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Strategy for Global Health Care for the 21st Century
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Strategy for Global Health Care for the 21st Century


Cloud computing, the prevasive Internet and Thin Clients/Netbooks/Smart Phones have made Health Care Hardware affordable for even the poorest of our 6 billion fellow humans who are at the BOP. …

Cloud computing, the prevasive Internet and Thin Clients/Netbooks/Smart Phones have made Health Care Hardware affordable for even the poorest of our 6 billion fellow humans who are at the BOP.
Free Open Source, software (FOSS), like US Veterans Administrations EHR - VistA, with 30 years of operations, in over 1300 facilities, from small clinics to 1000 bed specialty hospitals, in a realtime, fully networked paperless system provides globally acclaimed quality and cost effective health care to over 25 million veterans at over 1300 facilities spread over the US is available. A strategy for a fifth of the global population (India) to leverage its potential to serve the globe, by tele-medicine, EHR, Medical tourism and use of ancient systems of medicine, Yoga, Ayurveda etc.

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  • 1. Health Care Powered by Open Source Software: An Out of the box approach Vipen Mahajan Principal Consultant Leo Systems Chicago, Boston, Munich, New Delhi
  • 2. Open Source: Brief backgrounder
    • 21 st Century is knowledge driven, unlike the earlier agricultural and industrial waves (Alvin Toffler)
    • For IT and software Open Source (OSS) is arguably closest to the doctors Hippocratic Oath as against the prevalent the Industrial/Medico-corporate ethic.
    • Allows you to see the source (blueprints), alter/improve/modify it to suit your needs, with little restrictions.
    • Can be maintained/improved even if the vendor shuts shop.
    • OSS caught on in 1990s with Linux Operating Systems and has diversified with an exponential growth since.
    • Today OSS is used widely in practically every field. New solutions sprout up everyday, challenging old concepts and proprietary/closed software.
    • Allows you to see the source (blueprints), alter/improve/modify it to suit your needs, with little restrictions. No vendor lock-in.
    • Can be maintained/improved even if the vendor shuts shop.
    • OSS often is free (to become FOSS) so you save on license fees and maintenance charges.
    • There are over 300 F/OSS (free open source software) in Health Care domain alone.
    • Notable amongst them is VistA a Health Care solution, not to be confused with Microsoft Vista Windows Operating system !
  • 3. Vista - Health care IT System
    • Developed by dedicated teams of doctors and programmers, using Open Source collaboration and RAD development process.
    • Enterprise level, has over 150 clinical, financial and administrative modules.
    • Cost billions of US taxpayers dollars to develop. Available as FOSS under FOIA (with limitations)
    • Over 1000 full-time developers and support staff who maintain it. A Healthy Open Source Community (Hardhats and WorldVistA).
    • VistA runs the US Military’s Veterans Administration (ex-servicemen) health care system.
    • Connects over 1300 VA facilities from small clinics to large 1000 bed hospitals in a fully integrated paperless network.
    • Serves over 25 million Veterans
    • Proven, in use for over 3 decades
    • VistA has had rave reviews from Time, Newsweek, Washington Post Wired etc.
  • 4. Vista outside VA and around the world
    • VistA derivatives also being used in US military, US-Indian Health Care System.
    • WorldVistA, a non-profit for VistA outside the VA has developed WVEHR- a Vista based EHR.
    • Medsphere, DSS and others also developing on VistA base
    • Growth into Mexico, Germany, Egypt, Finland and recently Jordan etc.
  • 5. US Health Care Bills and VistA
    • Health care has not benefited from the IT revolution like other Industries/businesses.
    • In US 10% mortality caused by the Health Care systems.
    • Health care costs are galloping, making OECD economies un-viable.
    • In Feb 2008, Obama Admin. passed $16B ARRA act to stimulate/ streamline/modernize Healthcare through a nation-wide IT driven EHR.
    • EHR systems proliferate, rarely talk to each other, with little standardization, much like a tower of Babel !
    • Obama’s CTO, Aneesh Chopra , examining if VistA could become a platform for national health care IT standard, in an IAC meeting, which has members like IBM, Dell, Oracle, CISCO etc. The jury is still out.
  • 6. 21 st Century Technology enablers
    • FOSS slashes software costs
    • Internet slashes network costs
    • 3G, WiMax, DSL etc allow rapid, affordable deployment of digital networks. Probably the cheapest infra-structural investment.
    • Virtualization/Cloud/Utility/Grid computing slashes server costs.
    • Thin Clients, net books, net-computing, PDAs, cell/smart phones slash personal computing costs
    • Even the BOP can afford IT based solutions!
    • An entrepreneur, with an idea can compete with an IT giant !
  • 7. 21 st Century Paradigm shifts
    • IT usage widespread in OECD nations
    • IT affordable even for the BOP, i.e. 6 Billion people can be covered with IT access.
    • Cell phones being added in tens of millions per month, in developing countries.
    • Knowledge doubles every 2 years
    • Distance and elearning revolutionize the spread of Knowledge, and the way we learn.
    • ERP/CRM help to manage networked organizations of all sizes
    • IT integrated supply/distribution chains power global commerce.
  • 8. 21 st Century Health Care Paradigm shifts
    • Recession proof with large unfulfilled demand. Global Health Care capacity shortage
    • Health care Accounts for nearly 20% of GDP for OECD.
    • VA and Vista has shown that IT driven systems result in better Health Care at lower costs.
    • Tele-medicine, ship information not bodies!
    • Runaway OECD health care costs make “Medical Tourism” viable
    • Global Health Care systems/supply chains?
