Gap analysis in India healthcare systems by Simplisse Eyadema

Gap analysis for Information Technology in India heath care system
2011
ECU_MBA_IS Bangalore Management Academy, Bangalore Page 1
CHAPTER ONE: INTRODUCTION ------------------------------------------------------------------------------------ 3
1.1 BACKGROUND -------------------------------------------------------------------------------------------------- 3
1.2 GAP ANALYSIS BASED ON THE INFORMATION TECHNOLOGY INDIAN E-HEALTH CARE
SYSTEM. --------------------------------------------------------------------------------------------------------------- 4
1.3 PROBLEM OF THE STATEMENT ----------------------------------------------------------------------------- 5
1.4 PROBLEM ASSOCIATED WITH THE CURRENT SYSTEM ------------------------------------------------ 5
1.5 HYPOTHESES OF THE STUDY -------------------------------------------------------------------------------- 6
1.6 SIGNIFICANCE OF THE STUDY------------------------------------------------------------------------------- 7
1.7 SCOPE AND LIMITATIONS OF THE STUDY---------------------------------------------------------------- 8
CHAPTER TWO: LITERATURE REVIEW ----------------------------------------------------------------------------- 9
2.1 INDIA HOSPITAL INFORMATION TECHNOLOGY INFRASTRUCTURE-------------------------------- 9
2.2 INFORMATION TECHNOLOGY FRAMEWORK FOR HEALTHCARE SYSTEM -----------------------11
2.3 INDIAN HEALTHCARE SYSTEM -----------------------------------------------------------------------------12
2.4 HIERARCHY OF INDIA HEALTHCARE SYSTEM-----------------------------------------------------------13
2.5 PAPER-BASED PATIENT RECORD SYSTEMS -------------------------------------------------------------13
2.6 BENEFITS OF ELECTRONIC BASED SYSTEM:-------------------------------------------------------------15
2.7 THE CHALLENGES OF INFORMATION TECHNOLOGY HEALTHCARE SYSTEM--------------------16
2.7.0 Private hospitals achieved information system infrastructure.---------------------------------16
2.8 COLOMBIA UNIVERSITY RESEARCH INSTITUTE --------------------------------------------------------17
2.9 IMPLEMENTATION OF INFORMATION SYSTEM IN APOLLO HOSPITAL --------------------------18
2.9.0 Horizontal Integration of Hospital Information System-------------------------------------------23
2.9.1 Integrated seamless healthcare delivery system---------------------------------------------------23
CHAPTER THREE: METHODOLOGY--------------------------------------------------------------------------------24
3.1 INTERVIEW -----------------------------------------------------------------------------------------------------24
3.1.0 Types of interview used in this research.-------------------------------------------------------------24
3.1.1 The unstructured interviews:----------------------------------------------------------------------------24
3.1.2 The structured interview: --------------------------------------------------------------------------------25
3.2 QUESTIONNAIRES---------------------------------------------------------------------------------------------25

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3.2.0 Advantages of questionnaires---------------------------------------------------------------------------25
3.3 THE DEPENDENT AND INDEPENDENT VARIABLE------------------------------------------------------25
3.4 THE ELECTRONIC HEALTH RECORDS ---------------------------------------------------------------------29
3.5 MEDICAL HEALTHCARE OUTSOURCING SCENARIO---------------------------------------------------29
3.6 BUSINESS INTELLIGENT IN HEALTHCARE SYSTEM-----------------------------------------------------29
3.7 EHR: A SYSTEM TO SYSTEMS -------------------------------------------------------------------------------30
3.8 ELECTRONIC HEALTH RECORD (EHR)---------------------------------------------------------------------31
3.9 STATISTICS HEALTHCARE SYSTEM IN INDIA ------------------------------------------------------------31
3.9.0 Three tiered government healthcare infrastructure-----------------------------------------------32
3.9.2 Public Private Partnership (PPP)------------------------------------------------------------------------33
CHAPTER FOUR: RESULT AND DISCUSSION---------------------------------------------------------------------34
4.1 IMPROVING HEALTHCARE INFRASTRUCTURE----------------------------------------------------------34
4.2 MEDICAL INFRASTRUCTURE DEVELOPMENT-----------------------------------------------------------35
4.3 HEALTHCARE INDIA MARKETS TRENDS.-----------------------------------------------------------------35
4.4 INDIA HEALTHCARE ESTIMATION MARKET OVERVIEW BY 34.2 BILLION------------------------36
4.4.0 India healthcare estimation market overview ------------------------------------------------------36
4.4.1 Healthcare System Investment in Information Technology Market ---------------------------37
4.5 HEALTHCARE SYSTEM MEDICAL EQUIPMENT AND IT.-----------------------------------------------37
4.6 THE STATISTICS OF HEALTHCARE INFRASTRUCTURE IN INDIA-------------------------------------37
4.7 HEALTHCARE SYSTEM OF AUTOMATION INTEGRATION --------------------------------------------38
4.8 PATIENT CENTRIC APPROACH -----------------------------------------------------------------------------38
CHAPTER FIVE: CONLUSION ----------------------------------------------------------------------------------------39
REFERENCES------------------------------------------------------------------------------------------------------------49

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CHAPTER ONE: INTRODUCTION
1.1 BACKGROUND
The health care system in India is one the largest sectors, based in economy, which is
bringing revenue, employment in a since of expanding the economy rapidly. In 19
century the Indian health care system grew 16% per annual. This 21 century the total of
the value increased about more than 34% per capita by 2012 the healthcare system in
India is expected to be 40%.The private sectors is contributing more than 80% of total
entire healthcare system . Growing and the economy the healthcare sector Indian
booming population this time now more than 1.2 billion and annual increasingly by 2%
rate per annual the India expected surpass the China by 2030 and will be the most
population in the world by 2050 with population of 1.6 billion.
The Information technology is tool and competitive „weapon‟s today business among the
firms especially these have a lot of customers and many department like Hospitals. This
topic is related to research perspective and analyses the gap between infrastructure
hospitals as whole the current scenario and the past, how manual system was used before
and how technology today‟s improving hospital productivity through efficiency and
responsiveness.
The healthcare Indian system today can be described inter-organisation “hospitals”
collection of people, resources to deliver services in order of response the health care
system, to meet, mission, vision, and target of population needs. There is a wide variety
of health care system across the India and different technology using are differ depend
upon the organisation working condition and how its vision, mission, core value and
objectives have been set up by the top management.
However last decade the Indian health care system was using traditional manual system
which was not suitable items of humans error, recording missing, treatment mismatch
because the technologically laboratories, medical error during production and distribution
system, patient safety. These errors and other problem associated is because the
traditional system record keeping, written data, store on the paper, therefore that can be

