September 2010

THINKING iBOX : Aniruddha Nene, 21st Century Health Management Solutions

Aniruddha Nene
Principal Consultant – Imaging & Director
21st Century Health Management Solutions Pvt Ltd


The article gives an account of Aniruddha Nene’s discussion with a CTO of a hospital in Guwahati, which resulted in the birth of iBox, a component of Advance Imaging Systems to address the need of comprehensive digital record for diagnostics.

I recently visited a new hospital in Guwahati to understand the ground issues. While doing this personal ‘recce’, the office bearing the designation of CTO, caught my eye. Nowadays, thanks to lot of noise made on how badly healthcare providers need ICT solutions, I felt the drive to just go and have an informal discussion with him, in a bid to learn something new or find some solutions.

I introduced myself and the interaction began with a heartfelt discussion on how Indian Healthcare industry is primitive as compared to western counterparts. The CTO had a good experience of software and in fact had worked on a large project implementation of HIS overseas. We started discussing on the need of clinical records in hospitals. The CTO reacted immediately, saying that there was an urgent need of PACS for the hospital and suggested to propose the solution the next day itself. He almost expected that I always carry ‘fit-to-size’ proposal in my briefcase!


Well this reaction was not different and I have witnessed most of these cases over the past two years. Still discussing and undecided, on this one (hoping to get a new input) I asked him as to what was his utmost priority or concern that  PACS will solve?

As it turned out, it was to access all the previous diagnostic imaging records. But when asked about how long he plans to store them on-line, the answer was ambiguous – “Not sure”, he said. This time I had another question ready-“Do you have elimination of films in your road map?”  He replied, “Well, we have to give films because many of the referring physicians want films and we can’t say no. I know that in the West filmless environment is the main driver to implement PACS. That’s why you know we want something like MiniPACS”. Frankly speaking, I do not know who coined this word ‘Mini PACS’. Hopefully s/he meant that a product with restricted feature functionality, but in Indian context it can be redefined as ‘something cheap but having the four letters P A C S’ when I am not so sure what I want!

Anyways, I tried to look surprised and reacted “When the doctors are not sure about the utility, Radiologists look at it only from the perspective of storing interesting cases. Management is questioning every rupee spent on this from ROI perspective, what makes you feel that this is an urgent need?” His answer this time was, for a change, quite interesting. “You know, the hospital that is coming up on the other side of the town is already having it and we want to take some step in this direction anyway. We are sure that’s the road ahead. It’s just a matter of time and as a new hospital we do not want to lag behind.” I admired his frankness, though. It is easy to discuss meaningfully when the ‘other side’ is open to admit that they need help.

I was perseverant. “Who is your target? Is it the referring physicians and consultants, insurance companies, patients, corporate customers-” Prompt answer – “Patients first. Our mission statement talks about it very clearly. Patient First”.

That’s where I got somewhat ‘aggressive’ and asked him looking straight into his eyes, “Which PACS or Mini-PACS was ‘patient centric’ that looked upon the patient as the direct beneficiary who would feel and appreciate the impact of PACS?” After a pause, came the answer, “If patients gain confidence that their data is safe with us, they will naturally feel good about it.” I disagreed and said, “We (Indians) are different. We take ownership of our health records and this is irrespective of the hospital taking the onus. So, if we really need to be patient centric we should think what will reduce their anxiety.”

If he needed to reach out to the patient, it is best if we could capture all the diagnostics data in the form of images in digital media like CD or DVD. An anticipated reaction from the CTO, “Giving data in a CD is nothing new. We already plan to give DICOM CD for our CT scan examinations and Angiographies”.

Even though, I was anticipating this, I was still happy that at least the focus was now moving closer to the patient centric approach. I said, “What if you can give all images and reports for all diagnostics to the patient in ONE CD. This CD can have information about the tests that you would like to share with them as a part of counseling. This will have information about precautions and preparation for the tests. The best part can be that it will give three different user interfaces: One for patient and second for Consulting Doctor. Each interface providing the tools and means for the data to be presented in a manner each user needs. For example, a consultant may need an embedded DICOM viewer but patient may not. Patient may need information on tests and preparations but Consultants may not. Look at it from process angle, imagine having a Mini PACS that provides a terminal near central dispatch desk that will compile information of all tests and reports on a single click. No need to burn multiple CDs at each modality that adds unnecessary task to the technician. Patients would definitely appreciate such comprehensive digital records in one media and I am sure a time will come when referring physicians will start appreciating too.

Third interface “Management iBox” can open Pandora’s box for the management to get statistics for the Department Manager of the diagnostic. But that remains in the Mini PACS and obviously does not go to the patients! “

I learnt something and iBox  was born!

The site

21chms iBox workflow is simple and it hooks onto the 21chms AIS Mini PACS. Since patients preserve iBox reduces the storage requirement substantially to begin with. iBox is being implemented in Ayursundra ‘One Stop Medical Centre’ in Guwahati and to be rolled out in the tertiary care unit of the same group to be launched soon.

Dr Abhijit Hazarika, Chief utive Officer, Ayursundra, is confident that this is the best practice for our country and prefers to be the trend setter than a follower.



21st Century Health Management Solutions has introduced iBox as a component of Advance Imaging Systems to address the need of comprehensive digital record for diagnostics. It is a radically different approach for geographies like India where the responsibility of patient records still lies with the patient and it is willingly accepted by the patients. iBox offers consolidation of all images and reports in a single media. ‘My iBox’ is utility for the patient to view the data, and ‘Doctor’s iBox’ is a utility for the clinicians to refer to the images and reports more meaningfully”.

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