Achieving Integration – Apollo Hospitals Dhaka : A.K.M. Nazrul Haider, General Manager – IT, Apollo Hospitals Dhaka, Bangladesh

What has been your overall strategy in adoption of IT for gaining operational and business efficiency at Apollo Dhaka?
Established in 2005, Apollo Hospitals Dhaka is a recognised provider of premium private healthcare in Bangladesh, and the first-of-its-kind in the country that redefines healthcare delivery system with a paper-less environment by introducing a robust IT system and infrastructure. Since inception, our IT system has created an environment that allows our doctors to practice medicine in the best way possible and create a good relationship with their patients through information sharing. We wanted clinical information at the fingertips of our doctors to enable quick diagnosis. Like most world-class hospitals, Apollo Hospitals Dhaka is also focused on maximizing patient safety, quality and value with the adoption of IT. We focused first on the fundamental technology needs in our hospitals – EMR [electronic medical records], CPOE [computerized physician order entry] and BPOC [bar-coded point of care] interface solutions. To accomplish the goal of unique identification of our patients at the time of registration, we opted for a combination of bar code and RFID [radio frequency identification] technology so that we can create electronic records that ensure the right patients received the right medication at the right time. To manage safety and improve quality, the system ensures that all clinicians have the information they need to support optimal decisions and actions at every point of the medication cycle.

Please elaborate on some of the technological and clinical innovations at‚ Apollo Dhaka.
We had started operations by implementing the Hospitals Information System (HIS) from Akhil System Pvt. Ltd, based in New Delhi, India, a professional software company specialising in delivering total health care IT solutions for hospitals. The system was developed over decades under supervision of practicing medical professionals and domain experts with a specialised IT team, who have successfully computerised a large number of hospitals with a wide range of functionalities. During implementation period, the system went through a variety of changes to accommodate the unique nature of our health care delivery system, especially in the area of high volume Outpatients and management of Pharmacy, single dose concepts and use of generic drug names. The system is an integrated enterprise software solution that integrates virtually every department. It is unique in the fact that it is an integrated solution that combines both healthcare (front-office) and back-office operation in a single database, which works virtually 24 hours a day throughout the year.

Apollo HospitalsThe HIS system architecture was based on a single-server and single-database model containing the entire facility¯¿½s data, solely using Microsoft 2003 server and Microsoft SQL2000 database platform technology. The database server is dual HP DL380 Clustered with Fiber Channel storage in the form of HP MSA1000. The hospital¯¿½s network infrastructure was designed to cater to the high-volume data/image traffics with fiber-optic backbone and structured cabling with state-of-the-art Cisco switches under certification from Systimax Engineers.

Most of the Lab equipment are connected and interfaced with the HIS system and the data flows communicate with the host without manual interventions. We have also introduced RFID technology to track the doctors and staff, and this will soon extend to track patient movement and mobile life-support equipment on a real time basis to increase operational efficiency and improve quality of patient care delivery.

Apollo Dhaka has been a pioneer in developing a fully IT integrated hospital in Bangladesh (near paperless environment). How have these and other innovations enhanced the hospital¯¿½s workflow?
We have been using IT system in the form of HIS across various functions to enhance patient safety and reduce the risk of medical errors through seamless integration of clinical information. It helped us introduce a paper-less and film-less workflow for achieving error-free healthcare environment. The HIS system network will soon be expanded for supporting tele-health by creating a connected community encompassing the patients, families and clinicians for improved care, greater convenience and less expense for all. Medical records including the radiological images of all registered and referral patients are archived in an optical jukebox for future retri.

By implementing PACS (Picture Archive and Communication System), we have achieved an efficient digital workflow, which enhances radiologists¯¿½ productivity because current and prior imaging studies are available instantly for side-by-side viewing. In addition to efficient review, storage, and distribution of images, a digital imaging and information platform enables new clinical tools such as computer-aided detection to be efficiently employed. This can enhance efficiency and accuracy, especially in screening efforts.

