Automating All Hospital Workflows

Several trends are causing health systems to adopt technology-enabled solutions to minimize cost and improve value. And, in response to rapidly changing consumer demands, many health systems are focusing on factors beyond price and quality to create customer-centered business models. Technologies, such as electronic health records (EHRs) and patient portals, are often key components of such strategies.

Many health systems are facing a margin cliff as the aging of the world population, combined with lower reimbursement from various government payers, puts pressure on traditional revenue sources. Health systems’ ability to succeed and realize value after a merger or acquisition can largely hinge on capabilities to effectively collect, understand, and act on information.

The evolving market shift from payments based on volume toward payments that emphasize outcomes and risk is one of the largest drivers of technology adoption. Health systems need to derive meaningful information from data to monitor patients and reward providers throughout the care journey. New ways of collecting, processing, and analyzing data, coordinating care in and out of the hospital setting, and supporting clinicians throughout the care journey can, therefore, be critical.

Indian scenario
Health information systems in India have evolved in a haphazard and fragmented way as a result of administrative, economic, and policy-related decisions. The responsibility for health data is often divided among different ministries or institutions, and coordination is difficult due to financial and administrative constraints. The goal of a health information system is often narrowly defined as the production of good-quality data. However, the ultimate goal is more than this – it is to produce relevant information that health system stakeholders can use for making transparent and evidence-based decisions for health system interventions.

The Manual on Health Statistics in India, published by the Ministry of Statistics and Program Implementation, lists multiple benefits that can be reaped from higher investments in HMIS, including helping decision makers to detect and control emerging and endemic health problems, monitor progress toward health goals, and promote equity; empowering individuals and communities with timely and understandable health-related information, and drive improvements in quality of services; strengthening the evidence base for effective health policies, permitting evaluation of scale-up efforts, and enabling innovation through research; and improving governance, mobilizing new resources, and ensuring accountability in the way they are used. An efficient national health information system facilitates transparent and evidence-based decision making which, in turn, leads to improvements in health outcomes.

Availability and use of regular, good-quality health data is increasingly becoming a policy imperative. Health ministry is already at the forefront of incorporating the benefits of digital technology toward achieving the goals elucidated in National Health Policy, which are synchronous with the Sustainable Development Goals (SDGs). Currently, around 200,000 health facilities across all districts are uploading facility-wise data on a monthly basis directly on the HMIS web portal. HMIS was intended as a management information system to oversee the working of the National Health Mission (NHM). The mission is using a web-based HMIS to collect and collate data related to the health infrastructure to monitor its health programs and provide key inputs for policy formulation and interventions throughout the country. As part of NHM, health facilities capture data for HMIS about antenatal coverage, immunization coverage, delivery services, and family planning coverage indicators, among other variables.

Computerization of district/sub-district hospitals and community health centers (CHCs) to implement the HMIS for creation of EHRs and online prescription is being undertaken in a phased manner with the purpose of better delivery of services to patients and improvement in efficiency of processes at hospitals/healthcare institutions. The new digital system will help doctors see the medical history of the patients and all medical records online. The system will also introduce e-cash payment cards for the patients and will also let doctors check the availability of medicines before they prescribe a medicine.

The Centre for Development of Advanced Computing (C-DAC) has designed and developed a versatile hospital management information system in various models like conventional stand-alone hospital version and SaaS (Software as a Service) over the cloud infrastructure. The real-time HMIS streamlines the treatment flow of patients and simultaneously empowers the hospital’s workforce to perform their duties effectively and efficiently. It is modeled on the unique combination of a patient-centric and medical staff-centric paradigm, thus providing benefits to both the recipients and the providers of healthcare. The company has also developed a concept of statewide implementation of HMIS across various government hospitals ranging from super specialty hospitals, medical college hospitals, and district hospitals to area hospitals. This has been deployed in more than 40 hospitals across India. The company has developed various solutions in this area. These include:

• e-Sushrut, a web-based HMIS using open source technology and with compliance to various national and international standards. It can be easily integrated with other systems using HL7 messaging;
• eSwasthya, a web based SaaS model HMIS software suite built on open-source platform that facilitates hospitals for delivering effective, patient-centric services more efficiently;
• Medical document semantic analyzer, an HL7 compatible tool for unlocking healthcare data from narrative reports;
• Megh Sushrut, an ERP solution for health delivery in SaaS model;
• ONCONET – cancer care for rural masses; and
• Tejhas, an HMIS solution with special features for cancer care.

Challenges
Evaluation of indicators across data sources and examination of linkages of health data with reporting systems present a major shortfall in India’s HIS capacity to provide useful information.

