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This was a presentation made as an 'Opening Keynote address' at the HIMSS India Dialogue'13 at New Delhi on the topic' State of Healthcare IT in India - Next five years'

This was a presentation made as an 'Opening Keynote address' at the HIMSS India Dialogue'13 at New Delhi on the topic' State of Healthcare IT in India - Next five years'

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    Healthcare IT in India Healthcare IT in India Presentation Transcript

    • 14TH  MARCH  2013   THE  PARK  HOTEL,     NEW  DELHI,  INDIA    A                                                    thought  leadership  event  where  you  can  contribute  your  ideas  for   the  future  of  healthcare  IT  in  India  
    • Rajendra  Pratap  Gupta   Chairman   Board  of  Directors     Opening  Keynote  address  Healthcare  IT  in  India    -­‐  The  Next  5  Years       ©Rajendra  Pratap  Gupta  .  Email  :    office.rajendra@gmail.com  
    •  ‘Delivering  healthcare  without  using  InformaBon   Technology  is  like  driving  a  car  without  a   dashboard  &  a  steering.  Neither  you  can  make   out  what’s  happening,  nor  you  can  manoeuver   the  vehicle  to  avoid  mishaps’   Rajendra  Pratap  Gupta    15/03/13   3   ©Rajendra  Pratap  Gupta  .  Email  :    office.rajendra@gmail.com  
    • Who  will  drive  the  Change    ?   Government   PAC  /  CAG   Insurance     Drivers   Changing   HCIT   Demographics   of   Providers   Change   InternaEonal   PaEents     Developments   Professional   Developments   &  Challenges  15/03/13   4   ©Rajendra  Pratap  Gupta  .  Email  :    office.rajendra@gmail.com  
    • Government  :  IniBator  of  the  ‘Mega’  change    •  The  spending  on  healthcare  as  %  of  GDP  to  increase  every  year  •  Increased  spending  will  lead  to  increased  scruBny    •  Increased  scruBny  will  call  for  increased  accountability    •  For  accountability  in  healthcare  ,  use  of  IT  is  the  starBng  point    15/03/13   5   ©Rajendra  Pratap  Gupta  .  Email  :    office.rajendra@gmail.com  
    • Government  :  IniBator  of  the  ‘Mega’  change    •  2012  was  a  historical  year  –  UHC  &  decision  to  increase  our  GDP  spending   on  Healthcare    •  Increase  the  Health  spending  to  3.0  %  by  2022        •  Five  fold  increase  in  per  capita  spending-­‐  from  Rs.650-­‐700  in  2011  to  Rs. 3400-­‐3500  in  2021-­‐22  •  Private  OOP  spending  will  decline  from  Rs.1800-­‐1850  to  Rs.1700-­‐1750  by   2021-­‐22,  i.e  decrease  from  67  %  to  33  %  15/03/13   6   ©Rajendra  Pratap  Gupta  .  Email  :    office.rajendra@gmail.com  
    • Government  :  IniEator  of  the  ‘Mega’  change      •  Ensuring  effecBve  and  affordable  access  to  medicines  ,  vaccines  and   appropriate  technologies  is  criBcal  for  promoBng  health  security*                                •  Every  ciBzen  will  be  issued  an  IT  enabled  NaBonal  Health  EnBtlement  card   (  NHEC  )  that  will  ensure  cashless  transacBons  ,  allow  for  mobility  across  the   country    and  contain  personal  health  informaBon  .  Such  a  card  will  also  help   the  state  to  track  paderns  of  disease  burdens  across  the  country*   * High Level Expert Group Report on Universal Coverage for India15/03/13   7   ©Rajendra  Pratap  Gupta  .  Email  :    office.rajendra@gmail.com  
