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Leveraging
IT to increase efficiency is old hat, but using it to change
the very way business is done, is something very few can boast
about. Max Healthcare, a division of Max India has done just
that with its recently implemented Hospital Information System
(HIS). Shipra Arora reports
As
you read through the pages of Express Computer, so very often
you come across companies that have leveraged IT to not only
move up the value chain, but also change the way business
is done. The healthcare industry has been no different with
the likes of Morepen Labs and others taking to IT in an effort
to increase efficiency. Another significant addition to this
list has been Delhi-based Max Healthcare, a division of Max
India, one of India’s leading multi business corporations.
Says Rajan Chadha, chief information officer, Max Healthcare,
“In order to make a mark in the healthcare sector, we
needed to provide standard, seamless and integrated service,
which could be done only by incorporating IT within the company’s
core functions. We realised this from day one itself, and
therefore began to work in this direction.”
Chalking out the need
In an effort to achieve the kind of service levels it desired,
the company set up a two member IT team even before commencement
of operations. This team along with a team of actual users
were entrusted the task of laying down the objectives and
expectations from an IT implementation. As part of this exercise,
the group analysed systems which needed automation, thus arriving
at the scope and extent of the IT implementation. In short,
it formulated the company’s IT policy. The primary objective
of automation, says Chadha, was to provide for online availability
of records at the touch of a button at any of the facilities,
a need which forget government, even private healthcare players
had turned a blind eye to. “This meant that a patient
needed to carry all his records and reports, every time he
visited a clinic or hospital. As a by product of this, even
doctors, nurses, pathologists and administrators had to contend
with incomplete information each time the same patient came,
thus leading to inefficiencies in terms of internal administration
as well as patient inconvenience,” he adds. In an attempt
to iron out these issues, a need was felt for a system that
would allow for remote access to patient records along with
a patient tracking system. This could be fulfiled only with
a Hospital Information System (HIS).
Making the right choice
Having laid down its basic need, the next problem came in
the form of actually choosing a package, as no other company
in India had implemented such a package till date. Nonetheless,
after running a check list on the various features and evaluating
both Indian and overseas vendors on these grounds, the company
chose Trak, a product offering by an Australia-based company.
“The product satisfied almost 80 percent of our requirements,
which in our opinion made for a good fit. The rest could be
tailored to our own requirements,” Chadha explains. This
ability to customise the product, coupled with the popularity
of the same (around 200-300 installations worldwide), only
helped tilt the scales in favour of the product.
The Trak Hospital Information System currently covers the
entire gamut of Max Healthcare’s operations right from
PACS to pharmacy, pathology to billing. Today, the system
forms the core of the company’s operations, or rather
its lifeline. All the other IT requirements and installations
have been built around the package to support it more effectively.
Trak has been broadly categorised into two functional areas
Medtrak and Labtrak. Medtrak is a fully integrated Hospital
Management System that caters to the needs of patients and
simplifies the day-to-day task of running an efficient medical
facility. Labtrak, on the other hand, is a modular pathology
laboratory system that is fully integrated with Medtrak to
manage samples, and provide results, data and information
to doctors and patients.
Chadha explains that the process is set in motion when a patient
seeks an appointment with a doctor. The company has set up
a call centre to take their calls. Trak checks out in real
time if there is any empty slot available for an appointment
with the concerned doctor by checking out his online schedule.
In case there is a slot available, the appointment is fixed,
else the system, looks for an alternative slot. The appointment
takes place within the fraction of a second. Once the appointment
is made, the schedule of the doctor is updated real time.
Chadha adds, “All the doctors have been given a mail
ID, using which they can login at any time and check out all
the patients booked for the day. If the patient had visited
earlier, a doctor can check his past history as well as all
earlier records, since they are available online.” The
system also provides for transfer of appointments and cancellation
of the same.
The next stage is the actual appointment. Here too, a seamlessly
integrated IT system has been put in place to take the patient
through the entire administrative and clinical process. Once
the patient arrives, there is an online electronic registration
process on payment of a specific amount after which an invoice
is prepared. At this time, the doctor is also alerted about
the arrival of the patient. He is then escorted by the patient
care co-ordinator to the nursing station, where all mandatory
requirements such as height, weight, blood pressure, etc are
recorded in the system. These are made available to the doctor
on his system before the patient actually meets him. The availability
of all this information, Chadha points out, helps the doctor
in his diagnosis. Once the doctor has finished examining the
patient, he enters the patient record in the HIS.
During the standardised 30 minutes diagnosis time, the doctor
takes down vital information and prescriptions for the patient
on his desktop. However, Chadha adds, this is quality time
that the patient gets to spend with the doctor and therefore
the company ensures that this time is spent with the patient
and not just in keying-in information on the desktop. Hence,
at the time of the appointment, the doctor is supposed to
feed in only his diagnosis and the medicines prescribed. The
rest of the inputs such as a detailed analysis etc, are keyed
in by the doctor only after the patient has left. As soon
as the doctor types in the prescription, it reaches the nursing
station as well, where the nurse takes the printout and gets
it signed from the doctor, which is then handed over to the
patient. This helps in regularly auditing the doctor’s
performance, whether he is working properly and giving the
right treatment or not. This has allowed Max Healthcare to
have a standardised service across all its locations.