Issues at national level. At the national level, there is no independent central resource center to provide stewardship to the health information and data management in the country. There is no unified body at the national level to provide guidance around: types of data that can be collected at various levels; responsibility for col- lection; legal and policy framework; use of standardized definitions; and quality control and validation mechanism. Different ministries produce different data sets to fulfill their program-specific needs.

Issues at a sub-national management level. At a sub-national level, there is no state-level data resource center to coordinate and collaborate with national data resource center for steering decentralized data collection and collation across sources. The data that is generated at state level lacks any information on private sector, where about 70 percent of population seeks treatment.

Issues in data compilation and analysis. A lot of success of any survey depends on probing and interviewing skills of field officers conducting surveys. While both CSO and NSSO have a training division for their field officers, but they lack in various areas. There is a marked lack in infrastructural facilities; there is no systematic calendar or arrangement for training; and there is often no linkage between the kind of training received by an officer and his or her assignment. As a result, for example, while both Consumer Expenditure Survey and Morbidity and Healthcare Surveys conducted by NSSO collect information on health expenditures, it has been shown that the way questions are put forth to households, the spending reported by both surveys lead to very different results.

Global scenario
The global healthcare information systems market size is expected to reach USD 169.2 billion by 2025, registering a 7.7 percent CAGR during 2018–2025, elucidates Grand View Research. In 2018, hospital information system held the largest share by application owing to increase in adoption in hospitals for improving operational efficiency.

Inefficiency of manual procedures due to increased patient inflow in the hospitals has created huge demand for information systems in hospitals. In addition, recently developed information systems possess several benefits, such as easy data access and data security. Also, software offers maximum flexibility and data integrity to users. Therefore, increasing demand of such technologically upgraded systems to manage patient data in hospitals will positively influence the industry growth in forthcoming years.

Rapid development in healthcare infrastructure coupled with factors, such as rising investments in medical policies, are forcing hospitals to adopt effective and safe hospital information systems to sustain the consistency of healthcare procedures. These software monitor, control, and integrate all the activities that improves staff efficiency, minimize procedure duplication, and data theft. The aforementioned factors will favor the industry growth in near future.

Clinical information systems segment will experience considerable growth over the next 7 years. Clinical information includes electronic medical records, telehealth software, patient-engagement solutions, and other clinical data. These systems are automated and contain clinical data about patients that facilitates the success rate of treatment and procedures. These systems are very useful in ICUs to efficiently manage patient data and thus, high adoption of clinical information systems in hospitals will prove beneficial for segmental growth.

Software segment will experience considerable growth. Recently developed hospital information software can address wide range of issues ranging from data storage to data management. Many healthcare cloud software such as EMR systems, EHR systems, e-prescribing, remote medical care, and hospital telemetry system have proven their efficiency in managing huge data and providing accurate outcomes. Moreover, healthcare software are also used to analyze patient information. Thus, growing applications of software in hospitals has substantially boosted the segmental growth.

Cloud-based segment had significant revenue share in 2018 and is expected to grow in coming years. Cloud models are owned by hospitals that enables use of cloud computing technology as a centralized IT resource accessible by different departments. Currently utilized software allows effective communication between different departments of hospitals. Private cloud service provides exceptional control over patient data that proves convenient to internal or outsourced hospital staff that increases its preference escalating industry growth.

Factors along with rising government initiatives to create awareness about availability of technologically upgraded hospital information system in public as well as private hospitals will augment the segment’s market growth.

Healthcare data privacy concerns are making people think if they should adopt the digital health tools or not. The limited functions, redundant and confusing app environment are some of the issues that healthcare payers and providers face while dealing with the mobile or digital health tools. In spite of the presence of regulations regarding the patient’s personal data security, it becomes challenging for population to trust the online healthcare services. Developed nations have lesser concerns about data security due to strict regulations about the same, but developing regions are still fighting with the privacy issues owing to the lack of proper regulations. People in developing regions are still away from digitization of the healthcare industry and latest technological advancements in the same, which is resulting into less trust on digital tools. Increase in the privacy and data security concerns is limiting the growth of hospital information system market as HIS is also one of the tools that uses and stores a person’s medical information. In addition, lack of proper IT infrastructure in developing regions is hindering the growth of hospital information system market.

Major industry players in hospital information system market are Cerner Corporation, Comarch, Meditech, McKesson, Epic System, Siemens Healthcare, CPIS, Eclipsys, GE Healthcare, Carestream Health, and Wipro. Industry players focus on product launch as their main strategies to expand existing product portfolio and capture potential market share.

Recent key developments
In March 2019, McKesson Corporation announced collaboration with Navigating Cancer to offer patient relationship management platform.