  • 9. The Indian Health Care Scene
    • Manpower shortages, India has 0.5 doctors and 0.6 nurses per 1000. vs. OECD’s 4-6 and 10. The problems gets worse in rural areas.
    • Manpower and facilities acute shortages, more so in rural areas.
    • Most health care provided by private sector. Govt hospitals state is poor.
    • Spurious drugs are a serious problem
    • Rich, time tested age old alternative medicine systems, Yoga for example, need research and integration with modern systems
  • 10. An Opportunity for India
    • An out of the box, innovative approach needed to address the needs of the BOP.
    • China, in less than a decade has become the “Factory to the World” .
    • Challenge:
    • In next 5-10 years can India become the “Global Health care Provider” (GHCP) ?
  • 11. Indian Scene Creating Capacity Manpower
    • With a billion plus population we have enough “raw manpower” to build a world class health care system, in fact one which can become a GHCP to meet global demand too.
    • 300,000 applicants for the 30,000 odd seats in Medical colleges. What needs to be done to increase the capacity to 150,000 ?
    • Distance and elearning, to meet teaching staff shortages.
    • Can we have a few lacs “barefoot doctors”, technicians, etc with short sandwich courses? They will staff the local Primary health care centers, which will be linked by tele-medicine to centers staffed by more qualified providers/consultants and supported by secondary/tertiary/specialty hospitals
    • Similarly for other providers.
    • Extend the system for India/alternative health care systems like Ayurved, Yoga etc. Made possible with Open Source.
  • 12. Indian Scene Creating Capacity: Standard Modular Facilities
    • Develop standard modular designs of facilities, and with a few variations, and mass produce them, in a “factory” production mode, assemble them on standard sites.
    • This approach will slash to costs by 30-60%, and the lead time to create the infrastructure. Much like how the Chinese are able to build a 500MW power plant in 9 months while we cannot even design and send out tenders for the project.
    • After Pearl Harbor, in WW-II, the US was able to overhaul their factories to defense production in 6 months. Producing aircraft carriers, in assembly lines in 9 months vs older ways of 10 years ! Maybe because the Chinese leaders are all engineers while we have few leaders with industrial/manufacturing expertise.
  • 13. Indian Scene Creating Capacity with IT driven Processes and Management
    • Designed standard modular facilities.
    • Design best practices, ground up for optimizing the operations of these facilities. Develop SOPs for the same, with performance metrics, for management planning and control.
    • Train all fresher’s in these SOP’s to start at high EHR Level/stages. To achieve high quality. Replicate these facilities, by anchoring them with staff experienced in the standard SOPs.
    • Use IT for all aspects, paperless systems with realtime planning, monitoring and control.
  • 14. Indian Scene Managing with EHR/HIS and ERP/CRM
    • Standardize on a EHR - VistA.
    • Why VistA?
        • VistA has a proven track record and a brand name
        • Proven, Open Source. Extensible/Expandable
        • The Window of Opportunity is small. It will take many years to develop and test a proven new system ground up.
        • Cloud based, scaleable for a National/Global EHR network.
    • All citizens to have a common readily accessible EHR database, designed with adequate security and safeguards/privacy.
    • Link a cradle to grave EHR to Nilekani’s Universal Identity system.
    • The EHR integrates to other systems, like Insurance and billing, payments, reimbursement etc.
    • Pharma industry supply chain powered by CPOE, EHR and ERP/CRM/Supply Chain Software.
  • 15. Implementation Guide
    • We will setup a social networking group for VistA health care. Join it, to carry forward this discussion, and become a watering hole for like minded people to meet virtually, share thoughts and resources.
    • Undergo an elearning exposure to VistA as well as the hands-on experience of using Vista’s GUI provider interface (that is what the doctor sees and uses on his computer), so he is comfortable with it.
    • We use web-conferencing, Skype and emails to keep in touch. Develop eLearning based courses for training and re-learning/CME.
    • Develop a VistA based server data centers for small hospitals, PHC’s and GP’s.
    • Bootstrap tele-consulting, by providing part-time work to doctors for rural patients. All the time building upon the portable electronic health records of the public, so they have flexibility of choosing a provider for further consultation. Create a level playing field for the tele-consulting area. Practioners can work from home, and do not need expensive real-estate to setup their practices. His would further reduce their costs, and reduce the entry barriers for fresher’s to start their own practices.
    • Develop standard, modular facilities designs and building standard practices. Training people in these and then commissioning them.
  • 16. Funding GHCP
    • Start developing manpower to meet global HIS and EHR systems adoption.
    • Develop standard practices and modular facilities.
    • Aggressively build capacity and promote Medical tourism thru select world class Indian hospital chains.
    • The 1990’s Y2K crisis triggered of the Indian IT sectors. leverage US $16b infusion to boost the Indian EHR/HIS boom through man power exports.
    • Master tele-medicine with rural markets, EHR and modular facilities
    • Grab the global OECD and BOP markets.
  • 17. Join the Action/Movement
    • For a starter visit
    • www.indiaahead.net/vista
    • Join us to get more information and to get involved.
  • 18. Thank You
    • Contact Vipen Mahajan at:
    • [email_address]
    • Wiki/Weblog:
    • http://indiaahead.net/tikiwiki/tiki-index.php?page=A+Journey+Home
    • Skype ID – vmahajan
    • Cell phone: +91-981-890-4703
    • India Delhi:+91-11-41635329