The per capita income in Western India is the highest in the country at USD 850 (PPP). It would be appropriate then to assume that this would have an impact on the level of automation of medical care in the region.
Things are however more problematic than that when the regional inequalities are taken into account. The three states have their own peculiar issues which impact healthcare and the number and quality of hospitals in the respective region. Gujarat and Maharashtra have hospital facilities which far exceed neighbouring Rajasthan in terms of both quality and quantity. Maharashtra and Gujarat also have a number of civil society movements which promote sanitation and efficient water use ï¿½ precursors to well being.
Let us look at each of these states individually.
Rajasthan has a population of approximately 60 million and the health indicators in this region are often below the national average. The literacy rate is about 4% below the national average (at 61%) and female literacy is an abysmal 44.3%. The state has a poor sex ratio (909 in the 0-6 age group), an infant mortality rate of nearly 80 immunization levels of less than 37%, and 33.4% ‘safe’ deliveries. Clearly the entire health system needs an overhaul.
In such a situation, it becomes important that paperwork is minimised for patients and their relatives and they spend the least amount of time and money at a hospital. Implementing electronic health in Rajasthan is a challenge when less than 55% of households have electricity supply and just 23% of the population is urbanised. The condition of primary health centres ï¿½ which form the bulk of healthcare facilities ï¿½ is appalling. Less than 4% of these have provisions for training of any kind.
There are approximately 12,250 registered medical facilities with about 38,000 beds between them. Jaisalmer, Bikaner, Barmer, Jaipur, Jodhpur, Dausa, Dhaulpur, Alwar and Sirohi have decadal growth rates of over 30%, though only the district of Kota has an urbanisation level of more than 50%. One thing we notice is that there is no clear overlap between health indicators and the growth rate in district. The state urgently requires better infrastructure, more hospitals and better IT and support services.
On a more positive note, the capital Jaipur and other cities like Udaipur, Ajmer and Jodhpur are witnessing an increase in the number of large, speciality hospitals. The Jaipur Development Authority has plans to make the city a Medicity andÂ hub of medical tourism. Six large investors, including the Reliance Medi Care Ltd., Fortis Healthcare, Bombay Hospital, Trinity Group and SPA Enterprise are scheduled to invest over USDÂ 46.69 million in the project.
Gujarat ï¿½ Gujarat is one state where The Wockhardt group has plans for extensive expansion in the state’s tier-II cities. Over 65% of the population here is below 35 years of age and the state also has good infrastructure on the whole. The InfoCity at Gandhinagar has been set up to give a fillip to the IT sector. Rajkot, Surat, Bhavnagar and Jamnagar have planned Software Technology Parks. Vadodara has also been identified as a future IT destination by the state.
Maharashtra ï¿½ Pune is one of the fastest growing cities in the country and an IT hub. Due to this, private hospital chains are keen to set up shop in the city. Apollo, Sahayadri, Wockhardt and Ruby Hall are some of the companies with expansion plans here.
What are the main reasons for hospitals switching to another HIS?
Many hospitals have solutions created 10-12 years back, which are mostly obsolete in their capabilities. The users have also got trained to handle more complex solutions. So there is always demand to upgrade and move up the value chain for better products.
Driving forces of Automation
The second part of the IT@Hospital Survey looks at the level of automation in hospitals across these three states. Over half the hospitals surveyed [55%] belong to the Mission/Trust NGO category. Nearly 40% are privately owned. Also, a majority of them [55%] have less than 150 beds and only 17% are large, i.e. over 300 beds each.
The hospitals surveyed said that the most important reason for automation is the need for better service quality. About 61% agreed that corporatisation of healthcare delivery has an important role to play. None of the hospitals surveyed however, admitted to health insurance being a driver of automation.
Advantages of IT
As consumers, payers, and regulatory agencies require evidence regarding health care quality, the demand for process of care measures will grow.
When we talk of Hospital IT, it is not just installing computers in different departments of Hospital like OPD Regn & Billing , Labs & Radiology reporting, Pharmacy , Stores & Accounts and using them glorified typewriters . It should be a truly integrated HIS system with all the functions of the Hospitals connected to each other like links of a chain and helping various users to facilitate proper patients management which is patent senstitive, accurate , accountable , transparent and affordable. Satish Kini,Chief Mentor ,21st Century Health Management Solutions Pvt. Ltd.
India’s software service exports form the fastest growing industry today, with the western and southern regions taking the lead. The Ministry of Health of the Central Government has recently started consultations to examine the feasibility of creating a national consortium for the purchase of digital information products at favourable prices for the country.
The Indian government has been taking steps to build an enabling environment for the use of ICT in the health sector. The keyÂ enactment of the Information Technology Act 2000, providing a legal basis for all digitally related information actions and privacy issues; comprehensive guidelines and recommendations for IT infrastructure in health (2003); and the creation of a task force on the topic of telemedicine (2005). The most significant challenges to date have been the coordination of inter-ministerial and departmental activities, and resource constraints.
Within the private sector too, the IT players are beginning to consolidate. Recently, the Ahmedabad Computer Merchant Association (ACMA) organised a meet which brought 16 IT-associated bodies together. The future scenario in Maharashtra looks bright as industrial lobby groups and hospitals are keen on exploiting the potential the region has for medical tourism. Mumbai, the financial capital of India is also a major research hub. It remains to be seen how the IT industry and hospitals work together to make automation in the health sector more effective.
Watch out for Part III of the IT@Hospitals survey in the November issue of eHEALTH, covering southern and central India ï¿½Â Kerala, Tamil Nadu, Andhra Pradesh, Karnataka, Madhya Pradesh