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easily get lost. There are many disadvantages of using traditional manual system such
disadvantages was enforcing the organisation to shift from it to computerized system. The
hospital infrastructure IT/IS is helping both hospitals and patients to produce the data
required during consultants, operation and other kinds of services.
The current study is carried out in a project framework information technology
/information system of ensuring well explained of how integration, application of
technologies are correlated to achieve a hospitals goals. This current system will be look
at system integration of IT/IS in order to evaluate and analyse the gap available in Indian
health care system .This project will address the problem available during processing and
delivery the services to the end clients/patients.
1.2 GAP ANALYSIS BASED ON THE INFORMATION TECHNOLOGY INDIAN
E-HEALTH CARE SYSTEM.
Small pharmacies from rule area faced a lot of challenges for accepting e-prescription
together with refilling request.
The majority of rural and urban providers don‟t provide and support the electronic order
system of medication the providers still relay on old model thus are the challenges today
e-distribution and electronic prescription system needed to support healthcare efficiency.
Due lack of integration of IT/IS the large problems is the clinical laboratories items of
sending results electronically as results at the rural area do not have the capability of
sending the tests results electronically due the lack of HL7 integration.
Health care plans support the transaction to be eligibilities in order of payment,
replenishments, verification of FIFO, needed to be done for both interests either part of
supplier, client‟s side. EDI is the way of come up with this desired state due stabilizes the
verification of diversity of electronic interchange.
The finance struggle the most hospitals either private sectors and government since last
decade have never been accomplished implementation of IT /IS due the lack of financial
sufficient and not interests to invest in IT normally because of (RIO)Return On
Investment takes time, therefore makes them failure in their business process and its
established strategies.

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1.3 PROBLEM OF THE STATEMENT
The aim of this project is to research and analyse the gap available in the inter-hospitals
and its departments, services offered by the hospitals using the computerised and manual
system and then draw conclusion based on the facts findings how IT/IS infrastructure was
improving the services delivery to the customer, ensure the efficiency and responsiveness
of services delivered to the patients. This project will demonstrate how the
implementation of Information Technology in the hospital will be increase the
productivity across the hospital either internal and external business process, patient can
be able to contact doctor, and get response at time based in historitical status and also the
benefits of uses Information Technology especially HL7 integration for increasing the
efficiency and responsiveness of the hospital.
1.4 PROBLEM ASSOCIATED WITH THE CURRENT SYSTEM
The current system main problem faced by the Indian health care system is that failed to
satisfy the customers/patients expectation because it because inefficient. The following
are the several specific problems which include the following:
Since the India is the second largest population after china with the population of more
than 1.2billion if you compare the infrastructure of health care system is inadequate based
the information findings across the private and public hospitals the specialisation doctors,
Information, equipment, beds available are not fitting the population.
The Indian infrastructure system is inadequate if you compare with the population
available in India and therefore patients are not satisfied the beds, treatments, and others,
based in the analyses done through the various hospitals infrastructure. The Indian
infrastructure is composed the medical providers such as specialists, clinics, nursing
homes and hospitals, next is the diagnostics services canters, medical equipment
manufacturers, medical research organisation and so forth on.
The India total beds are inadequate current demand and based on research done India
office law on health care system illustrate that the multiple hospitals private and public
hospitals and clinics. Like Apollo hospital which has only the 9000 beds across the
countries, dispensary, Fortis heath care which is composed by 12 hospitals with 1,900
beds, Max health care system which can treats about 3000 patients per months are very

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few compare the India populations around the Bangalore, Manipal hospital which is
composed by 7 approximately 9 centres at 7 rural locations and 8 urban locations which is
inefficient, the statistical illustrated by analytical Arvind Eye hospital shows inadequate
due huge population.
The IT equipment in India health care system is poor based on economically and caused
of failure to investment in IT/IS because the (ROI) Return On Investment/ payback period
is not visibility it takes time and therefore the stakeholders are not interested in investing
much in IT.
Software also is an issue, the business strategy is based on implementation of new
software, hardware and networking is major of facilitating business process model in an
health care system like hospital therefore due to the failure Implementation and
adaptation new software makes the inefficiency and less effectiveness in the hospitals as
whole.
1.5 HYPOTHESES OF THE STUDY
This was undertaken after realizing the huge potential benefit which the proposed project
will bring into based the improvement of current working scenario of uses information
technology as competitive “weapon” is today in the organization in order to meet the
competency therefore a project can be technically, socially, organizationally and
economically undertaken
 Online schedule between doctors and patients based timetable for consultation
over the internet
 Appointment from doctor to patients is very hard due collaboration tools not being
available
 Online record keeping system regarding the medical record and report from
different department
 Online database patients record system which enabling historitical data for
patients to be recorded long term
 Enhancing innovation in the hospital from different perspective such as hospital
equipment
 Initialise of knowledge management either tacit or explicit knowledge in the sense
of share information among doctors and nurses.

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 Implement and install new technology to help hospitals for sharing information
effectiveness and efficiency.
The expectation is that if information Technology infrastructure will be well implement
and utilized in the Indian health care system then using my SAP, ERP,SCM HL7, CRM
and other technology integration software which available on the market will improve the
benefits. The currents procedures does not meet the suppliers and patient‟s requirement
items of response and knowing the stock level and reorder time schedule therefore if the
proposed project will be implement will minimized customer‟s complaint, the
transactions both side patients and hospitals will be easily collaborated through B2B, B2C
and others transaction related business exchange, the customization and configuration
will well done without complex on it.
1.6 SIGNIFICANCE OF THE STUDY
This study will assess and evaluate the current Information system infrastructure then
bring the fact finding and come up innovation and improvement supposed to be done in
order to suit the need both hospitals, patients and supplier. Based on this research will
continue to take place and gathering data, evaluate that data it is clear and understood that
improvement of the current system will help the hospitals to increase productivities, share
information and collaborate with their suppliers in such way that everyone will be in
position to benefit both parties patient , doctors suppliers and hospitals will have effective
communication, laboratories will provide the results on time and hospitals will gain
intangible and tangible benefits.
Data sharing across the hospitals from various perspectives is among of the key enabling
doctors to success their objectives. Examples (laboratories images)
Distribution network is the among of improving patients satisfaction and achieve
objectives of the business
Communication of general scheme of the security system should take place for

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Examples:
 Identification and authentication
 Digital signature and confidentiality
 Certification and notary‟s function
 Application rights should be addressed such as function rights, data access rights,
non- repudiation.
1.7 SCOPE AND LIMITATIONS OF THE STUDY
The proposed project is expected to improve the working condition of the current
Information Technology infrastructure and Information System of Indian health care
system by improving the Hospital Management Information System (HMIS) to help
administrator better management monitoring , control and functionality across the
hospitals by using decision support indicators to support doctors and staff to improve
better health service, work flow enabled work paperless process and decision making
based on the result provided by system. This is going to increase revenue and decrease
costs as results of selling products and services through computerized network system
across the hospital in a India, in other hand will improve the hospitals images by ensuring
the customer satisfaction.
This project will be best allocated at least 6 months to adequately address it requirement.
Therefore the allocated time constraint compromises the deliverables and there quality
thoroughness for this system may not be possible.
The major resource of information and other ideas are face to face visiting industry sector
for health care system information technology do conducting a lots of interviews but is
impossible due time constraint. This project is funded from the limited financial resources
as student who is unemployed thus all the positives quality and knowledge will be deep
generated from the internet, articles and Journals available in the library.