    •   Government  :  IniEator  of  the  ‘Mega’  change            •  InformaBon  Technology  can  be  used  in  at  least  four  different  ways  to  improve   healthcare  and  systems:*                                •  Support  public  health  decision  making  for  beder  management  of  health   programmes  and  health  systems  at  all  levels*    •  Support  to  service  providers  for  beder  quality  of  care  and  follow  up*  •  Provision  of  quality  services  in  remote  locaBons  through  telemedicine*     * 12th Five Year plan document .ihttp://dmai.org.in/12th-Plan-up-to-page-46.pdf15/03/13   8   ©Rajendra  Pratap  Gupta  .  Email  :    office.rajendra@gmail.com  
    • Government  :  IniEator  of  the  ‘Mega’  change      •  SupporBng  educaBon  ,  and  conBnued  learning  in  medicine  and  health*                              •  A  composite  Hospital  InformaBon  System  (HIS)  ,  when  fully  operaBonal  ,  would   incorporate  the  following:*  •  Universal  registraBon  of  births  ,  deaths  and  cause  of  death*  •  NutriBonal  Surveillance  ,  parBcularly  among  women  in  the  reproducBve  age   group  and  children  under  6  years  of  age*       * 12th Five Year plan document .ihttp://dmai.org.in/12th-Plan-up-to-page-46.pdf15/03/13   9   ©Rajendra  Pratap  Gupta  .  Email  :    office.rajendra@gmail.com  
    •   Government  :  IniEator  of  the  ‘Mega’  change      •  Disease  Surveillance  based  on  reporBng  by  service  providers    and  clinical   laboratories  (  public  and  private  )  to  detect  and  act  on  disease  outbreaks  and   epidemics*                      •  Out-­‐paBent  and  in-­‐paBent  informaBon  through  Electronic  Medical  records   (EMR  )  to  reduce  response  Bme  in  emergencies  and  improve  general  hospital   administraBon*  •  Data  on  Human  Resource  within  the  public  and  private  health  system*  •  Financial  management  in  the  public  health  system  to  streamline  resource   allocaBon  and  transfers,  and  accounBng  and  payment  faciliBes  ,  providers  and   beneficiaries  .  UlBmately  ,  it  would  enable  Bmely  compilaBon  of  the  NaBonal   Health  Accounts  on  an  annual  basis*   *12th Five Year plan document .ihttp://dmai.org.in/12th-Plan-up-to-page-46.pdf15/03/13   10   ©Rajendra  Pratap  Gupta  .  Email  :    office.rajendra@gmail.com   *  
    • Government  :  IniEator  of  the  ‘Mega’  change      •  A  naBonal  repository  of  teaching  modules  ,  case  records  for  different  medical   condiBons  in  textual  and  audio-­‐visual  formats  for  use  by  teaching  faculty  ,   students  and  pracBBoners  for  ConBnuing  Medical  EducaBon  (CME  )*                              •  Telemedicine  and  consultaBon  support  to  doctors  at  primary  and  secondary   faciliBes  from  specialists  at  terBary  centres  *  •  NaBonwide  registries  of  clinical  establishments  ,  manufacturing  units  ,  drug  –   tesBng  laboratories  ,  licensed  drugs  and  approved  clinical  trials  to  support   regulatory  funcBons  of  the  government  *  •  Access  of  public  to  their  own  health  informaBon  and  medical  records  ,  while   preserving  confidenBality  of  data*  •  Programme  monitoring  support  for  NaBonal  Health  Programmes  to  help   idenBfy  programme  gaps*   * 12th Five Year plan document .ihttp://dmai.org.in/12th-Plan-up-to-page-46.pdf15/03/13   11   ©Rajendra  Pratap  Gupta  .  Email  :    office.rajendra@gmail.com  
