February 2012

Swallow Tablets for Better Healthcare

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 A revolution is happening in healthcare sector. It is called: Telemedicine 2.0. This new revolution is providing many with the hope of access to quality healthcare anywhere, anytime

By Pragya Gupta

Handheld devices have very important role to play in hospital information management and patient care. Devices like PDAs, smartphones, tablets, hand monitors, and scanners are easily available in the market. Tablets are the latest in the array of devices that the healthcare segment is betting on.

Usage of tablet computers and smartphones in health segment has had the effect of providing us with better outcomes in patient care. Tablets and smartphones are widely being seen as tools for expanding the reach of education. But now the healthcare industry is taking the leverage of handheld devices like tablets to have an efficient health service delivery.

The Rise of the Handheld

Healthcare industry works as an enterprise, which has far too many critical needs and features. Enterprise segment has always been chasing after mobility. Tablets were first accepted as mobile computing devices by consumers, but gradually their significance has been realised by two important sectors where reach is still a challenge – healthcare and education.

Healthcare delivery is a function of diagnosis, care plan and timely action. The handheld devices can help in reducing the time that is usually wasted in transmitting information from one interface to another. Devices can lead to seamless integration of information leading to a faster decision making process. However, use of new devices and technology must be combined with good clinical practices.

The handheld products and its applications are accepted in the vertical because of the mobility it offers to the doctors and patients for care and administration.

Devices improving healthcare delivery

There are two major roles that tablets play in healthcare. The first is clinical role that is for patient care and the second is for non-clinical role, which is mainly administrative  in nature.

In the clinical process, these devices are directly used for diagnosis and care like the glucose checks, blood pressure equipment, ECG and ultrasound, etc.  Over a period of time these devices have become smaller and smaller and are now more or less ‘portable’.

Their non-clinical use offers CEOs and managers the facility to track the performance of the hospital. Use of tablets and smartphones keep them connected round the clock through closed  group emails, group instructions, customer feedback, graphs, charts, etc.

These days it has become common for ordinary stores and nursing counters to use the bar code scanners for quick disbursal.

“Typically hospitals where I worked they use Bar code scanners in lab for sample collection and processing in automated equipment. There are glucometers in wards, portable USG, ECG, Blackberrys for communication and emails for all senior managers, and few other devices,” says Dr Akash S Rajpal, MD and CEO, EKOHEALTH Management Consultants Pvt Ltd and former AGM-Operations and IT Head, L H Hiranandani Hospital.

Healthcare providers are always hard pressed for time. The premise of a handheld device is to bring information in a mobile work environment at the time of need. Such a promise holds a huge benefit in a  healthcare setting. This can free the provider from being tethered to a desk.

Neena Pahuja
CIO, Max Healthcare Pvt Ltd

“We are actively planning to extend the reach to our various data sources on hand held  devices. Towards this end we are looking for windows based devices which should be cost and power efficient, and provide new features like handwriting and voice recognition”

“In our hospital, we have implemented  mobility of access device at the point of care by the use of ‘Computers on Wheels’. Access of diagnostic images  on handheld devices and patient ADT messages are also being made available. Looking at the new age of tablets,  I soon see some of the roles done on COWs moving to these tablets. Additionally, these tablets have  good software’s for handwriting recognition, which the doctors really need for entering notes into the computer,” says Neena Pahuja, CIO, Max Healthcare Pvt Ltd

There are many other critical applications where tablets  and handhelds are playing crucial role. Some of the  important areas where handhelds  are being adopted include ECG (OPD/ Consulting  rooms, wards, ICU, casualty, and monitoring devices while shifting patient with bed/ambulance),  Blood pressure devices, USG(portable in ward/ICU), Pulse oximeters (ICU/ Casualty), diabetes insulin monitors, fetal heart monitor(labour room/ward), TENS (Transcutaneous Electrical Nerve Stimulation(physiotherapy/ward/OPD), Tablet PCs for consultants, nurses to view patient charts/communication),  inventory scanners (bar codes in lab, pharmacy and stores), Smartphones in administrative and nursing for dose calculation, home alerts, home monitoring devices after discharge.

Market and players

A report has estimated that total handheld healthcare device market is about US$ 9 billion. Total sales in 2009 for patient monitoring tools was about US$ 6  billion and PDAs, Smartphones, Tablet PCs and handheld scanners generated about US$3 billion. Market is expected to grow at a rather fast pace.

Many players have now introduced customised tablets for healthcare. RIM, Apple, GE Healthcare, Global Media, Medtronic, Omron, Siemens Healthcare, Socket Mobile, Welch Allyn, HP, Motorola,  etc. are now offering products in various platforms. In fact, Blackberry and Apple are leaders in tablet and smartphone  market in healthcare. Android platform based devices are also gaining momentum in the market as the open platform of Android is an attraction.

Healthcare’s wish list from handheld devices

  • Tablets are easy to use. They are also durable and function for long durations of time on a single charge.
  • Devices like bar code scanners, biometric authentication, document scanner etc should be preferably built in.
  • The devices have to enable doctor’s to use computers in a more user friendly way.
  • Tablets should increase productivity by being very responsive, fast, bug free and secure.
  • The devices must be more economical to incorporate in large numbers.
  • There must be a system of faster connectivity
  • A cheaper option will also help low rung ambulances to be equipped with such devices for better patient safety.
  • Doctors are looking for converging device and comprehensive radical information system.

