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How cost-effective EMR is possible in India
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  • 1. Deepak Agrawal I/C Computerization & Assoc Prof Neurosurgery, JPNA Trauma Centre, All India Institute of Medical Sciences, New Delhi How cost-effective EMR is possible in India JPNATC Experience
  • 2. Those who cannot remember the past are condemned to repeat it.
  • 3. • 1980’s • TCS WON TENDER TO COMPUTERIZE WHOLE AIIMS • WORTH SEVERAL CRORES • INSTALLED ‘STATE OF ART HARDWARE & SOFTWARE’ • ‘IMPLEMENTATION’ FAILED MISERABLY
  • 4. • Conceived in 1980’s by AIIMS • Handed to Delhi Government • Returned to AIIMS in 1992 • Dry run began on 27 November 2006 • Became fully functional on 26 November, 2007 (ED was opened to general public)
  • 5. • No precedent • Expectations were very low
  • 6. "The greatest danger for most is not that our aim is too high and we miss it, but that our aim is too low and we reach it."
  • 7. • Handwriting issues • Non-Reproducibility • Signature • Address, designation and registration number of Doctor • Not tamper proof • Storage issue
  • 8. • Hand writing not a problem • Reproducible • Tamper-proof • Electronic signature • Identity of issuing doctor • Space
  • 9. • Network printers • Duplex printing • Heavy duty • Full maintenance contract with per page price (<40 paisa/page) • Capable of scanning patient files
  • 10. 1. Mobile number is captured in the EMR and verified by the Call-centre during the first visit/ admission 2. Call-centre give appointment using voice &SMS 3. On day -1, sends list of all appointments that files can be taken out 5. Pt waits with token number which is displayed outside each room 4. On Day ‘0’, final list is prepared and put on each doctors table 6. Call centre phones in evening and gives next appointment based on doctors orders
  • 11. • New tender (Rs 1.3 crores over 5 years) • All software developed by vendor should be open source & released compulsorily in source forge for testing by community • Web-based front-end • EWD • Registration & lab front end should be complete within a month
  • 12. • Hardware • Servers 50 lakhs • Storage 25 lakhs • Desktops & thinclinets: 25 lakhs • Printers: 10 lakhs • Networking • Switches etc: Rs 25 lakhs • Wireless & wire: Rs 10 lakhs • Total: 1.45 crores
  • 13. • Cats etc-20 @9000 Rs 1.8 lakhs • Vista support Rs 2.5 lakhs • Stationary/printing Rs 0.2 lakh • Call Centre Rs 1.0 lakh • Miscl Rs 0.5 lakh • Total Rs 6.0 lakhs/month
  • 14. • Radiology (CT/MRI) • Cost of films/year Rs 60 lakhs • PACS • Now 90% filmless • Saving/year Rs 54 lakhs
  • 15. • Incalculable • Implementation pays for itself in direct & indirect benefits may times over
  • 16. • "If I have seen farther than others, it is because I was standing on the shoulder of giants."