    • Government  :  IniEator  of  the  ‘Mega’  change    •  To  achieve  these  goals  ,  computers  with  internet  connecBvity  would  be   ensured  in  every  Primary  Health  Centre  (PHC  )  and  all  higher  level  health   faciliBes  in  this  plan  period*    •  All  District  hospitals  would  be  lined  by  tele-­‐medicine  channels  to  leading   terBary  care  centres  ,  and  all  intra-­‐district  hospitals  would  be  linked  to  the   district  hospital  and  opBonally  to  higher  centres*  •  The  role  of  the  MOHFW  would  be  to  lay  IT  systems  standards  ,  and  define   indicators  which  would  be  openly  shared  .  This  will  be  funded  by  NaBonal   Health  Mission*    •  Health  surveys  would  be  annually  conducted  to  generate  district  level  health   informaBon  on  health  status  ,  which  will  also  serve  to  verify  the  accuracy  of   rouBne  health  informaBon  system*   * 12th Five Year plan document .ihttp://dmai.org.in/12th-Plan-up-to-page-46.pdf15/03/13   12   ©Rajendra  Pratap  Gupta  .  Email  :    office.rajendra@gmail.com  
    • Government  :  IniEator  of  the  ‘Mega’  change    •  NOFN  –  NaBonal  OpBc  Fibre  Network  –  3  pilot  projects  in  Telemedicine   (  Ajmer,  Tripura  &  Vizag  )  •  NaBonal  Medical  College  Network  (NMCN)  •  NaBonal  Rural  Telemedicine  Network    •  NaBonal  Health  Portal    •  State  Wide  Area  Network  –  SWAN  –  2  MBPS  connecBvity  up  to  block  level    •  NaBonal  knowledge  network    (NKN  )  -­‐    under  DieTY  –  100  MBPS  connecBvity  to   EducaBonal  and  research  insBtutes    15/03/13   13   ©Rajendra  Pratap  Gupta  .  Email  :    office.rajendra@gmail.com  
    • Insurance  –  The  Big  Bully    •  Under  UHC  ,  majority  of  the  populaBon  is  likely  to  be  ‘covered’  on  the  lines   of  RSBY  •  Insurance  companies  /  Payers,  will  ‘mandate’  for  pracBBoners  and  providers   to  have  IT  systems  to  get  instant  approvals  –  cashless  treatment  ,  follow   treatment  guidelines  and  protocols  and  demonstrate  outcomes  –  ACOs..  •  Those  who  do  not  deploy  the  IT  system  might  be  leo  out  of  empanelment    •  Aoer  the  Government  ,  Insurance  will  be  the  biggest  ‘change  agent’  for  HCIT  15/03/13   14   ©Rajendra  Pratap  Gupta  .  Email  :    office.rajendra@gmail.com  
    • HICT  Providers  –  Beacon  light    •  Thanks  to  HCIT  providers,  we  have  ‘technical  maturity’  for  HCIT  •  HCIT  providers  will  need  to  invest  in  awareness,  educaBon,  research  &   evidence  of  improved  clinical  outcomes  using  HCIT    •  Work  with  industry  bodies  and  Governments  to  showcase  success  stories  •  Industry  must  set  the  interoperability  guidelines  ,  as  there  is  a  likelihood   of  mulBple  soluBons  being  deployed  for  1.21  Billion  people    15/03/13   15   ©Rajendra  Pratap  Gupta  .  Email  :    office.rajendra@gmail.com  
    • InternaEonal  Developments        •  Healthcare  in  India  is  driven  by  modern  medicine  /  Intl.  technology  •  India  is  a  ‘follower’  market  when  it  comes  to  ‘adopBon’    •  Be  it  standards  ,  regulaBons  or  best  pracBces,  it  always  look  at  the  west  •  InternaBonal  studies  &  reports  do  influence  healthcare  pracBces  in  India    15/03/13   16   ©Rajendra  Pratap  Gupta  .  Email  :    office.rajendra@gmail.com  
