier’s leadership in the global marketplace continues to gather momentum on the back of one of the most modern implementations of such a technology stack.

As an Eldercare thought leader, he has been driving productivity agendas for aged care models globally and seen to the expansion of Napier’s product vision to include elderly care services delivery. Applying technology-enabled solutions for senior care providers offering nursing home, home care and activity-centre services, Napier today enables productivity and improved quality of care.

SURVEY: The use of Big Data Analytics (BDA) for better healthcare delivery in India by Nishita Mehta

This survey tries to understand the state of healthcare data management in hospitals in India and the use of Big Data Analytics (BDA) for better healthcare delivery


The results of this survey will help obtain insights in how the hospitals can make use of technological developments for improving care delivery. 


The survey has been created keeping in mind the expertise of respondents, hence it has been divided into two categories: 

(a) User: hospital personnel 
(b) Solution provider/ healthcare technology experts. 

The survey has been distributed across two parts, each would take around 10 mins to answer. The responses to this survey will remain anonymous and will only be used for research purpose. 

I personally thank you for each minute you invested in this research.

(a) User: Hospital Personnel
Part I: https://goo.gl/forms/AS52RYFA4VDP9ct42
Part II: https://goo.gl/forms/ICXKGd19exvuMito2

(b) Solution Provider/ Healthcare Technology Experts
Part I: https://goo.gl/forms/WblNKZgRkq8PGAXs2
Part II: https://goo.gl/forms/WhUUIvfQCuvciwEG2

Author
Nishita Mehta

Ph.D. Scholar at SYMBIOSIS INTERNATIONAL UNIVERSITY
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