Dr Mehdi Khaled
Vice President, Healthcare and Life Sciences
Asia Pacific and Japan Oracle Corporation

While the use of IT within healthcare delivery organisations has been limited in the country, technology providers like Oracle are passionate about raising awareness about the benefits of IT among these organisations.

In conversation with Divya Chawla from eHEALTH, Dr Mehdi Khaled talks about the key aspects of the healthcare IT market in India and Oracle’s presence in this space.

What is your perspective on the growing healthcare IT market in India vis-a-vis the global market?

Public healthcare in India has urgent priorities to tackle, such as infrastructure, access and affordability of healthcare, health insurance coverage, and care consistency and coordination, especially for the chronically ill. In all these areas IT can add a tremendous value and directly contribute to efficiently manage the care delivery process in a transparent way.

States in India are at very different maturity levels in terms of quality of care. The more sophisticated states, such as Andhra Pradesh, Uttar Pradesh and Assam are already considering health IT as a cornerstone of their overall healthcare reform strategy.

However, the real growth is more palpable in the private healthcare sector thanks to organic growth of hospitals like Apollo and inorganic ones even outside of India such as the recent acquisition of 23.9% shares of the Singapore-based Parkway Group, through Fortis Healthcare. The scale of growth of the private healthcare sector in India is unprecedented globally and will be further accelerated by the rapid uptake of private insurance by Indian citizens. Increased private insurance uptake also means a decrease of burden on public institutions; however, two questions remain unanswered: will private hospitals keep up with the increasing demand without affecting the quality of their medical services? And will the government take the opportunity of decreased patient volume to redistribute medical resources and coordinate public care more effectively?

What are the key opportunities and challenges that health IT solution providers face in the Indian market?

In public healthcare: “Health for All” is an Indian government initiative that has been in place since 1995. However, since then, very little has been achieved and moreover, sufficient investment in health IT to effectively enable this program has not yet occurred.

Despite or because of the huge healthcare market in India (perhaps because of its size), the number one issue remains about being able to find good hospital managers who can keep profitability, quality of care and patient satisfaction well balanced. Today, there’s evidence that IT is a necessary management tool for hospitals. For example, real time analytics capabilities can help the management spot and address negative trends occurring in patient care with a lower impact on their bottom line and patient safety.

‘Build v/s buy’ remains another issue quite specific to the Indian healthcare market. There’s very little transparency from the healthcare providers in general on whether in-house software has been successful (financially or professionally), and whether the resources necessary to keep an in-house software factory defocuses these organisations from their core business of providing medical services.

As a healthcare technology solutions provider, we can play an active role in helping educate and demonstrate an evidence-based approach to showing the value of proposed solutions, ultimately equipping our healthcare customers with the capabilities to become more diligent and responsible with regards to the interest of their customers, which can be literally a matter of life or death. On a broader level, it is also important to look at the issues from healthcare providers’ perspective. These encompass the complex effects of globalisation, opaque healthcare costs and continuing industry consolidation.

How does Oracle support a large number of ISVs with its HIS solutions?

We are a proud supporter of the Integrating the Healthcare Enterprise initiative. Today, Oracle provides state-of-the-art open source technology supporting all health-IT standards like HL7 and DICOM. This standards-based approach enables a seamless integration of any clinical IT solution supporting the same standards. Put it another way, we don’t create electronic medical records (EMRs), but seek to make EMRs work better.

How does Oracle’s eHR solution in HTB (Healthcare Transaction Base) arena provide for secure transfer and sharing of patient data for purposes of treatment and trend analysis?

Oracle Healthcare Transaction Base (Oracle HTB) is the foundation of a healthcare information exchange platform for supporting the integration and operation of a full spectrum of healthcare applications. It seeks to help healthcare organisations increase the quality of its patient data, improve enterprise cost efficiency, and sustain system flexibility. In effect, leaders at all ends of the healthcare organisation gain a single source of truth for effective decision-making.

“Oracle offers healthcare-specific applications that help ensure quality care and decrease patient safety concerns through the integration of clinical data and the ability to analyse patient-specific information”

Using the techniques of semantic normalisation and data aggregation, Oracle Healthcare Transaction Base ‘unlocks’ data from transactional systems. The platform provides a complete, centralised, and normalised data source for viewing data via a portal or other healthcare applications. It also serves as a robust platform for developing data entry applications, helping healthcare organizations to improve outcomes and reduce enterprise costs.

How does Oracle support DICOM standards in Oracle Database 11g onwards?

Oracle Database 11g with DICOM support, is a high performing, low cost, and functionally-complete platform for large repositories and archives of Medical and Life Science images. 

With comprehensive support for the DICOM standard, Oracle Database can understand all the standard metadata tags and private tags in DICOM images (e.g. chest X-rays, mammograms, CT Scans, MRIs).   Any search mechanism in the database can be used to search the metadata. Using optional semantic features in Oracle Database, the information in the metadata can be further enhanced with domain expert knowledge specified in what are known as ontologies.  These allow queries about relationships among concepts in healthcare. A concept, such as ‘flu like symptoms’, may encompass fever, cough, symptom causing viruses, bronchitis, etc.

Oracle Database has semantic technology support to process such ontologies and link them with data from DICOM metadata to automatically identify all chest X-rays of people with the specific symptoms described in this example.

The advantages of using Oracle Database to build large, high performance repositories and archives for medical and life science content include the integration of medical images with patient data to avoid scattering of patient-centric health records across heterogeneous systems;  data transfer and sharing of medical and life science content without custom-built infrastructure; consistent enforcement of privacy and security policies for all archive content; and management of an esvolving DICOM archive (incorporation of new modalities, new DICOM standards) with no application changes or downtime.

Oracle Database 11g has two features that enable customers to build large, high performance repositories and / or archives of medical and life science content that are managed and secured using Oracle Database—Oracle Multimedia  and Oracle SecureFiles. Oracle Multimedia provides full support for DICOM (Digital Imaging and Communications in Medicine), the format universally recognised as the standard for medical imaging. Applications can now use Oracle Multimedia DICOM Java and PL/SQL APIs to store, manage, and manipulate DICOM content.

Oracle SecureFiles is specifically engineered to deliver high performance and scalability for storing file data compared to that of traditional file systems while retaining the advantages of Oracle Database storage. With SecureFiles, Oracle has introduced numerous architectural enhancements for greatly improved performance and scalability, efficient storage and easier manageability. SecureFiles features include encryption, intelligent pre-fetching, new network layer, file system-like logging and deduplication. 

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