As one who came to this Greenfield project as part of the systems implementer team, Dr. Rajesh Gupta, one of the few medical doctors in the Health IT field, was faced with a number of challenges he met head on and solved with the help of his team. He shares with eHEALTH the highs and lows of his experience as Controller of Medical informatics, Artemis Health Institute, Gurgaon.

Dr. Rajesh Gupta
Controller Medical  Informatics,
Artemis Health Institute, Gurgaon

Q. Do you consider lack of interoperability of Electronic Medical Records (EMR) as one of the bottlenecks for the growth of the health IT industry?

A. Even if we go in for EMR in the corporate hospitals, a very small percentage of the population will be covered. This is something that needs to be considered, since the greater part of the data is with the government hospitals. Unless the government has some policies to implement EMR in government hospitals and share the data among all hospitals, even if the private hospitals go forward with such a project, it will not benefit the society at large. Having said that, it would be a great beginning, if corporate hospitals take the initiative and share the patient records.

Q. Does that mean that unless we have a national level archiving and interoperability policy, it is not feasible? What about hospital chains having multiple locations?

A. If Artemis opens another hospital, we will definitely adopt this practice. Our current HIS is capable of doing it. If a patient has had a CT scan here, s/he doesn’t need to do a CT scan again in another Artemis facility. It is not only convenient and faster for the patient that s/he already has the results of some tests – it also benefits her/him financially.

However, sometimes there are genuine concerns, such as when the test is too old – you cannot hold a CT scan from a year back valid/informative. At the same time, if a patient has done a CT scan last week in Gurgaon and is now in Mumbai, then that report can be very useful. The patient doesn’t have to go through unnecessary radiation hazard as well.

Q. When you were setting up the entire HIS, what was your experience in handling the modalities? Were there interface problems?

A. There were problems. We had a team of 8 people from iSOFT who were here for 4 months – including technical persons developing the interface, a team of Philips, who were our primary suppliers for modalities, a team of biomedical engineers, and obviously various departmental users. While interfacing we had some problems, not major ones. We could go through radiology equipment easily.

However, we are facing difficulties with the Echocardiography. Echocardiogram (ECHO) is considered to be an ultrasound modality in DICOM standard. But Ultrasound belongs to radiology department, while ECHO belongs to Cardiology department, so we were finding it difficult to get that sorted out. Ultrasound is already integrated, and we are now trying to integrate ECHO as a different entity altogether.

But this is a limitation of the DICOM standard, which has no separate modality as ECHO, because it is an Ultrasound based equipment. So we are still working on it with the help of iSOFT who are helping us to figure out how we can program it so that we can get it online within existing DICOM standards.

“A big challenge is the HIS training to the end users. Today I can say that 95% of doctors are happily using the HIS with complete EMR available online at the click of a button.”

Q. What has been your experience in dealing with people during the implementation?

A. The biggest challenge to any HIS system is resistance from the user. We were fortunate that Artemis Management was very clear with its vision that we are going to use EMR. Its message was very clear to all the doctors, the nurses, the technicians, front office, inventory and store employees. Dealing with doctors and nurses was a challenge. We had nurses who had never touched a computer in their life and we had to plan their training accordingly. 

Initially when we started the implementation, we did not have data, being a greenfield project. Each department was asked to collect and feed their own data into the system. This was done in a specific format provided by iSOFT. After the data was collected, it needed to be validated, checked and then entered. Laboratory and radiology departments entered all the data, so it worked beautifully. Other modules’ data was entered by data entry operators, which took quite some time to correct.

Another big challenge is the HIS training to the end users. We had various kinds of feedback from all our users. Today I can say that 95% of doctors are happily using the HIS with complete EMR available online at the click of a button. Artemis has also installed the pneumatic chute which is used to dispatch lab samples, medicines etc.

Q. Do you have a practice of keeping any paper records at all?

A. We do. You cannot go totally paperless due to some legal constrains. Digital signatures are not yet legalised in India. So if we are taking consent from the patient for any procedure, it has to be on hard copy and it has to be stored alongside the medical record. All other patient records are available online.

Q. When choosing a health IT vendor, what are the top criteria you would base your choice on?

A. The first criterion is scope. What is the expectation from the solution? Whether you are looking at maintaining online EMR or you just want patient administration, stock, inventory modules. The second criterion is definitely cost. If your budget is limited, then even if you like some of the best solutions, you simply cannot afford it. The third criterion has to be post implementation support and vendor’s reputation, which is critical in order to achieve success.

The best solution should capture each and every detail of a hospital transaction, be it any department. According to me it would be complete EMR, complete patient administration, finance, billing, stock, purchase, business intelligence, PACS and MIS.

We at Artemis do not yet have the purchase and finance modules, for that we are going to implement SAP and integrate it with HIS to complete.

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