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CHAPTER TWO: LITERATURE REVIEW
The current scenario is that there is no adequate infrastructure information technology
across the hospitals. However there are some hospitals already trying to come up with the
new technologies and integrate the information technology infrastructure like Apollo
hospitals such technology there is some equipment the researcher identified as tool to
help the hospital working condition and improve productivities and efficient such
technology like ”portable mobile technology” infrastructure which is enabling the
hospital rapid communication related information exchange among departments, doctors,
nurses, employees as well as patients. The other researcher talked about networking
infrastructure in the hospitals which is defined as physical component of computer
technology today‟s era such kind of infrastructure like wired and wireless technology will
be elaborate further in this chapter how is improving working condition in the Indian
hospitals. The most hospital do not have the linkages between the patients and doctors
which is appear as gap in the client side whom want services. Transaction and consultant
via the internet is still problems in the most of hospitals, appointment still being done
manually, e-laboratory too, in other hand e-lab can be defined as CDR (Clinical Data
Repository) which is one architecture in distributing results is different levels and
department across the hospitals as results is enhancing services and security, help to
manage data across the multiple healthcare providers and improve quality services in
healthcare system.
The patients need to access directly healthcare Indian system via web based interface.
This interface will bring the patients, doctors, nurses and employees to transact or
exchange information easily and together will benefits. The patients not need to go to the
hospital without appointment from doctors even though doctors will be able to do
consultants via the net and write the prescription to the patients electronically. The
patients will need more services online and immediately feedback will be delivered to
them whenever transact, request for any service. The patients will need the information
related their historitical data, laboratory test, appointment with doctors and others.
2.1 INDIA HOSPITAL INFORMATION TECHNOLOGY INFRASTRUCTURE

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The national bureau of Asian research on Indian information technology healthcare
system have been talked and summarized the statistics about the ratio was available in
2005 out of 5000 hospitals the researchers find out that an average of 89 beds was
available per 100,000 persons for a total of approximately 870,000 beds. This implies
that the population/ patients to bed ratio in India healthcare system infrastructure is one
bed per 1000 patients whereas the WHO is an average of one patient to 300 beds. [1]
Related to the Indian populations which about 1.2 billion and came to second largest after
china this statistics are not adequate and Indian population are accepted to growth in
coming years and researchers determine that in next coming years the India will be first
country with highest populations in the world even though the researcher have been find
that in the next 50 years the India will be the number 1 on economy as well as richest in
the world thus the healthcare infrastructure must be considered from the public and
private sectors. The India is leading technology world-wide related Information
technology and services and in 2005 was number four largest economy in the world with
GDP of 4 trillion items of (PPP) purchasing power parity.[1]
Furthermore accordingly this research done in 2006 hospital information technology
adoption or implementation as well as policies are not yet exist. However hospital
information Technology is the course of government to make sure that are adopted and
implemented initiatives of other related innovation technology are taking place in several
hospitals across the country.
Quality in healthcare system in India (gyani, 2010) may compromising newer technology
and effectiveness medication, higher nurses to patients ratios affordability, efficiently and
effectively of healthcare delivery the private hospital contribute approximately around
68% of the total hospital while the total beds are approximately 37%.
National Accreditation Board for Hospital (NABH) and healthcare providers like national
level accreditation this accreditation of healthcare information system encompasses the
physical infrastructure, infection control standard, security and medical equipment
technology furthermore this review was generating and demonstrating the clinical and
hospital competency items of delivery services to the customer within its boundary.
NABH described the roadmap as future quality initiatives in the areas of healthcare
system delivery furthermore the clinical establishment act 2010 have been mentioned

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about designed for mandating certain provision in the private hospital medical care
facilities and it‟s lunched phase wise from corner to corner in India(CEA, 2010).
2.2 INFORMATION TECHNOLOGY FRAMEWORK FOR HEALTHCARE
SYSTEM
Information technology framework have been implemented by Apollo hospital and its
branches across the country in 2003 the framework was to establish the information
technology infrastructure, IT governance and innovation, comprehensive roadmap,
guideline and prescribe IT standard, IT alignments and other related integrated healthcare
information networking technology.
Furthermore accordingly this research done in 2006 hospital information technology
adoption or implementation as well as policies are not yet exist. However hospital
information Technology is the course of government to make sure that are adopted and
implemented initiatives of other related innovation technology are taking place in several
hospitals across the country.
This chapter will provide a critical review to the literature based address the design of one
of major facilitating the hospital known as Electronic Patient Record (EPR). Based on the
current healthcare system in India the current scenario most of hospitals still using paper
based medical record system which are time consume and costly it is also throws the
lights on factors of designing of ERP in healthcare system in India.
According to Kalim (2008), in his explanations to the electronic patient‟s healthcare data
such as Electronic Patient Records (EHR), Electronic Medical Record(EMR),
Computerized Patient Record (CPR), and Computerized Medical Record(CMR) this
terms came time to time based the environment of nations Indian healthcare system and
its turbulent environment of healthcare organisation and industrial who was responsible
for designing and monitoring the International Organisation Standard (ISO) based
international committee of improving the healthcare.
Abdul (2008) argues that EHR is different from ERP/EMR he summarized these names
and terms and described each of how differ each other therefore found out that each has
its function slight different with others. In 1999 the information relating the to the past
was came up with Murphy in 1999 he mentioned that ” related to past, present and future
physical health of patient existing in an electronic system which is used to capture receive