    • Professional  Developments  &  Challenges      •  Medical  educaBon  ,research  &  pracBce  is  undergoing  a  change    •  ConBnuing  professional  development  is  a  necessity    •  Medical  pracBce  is  becoming  more  demanding  w.r.t.  Bme  &  travel  .    •  Compliance  to  complex  regulatory  changes  •  Increase  of  medico-­‐legal  costs  would  complicate  the  maders  further      •  If  the  clinicians  need  to  keep  pace  with  the  fast  track  professional  changes   (&  challenges)  ,  AdopBon  of  IT  is  imperaBve    15/03/13   17   ©Rajendra  Pratap  Gupta  .  Email  :    office.rajendra@gmail.com  
    • PaEent  :  ‘impaEent  for  change’    •  PaBent  has  a  lot  more  informaBon  about  ‘medical  issues’    •  PaBent  Groups  will  be  around  in  the  next  3  years  –  PaBent  Safety    •  PaBents  expecBng  an  automated  environment  like  other  sectors    •  Processing  ePrescripBon  through  electronic  ordering  system  can  halve  the   likelihood  of  a  drug  error  ,  and  avert  more  than  17  million  such  incidents   in  US  hospitals  in  one  year  alone  (  AMIA  ,  March  ,  2012  .  Courtesy  ,  The   Economic  Times  dated  25th  February,  2013)  15/03/13   18   ©Rajendra  Pratap  Gupta  .  Email  :    office.rajendra@gmail.com  
    • Changing  Demographics      •  By  2026,  the  geriatric  populaBon  will  increase  from  96  million  (  2011  )  to   168  million    •  Moving  towards  nuclear  families    •  NCDs  are  on  the  rise  .  India  set  to  lose  USD  237  billion  by  2015  because  of     pre-­‐mature  deaths  due  to  chronic  diseases    •  ‘Baby  boomers  of  today’  will  become  ‘PaBent  Boomers’        15/03/13   19   ©Rajendra  Pratap  Gupta  .  Email  :    office.rajendra@gmail.com  
    • CAG  &  PAC*    •  In  India  ,  the  recent  trends  point  to  ‘acBvism’  at  CAG*  &  PAC*  •  ‘The  commidee  are  perturbed  to  note  the  abysmal  low  per  capita  public   expenditure  on  the  health  care  in  India…  at  such  a  paltry  rate  of  public   expenditure  on  healthcare,  the  commidee  fears  that  the  goal  of  universal   health  care  to  all  the  ciBzens  as  envisaged  in  the  Mission  may  remain  a   pious  plaBtude  and  a  distant  dream’**  •  ‘While  the  actual  allocaBon  in  the  Eleventh  Plan  was  lower  than  the   original  plan  allocaBon  ,  the  actual  expenditure  has  sBll  been  lower  i.e.  the   system  has  not  even  been  able  to  uBlize  the  curtailed  outlay’**  •  ‘Given  the  glaring  deficiencies  ,  loopholes  ,  infirmiBes  and  want  for   effecBve  monitoring  mechanism,  the  NRHM  warrants  a  thorough   restructuring  so  as  to  remedy  the  shortcomings  and  difficulBes  in  its   effecBve  implementaBon  so  that  the  laudable  goals  of  providing   accessible  ,  affordable,  effecBve  and  reliable  healthcare  to  the  rural   people  especially  the  poor  are  adained’**  15/03/13   20   ©Rajendra  Pratap  Gupta  .  Email  :    office.rajendra@gmail.com   **Public  Accounts  Commi@ee  report  no  1939   *  CAG  –  Comptroller  &  Auditor  General  .  PAC  –  Public  Accounts  Commi@ee  ,  Parliament          
    • Where  all  will  the  Changes  happen?   Rural   Health     EducaEonal     Hospitals     InsEtuEons     Home  based   care   EMR   Changes   will   happen     Imaging  /   Radiology   Telemedicine   POC  -­‐  D   NCD   MCH  15/03/13   21   ©Rajendra  Pratap  Gupta  .  Email  :    office.rajendra@gmail.com  