Commenting on the advantage of this system, Chadha says, “Traditionally,
medical notes of doctors and nurses form the main record of
patient care. Unstructured medical notes normally have a retrospective
record of what happens to a patient, but do not contain all
the information necessary for quality assessment and may include
a lot of details which are redundant. Electronic Medical Record
(EMR) on the other hand, enables the patient record to be
in a structured format, which not only provides a detailed
medical record, but also a forward plan of expected treatment.”
Labtrak
The next benefit of the system is made manifest when the patient
has to get various tests like radiology, pathology etc done
as recommended by the doctor. Here, the integration of Medtrak,
with the laboratory system, LabTrak comes into play. The union
of these two modules allows the entire process of healthcare
delivery to occur in a seamless manner with minimal manual
intervention. There are standard operating procedures laid
down for each test to be performed so that results are consistent,
fast and best. The LabTrak system allows for the automation
of various exercises that the patient has to go through, right
from registering for the tests to collection of reports. Chadha
adds that according to him, LabTrak is the modern dynamic
way of providing pathology services, which enables the healthcare
sector to manage their workflow effectively.
The process is set in motion when the patient decides to get
the prescribed tests done from the company’s clinics.
As he registers (which is again online) for the tests, the
concerned department’s system receives a pop up that
a patient is waiting outside. This allows them to be aware
well in advance of all booked patients. The testing methodology
and procedures have also been automated in order to ensure
greater efficiency and minimal loopholes. Bar coding is also
used to provide greater accuracy. For instance, if a patient
is getting a blood test done, a bar code, containing the patient’s
unique registration number, is stuck on the test tube containing
the blood sample. Chadha explains that the laboratory testing
instruments have been equipped to scan the bar code for the
patient registration number and complete processing the results.
Whenever a specimen/sample arrives at the pathology department,
the lab technician places the specimen on the appropriate
analyser. The results are attached to the registration number
and immediately passed from the analyser to the system. This
does away with the human element. The report is then redirected
to the pathologist for final approval before it is printed.
The report is simultaneously attached to the medical records.
Hence, the doctor can, at any point in time, see not only
the test reports but also the images as well. This is possible
as the lab instruments are connected to the server and HIS.
Says Chadha, “Labtrak allows the entry of unlimited clinical
history and also rapid turnaround time especially for those
samples that are urgent, thus scoring over a manual system.”
Spanning this comprehensive workflow are 20 modules taking
care of both the clinical and administrative aspects of Max
Healthcare’s operations. The prominent modules include
materials management, appointment, OPD, billing, nursing,
radiology and pathology. However, as Chadha points out, the
package is highly scalable to 32 modules as the company plans
to expand over the next few years with the setting up of about
30 clinics and 2 hospitals. “As our operations are going
to grow phenomenally over the next few years, we are ready
with the modules to take care of our future requirements.
All that needs to be done, is activate them and integrate
with the system as and when required,” he explains.
A healthy spine
 Chadha
points out that in order to effectively deliver this seamless
integrated workflow, it needs to be supported by a robust
infrastructure at the back-end. As of today, the company has
4 NT based servers and around 180-190 desktops operating at
the back-end in 4 of its clinics, which are currently operational.
This means that each doctor has a desktop, with the nursing
station, laboratories and other departments taking the rest
of the share as per their requirements. All the workstations,
servers and some of the hospital instruments within a location
have been inter-connected through the Local Area Network.
Further, all the company’s locations have been tightly
integrated with a Wide Area Network (WAN). This makes it a
real-time system accessible throughout the geographies and
enables functional integration in multi-locational areas by
ensuring availability of patient records at the touch of a
button at any of the Max Healthcare facilities. For example,
once the patient is registered in any of the Max Clinics,
his records can be accessed from any other Max Healthcare
facility. This means that a patient can visit any location
as per his convenience without worrying about carrying the
bundle of records and reports. The robust WAN system allows
for remote access to patient records, a patient tracking system
and online help to deliver patient-centric care.
Currently on a leased line network with ISDN backup, the IT
department is now working on upgrading to a wireless WAN,
which would allow for improved up time. For this, the company
plans to hire a Radio wireless system from Infotek Network
System. “Time is a crucial factor in the healthcare industry,
as even a few seconds can save a person’s life. Realising
this, we have decided to go in for wireless WAN,” explains
Chadha. Even though it will require an upfront capital cost,
the day-to-day working cost is estimated to be almost equal
to its existing leased line network.
Future plans
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Chadha
says the desire to raise the bar on the quality of service
provided in the industry drove the company’s IT initiatives |
With
the fundamental infrastructure and systems already in place,
Max Healthcare’s IT policy for the next two years is
to concentrate on stabilising the HIS and build more applications
around it in order to optimise its full strength and further
its scope of operations. Customer Relationship Management
(CRM), intranet and an online monitoring system are some of
the key projects that the company plans to implement over
the next two years.
Max Healthcare’s technical collaboration with Harvard
Medical International enables Max Healthcare, exchange clinical
protocols and procedures online to ensure excellent clinical
outcomes. Hospital information systems and procedures, Lab
design and planning have been benchmarked with international
best practices.
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