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,transmit store ,retrieve and manipulate information the most important reason is to
providing healthcare related wireless based services. ”
The hospitals database of EPR consists of registration of patient, billing data based
patients, clinician‟s diagnosis laboratory data like X-ray, pathology, blood results, cardiac
and many more...The primary information is emphasizing the in formations related the
medicines, stock monitoring of drugs and its equipments facilities all these systems are
interconnected with its central data base and interoperability which helps and facilitates
physicians, reduces cost and improving healthcare system considerably.
Hannan (1999) described EPR as an essential tool for collecting and integrating medical
information in such way that order to improve efficient and effectiveness o clinical
decision-making and also Hassey (2001) described it as wide-range of practice records
which is containing the data for person as well as list entries about patient‟s medical
record health care systems.
2.3 INDIAN HEALTHCARE SYSTEM
In India, healthcare system is among of the largest service sectors, with more than 4
million employees working in the industry sector healthcare system. According to Koppar
et al 2007, in Indian healthcare sector, pharmaceutical and health insurance services
currently are estimated at US$ 22.2 billion, and is probably to be increased the range of
US$ 50 billion and US$ 69 billion at the end of 2012.
The Indian healthcare system its industry sector is developing at the rate of phenomenal
rate, with private sector hospitals, government funds and foreign aid in the public health
program steering this growth. The mixture of high quality standards service at low down
cost is also making India a destination of health tourism as this mixes fun and leisure with
necessary medical attention. The positive effects of all these endeavours is that the life
expectancy of an average Indian has increased up, moreover this is not a reason to be
satisfied as figures are still very modest when compared globally (Mukherjee et al.,
2007).
Furthermore about 70% of the people in India live in rural areas and live below the line
of poverty. These population are not capable to access the good quality healthcare,
nevertheless the hospitals located in town, small and medium cities (Mukherjee et al

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2007). After all these above the reason of implementing e-governance took place in
healthcare system based on EPR and was considering as starting point.
2.4 HIERARCHY OF INDIA HEALTHCARE SYSTEM
The Indian healthcare system follows a three tier hierarchy systems starting with
Periphery Health Centre (PHC) in remote areas, Secondary health centres that are District
hospitals and Tertiary health centres which are located in the state‟s capital cities. The
PHC provides basic health support, if the patient needs examination, they will be referred
to a district hospital and if the case needs more attention or is complex then they will be
referred to the Tertiary hospitals. This is the pattern followed by both public and private
sectors, but the difference is that private sectors will offer more choices of treatment,
depending on the paying capacity of the patient whereas public sector has single hospital
(Mishra, 2008).
According to Mukherjee et al (2007), the Indian healthcare industry is divided into two
classifications public and private sectors, where private sector serves about 80 percent of
health services and 20 percent by public sector. The private sector can be further divided
into
 Private dispensaries
 Private hospitals
 Charity hospitals managed by NGOs
 Corporate hospitals
At present, all the health providers work separately from one another thus providing no
means for continuous care of the patients. Abdul (2007) feels that, there is a desperate
need for network or continuous communication between both public and private sectors
to share information about the patients.
2.5 PAPER-BASED PATIENT RECORD SYSTEMS
According to Nanda (2006), the current situation of healthcare in developing countries
like India are quite discouraging, as the physicians use a paper based system whereby
they record patient information, diagnosis and treatments on a “Case Sheet”. Abdul
(2008) mentions that each time a patient visits a hospital, a new case sheet is created, and
this creates an excess of paperwork, repetition of examination done previously leading to

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over-consumption of work force and other resources. In India, the case sheet is an
official and legal document written by healthcare staff about all the medical information
of a patient. It includes past medical history, present complaints, results of examinations
done, diagnosis and treatment and the condition of these medical records in public
hospitals in quite disappointing. This situation is due to reluctant hospital administration
or inefficient medical record staff and it is increasing constantly by the year.
Abdul (2008) indicates that one of the important issues in paper-based records are, all the
clinical information is written in free style, and chances are high to miss or forget some
important information, as this will lead to serious effect on patient‟s treatment and care.
The case sheet is a hard copy that can be accessed by one person at a time and needs
physical transfer for other physicians to access. Retrieving a record will be a hard task
given number of medical records present and missing a record won‟t be a surprise in a
huge pile of paper based medical records. Moreover, with time, information in paper
records gets diminished of ageing paper and ink, even fire accidents or natural disasters
can ruin the archive of paper records. Karim (2008) explains that all the above discussed
issues can be over-come by implementing EMR/EPR systems, it can not only solve the
problems but also improves the efficiency of healthcare by increasing accessibility, and
needs less resources to maintain records. EPR system can be used as a resource of
researchers, it will be a tool for disease surveillance, which can be used for public health
initiatives and for practicing Evidence based medicine.

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2.6 BENEFITS OF ELECTRONIC BASED SYSTEM:
Nanda (2006) also highlights some of the benefits of EMR/EPR systems, they are the
following:
Improves efficiency: The system will increase efficient both perspective clinical
healthcare and by reducing cost while increasing staff productivities.
Quality assurance/improvement: The most electronic clinical uses to capture, store ,
retrieve information about information related patients basically is quality improvement
exam and analysis study based an outcome.
Measure physician/hospital performance: This is possibly merits of EMR/EPR
interoperability and comparability; which enabling the physicians to rectify any possible
fault relating to the healthcare.
Increase accountability: EPR system make vendors more reliable and accountable,
responsible for their daily activities
Managerial tool: EPR system can also be used as a managerial tool as it offers total, cost-
effective access to more complete, accurate patient care data. It plays an important role in
improving quality of patients care, strengthens the clinical best practice, and contribution
to managerial for healthcare costs.
According to Saleem (2009), the negative aspect of paper-based medical records systems
can be overcome by implementing EMR/EPR systems. This significance that patients
have multiple choices and no more waiting time, furthermore the physicians save time
and have past historitically of patient instantly online , therefore is ensuring safe,
efficient, consistent, and continuous healthcare for patients.

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2.7 THE CHALLENGES OF INFORMATION TECHNOLOGY HEALTHCARE
SYSTEM
Policy: It can be seen as absence of courage and clear of need IT implementation
coordinated by the government policies and initiatives of adoption the standardization in
healthcare system.
Government funds: This the researcher have been pointed out that government is not
supporting the healthcare system much, it seems like non-existed this activate such as
lack of training medical IT professionals, lack of information technology adoption and
lack of innovative of existing system in healthcare system.
Infrastructure and coordination: Both public and private sector are not supporting
hospital infrastructure in adequate manner therefore the need of initiative of IT and
infrastructure in general must be considered because today‟s business all the firm are
going to edge digital and automating process business.
Legacy system: apart from the few private sector hospitals owned by large hospitals
most record are paper based and the research find out that will be difficult to convert them
from tradition way into electronic format. Therefore need a lot synergy which will enable
the hospital to get competitive advantage, efficient and effectiveness.
Privacy : Patients confidentiality is the one major area where the hospitals must focusing
the “researcher said” the supreme court and the law of India did not addressed the specific
right of privacy issue of respect the healthcare information
2.7.0 Private hospitals achieved information system infrastructure.
Indian Space Research Organisation (ISRO) wrote about the private sector and
government hospital then there have been seen and entry of established hospital
information technology vendors like GE Siemens and home grown vendors have started
to implement IT solution in the private hospitals healthcare system facilities like
wockhardt and tertiary care hospitals group in India