In May 2018, Allscripts Healthcare Solutions MDRX acquired Florida-based, HealthGrid Holding Company for USD 60 million.

In January 2018, GE and Roche entered into a partnership to develop integrated digital diagnostics platform to improve oncology and critical care treatment.

Buyers’ perspective
Technology is rapidly evolving healthcare industry by automating all of its tasks. An effective healthcare information system streamlines the flow of all data. The decision to implement effective software is a big one that needs deep consideration. It is crucial, not due to investment, but the major reason is cultural changes that may occur. While contemplating the need to have healthcare information system implementation, following improvement factors should be considered.

Speed up procedure. One of the most significant reasons behind failure in the healthcare industry is that operational processes are not strictly followed. A healthcare center needs to improve patient care and their access to real-time information for better outcomes. Healthcare information system speeds up the entire process with improved efficiency. It leaves a positive impact on hospital culture in multiple ways.

Reduced errors. Healthcare information system has automated several tasks and reduced human interference. Reducing human interaction positively supports lowering down errors. Let us suppose you need to generate a final bill for the patient before checking out. All routine records and previous bills need to compile. Manual record management is quite difficult and chances of double entry are still there. Hospital management software is an easier, transparent, and faster approach to record keeping to improve accuracy and eliminate errors.

Cost effective. Hospital information software cuts out manual efforts, especially related to record keeping and documentation management. It also reduces the manpower costs because most of the tasks that need to be automated do not need manual intervention. The effective software automates the process of store analysis and information management process. There is no more need to invest separately in storage devices. A cost-effective solution encourages paperless environment. As a whole, implementation of right software is going to secure hospital investment in several ways.

Data retrieve ability. In the health industry, data availability and its capability to retrieve it is the most important requirement. Cloud-based healthcare information system stores data on a server out of hospital premises. Therefore, few clicks can ensure its easy access and efficiency. It includes all types of data including financial, medical, and operational. These are just a few reasons that encourage the healthcare centers to move on with technology. It undeniably offers best patient care and ensures the availability of error-free and clean information. As software offers endless benefits and needs long-term investment, it requires proper planning before implementation.

Selecting right system
Selection of the right healthcare information software is a challenging process. Here are a few steps to lead toward the best HIS.

Workflow review. Information technology advancements have brought automation in various aspects of the hospital information system. Therefore, buyers have to go through complete workflow and information flow of hospital and healthcare center. Some of the software is easily customizable with automatic billing and record management. Buyers are the ones to decide which features and what workflow is required. A complete software suite includes: pharmacy management; store management; OPD scheduling; patient record management; patient billing management; and staff management.

Buyers have to review their own requirements and cost factors before selecting a healthcare information system.

Vendor selection. Vendor selection is important to step toward healthcare software to automate all process. This selection is going to help buyers in running hospital operational processes in the right way. A vendor is not someone to work with for a day or a year. One has to build a long-term relationship with the vendor. Therefore, the selection of right vendor is necessary. The buyer can approach the right vendor by following steps: brain storm; contact vendor; specialty check; take a demo; discuss scalability and customization; review integration process; hidden cost acknowledgement; and credentials check.

Integration. The trend of healthcare information software implementation is growing rapidly. Doctors, physicians, administration, and staff start smart working and consume less time in information collection with the right implementation. Patient’s physical parameters, lab reports, etc., enable instant reporting that leads towards effective decision making. An effective healthcare information system helps in collecting real-time data and keeps it secure. It could be easily accessed with a few clicks in a presentable way. The software has positively raised the satisfaction level and improved data accuracy as well as ease of communication between different departments and doctors. Right integration of all components and features is needed for outstanding outcomes.

Software implementation timing. Implementation of software means the successful installation of entire software after testing and training. Successful implementation of HIS automatically reduces the stress of daily hospital operations. It ultimately encourages staff engagement, patient care, and other processes. Furthermore, in order to purchase the right HIS, pre- and post-implementation cost acknowledgment is essential. Cost is an important factor to understand but it still does not compromise quality over investment. Before implementation collect all required information.

Way forward
Information systems at hospitals present a balkanized picture. Although a host of applications capture patient data at different points of contact, an integrated picture of the patient is missing. India has not fully tapped into the potential that information technology offers to integrate the health information systems in the country. Complete implementation of hospital information system would prove invaluable in data collection for predicting disease burden and local health needs, rapid data collection for outbreak, early warning, and response to a disease. Information technology has great potential toward improvement of delivery of healthcare services. India is committed to reforms in health service delivery, using IT under Digital India program. With huge investments being made in tertiary care, India’s health sector is expected to double in revenues to USD 280 billion by 2020; and this growth will be largely facilitated by IT.