Introduction / Vision
The project was envisaged during the early part of year 2007 to support a new business unit of the Manipal Group called Manipal Cure and Care (MCC). This project had distinct goals of using technology to automate retail business operations in a healthcare environment, as well as to incorporate best practices and a process based care management solution.
The first steps
The whole vision was finalised around mid-2007, and after uations on multiple products and solutions, it finally came to light that there does not exist a single solution that can be used in a retail healthcare environment. The challenge was not only in retailing medical services, but also in automating all the front/back-office functions, integrated with a comprehensive care management system. Something like this was never done before, and/or there weren’t any such past implementations to draw references from.
Multiple ‘best of breed’ products against a single end-to-end solution
Though MCCs initial goal was to choose a vendor to provide an end-to-end solution; but during the process of uations, it was clearly identified that there did not exist any ‘single’ end-to-end solution which could fully be qualified as the ‘best’ on both counts of business operation management and clinical information management. Always a solution was found to be very good on the business operations part, but lacking in clinical information management or vice versa.
Over a period of time, it was abundantly clear that if MCC were to automate their new business with ‘best’ technologies; then the same was not achievable using an end-to-end solution from a single vendor. This fact threw open an option of identifying multiple solutions to run their operations. A decision was made and there were no second thoughts in getting to the task of planning, strategizing and going ahead with the vision of getting multiple solutions to work together. There began a journey in looking for different systems that can cater to the needs of a retail environment and to the needs of a clinical data/care management and co-exist.
MCC uated and zeroed in on 2 different products which could be a perfect fit to automate healthcare operations of MCC. But, the challenge began right there, though the products were identified as perfect fits, both these products were radically different in all aspects, ranging from technology, implementation methodology, licensing and functions. While the clinical management system was a web-based product incorporating latest technology offerings on JAVA; the retail management system was a Microsoft based solution.
ezEMRx, a practice/care management product from ezEMRx, Inc, Chicago USA, was selected for clinical operations, data management and for EMR; while Microsoft Navision/LS Retail, with PwC as the implementation partners were identified for retail and ERP functions.
The act of getting everybody together!!!
MCC engaged in a discussion with all the solution providers and shared their vision, and made a strong case for all the partners to work and contribute in the right earnest and get distinct products/solutions to work as one single unit; while at the same time it was also highlighted that the effectiveness and the specific functions of distinctly different solutions were never to be compromised.
Bringing in a method
A Project Steering committee consisting of top management resources from MCC, ezEMRx and PwC were formed to set goals, oversee the project and provide direction. This committee met once every month during the initial stages and met once every 2 weeks as the implementation date neared.
A Project Management office consisting of IT personnel, functional heads from MCC and project managers/coordinators from ezEMRx and PwC were established to manage the project.
This team met once every week, and then met twice every week and moved on to meet once every day to discuss, plan and make decisions to ensure on-time rollout.
Project Implementation teams consisting of resources, end-users, technical leads, functional leads and other resources was established to implement the project directives and goals. These teams interacted on a daily basis, identified the touch-points between both products and went about getting them to work seamlessly.
A clear communication mechanism, reporting structure, risk management, escalation structure and progress uation methodology, and other critical procedures were established. This fostered for a very healthy situation where resources and members from different organizations with diverse products and technologies worked as one single unit with razor sharp determination to accomplish the goals that were set for the project.
Within a span of around 5 months after the vision was finalised, the solution was fully implemented in one of the MCC retail healthcare outlets in Bangalore and within a short span of 4 weeks, around 6 other MCC units in different cities including Mumbai, Pune, Ahmedabad and Bangalore were rolled out successfully.
All the initial issues were ironed out within a matter of another 4 weeks and from the 3rd month on the entire solution was moved onto a maintenance mode.
ezEMRx, is used for guest management, guest medical condition management, guest care management and also has an advanced integration with lab/medical equipments. This automates the processes of care management.
Microsoft Navision/LS-Retail, is used for POS, billing and back-office operations like inventory, finance, purchase, sales and all other ERP functions.
