Re: [Care2002-developers] Indian Hospital Informatics Network

[Akhil Gupta]

Hi Ashwin, Hemant, Sarath and Sushil,   I represent Mokshita Technologies (www.mokshita.com) which does intensive LAMP (Linux/Apache/MySQL/PHP) development in Open Source.  Me myself and my team have gone through each and every portion of Care2X in detail and are already working on re-engineering these modules to suit Indian needs.   On Ashwins' Point : Your breakdown of the healthcare industry in India is excellent.  I really appreciate this.    If you have had a chance to go through the entire code of Care2X, you must have found that the code is not professionally designed.  It lacks structure because it's a mix and match of many contributions from various developers which were added to the project mostly in their original forms.    I personally do not see it worthwhile to recode HIS to suit Indian market because its just another HIS in the making.  In my opinion your should start an open-source project for India with HIS as the base and inspiration if you have already made your mind to seriously take this matter forward for years to come.  In this Elipido can help and so can the other developers from their experience.  Hope they read this with as much enthusiasm as we write.   Care2x is not the only OpenSource Healthcare related project on net.  There are enough OS projects like OpenEMR, FreeMed, HOSxP etc. There is one OS HIS already existing to fit the needs of every hospital category you have mentioned.   Any Indian healthcare setup aspiring to computerize their operations over a HIS must either orient themselves to global HIS standards or get a customized solution as per their needs.  I think first option is better as this is in long term interest of such hospitals both in technical and commercial aspects.   The challange lies in the blue print of the Indian version.  Ask yourself - how many hospitals in India follow common laboratory and testing procedures?  I do not see any platform on which you can bring the entire Indian healthcare fraternity together to share common medical practices.  People will come, have dinner and forget the very next morning where they dined last night.   On Hemant's Point : Yes, there is a Hospital in India which is using Care2X.  We have deployed this in a hospital in Delhi.  We have already modified some modules as per Indian standards and the rest are being modified.   On Dr. Sushil's Point : I think no one is questioning IT intellect of doctors.  I personally take them as engineers - skilled craftsman who can operate computers as brilliantly as they operate the robots.  I can cite example of Micro Surgery to support you.  However in a hospital setup, most doctors leave the data entry and computer operation jobs to receptionists and assistants because they are simply too busy to do this.  Operators are ready to register a patient but reluctant to punch the prescription because of bad hand-writing and fear of accountability.  I have come across many doctors who simply do not want their prescriptions to be computerised due to legal reasons.  Even the big and 'computerized' hospitals prefer not to issue computerized prescriptions for overall well-being of doctor community.   FYI - HIS has a feature to store prescriptions.  You however don't get a list of medicine names in it to specify how many doses per day ::)).  This can be done per encounter also with minor tweaks.   On Sarath's Point : Can we see demo of your software somewhere?  Do you have an online version for demo purposes?   Regards,   Akhil Gupta   ----- Original Message ----- From: Ashwin Naik To: care2002-developers@lists.sourceforge.net Sent: Saturday, April 30, 2005 1:35 PM Subject: [Care2002-developers] Indian Hospital Informatics Network Hello Everyone,   I noticed that there is considerable interest in Care2X deployment in India, so i thought i will share my thoughts and our experiences.   A. Number of implementations of Care2x are not substantial, and also not much publicised B. There is considerable amount of customization needed to make Care2X suitable for local needs C. Most importantly, Care2X is a comprehensive solutions for HIS needs, but in India we are stuck with a unique problem of not having enough IT savvy medical and support staff to efficiently use the system. This is both because of lack of time and education.   However, Care2x is a powerful system which can help integrate the various departmental data in a single solution, not to mention the world wide support available from dedicated developers. We, at vaatsalya, promote care2x on our website and are keen in developing it further.   Now coming back to whats possible and what we are doing.   We have looked at the HIS needs in India, considering the fragmented health care industry and broken it down into following sections   A. Rural/Semi-urban single practice: Typically a single doctor working in a 300-400 sq. ft. with basic amenities. Typically, doesnt even have an X-ray or a lab. Here we need a very basic system which can capture the clinical information, along with demographics and a referral system to higher centres is needed.   Key requirements: a) User friendly b) Affordable/low cost of adoption c) Training   B. Polyclinic practice: 2 or more doctors working together sharing common staff, typically 15 - 25 beds. Doctors and nurses are typically pressed for time, and WILL not enter data into the computer. Has access to pharmacy, X-ray and laboratory, and needs a system to capture clinical (Inpatient, Outpatient), demographic, laboratory, pharmacy, radiology information and a referral system along with billing and insurance linkup.   Key requirements: a) User friendly and training for front office staff to double up as data entry professionals b) Low cost of adoption and scalability c) Extensibility to add more modules   C. Multispeciality Hospital: 2 or more specialists working together, sharing resources, typically 20 - 40 beds. No time available for any one. Full fledged hospital with inpatients, ICUs, Operation theatres. Need a high end system which can be deployed across the hospital which enables data sharing in realtime, has operation theatre module, scheduling, pharmacy, billing, insurance, radiology and possibly tele-radiology and clinical research modules.   Key requirements: a) 24/7 IT support and training of dedicated data entry personnel b) Low cost of adoption and scalability of system c) Extensibility to add more modules   D. Tertiary Care Hospital: I dont need to dwell on this, these guys typically have a large IT team which basically tells the management how to create more jobs for the IT teams! Very few players in this segment, concentrated in metro cities.   E. Network of Hospitals: Hospitals run by corporates or missionary organisations or by non-profit groups. This is where there a large impact to make a difference, in addition to A and B above.   These networks usually have highly efficient hospitals, which provide excellent care, have extremely dedicated teams and are extremely progressive. However, funding is a constant worry, but groups manage to do an excellent job within resources available. Network hospitals range from stand alone polyclinics to large tertiary care hospitals, and the main requirement is efficient sharing of clinical, laboratory and radiological information along with billing and insurance. In addition to the HIS for the hospital network, what is needed is a management console (what i like to call the hospital resourse planning software, HRP) which can help in monitoring all the different aspects of the hospitals, and not limited to clinical care. I would include resource planning, salary, stock and inventory, pharmacy, scheduling, appointment management, health education, outreach, tendering, reporting etc.   So, now that we have broken down the segments, this is what we are doing about it. We are looking at open source solutions suitable for each segment and customise it for individual hospitals. We have identified a few IT service providers, and depending on the skill sets available and the expertise, we work with them to customise the software. We realise that there is a large talented IT pool, but what is happening is that the IT companies are handing out solutions that they can build as opposed to building solutions that the hospitals need. At Vaatsalya, our goal has been to leverage both our clinical and IT experiences to design affordable, and scalable systems which are doctor friendly.   We will be announcing some of the findings and tie-ups with IT service providers on our website soon. Please feel free to contact me if you need specific information and help.   Good Luck, Ashwin