Cloud computing has the potential to be a game changer for the Indian healthcare system. The adoption of cloud services can help address issues like the high cost of infrastructure for hospitals while improving scalability, access, and efficiency. One example is Rainbow Hospitals, a large pediatric hospital network, which overhauled its legacy IT systems by implementing a new electronic medical records and other software systems on the cloud. This allowed the hospitals to scale resources as needed, gave clinicians ubiquitous access to patient information, and led to improvements in turnaround times, documentation accuracy, and other operational metrics. Cloud computing can reduce costs for healthcare organizations while improving care delivery if implemented successfully.

1. 1
Cloud Computing in Indian Healthcare -
A Game Changer
U.K. Ananthapadmanabhan

2. 2
Dichotomy in Indian Healthcare
 40% children malnourished / inadequate Public health infrastructure
/ Acute shortage of medical professionals
 Public sector provisioning 20% while private sector is 80%
 Overall, good improvement in life expectancy/MMR/IMR/eradication
of polio
 Corporate hospitals and medical colleges established / Reforms
initiated – NEET
 Huge Private equity / Venture capital / Foreign / NRI investment in
Healthcare
 Hitech procedures done at a fraction of US costs – Emergence of
medical tourism

3. 3
Technology Penetration
 India leapfrogging in Information Technology and Telecom. India is a IT
power house of the world
 Enormous support, encouragement and investment by state and central
governments under “Digital India“ initiative
 Healthcare – a slow adopter of technology, unlike Banking, Manufacturing
and Retail
 Healthcare organizations are slowly changing focus from automation of
back office systems/reimbursement methods/regulatory compliance and
accreditation requirements
 Major drivers of Healthcare IT - establishment of large hospitals in private
sector, insurance penetration, accreditation requirements and emerging
disruptive technologies like cloud computing, Robotics, Machine leaning,
Big data and BOTs

4. 4
What is Cloud Computing?
Discussion
 Hardware, software applications, Network,
storage resources are sold and consumed as
a service or utility like electricity / air travel
 Shared pool of configurable computing
resources
 Real time, available on demand, rapidly
deployable, minimum management effort or
service provider interaction
 Any time, any device, any place access

5. 5
Key Characteristics of Cloud Service
Measured
Service
• Pricing for no. of cores,
RAM, Storage, Disaster
recovery systems, Band
width
• Annual Maintenance
contracts, MC
• Escalation Matrix
Rapid Elasticity
& Homogeneity
• Provisioning by day /
time for increasing
patient loads in existing
/ new hospitals
• Version upgrades
• Master data and work
flow standardization
Multi-tenancy
& Resource
Pooling
• Multiple hospitals / clinics
• Operating systems / HIS /
SAP / email services / 3rd
party software tools
Ubiquitous
Network Access
• Remote / any device / any
location (hospital / clinic /
home) access

6. 6
Cloud - Service & Deployment Models
Cloud Service Models Deployment Models
Infrastructure
as a Service
For processing, storage,
networks, and other
computing infrastructure
resources
Platform
as a Service
To deploy applications
developed using specified
programming languages or
frameworks and tools onto
the cloud infrastructure
Software
as a Service
Private Cloud
Public Cloud
Hybrid Cloud
To access applications from
varied end-user devices
(generally through a web
browser)
Operated solely for one
organization only or for an
individual person
Open to the general public or
large industrial groups and are
owned and are usually managed
by a cloud service provider
Combining two or more clouds
(private or public) that remain
unique entities but are bound
together with data and
application portability.

7. 7
Why Cloud in Healthcare?
Cost Effectiveness
Elasticity
Rapid Scalability
Anytime-Anywhere Access
 Move from CPEX to OPEX for new hospitals (Pay as you go)
 Long term reduced cost of owernership for existing hospitals
 Less IT manpower costs
 Computing resources can be configured for varying transaction
load patterns peak times in a day / week or Holidays
 Ensures optimum untilisation of resouces
 Establising servers / networks / airconditioning / power
conditioning equipment may take one or two months
 Provisioning hardware /software / tools will just take few hours
 Clinicians access any data from any place at any time for any
patient – improving quality / efficiency and patient experience

8. 8
Benefits of Cloud Computing

9. 9
Key Risks & Challenges
Data security,
Integrity, Privacy
and Compliance
Latency Risks
 Lose contorl over patient data and
privacy
 May not be certified or compliant
for industry standards / regulations -
NABH / HIPPA
 User request to server response
 Time – Ping time
 Computational and Network
 Bandwidth constrains from network
vendors – Fibre optic lines?
Few Hospital
Information
Systems in the
Cloud
 Most HIS not cloud ready
 Hospital Management and IT staff
still hesitant to embrace cloud
Description
 Identify vendors with region specific
certifications / compliances
 Ensure data security / privacy
guarantees
 Choosing the right / trusted vendor
 Proximity of hospital to data centers
locaton
 Indian and foreign vendor gearing
 Cloud version / localization and
customization of software CST / TCS
Mitigation