    • The  Next  five  years  …..    •  ConnecBvity  will  not  be  an  issue    •  Web  portal  on  Health  would  be  live  and  running    •  Roll  out  of  UHC  –  NHEC  (  NaBonal  Health  EnBtlement  Card  )  •  Government  Hospitals  being  connected  via  NMCN   Since    the  IT  deployments  are  taking  off  ,  the  growth  will  be  fairly  high  over   the  next  15  years,  as  the  starMng  base  is  at  ‘ground  zero’  15/03/13   22   ©Rajendra  Pratap  Gupta  .  Email  :    office.rajendra@gmail.com  
    • The  Next  five  years  …..    •  All  states  will  have  State  wide  Telemedicine  Networks    •  Insurance  will  mandate  clinicians  to  use  IT  for  instant  approvals  ,   adherance  to  treatment  protocols  and  payment    •  mHealth  would  have  covered  the  enBre  naBon    •  Chronic  disease  management  will  start  using  apps….   Most  importantly  ,  doctors  &  paMents  will  be  at  the  forefront  of  driving  this   change    15/03/13   23   ©Rajendra  Pratap  Gupta  .  Email  :    office.rajendra@gmail.com  
    • Challenges…..    •  AdministraBve  automaBon  Vs  Clinical  automaBon    •  HCIT  Projects  not  documented  for  clinical  outcomes    •  Return  on  Investment  (ROI  )  Vs  Value  on  Investment  (VOI)  •  Leading  standalone  clinicians  and  small  nursing  homes  do  not  wish  to   disclose  the  ‘actual  earnings’    •  Industry  not  on  the  same  page  –  InfighBng  derailing  most  of  the   Government  projects  –  A  serious  cause  of  concern  !  15/03/13   24   ©Rajendra  Pratap  Gupta  .  Email  :    office.rajendra@gmail.com  
    •     ‘Government  IT  plans  in  the  public  sector  will   need  significant  investment.  The  private  sector   needs  to  take  the  lead  in  innovaBon  ,   incubaBon  ,research  of  IT  products  &  projects   and  training  of  clinicians  for  IT  adopBon’   Rajendra  Pratap  Gupta    15/03/13   25   ©Rajendra  Pratap  Gupta  .  Email  :    office.rajendra@gmail.com  
    •     USA  is  moving  to  ‘meaningful  use’  of  IT,  and   India  is  just  about  to  start  ‘using’  IT.  So  ,  while   USA  has  become  a  pioneer  as  a  user  of  IT,  India   is  just  a  provider  of  IT  services.  But  in  the  next   five  years,  India  will  move  ahead  of  USA  in  the   adopBon  curve  of  HCIT’     Rajendra  Pratap  Gupta     15/03/13   26   ©Rajendra  Pratap  Gupta  .  Email  :    office.rajendra@gmail.com  
    • Disclosures  &  Acknowledgements     •  Views  presented  are  personal     •  Presenter  is  associated  with  healthcare  organizaBons  across  USA,  Europe  ,  U.K.   Middle-­‐East  &  India  .     •  The  figures  and  studies  are  indicaBve  &  for  representaBonal  purpose  only     •  Utmost  care  has  been  taken  to  quote  the  data.  Any  inadvertent  error  is  regreded   •      •  The  presentaBon  has  used  many  resources  and  acknowledges  the  contributors   with  appreciaBon  and  thanks  .  Some  of  the  trade  names  /  marks  used  may  belong   to  third  parBes  ,  and  have  been  quoted  just  for  the  sake  of  informaBon  for  the   audience  with  or  without  the  consent  of  the  respecBve  trademark  owners    .     •  Please  do  not  copy  or  reproduce  in  whole  or  part  thereof,  the  contents  of  this   presentaBon  without  the  wriden  permission  from  the  presenter  .     •  Website  for  downloading  www.rajendra.groupsite.com     27  ©  Rajendra  Pratap  Gupta  .  Email:  office.rajendra@gmail.com