Scope of hospital automation
Any organisation when automated, transforms its business processes into a near paperless system, controlling costs, saving time and thereby aiding in quick decision making and increasing the efficiency of the total system or organisation. This is possible as all the information is available online at any point of time.
For example, if a bank is automated, then one would know the details of the transactions of an account-holder instantly based on the unique account number of the account holder.
Now the question is, when a hospital is automated will the doctor know his in-patient’s condition or progress online, based on his unique identifying number or code and give instructions online? Is the information pertaining to the patient’s previous visits, surgeries, diseases, allergies, lab reports, medication, etc., available at his fingertips for analysing and providing proper medication?
Though most would say ‘yes’, the fact is, it is not happening in the hospitals in India with an exception of a handful of corporate health care providers who claim that they have almost transformed their hospitals into paperless and filmless systems.
Many hospitals are being automated, but the scope of their usage is limited to administrative functions.
Most of the hospitals, which claim that they have computerised their business processes, have only billing, finance and accounts and to a certain extent inventory either fully or partially automated. This means that only administrative staff would be using computers, leaving little or no scope for doctors in using computers for providing quality patient care.
Usage of computers by doctors in developed countries
According to a study conducted by American Medical Association, 94 per cent of the US physicians use computers in their practice, and 79 per cent use the internet or an online network compared to 80 per cent and 61 per cent averages for the 15 countries in the European Union. Cent per cent of doctors in Finland and the Netherlands are reported to use computers and an online network.
According to a survey from Harris Interactive Inc., 26 per cent of America’s practising physicians used hand-held devices for professional and personal activities in 2001, up from 15 per cent in 1999. Harris Interactive estimates that 50 per cent of the country’s physicians will be using the devices by 2005. But that could change markedly if insurers, employers, hospitals and other providers mandate physician usage.
Are Indian Doctors averse to Hospital Information Systems (HIS)?
The answer to this is ‘yes’ to a large extent. Recently, an expert from the US, told a leading Australian IT magazine that in IT terms, doctors are practising the same way they did 75 years ago — with pencils and pieces of paper. One of the reasons is the lack of awareness among the doctors about the potential of using computers for providing quality patient care.
Time is the main constraint for doctors to learn or adopt new technologies emerging around them. Time is money for them. For the time spent to see one patient by an American doctor or a European doctor, an Indian doctor would see around 15 patients though the revenue generated by 15 patients in India may be less than the revenue generated by one in the west.
Key board shyness is another reason. A senior manager of Escorts Heart Institute feels that their vision of a hospital computerised end-to-end, is realised with 250 computers in two buildings with 19 servers, but he mentions that it is the nurses who are making it possible to run the system successfully. Doctors want others to feed the data for them.
Other reasons could be ‘fear of the unknown,’ fear that the computer will make him redundant, lack of doctor friendly interfaces, etc.
Computerisation of hospitals in India
Only a handful of state governments in India have taken the initiative of computerising the government hospitals though they have a long way to go as far as enjoying the fruits of computerisation is concerned as, networking of the intended hospitals in the state, training and implementation etc. would take a lot of time. One such example is the initiative of the Andhra Pradesh Health Ministry to computerise all the district hospitals, area hospitals and primary health centres (PHC) in Andhra Pradesh initially.
This would enable the Ministry for making various analysis and take effective measures for better patient care.
In this regard the government has already completed a pilot project by computerising one 250 bedded district Hospital, one 100 bedded area Hospital and one 30 bedded PHC.
In India, most of the corporate hospitals have either computerised or are in the process of computerising their hospitals which mainly covers their billing, finance and accounts and to some extent pharmacy.This may not result in improved patient care.
The main benefits of computerisation are being enjoyed by the administrators and the management for MIS reports like the hospital occupancy, revenue generated by various departments etc. The support staff use computers for the operations like registration, billing, finance, pharmacy etc whereas the doctors very rarely use computers to see their patients condition/progress online.
When would a doctor appreciate the importance of computers?
Doctors would definitely appreciate the technology, if they are made to know/understand that adopting computer technology is not cumbersome and tedious. Instead, it is easy to view, store and exchange medical information. Using computers and the internet and share with colleagues video images of patients before and after treatment.
Doctors should be shown how computers could prevent or minimise medical errors. Doctors should be told how they could save time and earn more. It is interesting to note that according to an estimate in the US, by increasing the speed of patient history gathering, using technology, a doctor can see 30 per cent more patients a day without extending his workday, a net saving of more than $80,000 per year.
With a computerised environment, doctors will have the patients’ information at their finger tips.
What the hospital can do?
The hospitals should look at the computerisation as a patient care tool rather than a mere accounting and inventory mechanisms. The clinical process and patient information access should be given priority.
‘Indiana Heart Hospital’ in US is a $60 million Hospital with 25 percent of the investment going into Information Technology. Its CIO says that there are 795 workstations in the 88-bed facility - nine computers for every bed. Executives are aiming to reduce medical errors by 80 percent or better through the use of physician order entry systems, drug checking databases, and other methods.
What can the government do?
As the government is primarily responsible for effective health care in the country, it is their responsibility to encourage doctors, hospital administrators and other medical staff to imbibe the computer culture in them by automating their operations. It can do so by computerising all the government hospitals with focus on clinical management.
In medical colleges and the colleges related to medical profession, a few topics related to computers and HIS should be introduced in their curriculum which would enable the professionals to appreciate the potential of IT in medical field.
Like HIPAA (Health Insurance Portability and Accountability Act) in the US, the government can formulate certain code sets which would streamline the operations of Indian health care providers.
Launch National Health Servive like what is planned in UK (to modernise the NHS, which supplies free care to the entire population). This year, England plans to launch one of the largest IT projects in the world - a bid to wire-up the National Health Service and its myriad of hospitals and physician practices. At the same time, the project aims to spur the use of computerised communications, including a standardised ‘national’ electronic health record. Government is aiming to spend ś5.3 billion for next three years.
What the HIS vendors can do?
The main responsibility of HIS vendor is that he should develop the software in such a way that even a computer illiterate doctor can understand with ease.The AMA study findings suggest that technology companies should seek to include office staff in their efforts to educate physicians about the potential benefits of using electronic records to better manage or practice medicine. Vendors also should develop HIS based on the future needs of the hospital and the international trends.
What should we expect?
If the hospitals, the government and the information technology vendors come together with an agreed framework regarding the use of the technology to improve the quality of the patient care, then one can see smiles on the ailing faces, calmness in the working nurses, freshness in the technology savvy doctors, and cash flow fulfilment in the anxious management.
Article Published with: Indian Express Group (Mumbai, India) |
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