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Apollo is among the hospital who tried to implement and integrate the information
technology infrastructure. Apollo is number one leading hospitals and is private hospital
has about 42 hospitals with equal platform. Apollo introduces HIPPA standards in its all
hospitals and initialized to implement the core of business process and is growing the IT
budget and operation budget.
2.8 COLOMBIA UNIVERSITY RESEARCH INSTITUTE
According to Colombia university research institute (may 2005) have been emphases on
the medical healthcare system as whole and demonstrated the important of Information
Technology in the healthcare system the research done and evaluate the implantation of
medical healthcare using Information Technology this analyse was analyse the current
status and future status for using (ICT) information Communication and Technology and
therefore this research illustrated the follows;
 Using the ICT infrastructure across Indian healthcare system will increase access
healthcare and health related information
 Increase efficiency and effectiveness of the hospital and lower cost service
delivery
 Improve ability to diagnose, treat and treat diversity diseases
 Timely more actionable public health and information accessibility
 Expand access to ongoing medical education and training for health workers
This current research will demonstrates the medical healthcare infrastructure done by
previous research on Indian healthcare system infrastructure in the private sector hospitals
and how it relate to the research provided by Colombia university research institute based
business model of hospitals implemented information technology infrastructure.

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2.9 IMPLEMENTATION OF INFORMATION SYSTEM IN APOLLO HOSPITAL
Figure 1, Shows the information technology 'Clicks' Healthcare in India
The Indian healthcare system is witnessing a rapidly change with the onset of newer,
better IT/IS applications as well as a broadening focus and increased investment in
technology by private or government hospitals
Information technological trends‟ appearing on the Indian scene, several positive
developments in the last couple of years have driven the adoption of IT/IS in healthcare
system delivery. Today the hospitals industry across India is lapping up better uses
Information Technology to access and deliver information and services at the right time
to the right people who needs services at the hospitals not only citizens also the foreigners
the India hospital is top of the country has huge number of specialists in the healthcare
system and is gradually moving on to leverage the benefits of outsourcing their non-core
functions. In reference to US based research firm Data monitor estimates Indian
healthcare Information Technology market to be the fastest growing in Asia, with around
22 per cent annual growth, followed by China and Vietnam.

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In reference of to India, it estimates that Information Technology spent on healthcare will
reach INR 1,260 crore by this 2011.As the scenario is changing as more and more
hospitals are realizing the advantages of IT enabling their hospital.
Commercial Information Technology systems for administrative functions related to
patient care introduced in the late 1990s in India have become the most widely installed
type of hospital information Technology/Information systems.
The hospitals from medium and large areas are now aware of Hospital Information
Systems and ~80% to 85% of them have implemented at least basic versions of the
system to computerize registrations, admissions and billings healthcare system.
Department-specific information systems or clinical information system (CIS) is
comparatively lower than hospital administrative Information Technology (HIS),
however market interests and demand for CIS is Building.
An estimated of 2,000 CIS have been done installations in over 550 hospitals in India.
Bulk of Laboratory and Pharmacy Informatics account for 70 – 100 installations detected
per year, followed by ICU and operating theatre, with relatively lower demand for
prenatal/ neonatal/ maternity CIS.
The HIS and CIS Indian market has reached about USD 14 million in 2008,with HIS
representing over 70% of revenue and CIS representing the remaining 30%. It is higher in
the private and corporate hospitals segment at around 80 per cent. In the public sector
(Government hospitals) segment it is around 25 %.

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Figure 2, Shows the High needed for Information Systems in Indian Healthcare
industry like in Hospitals
There are 4 basic areas that benefit from computerization:
 Activities related to Patient management like admissions, billing and discharge.
 Inventory management in a hospital.
 EHR Implementation.
 Functionalities in Back office like accounts, human resources and payroll.
Standards For distribution Information/Medical Systems:
 DICOM(Digital Imaging & Communications in Medicine)
 HL7(Health Level 7)
 UMLS(Unified Medical Language System)
 SNOMED(Systemized Nomenclature of Medicine)
 HIPAA(Health Instruments Portability And Accountability Act)

2011
Figure 3, Shows the HL7 distribution information systems across the hospitals
According to Catherine Creighton (2002) in electronic Journal of Digital imaging the
purpose of HL7 is to demonstrate the surrounding benefits of collaboration between the
system themselves disseminates and forwarding Pictures Achieve and Communication
system(PACs) across integrated applications modules PACs integrated/Interfaced with
RIS (Radiology Information Systems) or Hospital Information Systems(HIS) as whole
infrastructure information systems. All these enabling HL7 application to facilitate and
exchange interfaces used electronic text interface healthcare system. DICOM (Digital
Imaging and communication in Medicine) and HL7 describing a ways of interchanging
the data hospital
Figure 4, Shows the Laboratory Integration System.
Digital
Modalities
Hardcopy
Diagnostic Workstation
Digital Image Archive (PACS)
HIS
RIS
Digital
Modalities
Hardcopy
Diagnostic Workstation
Digital Image Archive (PACS)
HISHIS
RISRIS

2011
Based on empirical of other electronic internet paper which I went through the Apollo
has consistently led game-changing developments through cutting-edge technology now
most hospitals in India healthcare built strong infrastructure information
Technology/information system which helped them to competitive globally and satisfy
the needs to the customer moreover this is being achieved by private hospital not
government hospital. There is still a lots of things to be done in order to achieve the
required to satisfy the customer‟s need.
Figure 5, Indian healthcare system private hospital cutting edge technology

2011
2.9.0 Horizontal Integration of Hospital Information System
In additional the integrated delivery system (IDS) is a network in healthcare hospitals
which provide integrated healthcare system and offer the continuum of healthcare
services. Its improving an efficiency and maintenance delivery systems improving
productivities and sustainability of IDS, under manages care.
2.9.1 Integrated seamless healthcare delivery system
Figure 6, Horizontal Integration of Hospital Information System

2011
CHAPTER THREE: METHODOLOGY
The current system of healthcare system in India the problems have been identified and
the new system requirements established through a variety of requirement discovery
methods and analysis tools. The objective met was to establish the user and the system
requirements and document them clearly using several tools and techniques that are
suitable in the specific situation. The process of requirements discovery employ several
facts finding and gathering techniques are used such as interviews and questionnaires.
Several methodologies for analysis data and design were evaluated and the most
appropriate of information system healthcare infrastructure was established to take place
in this current situation several technology was proposed in order to eliminate the paper
based and the current healthcare system which will be established is integration of
modules applications based technologies and networking which will be enables the
system to interconnect each other across the hospital and sometimes across boundary if
the user request it.
3.1 INTERVIEW
In order to understand how current system works the some information gathering were
collected from the difference sources and also the interview was conducted. The face to
face meeting used for collecting the required information. Several researches have been
done through the different hospital such as Apollo, Fortis and other small hospitals in
other to collect meaningful information. The interview method was helpful for gathering
information about existing system as well as from individual who cannot communicate
effectively because the position they occupied and other various reasons.
3.1.0 Types of interview used in this research.
It was important for the project for gathering effectiveness to employ both the structured
and unstructured interviews. This depends on the goal of the interviews.
3.1.1 The unstructured interviews: where conducted with only a general goal with few
specific questions this type was used only once because it can be difficult to control
interview.