10. 10
Cloud Market in Global Healthcare
By Region
North America Europe Asia Rest of the World
Pricing Model
Pay as you go Spot Pricing
End-users
Healthcare Providers Healthcare Payers
Deployment Model
Private Cloud Public Cloud Hybrid Cloud Community
Cloud
Software
Clinical Information Systems Non-clinical Information Systems
Component
Hardware Software Services

11. 11
Cloud Deployment in Healthcare
Hospital
Information
Systems
Network Vendors
Disaster
Recovery
Systems
Data Centers
Provision VMs / storage
Location of data centers
Long term contract (5years)
Better pricing; Falling Cloud
services pricing
SLA contracts
Escalation Matrix
Monitor Resource consumption
Primary & Secondary
MPLS connectivity
Fiber optic Vs RF
connectivity
SLA - 99.9% up time
Take advantage of falling
prices
Patient Management
Op/IP Billing; CPOE
Radiology/Laboratory services
EMR/PACs and ERP- SAP
Third party software – Asset
management, canteen billing
Claims Management
Hot / Cold DR
Remote location
Expensive

12. 12
Sl No Name of vendor Healthcare Organization
1 CtrlS Data center,
Hyderabad
Apollo Hospitals, Rainbow Hospitals, Call Health
2 Ricoh India data
center
Fortis Hospital, Delhi /Artimis, Gurgaon / Emanuel Hospital
3 Microsoft Azure L V Prasad Eye Institute, Hyderabad / Partners Health, United
States / Apollo Hospitals / Fortis Hospitals
4 Amazon Cloud
services
Cleveland Clinic, Ohio, United States
Cloud service providers & Healthcare
customers

13. 13
Case Study: “Rainbow Digital” – Cloud HIS for
Rainbow Hospitals (1/2)
Context
Legacy Systems
Key Initiatives
Rainbow Children’s hospital is one of India’s largest,
foremost and most progressive super-specialty pediatric
hospital networks - 800-bed, private, equity-funded group
has positioned itself nationally as a center of excellence.
Why Cloud?
Growth necessitated a complete digital transformation and meeting commitments to ongoing
improvements to patient safety, quality of care and efficiencies as more hospitals came online.
Decision to comprehensively overhaul all hospital IT systems and replace the old legacy system
with a new state-of- the-art integrated solution.
1200
600
1200
# of Total Beds Daily in-patients Daily out-patients
Newly procured Arcus hospital information system including electronic medical records
SAP and Adrelin (Polaris) ERP systems for materials, HR, and finance management
Integrated and hosted on the cloud at the well-established Tier4 cloud service provider, CltrS
limited, Hyderabad. CltrS has data centers in Hyderabad, Mumbai and Delhi.
Cloud-hosting has enabled Rainbow to scale up or down its infrastructure requirements based on
fluctuating and evolving demand with minimal investment.
Rainbow ran with two large computer servers - one supporting four hospitals in Hyderabad (the
Hyderabad cluster) and another - a stand-alone server at Vijayawada hospital.

14. 14
Sl
No
Name of Hospital /Clinic location No of Beds Type of
Project
Date of Go
live
1 Raiinbow ,Vikrampuri, Hyderabad 75 Existing 25/1/15
2 Rainbow ,Kondapur, Hyderabad 70 Existing 22/2/15
3 Rainbow Kukautpalli Hyderabad 100 7/3/15
4 Rainbow Madhapur clinic Hyderabad NA Existing 17/3/15
Rainbow ,Banjara Hills Hyderabad 175 Existing 19/3/15
Rainbow children’s hospitals with cloud enabled Arcus HIS

15.  Clinicians visiting multiple hospitals - now able to access HIS and order for tests,
procedures, view reports and write notes from remote locations
 Group purchasing and centralized store management for all hospital units with SAP
hosted on the cloud – helped reduce inventory & material purchase costs
 Real-time dash board reports on number patient visits, inpatient and outpatient billing,
pending laboratory reports, manpower/ material cost greatly improved
 Turnaround times in laboratory, radiology, OT & OPD areas down by 40 to 50 percent
 Configuring 3rd party software, lab equipment, tariff across all the version upgrades of
application software, operating systems and tools became very simple as they could be
done centrally on the cloud eliminating the need to perform in each hospital server
 Ensuring security, integrity, and privacy of patient data practically shifted to Cloud
service provider. Hospital IT department - no longer required to ensure these in each of
the hospital units and less dependent on their IT personnel
 Legacy software in hospitals replaced by new Telstra Arcus HIS one after another over a
period of one year with a time gap of one month.
Key Outcomes
60%
50%
60%
50%
50%
Improvement in
documentation
accuracy
Increase in patient
satisfaction rates
Reduction in theatre
waiting Time
Reduction in laboratory
test results turnaround
times
Improvement in
radiology turnaround
times
Productivity Impact
Case Study: “Rainbow Digital” – Cloud HIS for
Rainbow Hospitals (2/2)
 With Cloud - existing hospital servers became redundant and no infrastructure maintenance required in any hospital

16. 16
Thank you!
Questions?