Group – 1: Ashwin, Noel, Sreehari, Samson, Gargee

E Governance in Health Care

Agenda

Health Care in Indian Context 1

2

3

4

5

6

E Governance in Health Care

Current Technologies

Bangalore Public Survey

Bangalore Doctor Survey

Learnings

• The health-care industry incorporates several sectors like biotechnology, diagnostic substances, drug delivery, drug manufacturers, hospitals, medical equipment and instruments, diagnostic laboratories, nursing homes, providers of health care plans and home health care.

• Indian healthcare industry currently stands at USD 35 billion.

• The healthcare industry in the country, which comprises hospital and allied sectors, is projected to grow 23 per cent per annum to touch US$ 77 billion by 2012 from the current estimated size of US$ 35 billion, according to a Yes Bank and an industry body report published in November 2009.

• Union Budget 2009-10 has provided increased allocation of around Rs. 4000 crores amounting to total sanction of Rs. 21,113.33 Crore. Of this Rs.12,070 crore has been allocated for National Rural Health Mission towards providing primary health care facilities

Health Care in Indian Context

• The sector offers immense potential to healthcare players as the country witnesses a rise in the incidence of lifestyle-related and other diseases. A growing elderly population and rise in income levels are also pushing for better facilities in the country.

• Driving the sector's growth will be the health-conscious middle class which can afford and wants quality healthcare.

• The healthcare industry is interestingly poised as it strives to emerge as a global hub due to the distinct advantages it enjoys in clinical excellence and low costs

• The industry, which was once the exclusive domain of the government, has seen a steady participation of major corporate houses which have helped set up premium hospitals and medical facilities across the country.

• Health spending in India at 6% of GDP is among the highest levels for developing countries

• In a survey conducted to study the spending by government (as a percentage of its GDP) and private companies in healthcare its found that India ranks 171st among spending by government and 17th among spending by Private companies. This shows that India should go in for Public-Private Partnership (PPP) Model

• Due to large population in India where around 70% of the population is residing in villages, E-governance could be the only solution to reach out to the villages through E-village centers

• Currently only 10 per cent of the Indian population has health insurance, which means that there is tremendous scope for growth in this area. The Indian health insurance business is growing at 50 per cent. The sector is projected to grow to US$ 5.75 billion by 2010, according to a study by the New Delhi-based PHD Chamber of Commerce and Industry.

• India has the 2nd highest number of qualified doctors in the world with success rates of surgical procedures at par with international standards.

• The sector has registered a growth of 9.3 per cent between 2000-2009, comparable to the sectoral growth rate of other emerging economies such as China, Brazil and Mexico.

• As per a study by an industry body and Ernst & Young, India would require another 1.75 million beds by the end of 2025. The public sector however is likely to contribute only around 15-20 per cent of the required US$ 86 billion investment. The corporate India is therefore, leveraging on this business potential and various health care brands have started aggressive expansion in the country. Some of the companies that plan to increase their footprints include Anil Ambani’s Reliance Health, the Hindujas, Sahara Group, Emami, Apollo Tyres and the Panacea Group.

• Sahara Group is planning several healthcare projects such as a 200-bed multi-specialty tertiary care hospital at Gorakhpur in Uttar Pradesh, a 1,500-bed multi super-specialty, tertiary care hospital at Aamby Valley City and 30-bed multi-speciality secondary care hospitals across all the 217 Sahara City Homes Townships.

• Meanwhile, Artemis Health Sciences (AHS), a health care venture of the Apollo Tyres Group, is also planning to establish four to eight multi-specialty hospitals in Punjab, Uttar Pradesh, Madhya Pradesh, Rajasthan and Haryana over the next three years.

• The rural healthcare sector is also on an upsurge. The Rural Health Survey Report 2009, released by the Ministry of Health, stated that during the last five years rural health sector has been added with around 15,000 health sub-centres and 28,000 nurses and midwives. The report further stated that the number of primary health centres have increased by 84 per cent, taking the number to 20,107.

• One of the major contributions of Information technology is the development of E-Governance program which aims in providing benefits to the people.

• The most common definition of E-Governance can be defined as the use of information technology to improvise the accessibility and deliverability of the government services to benefit the citizens, business partners and employees.

• E-governance in the healthcare system can be as simple as providing a patient with the means to alert a remote care provider of their need for assistance.

• E-governance in healthcare industry is an emerging subject which aims in not only providing the best health service to the people but also improvising the work done by the stakeholders in the hospitals.

• E-governance would help healthcare in reaching the interiors where they are most needed.

E-Governance in Health Care

• E-governance deals with multiple organizations the implementation and control of it can be done effectively with the help of information technology model.

• It can help in various functions like enabling health related information on the web, help patient contact with the healthcare, patient allocation, building e-prescription etc.

• The rise of e-healthcare in various countries can be understood with the face that 40% of internet queries are health related.

• Due to large population in counties like India and around 70% of the populations residing in the village E-governance could be the only solution to reach out to the villages through E-village centers

• EHR and EMR would reduce the time taken for documenting, storing, retrieval of medical records. It would completely eliminate the space requirements which can be devoted to other value adding activities.

• It would reduce the time spent on non-value adding activities. It would ease the availability of Diagnostic Reports during emergency situations across hospitals.

• It would ease the processing of Insurance claims and help the government in enabling the reach of BPL cards to the people so that they could avail the benefits of Cashless facility. At present only 10% of the population utilize the cashless facility.

• It would improve the Quality of service and make it much more structured as documentation is the first step towards Quality process.

