October 2007

Hospitals – Know IT Right : Vishal Ranjan, Asclepius Consulting

Given the nascent stage of the industry, Indian hospitals are taking a cut-paste approach to IT… however, such an approach fails to deliver its potential and creates pockets of excellence. Healthcare IT solution should emerge as an output of an overall endeavor to improve processes than as a stand alone tool for quick fix solutions.

Healthcare IT in India

The healthcare sector in India is witnessing increasingly higher service requirements from the population it serves. However, delivery mechanisms are currently plagued with several process inefficiencies and disconnected work flows, leading to poor patient care and management failure in hospitals.
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The acute shortage of doctors resulting in poor doctor-patient ratio limits the quality time and attention for each patient. At times, absence of medical records and poor diagnostic facilities leave significant gap in the clinical analysis. Further, there are informal levels of information and clinical data exchange both within the hospital as well between different healthcare centers leading to significant information loss, errors and poor quality of patient care.
Significant benefits can be achieved by streamlining activities, redesigning work flows and institutionalising processes across hospitals. Globally, IT adoption and implementation of hospital-wide IT systems is an accepted solution to roll out efficient and standardised processes.

However, given the nascent stage of the industry, Indian hospitals are taking a cut-paste approach to IT. Owing to the poor supply market of Healthcare IT products, Indian hospitals have lesser choices and end up adopting a solution which is either over-designed and hence costly, or under-designed and hence useless. Bigger hospitals end up automating select operations using ‘Best in Breed software’ while smaller hospitals employ the ‘next door software developer’ to quickly fix the billing and appointment processes. Unfortunately, both end of the spectrum remain wrongly served and continue to struggle with the same inefficiencies which they started with. Given the resource crunch, such errors are costly and amount to overall skepticism against IT by doctors.

What comes first?

The most common challenge for IT implementation is an ambiguity on the problem definition. Typically, hospitals choose an IT solution to automate specific work flows or adopt the latest software which gives brilliant results. However, such an approach fails to deliver its potential and creates pockets of excellence, rendered redundant by the slow and inefficient processes around them.

One of the highly reputed hospitals adopted IT to schedule their patients for the doctors to avoid waiting time at the reception. However, the problem did not go away as the scheduling in radiology department (X-rays, CT, MRI etc…) was not digital.

A good IT solution emerges as an output of an end-to-end process design exercise – clearly identifying existing gaps, bottlenecks and repetitive inefficient activities. In fact, several IT solutions would need a certain level of maturity of the non-IT processes to truly deliver the real potential of IT.

Where does IT create the most value?

Most IT enablement is driven by an opportunist approach of minimising cost and maximising automation of non-skilled manual activities. IT is more important for certain things, which are datacritical. For instance, EMR (Electronic Medical Record) is infinitely more important than the list of appointments. IT can also be useful to cut down repetitive activity of doctors. An IT solution should relieve doctors from routine work and allow them to  attend complicated cases and carry out quality conversation with patients.

Industry experiences suggest that IT can be best leveraged in reducing cost of errors in clinical work flows than in administrative activities. Exhibit 1 (in the following page) depicts the relative cost per patient in each step of a patients journey from admission to discharge, overlaid with corresponding levels in ‘chance of error’ at each step.

Healthcare IT provides significant value in activities where hospital representatives (doctors, nurses, laboratory etc.) interact with patients. In healthcare workflow, the high cost and high probability of error drive an inordinate cost of inefficiencies in patient-facing processes and should be addressed first-hand to achieve seamless patient care.

How to implement IT?

Having  decided  what processes need IT enablement it is important to undertake a scientific approach for IT sourcing, as explained in Exhibit 2;

Document the scope A documented scope of IT implementation is very important to control the implementation. Ideally, this scope of functional requirements should be prepared with the user group (doctors, nurses, clinicians etc.) and it should emanate from a process mapping exercise. Nevertheless, a stand alone scope document should be prepared in terms of process elements, rather than functionalities required.

Preparation of sourcing strategy and sourcing the IT solution

As a best practice, clear metrics, deliverables and the sourcing plan should be in place even before a vendor is approached. The sourcing objective should be articulated and should drive all aspects of the procurement cycle. The sourcing strategy should drive specific efforts in finding the correct vendor, negotiating and designing the contract.

Installing and testing the solution

Unlike manufacturing ERP solutions where the solution is ‘released’ on a final ‘Go-live’ day, healthcare solutions need a significant pilot phase to test the solution under live conditions, as human work flows are less predictable than manufacturing processes. Overall, the pilot on a group of patient reflects the ability of the software to respond to varied operating scenario. During this period, the solution should be tested against the benefit metrics. Unless benefits are defined and measured, the Return on Investment for IT solutions disappear readily in ‘intangible benefits’.

Training and change management

If there is one thing that derails IT implementation time and again – it is the ubiquitous skepticism against IT. Training and change management, especially for the doctors, is critical for the success of IT implementation. However, unlike manufacturing ERP, where change can be driven from the top; it may work totally reverse as doctors are more independent and do not necessarily fall under strict hierarchy. Here the role of training, hand holding and befriending the doctor is much more critical than in any other industry.

Continuous improvement

It is estimated that more than 60% of the value of software is realized 12 months after its installation. Quick wins typically emerge from plugging process inefficiencies or by reducing the number of errors. However, as users get familiar with a product, they deploy the same tool in innovative situations and create much more value than what was envisaged as a sourcing objective. A configurable product from a long term vendor, committed to upgrades, is advisible for continuous value from investments.

What is my correct solution?

There is no correct answer to this question for in Healthcare IT, even the best solution may not be the correct solution. Overall, the correct solution is the one which can meet your process requirements and support your vision of seamless patient care. The technology and delivery capabilities of the vendor should be the most important constituent of uation criteria. Product flexibility, modularity and configurability should be uated. The product should be an assimilation of IT as well as clinical knowledge.

Conclusions

Given the infancy of healthcare IT industry, adoption of IT in a hospital can be a strong sustainable competitive advantage for an ‘otherwise’ commoditised healthcare market. However procuring healthcare IT is an involved process and should get strong senior leadership attention. Healthcare IT solution should emerge as an output of an overall endeavor to improve processes than as a stand alone tool for quick fix solutions. The challenges for IT implementation emanate from external as well as internal factors and a robust sourcing strategy is critical to address these challenges. The vision of ‘Seamless Patient Care’ cannot be achieved on the back of broken processes and stand alone pockets of excellence; but by an integrated and efficient workflow sitting on the back of smart and simple IT solutions. 

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