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“Digitally Enabled” Healthcare Models – Indian Context XIII NATIONAL SEMINAR: HOSPITAL , HEALTH CARE MANAGEMENT AND MEDICOLEGAL SYSTEMS 6th and 7th May 2011 The contents of this document are proprietary and confidential to Infosys Technologies Limited and may not be disclosed in whole or in part at any time, to any third party without the prior written consent of Infosys Technologies Limited. © 2011 Infosys Technologies Limited. All rights reserved. Copyright in the whole and any part of this document belongs to Infosys Technologies Limited. This work may not be used, sold, transferred, adapted, abridged, copied or reproduced in whole or in part, in any manner or form, or in any media, without the prior written consent of Infosys Technologies Limited. Information in this document is updated as of Feb 20, 2010 Contents • Digital Technology in the context of healthcare • Digital Technology enablement in Indian Context • Successful Healthcare IT models / trends across the globe © 2011 Infosys Technologies Limited 2 “Digital Technology” is the confluence of Medical Equipment Technology, Operational Technology and Information & Communication Technology (ICT) Enterprise Applications Data Analysis & Visualization Apps IT Infrastructure Communication Interface Medical Equipment © 2011 Infosys Technologies Limited 3 Challenges in Digital Enablement • Tremendous volumes of data from different and disparate sources • Data security and privacy • Data visualization and intuitive user interface • Remote access of data • Adoption / usage • Conviction on business and societal benefits © 2011 Infosys Technologies Limited 4 Healthcare expenditure constitutes 6.1% of country’s GDP • Expenditure increases 15% every year • Technology intervention to reduce the drain on country’s resources © 2010 Infosys Technologies Limited 5 Application of Digital Technology needs to looked at from 3 perspectives Pharma Private Hospitals Societal Healthcare • India is a paradox - world class hospitals providing state-of-the-art healthcare while 700 million people in semi-urban and rural deprived of such facilities • Digital Technology adoption is very different across these 3 perspectives • Pharma – Promote innovation and accelerate drug discovery. Bring more structured approach to clinical trials. • Private hospitals – Motivation is higher bottom-line. Basic systems in place, however structured approach / investments in digital technology missing • Societal healthcare – Motivation is to solve societal problems. Lot of initiatives, however efficacy is questionable. © 2011 Infosys Technologies Limited 6 Digital Technology for “collaborative” drug discovery • Open Source Drug Discovery Portal • Help collaborate and hasten discovery of drugs for malaria, tuberculosis etc. • TB is the leading cause of death from bacterial infection. An estimated 370,000 deaths due to TB occur each year. • Tries to follow the success of open source models in IT (Linux, Web) and apply the same model for drug discovery • OSDD contains • Sysborg 2.0: A Wiki based genome annotation service • Computational Resources for Drug Discovery (CRDD) is a platform for open source tools for drug discovery • TBrowse: Integrative genomics map of Mycobacterium tuberculosis • OSDDPUB: Open Access Repository Document Repository • OpenScience: Metadata archive and Search engine for Open Access theses and dissertations © 2011 Infosys Technologies Limited 7 Private Hospitals – Digital Technology Enablement © 2010 Infosys Technologies Limited 8 Benefits from Digital Technology enablement Integrated Clinical / Financial BI System •Combines traditional data sources (such as general ledger, HR, cost accounting and claims/revenue data) with rich clinical data systems •Improves resource utilisation, Patient throughput, Proactive defect prevention Patient throughput and Logistics management •Delivers value by providing real-time, hospital wide visibility into operations •Technologies such RFID for person and asset location; voice over IP for "everywhere" communications •Improves resource utilisation and Patient flow •Reduces turnaround time, OPD/ER wait time, discharge time Wireless Healthcare Asset Management © 2010 Infosys Technologies Limited •Usage of RFID / Zigbee •Timely delivery of care, scheduling preventive maintenance etc. 9 Benefits from Digital Technology enablement (contd.) E-visits / Video visits Home Health Monitoring Integrated Clinical Data Repository © 2010 Infosys Technologies Limited •Structured, secure messaging between a patient and a provider for a well -defined and narrow range of consultations, such as for nonemergency questions, prescription refills and routine chronic disease management •Enables cost reduction, increased patient satisfaction and improved clinician productivity •Enables specialist interaction from rural areas •Transmission of patient data to clinicians •Improvements in the quality and timeliness of care, improve the accessibility of care, and reduce travel time for patients and clinicians •Aggregation of granular patient-centric health data usually collected from multiple-source IT systems and intended to support multiple uses 10 Societal Healthcare – some Digital Technology interventions • Telemedicine • Enables remote medical diagnostics and services • Key is “reliable” and “fast” communication infrastructure • Huge reduction in costs and time • Emergency Health Services • Intelligent routing of ambulances using GPS • Call center data analytics for improvement in service levels • IMR / MMR reduction • Usage of mobile based supply chain management • Integrated Disease Surveillance • “Data analytics” to find out trends of communicable disease spread © 2011 Infosys Technologies Limited 11 Summary of key Issues in Indian healthcare and how technology can help Key Issue How Technology can help? Lack of awareness and health/nutrition education Patient enablement through portals, mobile applications and social networking sites. Shortage of facilities leading to overcrowding Remote healthcare, Tele-consultation, self-service kiosks Severe shortage of trained health personnel Automation of care processes, optimal utilization of skilled staff Lack of accountability Easy to search and analyze electronic medical records Rural/Urban differential Telemedicine for rural outreach Affordability Reducing cost of care through integrated IT, data sharing and increased patient safety Insufficient IT funding Monitor benefits realized from