Integration and Communication
Built on a hybrid model of centralised and decentralised operations and management, both these systems integrate with each other using a web services (SOAP) based communication methodology. The integration happens at the store level as well as at the central level and this drives the business operations of MCC.
“ezEMRx, is used for guest medical condition management, guest care management and also has an advanced integration with labÂ and medical equipments.”
ezEMRx also integrates with CIMS a detailed database of drugs and enables for critical care management features like drug interaction information, electronic medical records, e- Prescriptions, schematics, schedule management and process management.
Enhancing the experience
One of the objectives was overall enhancement of patient experience in MCC, a patient walking into avail medical services, or wanting to purchase retail medical merchandise, goes through a wonderfully transforming experience to a world of SMS alerts, prompts on appointments, prescriptions and medications and retail offers.
Between ezEMRx and Microsoft Navision/LS retail, MCC has more than met its match for whetting its appetite of using the best of the breed technology to improve business operations, enhance customer experience and to offer the healthcare services that can be benchmarked with international standards and practices.
What was bold or radically different
The very fact that a strategy was envisaged to streamline healthcare operations in a retail environment with the use of technology was bold and radically different.
Broadly, retail operations worldwide deal with a POS for its front-office, and a variety of ERP like features for the back-office.
Clinical operations/data management/EMR, include highly secure data management and patient condition management features and EMR, apart from other data points like demographic details, medication history, allergies, family and social history and the like.
It’s these functions that were radically different, and a bold step was made to get both these radically different pieces of the business operations to be automated with 2 distinct solutions/products that were also radically different in their technology.
Risks and Challenges
Technology: One of the biggest risks and challenges were to integrate radically different products into a single solution for the business operations. The second was the risk in terms of integrating products/solutions built on two diverse technologies such as Java/J2EE and Microsoft. One of the primary challenges was to identify a mechanism, or a methodology wherein both the products/solution could talk to each other without affecting the operating parameters of each other. Other challenges include, getting both the solution providers to agree on the desired integration mechanism – HL7 based Web services communication.
It’s a foregone conclusion that MCC reaped the benefits for choosing disparate, different; but, ‘best of the breed’ solutions to automate their business operations.
The integrated solution is now well entrenched into the MCCs business operations and has now been in operation for over 16 months now.
It was finally realized that the challenge of having to deal with the issues and risks of getting multiple products and vendors to work together was a challenge only up to the point of getting everybody together and motivating them to work towards a common goal. Once MCC got past this stage, it was all about establishing methodologies to direct, manage and implement.
By choosing ‘best-of-the-breed’ products and getting them to work together, MCC today is reaping the benefits of having implemented best practices and solutions on its business operations as all operations.
“Manipal Cure and Care has always been committed to adopting technology that complies with international standards. The entire experience of our guests from the point where they register themselves are driven by technology, most of the typical concerns that our guests come with are addressed by technologies like our ezEMRx deployment. For instance, if a guest is transferred from one diagnosis department to another, there is a fear that he/she might be asked to do the same round of tests again. ezEMRx alerts the doctors if a test prescribed has been carried out before and flashes the results in front of him. Even for research purposes, the archived EMR information can be easily accessed from ezEMRx.”
COO, Manipal Cure and Care
“ezEMRx has primarily helped us in three ways. Firstly, ezEMRx starts functioning at a level where it allows us to create an electronic image of the patient (whom we call guests); secondly, from a doctors point of view, it spares him/her the task of writing/typing down every guests case history as ezEMRx provides us with a very powerful ‘aim and click’ feature to make detailed clinical notes and create an EMR within a few minutes; thirdly, ezEMRx is compliant to international standards and incorporates support for delivering evidence based medicine.”
Dr. Satish Amarnath,
Director – Medical Services, Manipal Cure and Care.
“From a technology point of view, ezEMRx is easy to deploy and maintain. The fact that the architecture and backend technologies have been built using open sources tools makes it easy to manage. With all our centers being enabled with ezEMRx, there is a certain consistency in the information collected as dialects, accents and language are not interferences any more.”
Information Technology Department, MCC.