What is your average annual IT spend? What areas of technology do you plan to invest more in near future?
The biggest obstacle in healthcare¯¿½s attempts to fully embrace IT is it¯¿½s funding. Healthcare organisations have traditionally under-invested in information technology, and the reason is obvious. Investment focus goes to direct revenue generation equipment than support services. The ROI for some of the projects is questionable when you start to look at soft benefits like enhanced patient safety and increased clinician productivity. The healthcare industry is at least a decade behind other information-intensive industries, like the airline industry, retail and banking. In Asian countries, the healthcare industry invests some 1 to 2% of revenues in IT as opposed to 5% in the banking industries. Enterprise level IT projects require a sizable capital outlay and a multi-year commitment from the organisation. Apollo Hospitals Dhaka is a fairly new establishment and the investment on IT systems is on the higher side as compared to similar but older setups.

We are currently focusing on disparate systems that need to interface with the main HIS system. To cope with the projected rise in patient volumes, we are looking for an exclusive storage system in the form of SAN, this will not only increase the capacity of the progressive storage but also efficient handling of data to reduce the response time of a vastly integrated system. Tele-Medicine is the other priority area where our focus will be to reach remote patients and linking patients and clinicians to create a connected continuum of care that leads to better quality of life for patients at minimal cost.

Who are some of your major technology vendors for different application areas? What is your expectation from the vendors in terms of customer support and future offerings?
We do not interact with many vendors for our different application needs. We like to depend on a single vendor for all of our software and hardware needs and support. As far as hardware is concerned, we have HP products catering to our computing needs and CISCO products for our networking equipment and support. We depend on Akhil Systems for HIS, and also expect HIS as a central point for all peripheral interfaces irrespective of 3rd party integrators and hence HIS vendor should have collaborative tie ups with all those integrators and peripheral suppliers to support their clients as single point of contact.

Interoperability is an issue confronting all aspects of healthcare. Even in traditional modes of healthcare, when we consider electronic health records, we have problems in terms of sharing the patient information across the various provider silos and making them interoperable. It is no longer just the electronic health record that needs to be interoperable; it¯¿½s the entire system incorporating various patient monitoring devices that needs to talk to each other. In this scenario, there is a pressing need to bridge all islands of information and decision support tools to aid clinicians so they can seamlessly traverse these independent silos of information. Vendors of all healthcare system providers have to form an alliance to set up standards for creating interoperability between devices operating in the healthcare space. Until these standards are in place, harmonized and adopted universally we will bear the burden of the lack of seamless information flow.

How have you handled issues of technology awareness among doctors and clinicians? What is the level of technology interface for doctors and nursing staff in your care delivery process?
One of the biggest challenges healthcare organisation face is providing appropriate incentives to adopt new technologies. Hospitals need to implement systems that are easy to use, integrate with clinician daily workflow easily, save clinician time and improve the quality of care. Younger clinicians are technology savvy. They grew up with the Internet and video games. Older clinicians, on the other hand, are comfortable with the paper-based systems they have been using for the past many years.

We introduced ¯¿½PACT¯¿½ [Physician Adaptation with Computer Technology] program which consists of hands-on training with the HIS system which they use on a daily basis in their OPD and other clinical activities. Every new doctor and employee of Apollo has to attend an intensive 3 day IT adaptation training along with HIS operation where they are provided with an overview of the system and specific modules s/he has to use on their job. In addition to this, there are a series of IT-refresher training programs organised for all stakeholders through out the year.

All our clinicians are familiar with the HIS system they use on a day-to-day basis. The OPD system is clinician-centric and integrated with pharmacy and investigation modules. Doctors use the system at the point of service and select the medicines and investigations required through a drop-down menu; the system provides a powerful search engine for locating any type of information related to patients. Currently, we do not have any plan for remote patient monitoring (RPM); but we see a potential benefit in the future to provide this service, as the increased access of mobile phones in remote and rural areas increases.

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