At any conference of this kind, the topics that come up for discussions are
- Why is Indian health care industry not proactive in implementing IT solutions for better health care delivery.
- Despite the remarkable growth of the Indian health care industry , the investment into IT systems are far too below expected industry standards the world across.
- Telemedicine holds the key to the future of health care in India ,as most of our populations live in the rural areas and there is no functional health infrastructure in the rural areas.
Indian health care industry has definitely been slow to automate the health care delivery, there are several factors contributing to this.
- Deploying a health information system means different things to different people. Most of the off the shelf solutions concentrate on the financial transactions that occur in a health care delivery system. The next higher version of available HMS, HIS in addition to the financial components contain patient logistics handling - appointments, admissions, discharges, deaths and some level of inventory control. Perhaps the most advanced version of these packages contain some level of clinical details capture with the most harped about feature of decision support : which in essence is no more than prerecorded information on allergies popping up while prescribing drugs that the person is known to be allergic to, or alerts on cross reacting drugs.
- The return on investment in terms of adding value to the patient is almost non existent, one feature that vendors quote to sell these products are that it significantly reduces medication errors, true it definitely does. However this becomes true only when the solution gets deployed successfully. The accepted rate of failure of a software project is about 65% !( 2006 CHAOS report: The sandish group). The rate of successful implementation of a health automation project is much lower than those of the general IT industry ( authentic figures are not available !) that the risk far outweigh the benefits.
- Every vendor has few anecdotal success stories , however if one talks to the end users,their expectations are far from being met.
- The prohibitive costs of available IT solutions : the IT industry for some peculiar reason believes that any form of software linked to health care practice has to be exorbitantly priced, sort of a luxury tax that it believes the health care practice should bear for being a player in the area of health care !. A solution capable of similar functions offered to a shop keeper costs a fraction of what a health care practice is billed.
- Most of the currently available, latest versions of the proprietary HMS / HIS solutions are at least two generations older in the technology they use. Currently available technologies ( both OPEN and closed source) allow the users to customize the look, feel and features of their applications, one can create forms and fields on the fly as the need arises and the databases have matured to allow this flexibility. However the packaged HMS, HIS are far too rigid for any ones comfort.
- Patient centric information flows is what most claim as their USP, however the patient has very little say in how his/her information navigates through the work flow. This is particularly important in a multi location care provider delivery model such as in India. Can the patient determine what of his/her data is being made available to his various providers ( if and when sharing of patient data is remotely feasible ?). If some does not want his phone to call ISD he can lock that feature, if he doesn't want his phone be able to dial out mobile numbers , he can block all numbers beginning "09", if he wants to take his calls on another number he can divert the calls to a number or a range of numbers....but when it comes to his sensitive person medical record hes got no say !.
Does tele medicine really improve the health of the masses ?. Currently available evidence ( published research findings) seems to throw no light on this. There are claims of high success rates. Depends on what one defines as success. To a corporate referral hospital , success is likely to be defined as the revenue they can generate through the consultations provided, conversion ratio of consults as referral visits.
A true indicator of success would be to measure the number of individuals who were managed at the rural local hospital, with the technical expertise that was provided to the non specialist health care provider through the tele-medicine consultation.
One would believe that telemedicine by its very definition is about making available the expertise to areas of need where it is otherwise not available, what good is it , if most of these consultations end up as referrals to the cities ?.
- Can the government justify the utilization of tax payers money into funding the high bandwidth connectivity provided to private and corporate health care players to attract rural patients to their hospitals under the auspices of improving the health of the rural masses ?.
- Are Rocket Scientists the right kind of technical resources to drive this initiative or the corporate health-care providers the experts to define the standards for tele consultations in this country ?.