• 21st Century's Health NET in Goa: The Gov.of Goa in association with 21st Century Health Management Solutions implemented a Rs-2.5-crore Hospital Management Information System (HMIS) called Health NET in Goa Medical College (GMC) Hospital

• Intel's World Ahead: The child health monitoring system in Chandanichowk in Newdelhi for poor needy urban children, to check for under nutrition as per WHO guideline digitalized health records

•HP in Maharashtra: In January 2007 with 100 Cr. funding automation project of 19 Govt. hospital and 14 medical colleges started. HP healthcare solution and Amrita Technology worked together for system integration and doctor’s training.

• Orissa GRAMSAT project: Is a satellite based communication network for conducting training programme, tele-education and tele- medicine etc. It operates on INSAT 3A

Current Technologies

• TCS for Tamil Nadu: The TN Gov. has allotted Rs 5 crore to TCS to develop a suitable solution to maintain electronic medical records (EMR). The system is functioning in all the 26 district headquarters hospitals, 162 taluka hospitals and 77 non-taluka hospitals. Decrease in AIDS prevalence in Tamilnadu speaks about success of Tamil Nadu State AIDS Control Society(TNSACS) and e-governance .

• E-Grama: Is an e-governance effort with the objectives of providing G2C services to common man through different Gram Panchayat and village level IT KIOSKS using Information and Communication Technology.

• Hello doctor 24X7 at MKCG Medical College: Is a project extending e-health care service undertaken by 3 final yr medico of MKCG medical college using internet and mobile phones

• Wipro for Delhi Municipal Corporation (DMC): Wipro provided Hospital Information System (HIS) tosix hospitals of DMC. This HIS has 28 modules meeting the hospital needs. An Electronic Patient Folder-ready access to past episodes. Clinical history of patients.

• The VSAT (Very Small apertures Terminal) data network connects 30 DRDAs , 314 Blocks, 9 State Govt. offices and 800 gram-panchayats of with the objective of providing digital communication between the state capital, districts and blocks for different e-governance projects.

• The primary objective of administering questionnaire to patients was to find the computer usage, internet usage, purpose of use and awareness about telemedicine which would give an idea about technological advancement and level of satisfaction by patients regarding the services provided by hospitals in terms of issue of reports, fixing appointments etc. This can be made more organised through ICT applications.

• It was seen that 62% of the people used internet almost daily and did so through their office or home which shows the ease of accessibility which would help in delivering the benefits of e-governance directly to the patients.

• Around 62% people use internet for medical related information of which 58% did so based on self interest and were not asked to do so by their doctors.

• Only 25% of the people were aware of remote patient monitoring system i.e. telemedicine and agreed to the benefits it provided in terms of emergency care, cost effectiveness.

Bangalore Public Survey

• It was seen that people used internet to search about facilities provided, doctor’s profile, health care provided by the hospital before making visit to the hospital. It was surprising to find that the 60% people were satisfied with the current methodology of fixing appointments through phone, personal collection of their diagnostic reports and few expressed grievance in form of no quick reply through phone.

• On a closer look it can be seen that the satisfaction of people to current methodology can be attributed to people not being aware of the technological advancements and not having experienced facilities like fixing online appointments, collecting online reports.

• Few hospitals in Bangalore like Apollo Hospitals, Fortis, Narayana Hrudalaya have taken step toward this by implementing fully functional telemedicine departments where remote patients are provided treatment and consultation. Fortis has also started on-line appointment fixing facility but its not operational on a large scale.

• Marketing of these facilities and encouragement by doctors to patients to use internet for medical purpose, fixing appointments, collecting reports, asking queries can help in creating awareness among the people also increase the hospital’s productivity. It would thus create a win-win situation and provide quality healthcare to patients. Also, state and central governments can come up with standardised accreditations which would make mandatory for the hospitals to take steps for towards ICT development

• The primary objective of Questionnaire administered to doctors was to check the awareness about e-governance and to study their e-mail, SMS usage pattern and purpose. The secondary purpose was to check if they are aware and agree to the benefits provided through e-governance and telemedicine.

• It was found that 90% doctors posses either personal desktop or laptops and spend around 10-11 hours per week in front of computers. The frequency of e-mail checks is daily.

• Around 50% doctors use e-mails mainly to discuss medical issues with colleagues. 50% agree to the e-mail usage in terms of reminding patients about medications and appointments whereas 30% are neutral about it.

• It was surprising to note that only 50% were aware about the EMR. Around 50% say that current system of medical records is costly and cumbersome as it occupies lot of physical space and requires maintenance, does not provide easy accessibility of the same.

Bangalore Doctor Survey

• In case of telemedicine 44% doctors say that its much useful in life saving condition and 28% say that its cost effective in long run. Only 35% doctors have heard about e-governance that too only once or twice through books and journals.

• This shows that there is lack of awareness among the doctors regarding e-governance and the hospitals which are on the steps of implementing the process have not disseminated the information regarding the same to doctors and staffs at all levels in the organisation. Such organisations would not succeed until everyone is made part of the system and educated about the same.

• On the basis of research conducted and the sample population surveyed. It showed that Healthcare is one of the industries in the top list which needs IT support for its efficient functioning.

• Its seen that advancement has been made in the industry in terms of HER, EMR, Tele Medicine and the government and doctors are aware of its benefits but still they are not ready to use it or implement it and also patients are ignorant about the technology but when they were briefed about the technology and its benefits even they agreed upon to the same.

• Therefore the research conducted. Shows that there is a need for creating awareness about e-governance among the jr. doctors and patients. Many hospitals where the project of e-governance is under process does not have the details disseminated to all the levels in the organization and hence the technology and its benefits are neither promoted nor fully utilized.

Learnings

THANK YOU!