IT investments © 2011 Infosys Technologies Limited 12 Global Healthcare IT models Best practices that could be adopted by India The contents of this document are proprietary and confidential to Infosys Technologies Limited and may not be disclosed in whole or in part at any time, to any third party without the prior written consent of Infosys Technologies Limited. © 2011 Infosys Technologies Limited. All rights reserved. Copyright in the whole and any part of this document belongs to Infosys Technologies Limited. This work may not be used, sold, transferred, adapted, abridged, copied or reproduced in whole or in part, in any manner or form, or in any media, without the prior written consent of Infosys Technologies Limited. Information in this document is updated as of Feb 20, 2010 Successful Healthcare IT Models : Healthcare Information Exchange CONFEDERATED CENTRALIZED Data Users Central Database Migrating all the data f rom dif f erent systems in all the dif f erent locations to Centralized Repository. This would be a monumental ef f ort - time consuming and a bit expensive but once done you will have a true centralized repository. Data Users E Data Sources Legend: E Data Sources Firewall © 2011 Infosys Technologies Limited E Edge Proxy 14 In this you would need to maintain a clinical metadata and access selectively and as required the data from each local system with the use of EMPI and Edge proxy servers. FEDERATED Data Users E Data Sources Keep all the data in local repositories and extend it to all the hospitals and clinics f or use. Involves lesser cost investment to begin with. Successful Healthcare IT Models : Healthcare Performance Management Real Time Alerting Role & User Configurability • Real Time Alerting and Notification features • Process, Financial, Performance, Quality • Compliance KPIs with threshold monitoring. The Infosys solution provides role based access to the users. Access to the respective dashboards / UI screens / features are defined through the roles. Customizable Dashboards Data Analytics and Forecasting The Infosys solution dashboards provides for role based data access, representations, default setting, user preferences etc. • Supports problem analysis paths and “what if” analysis through drill downs and scenario development • Integration of forecasting models provide Predictive Modelling capability Complete Interoperability The Infosys solutions achieves interoperability with Provider systems irrespective of the data feeds native to the respective applications. Deployment on hand held devices • The Infosys solution provides deployment on handheld devices at multiple levels – • Simple alerting • Application hosting on handheld platform • Interoperability with native systems © 2011 Infosys Technologies Limited Workflow Manager Workflow Manager allows hospitals to define workflows and KPIs will very little IT intervention 15 Successful Healthcare IT Models : mHealth Care Coordination Services in a Software as a Service (SaaS) model • eConsultation • Telemedicine • Home Health • Post operative care • Chronic disease management • Appointment scheduling Physicians Pharmacies Patients • • • • Search physician, pharmacy, lab Prescription Refill Request Pre-registration forms Personal Health Record • Patient Diary Communication • Medication Compliance Management • Generic alternatives search • Drug interaction check Service Provider Hospitals Payers Pharmaceutical • View drug label information published by pharma • Payor formulary check • Claims status check • Quote generation • Eligibility check • Procedures cost comparison Nurse © 2011 Infosys Technologies Limited • Pharmaco-kinetic inputs to Pharma 16 Widget Framework Pref erence Services Localization Services Security Services Pref erence Service Master Data Management Services Notif ication Services Common Horizontal Services Gateways Messaging (Sync and Async) Webservice (REST, SOAP) Integration Services Adapters (FTP, HTTP) Wiki Content Aggregation & Syndication Reviews Rating Tags Social Analytics User Generated Media Search User Profile Management Discussion Forums Blogs Successful Healthcare IT Models : Health 2.0 APIs • Health education content • Chronic care references • Patient discussion forums • Review and ratings • Continuing Medical Education • Webinars • Online Chat • Wiki • Micro-communities • Campaign Management • Physician surveys • Clinical trial feedback • Webinars • Physician Discussion forums • Sentiment Analysis Successful Healthcare IT Models : Health 2.0 • Clinical cases.org is a blog site offered by physicians from Cleveland clinic and featured with BMJ. • “Ask Dr Wiki” is a collaborative knowledge platform for Physicians, nurses and residents. It is moderated for content posting by physicians thereby increasing authenticity of clinical content. • Offers weekly podcasts of latest happenings at the Hospital so that the community can be aware about newer initiatives and participate in them. • They offer RSS feeds subscription for latest news in John Hopkins as well. • MGH attempted social computing with success in neurology with their online community BrainTalk dedicated for epileptic patients and their care givers. • This community helped patients and care givers to unfold myths about epilepsy, treatment options about epilepsy, experiences from fellow patients. © 2011 Infosys Technologies Limited 18 Successful Healthcare IT Models : eProcurement © 2011 Infosys Technologies Limited 19 Successful Healthcare IT Models : Disease Management Physician Portal Member Portal Wellness Tools Care Plan Management & eConsultation Mobility Platform Device Integration Patient Diary Target Setting Healthcare Data Repository Interoperability Layer Electronic Medical Records CPOE © 2011 Infosys Technologies Limited Admission Discharge Transfer Laboratory Information System 20 Pharmacy Information System Ancillary Systems THANK YOU www.infosys.com The contents of this document are proprietary and confidential to Infosys Technologies Limited and may not be disclosed in whole or in part at any time, to any third party without the prior written consent of Infosys Technologies Limited. © 2011 Infosys Technologies Limited. All rights reserved. Copyright in the whole and any part of this document belongs to Infosys Technologies Limited. This work may not be used, sold, transferred, adapted, abridged, copied or reproduced in whole or in part, in any manner or form, or in any media, without the prior written consent of Infosys Technologies Limited. 21