January 2010

Critical Issues in a National Healthcare Discussion : Dr. Kevin Fickenscher, utive Vice President – International Healthcare, Dell Perot Systems

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Deliberations on access, transparency and efficiency should guide the process


Dr. Kevin Fickenscher is a global leader of international healthcare for Dell Perot Systems. A physician utive and a leader with extensive experience in strategic and operational development with complex healthcare organisations, Dr. Fickenscher has provided leadership for various organisations related to organisational transformation and development, physician management, health policy analysis, leadership development, information management, clinical quality and care management, among other areas.

eHEALTH recently caught up with Dr. Fickenscher to know about his vision of the future of health IT in India and the necessary strategies for avoiding pitfalls along the way.


Dr. Kevin Fickenscher
utive Vice President – International Healthcare,
Dell Perot Systems

India has emerged as a global economic force, and this has led the public to demand changes within India’s healthcare system.  This is a natural development that I have seen during my travels around the world.  The demand for better, more available healthcare for all, is truly at the forefront of public debate in India, and decisions about healthcare now will impact all the entire Indian population for decades to come.

While change can be daunting, India is accustomed to accepting and excelling at challenges. In healthcare, India has the opportunity to “leap frog” the current status quo and make investments that truly improve the nation’s ability to meet society’s healthcare needs.  However, to transform this promise from potential into reality will require India to focus attention on several critical issues. These issues will not only affect the quality and accessibility of healthcare, they will determine the sustainability of the healthcare system itself.
Issue number one is about access to healthcare services. Will it be limited, or will it be universal? While this will be a major debate, no doubt, it is an important discussion for a nation that is assuming a major profile on the world stage. The issue of universal healthcare access continues to be of critical concern to the citizens of my home country, the United States. Having the dialogue and debate on the basic healthcare package that should be available to all citizens is an important discussion. In fact, it could be the most important discussion a society might have.

Another crucial issue regards transparency. From my experience and travels, nothing creates more energy around reaching solutions than providing information so stakeholders can compare themselves to one another. Holding up a mirror is a very powerful force for change.

A major risk is the issue of waste and duplication of resources. As a nation that is consciously moving beyond the subjugation of poverty to an enhanced economic status for its people, India should realize that allowing unfettered development also creates unfettered costs. Nation’s around the world ultimately pay a significant price for inefficient healthcare systems. For example, in the United States, an estimated 25 to 30 percent of our healthcare spending is wasted due to duplication, inefficiency and other problems. Imagine if India had $500 billion to allocate for healthcare today.  That’s about 25 percent of the current US investment in healthcare services. Today that may seem like a huge sum, but in 10 or 15 years, India almost certainly will be investing at this level.

In terms of healthcare information technology, the development of national standards for interoperability and connectivity are crucial. This will eliminate waste and duplication while ensuring that patient information is available at the point of care, eliminating unnecessary tests, enabling more informed decisions and improving the quality of care.


“A more reasoned approach will help make India an international leader in promoting best healthcare practices, creating appropriate societal incentives, and deploying systems that actually provide the foundation for enhanced care, better access and lower cost.”


At its core, medicine is about using information.  Generations ago, the “sharing” of health information was limited to physicians in the backrooms of healthcare.  Then, the sector realized that documenting information could benefit individual patients as well as society as a whole. So, medical records were created to make sharing information about patients much easier to do.  In the 21st Century, IT will be the great enabler for information sharing and for helping achieve broad goals for healthcare access, affordability and quality.  The ability to “share” is no longer based on the quality of the paper but the quality of our ability to move data in structured ways. Indian physicians are very sophisticated – they are among the very best in the world. They know that sharing information fosters better care.  India should embrace this principle and pursue it with policies and financial support.  Last but certainly not least, making decisions on the issues mentioned above will shed light on which approach will best support a national healthcare information infrastructure for India.  Without consciously choosing a direction, scarce resources will be wasted, and goals will be at severe risk.

One of the key lessons, I have learned as a clinical consultant with Perot Systems, is that success in modern healthcare requires more than just re-engineering a process.  Success requires a profound cultural transformation. Consequently, a more reasoned approach will help make India an international leader in promoting best healthcare practices, creating appropriate societal incentives, and deploying systems that actually provide the foundation for enhanced care, better access and lower cost.

While many people believe that the United States is the world leader in healthcare, we are actually playing catch up in the IT area.  We literally spent billions of dollars to support IT systems over the last several decades. Despite those investments, we still have a very low percentage of hospitals and physicians using Electronic Health Record (EHR) systems less than 10 percent! And yet, key studies strongly show that electronic information systems in healthcare settings do enhance quality, allow for better service and, reduce the overall cost.   Recently, the U.S. Government committed over $27 billion in federal funding towards the advancement of health IT, including EHR systems. So, we are embarking upon a journey, but the final path is not yet clear.  There is much debate over how the funds should be used, where they should be used and even what constitutes “meaningful use” of these new investments.

I would encourage India to be more circumspect, to deliberate on the path before funding it and to invest wisely. In these deliberations, India will be well-served if key issues are thoroughly addressed.  Doing so will help India continue moving forward to assume its status as a leader across all areas of healthcare.

To meet these objectives, India should address these basic needs:

  1. Create standards for excellence that are openly exchanged across society.
  • Invest in an IT infrastructure that supports interoperability and open connectivity at all levels within the profession and among individuals.
  • Support privacy standards so that individuals have confidence in the system.
  • Create a payment system that encourages the use of efficient and productive information systems as a foundation for support of healthcare.
  • OTHER  IDEAS

India is among the great nations of the coming century. The country has an opportunity now to stand on the shoulders of those who have gone before, to benefit from their hard-learned lessons and to adapt those lessons to the needs of its society.  Postponing inevitable deliberations runs the risk of as we say in the United States arriving a “day late and a dollar short.” By setting a course now thoughtfully and intentionally, India can control its own healthcare destiny. 

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