With the increasing utility of these products more and more healthcare providers are seeing tablet as a solutions for providing better service and internal hospital  management. Still there are many hospitals, which have not adopted these handheld devices due to reasons like lack of supporting infrastructure in the hospital,  resistance among doctors, security related issues, etc. But they are welcoming tablets with open hands and looking forward to adopt these devices in  near future. Dr Karanvir Singh, (Head of HIS Implementation), Sir Ganga Ram Hospital (SGRH), Delhi says, “Personally, I feel that  handheld devices have a big role to play in hospital information systems.” However, the hospital is yet to adopt tablets.

Many hospitals have started by using handheld devices from one vendor, and gradually they started using devices from multiple vendors. For instance, Narayanan Netralaya started with iPad and now they are using blend of iPad and BlackBerry. Similarly, Max healthcare is using iOS, Android, and Blackberry, all of which allow the provider to access diagnostic  images and results in real time, helping a faster formulation of care plan. For mobility on EHR, they are working on Windows based tablets.

Dr Anand Vinekar
Associate Professor & Head, Department of Pediatric Narayana Nethralaya Bangalore

“We need to integrate solutions to cover the patient – doctor gap thus we have started using Blackberry solutons at our institute”

Dr Anand Vinekar, Associate Professor & Head, Department of Pediatric Retina & Pediatric Visual Rehabilitation, Narayana Nethralaya Postgraduate Institute of Ophthalmology, Bangalore, says  “With the use of these devices, I can talk to patients and ensure that I am seeing your reports and images according to the  condition we will call you for consultation. If technician gives the report, patient feels that the doctor has not seen report or not  paid attention. We thought we need to integrate it to cover the gap so we have started with Blackberry solutions.”

Opportunities Galore

The adoption level at private hospitals is more than that in government. However, government hospitals are gearing up to equip themselves with tablets and other handheld devices.

Tier -2, 3 and rural markets offer huge potential for tablet and smartphone companies. This is a market that needs infrastructural revamp to integrate handheld devices in non clinical  function. The increasing popularity of 3G and WIMAX technologies in the rural areas and smaller cities will reinforce the adoption.

Hospitals that have experience in tablets are looking for acquiring more and more tablets. “We are actively planning to extend the reach to our various data sources on hand held devices. Towards  this end we are looking for windows based devices which should be cost and power efficient, and provide new  features like handwriting and voice recognition,” says Neena Pahuja, CIO, Max healthcare

Factors for choosing handheld devices

Security – If doctors use their own tablets than there should be a way of making  sure they can be used securely.

Mobility –
Mobility is the key. While opting for any device it should be cross checked whether it suits your requirement. For instance, to conduct remote consultations with a patient faster connectivity and high resolution camera options in a tablet is a must.

Battery life –
Mobility can only be offered if tablets have battery backup for long hours. Invest in devices with a long battery life and short recharge time. Available apps – Different tablet runs different apps, so it is really important to research and compare what all application  are available on different platform. The tablet should be chosen that supports all the apps that a doctor needs.

Central file system –
The Android operating system includes a centralized file system. The iPad lacks this, meaning files might not be easily movable from one app to another.

Note-taking style –
Certain tablets allow freehand sketching and longhand note-taking, which some doctors may prefer.

“Tablet Technology Goes a Long Way in Establishing Effective Services”

Annie Mathew
Head of Alliances and Developer Relations, Research In Motion (RIM), India

Please give us an overview about tablet market in India especially in healthcare segment?

Tablet devices could deliver a lot to doctors, practitioners and telemedicine experts. In India, there is a huge need to outreach the rural population through technology such as telemedicine. These tablets actually make a massive change in  the way we deliver services. It is going to bridge the gap between doctors and the number of patients. This helps him track many patients  and he can actually talk to the patient via video chat. These technology interventions actually go a long way in establishing how big vendors are making it available in the right time  at the right place. The devices which are out of the field can be controlled from a central location, and that’s what a Blackberry  enterprise server does. So BlackBerry Enterprise Server at the core allows this data from those devices securely and a specific compression technique reduces the band width and  battery usage

This is an emerging space. It could be annoying to put it as a market cap, because, it’s just an outcome. We have deployed services at various places like Narayana Nethralaya, Max Hospitals and Nanavati Hospital in Mumbai. Our technology platform provides seamless support to the right and relevant partner for developing deployed solutions.

What can be the emerging areas where these Playbooks or tablets, the hand-held devices can be used?

Recently, we launched the e-track on Playbook. e-track is an equipment that sets in the ICU and monitors about 12 or 14 parameters of the patients in the ICU. This kind of technology made this collaboration very much easier. Another area is urban-rural telemedicine to remove the rural part. Technology reduces the time and thus facilitates better healthcare service delivery.

By when do you think we can expect such services expansion in India?

Teleopthalmology solution in Narayana Netralaya or the e-track which is the ICU monitoring has already emerged as a success and the pilot phase will be finished by March. We are working with government and government hospitals to create a commercial and sustainable model. The early adopters as of now are definitely the private players. But definitely government hospitals are also coming up. We have seen lot interest a lot of interest from the government side also at the telemedicine  congress, the Cardiology Society of India. A huge interest from the e-governance groups at the centre, from NRHM, they are all very interested and they are discussing this technology and they are supporting this. The government has equally invested  in this, just waiting for right model that will make it scalable and sustainable.

What should be done to overcome concerns about privacy and lack of infrastructure support?

We need secure relations in India where the patient demands for privacy of his reports irrespective of the fact how minor a problem may be. In rural setup, a doctor addresses one patient in a single room with others waiting in the same room, thus violating the privacy of the patient. When I talk enterprise grade then we shouldn’t be quiet. We can still make it work through a sustainable solution.

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