2011
3.1.2 The structured interview: Was extensively used because of the flexibility. It
allows interviewers to prepare specific questions to ask the interviewer. It is also allowed
additional questions and clarification depending on the specific needs open end questions
allowed flexibility on the interviewer was used as addition to a few question closed ended
questions which restricted choice.
3.2 QUESTIONNAIRES
These are special purpose documents which allows the researcher to collect information
and opinions from respondents who could be not be interviewed for varies reasons. The
questionnaires were designed in such way that there were easy to understand so that the
researcher could get fully contribution from all the stakeholders. Although fairly difficult
to use, there vital facts gathered from these questions.
3.2.0 Advantages of questionnaires
The method was very fastest way to collect information in many diverse facts. The users
or respondents were able to complete and reflects the questionnaires by hand and via the
internet. Based on secondary research on this project after combining all the idea for
framework for the different papers found out that there is challenge related the
information system infrastructure in India healthcare related different hospitals either
public or private.
3.3 THE DEPENDENT AND INDEPENDENT VARIABLE
The current healthcare system in India based on secondary data analysis is shown that
most hospital is paper based the statistical demonstrate that all most 18% from 20% of the
public are still using system legacy while the 80% in the private sector are trying to
eliminate the traditional working condition by implementing and installing new system
which will help to keep record of patient and his/her demography in long term.
Shifting from traditional system to new technology will increase efficiency, and
effectiveness at the same time will increase finance in the hospitals due this changes the
hospitals will competent and gain competitive advantage, increase operational efficiency
and decreasing the cost, keep track repetitive advantages, satisfy the patients and facilitate
the financial flexibility and increase the depreciation for essential rates of equipment, in

2011
this case will increase the hospitals growth rates in technology approximately to the
procedures of United Kingdom and united state working conditions.
The private sector in healthcare system in India either individual or group is the one
investment sector which is require more money and professional/ specialists to meet the
requirement and also its became on top of organisation which brings more investor from
western countries and its grown annual is about 15%which is faster than other service
sectors.
In this case demonstrate that private sector in India healthcare system delivery is
improving economic of the country and maximizing its profitability in a way of operate
and within under control. Working under innovation and affordability of quality medical
service care bring more tourism and government also is facilitating them to come to India
“medical visa” and “attendant visa” was granted to all these approximately one year
above and multiple visa of tourists was increase the economy of the country. Thus
medical tourism have been generate about 600 million revenue in 2006 is expected to be
increased about 1 billion in 2011 while the results of pharmaceutical markets expected to
grow from 6.2 billion in 2006 up to 10.3 billion in 2011.
Poor technology is one of barrier and is decreasing effectiveness of the healthcare system
in general thus the innovation is key success factor to improve the healthcare system.
Using the innovative technology in the healthcare system will be the only way help
doctors to increase a chance to identify the diagnosis and increase operational efficiency
and productivities of the hospitals across India.
Present healthcare system is no hope to meet competitive advantages and can‟t meets the
healthcare requirements of sustainable at the markets therefore needs correlating with
technology and most probably shifts from the legacy system to new innovation in order to
meet the future demand.
The technology benefits expected to be impact in the healthcare system in the coming
decades as results will be generating as the following:
Updating the clinical records will permit the doctors and the nurses to check existing
patients and drugs against new prescription in order to reduce errors.

2011
An intelligent patient and technology equipment will be able tracking based location
system and notify the employees need and required to take care about them. The CCTV
and other technology based hospital will identify the next stage, track loss and theft and
others.
Communication and collaboration between the staff to retrieve and see patient‟s record
will be based on real time such as communication like instead message and collaboration
tools, we conferencing inter doctors and nurses either in office or out of office the experts
doctors will continue to work may be from home or other workplace.
Knowledge management will be essential utilization in the future in order to record tacit
knowledge and using explicit knowledge will help the hospital to share knowledge which
is already stored in the hospitals system.
Social community health will be interconnected with other hospitals healthcare and
clinics doctors‟ offices as well as home care services to provide health care quality
patients care in this kind of scenario will allows hospitals to decrease costs by increasing
and managing resources effectively.
Healthcare system technology provides incredibly increase healthcare system with a
chance to heal itself. By simplifying measured in time-consuming processes and remove
some of the major impact causing the medical errors, technology will ensure the right
skill level and right cost structure is in place to provide the best care effectiveness and
efficiency of the system. Measurement by technology in the sense of high-speed wireless
networking, ubiquitous, mobility and new collaborative, and communications capabilities
which can deliver clinical, hospital and business solutions in this market."

2011
3.3.0 Challenges of Healthcare Services in India
Figure 7, Challenges an Opportunity for Information Systems Health Care Services
There are lots of opportunities available if healthcare systems in the public and private
owners which can be achieved using Information technology innovation such opportunity
will only be available if computerization integrated application, networking system to
meet the requirement for expertise likes doctors.
Figure 8, the model shows the opportunity of IT in healthcare system
Degree of merits of Infrastructure healthcare information system in India

2011
3.4 THE ELECTRONIC HEALTH RECORDS
The most important of information system infrastructure is improve and increase working
condition by keeping records for patients in all his/her life for examples are the (EHR)
which is facilitating physicians to record in electronically in digital format thus enabling
hospital to share information about patients to other hospitals across difference healthcare
settings as long as there is interconnected network and applications talking to each other.
The EHR contain all data about patients since started to visit doctors and his/her
demography must be review if is needed.
3.5 MEDICAL HEALTHCARE OUTSOURCING SCENARIO
India healthcare estimation share outsourcing last few years ago was approximately 65%
in IT service offshore and the BPO was about 46%. India have large opportunity as
skilled in IT manpoewer and is increasing broadband connectivities increasing and
sharing network, secure networking connectivities and offer robust infrastructure for
information technology healthcare servives. Year 2007-2008 market size of outsourcing
was $ US 38.5 billion and 22billions claims processing.
Healthcare Business Process Outsourcing:
Medical coding, medical bulling, patient demographics, charge entry, payment entry or
cash posting
The have also claim processing such as accounting receivable, teleradiology, medical
transcription and Patients Record Management (PRM) Electronic Medical Record as well
as Electronic Hospital Record (EHR)
3.6 BUSINESS INTELLIGENT IN HEALTHCARE SYSTEM
AS we know that the hospital store huge amount of information related patioents and its
information related medicines, employees, transactions process such as salaries, payment
and other many more information, therefore the dataware house, Data mart, data mining
and OLAP are needed to retrieve these data shotest time so that the user can get
information effeciency.
Business analytics is being used today in the hospital for effecteveness of operations
futhermore utilize new source of data digital for treating patients are improving medical

2011
experience therefore manager needs to evaluate and to solve some issues related. Using
software analysis business process management manager can over come the problem and
better control the variety of (financial, emmployees, clinical, pharmacies and patients
documents) futhermore to follow the flow of information related project being
implemented in the hospital needs that kind of software analytical. Financial flow allowed
the to use the scorecard and key indicator performance in order to evaluate financial
stement of hospital and phamacies, clinics perspectives. All these key factors of Business
Intelligence is to insure data management for effective communication and collobation
among the employee,doctors, nurses and patients in the hospital and out of hospital.
3.7 EHR: A SYSTEM TO SYSTEMS
Figure 9, EHR Architecture
Comprehensive EHR architecture
 Information Models: Define how information is stored
 Semantics: This is unambiguous representation of “meaning”
 Security: This describe and explain how to keep the information secure
 Communication: This is collaboration contained information in and out of
the EHR
 Standards: Technical concepts of building blocks for explaining and
understanding HER

2011
3.8 ELECTRONIC HEALTH RECORD (EHR)
Figure 10, Shows the statistics result of by using EHR
3.9 STATISTICS HEALTHCARE SYSTEM IN INDIA
India has occupied about slightly more than 5,92, 215 doctors 7,37,000 nurses, 170
medical colleges, 143 pharmacy colleges and 3,50,000 chemists. There are 15,393
hospitals accounting for 8,70,161 hospital beds in India.
Figure 11, Shows the statistic’s healthcare system in India
Medical colleges 170, Pharmacy colleges 143

2011
3.9.0 Three tiered government healthcare infrastructure
Figure 12, Three Tiered Government Healthcare Infrastructure
This statistics shown above are not sufficient based the country like India have about 1.2
billion and compare to US which had about 2,340 doctors as compare to India 143
doctors per 10,000 therefore still have shortage of doctors, nurses and hospital
infrastructure and currently India economy is growing quickly if you compare to other
country. Government must take control to ensure that the IT initiative must be accomplish
the arrays of activities together such as
a. Sharing information about the patients between providers and patients payers
b. Concerned with security and privacy
c. Increasing standards work IT related innovation of standard hardware and
software.
Without innovation the hospital cannot survive because of improvement of technology
therefore you found out that the increasing IT equipment together with knowledge
management is needed, much of application development software are increasing day to
day basis from different angle of the world where the engineering and research are
improving in the different perspective.

2011
3.9.2 Public Private Partnership (PPP)
The collaborative between the government and private sectors through PPP is helpful in
the sense of eliminating the inefficiently, addressing inadequate and inequity in the
healthcare system. The three major PPP are; community health Insurance; chiranjeevi
Yojna and (NHC) National Health Services. The PPP has the benefits such as cost
effectiveness, higher productivities, clear customer focus, and accelerated delivery,
enhance social services. The PPP current infrastructure investment including the
technologies like telemedicine is equalizing enhanced utilization resources in order to
improve the access to the healthcare for well utilize remote area and higher patient base
for private sectors players.

2011
CHAPTER FOUR: RESULT AND DISCUSSION
Based data collected from different sources the current healthcare system in India is not
inadequate due final constraint, healthcare system infrastructure, less investment of
government and specialists are still few compare to the developed country like USA, UK
and other development country like Brazil and China in facts the number of doctors in
USA is high than the number of doctors in India as second with huge population
worldwide after china. India population is about 1.2 billion and is expected to be
increased more than china. The healthcare system is divided into 2, as mentioned in the
early chapters one is public sectors which composed by the government and private
sectors.
The important of healthcare infrastructure system is to improve the country‟s wealth in
such way that helps the economy growth. In this scenario India is on the top country
which has speed of growing economy worldwide currently is the second largest in
economy based the report from PwC. India is the poor in the healthcare ranking 119 from
169 countries just ahead of developed co to countries.
India‟s healthcare infrastructure is insufficient items of to meet infrastructure and
equipment requirement to fit the hospitals as statistical reveal about 90 beds from 100,000
populations against a world healthcare average of 270 beds.
Still inadequate specialists such as doctors where 60 doctors occupied the position of
100,000 population against average world healthcare 140 and nurses 130 per 100,000
populations against world healthcare 280
India healthcare mechanisms item finance also is poor about 66 per cent healthcare
expenditure.
4.1 IMPROVING HEALTHCARE INFRASTRUCTURE
Based in the number of beds which shown above to improve the healthcare infrastructure
must be doubling from 90 beds per 100,000 up to 200 beds. Other position of improving
infrastructure the private sector must provide bulk of investment and therefore
government needs to do incentives. Private sectors must be improving infrastructure
rules, laws and procedures of IT equipment as well as software related healthcare.

2011
Suggestion to improve India healthcare system the equipments and other medical related
must be important duty free.
4.2 MEDICAL INFRASTRUCTURE DEVELOPMENT
The medical healthcare infrastructure is expected to increased at the rate of 14.5 % , and
the target is to achieve the hospital infrastructure requirement bed to persons with 1.98 an
investment will be needed. The beds from private by 2012 the estimation will be 38.8
billion. The India real estate company players who are powerful in leading others
organisation in healthcare system will be maximize business area in such that will
integrate townships across regions of India.
4.3 HEALTHCARE INDIA MARKETS TRENDS.
Healthcare system in India has been rapidly grow and the estimation shows that at least
by 2012 the India worth in healthcare will be 40 billion. This is revenue from healthcare
will be 5.2 % of GDP and will be among the largest growth.
Presently the India healthcare system market has estimation of 34.2 billion the market is
expected to be increased by US $50.2 and 78.6 billion by 2011 and 2016 correspondingly.
Private healthcare system expected for doubled by 38 billion and largest in the private
healthcare sectors yearly 2012 period.
Healthcare system delivery and pharmaceutics will be increased at total market by 75%.
As mentioned in the beginning this chapter the beds are about 0.9% per 1,000 people and
is below average of 2.6. The India required adding effort by increasing about 2 millions
beds to currently bed available which is approximately 1.1 million by 2027. In this case
demonstrate that government needs investment about 82 billion to increase infrastructure.
Investment early was 2:1 ratio in healthcare India system but this stage needs to be trend
up to 1:1 ratio.

2011
4.4 INDIA HEALTHCARE ESTIMATION MARKET OVERVIEW BY 34.2
BILLION
2006
100%=$34.2bn
2012
100% = $ 78.6bn
14% Infrastructure 14%
5% Medical equipment 5%
35% Bed revenues 36%
18% Pharmaceuticals 16%
2% Health insurance 5%
11% Health outsourcing 9%
1% Medical Value Travel 2%
3% Independent path Laboratory 3%
1% Clinical trial 1%
3% Training and education 3%
1% Medical Textiles 1%
6% Medical Consumables 5%
Table 1, Shows the survey result Source: the Business World, Y&E Survey, June 2007
4.4.0 India healthcare estimation market overview
2005
2006
2011
2012
Figure 13, the graph sows the market size ($ US billion)
22.8%bin
34.6%bn
50.2%bin
78.6% bin

2011
4.4.1 Healthcare System Investment in Information Technology Market
In Asia the India is on Top of fastest grow in IT healthcare market is expected to growth
about 22% this is closest to china and Vietnam. Moreover the India healthcare
technology is poised to grow and to be worth slightly more than 254 billion by 2012. The
India is expected to lead the Asia country in next 10 years due economically growth is
rapidly improving more than other counties including china. The India tourism market
worth is slightly more than US $333 million with about 100,000 foreign patients are
coming every years therefore the revenues in this segment is approximately 2.2 billion
and will continue to increase in 2012. More than 272,000 tourists have been travelled for
medical in the year 2009 and have been added over US $ 656 million in 2009.
4.5 HEALTHCARE SYSTEM MEDICAL EQUIPMENT AND IT.
Presently medical equipment and IT in healthcare more than 65 per cent are being
imported some of intellectual property right, engineering excellence, cost effective and
increasing emphases. The India hospital has been realised that Information system and
information technology (IS/IT) is the one major of effectiveness and efficiency in order to
improve productivity and services delivery to the end customers and patients. 5 billion by
2012 is expected to be increased due Information technology facilities. IT infrastructure
will allow the India rapidly produces the medical and chemists and reduces cost while
increases the revenues.
4.6 THE STATISTICS OF HEALTHCARE INFRASTRUCTURE IN INDIA
Sl.No Hospitals 15,393
1 Public 4,049
2 Private 11,344
3 Hospital beds 875,000
4 Doctors 592, 215
5 Nurses 737,000
6 Medical colleges 170
7 News doctors every year 18,000
8 Retail chemist (Pharmacy) outlets 350,000
Table 2, Shows the Statistics Of Healthcare Infrastructure In India

2011
4.7 HEALTHCARE SYSTEM OF AUTOMATION INTEGRATION
IT has the integral part of playing important role of improving healthcare system not only
India across the world Super Religare Laboratories is the among IT company dedicated to
IT system healthcare in India which is insuring that IT reduces time and errors free
therefore based the reports (Sonal Vil) now SRL limited is distributing using his
laboratory networks nearly 40,000 hospitals laboratories and about 50,000 doctors, SRL
limited can be able to perform slightly 34,000 tests labs per a single day. Based the Sonal
Vil report is expected to expand offices labs at the end of 2009 on ward due the
facilitating other IT system robust for pharmacy.
4.8 PATIENT CENTRIC APPROACH
Information technology infrastructure is gives the patients access to manipulate his /her
information related services provided by the hospital or clinics using web based IT , SMS
technology and different e-mails.
The patients is capable to receive soft copy related his / her information, such as invoices,
acknowledgement of payment can also change triggers on the web based internet such as
change password in specific time frame provided by the hospital.
Patients can receive the notifications from his doctors or in general from the hospital and
can be able updated in his /her profile, reschedule for appointment, getting their result
report, and sending also the evaluation of their health direct to his/her doctor.

2011
CHAPTER FIVE: CONLUSION
The India healthcare system infrastructure have been evolved in last past 6 decades after
the period of India independent both the public and private sectors have been increased
their working condition beat by beat depend upon the economy of the country how it was
going to and the status of the organisations as whole. This project have been identified
India healthcare system as whole it looks into the private sectors and public sectors, as
government not contributing much like private sectors researcher was concentrated to
private sector, items of evolution and innovation, economically growth, market size,
equipment required to be able for facilitating the hospitals as whole and infrastructure
required to be able to competent with other sectors and among them self.
The infrastructure in Information technology/ information system is a key framework of
IT hospitals as the development of this era required competitive information technology
as “weapon” in order to be able to carry out operation in effectiveness and efficiency way
this will help hospitals and other organisation related healthcare to improve productivity
gain competitive advantages, increasing economy while decreasing costs and minimizing
risks and errors in IT operational.
The current status of India infrastructure is not inadequate compare with the populations
of India which is slightly more than 1.2 billion and the numbers of doctors, nurses,
hospitals and beds both private and public sectors are not sufficient compare to other
country and the number of new babies‟ born are more and need more improvement of
satisfying healthcare related services.
In future study is most important to learn and research on the improvement of
technologies such as hardware and software in infrastructure healthcare system, research
and development normally the India is on top of the country worldwide which have a lot
of people skilled in IT sectors because of that the foreign companies have much invested
in India especial Bangalore called city of IT in the world. Continuous improvement in IT
sector must initialise to help much in healthcare in order to increase the worth of nation in
future.

2011
DEFINITION OF THE TERMS:
1. DICOM (Digital Imaging & Communications in Medicine): this is the standard
tools which is responsible for handling multi-activities and pass on data into
medical imaging. It can be involved the file format description and net
communication rules and procedures. Moreover this standard allows uses
application protocol and TCP/IP network communication which enabling
exchange information between two or more entities. For examples: it enabler of
integration of different hardware computers such as scanners, workstations,
printers and other manufacturer related to PACS.
2. HL7(Health Level 7): stand for Health Level Seven International is providing the
major comprehensive framework and related the multiple standards using in the
hospital heath care system such as integration, exchange, sharing, retrieval
information, best practice management hospital, delivery and assess monitor
information healthcare system.
3. Picture Archiving and communication Systems (PACS: Is medical technology
tool which offer the economical storage suitable and easy to use in multiple ways.
Is kind of electronics image which is reporting and transmitting data digitally.
4. UMLS (Unified Medical Language System): can be defined as concise yet
comprehensive the biomedical discipline of science and knowledge involved. It
also provide knowledge structure and mapping these natural language processing
and various terminology system such as comprehensive thesaurus and ontology of
biomedical concepts.
5. SNOMED (Systemized Nomenclature of Medicine): it can be described as
systematic way of organizing and enabling computer process of collection medical
technology covered by clinical healthcare system related information diseases,
pharmaceutical, microorganisms and procedures etc.
6. It determine the ways of organizing indexing, storing, retrieving information and
combine clinical data across clinical healthcare system
7. SCM supply chain management: Is a computer software packages which helps
an organisation to improve business activities by reducing error and increasing
relationship between employees and customers as well as suppliers managing
workflow activities and mitigate risks.

2011
8. ERP Enterprise Resources Planning: is computer software packages which is
integrating the a lot modules to link internal and external of entire organisation
and outside of organization for managing the business process by improving
efficient and effectiveness of organisation.
9. IT information Technology: this is a set of hardware software network
technology, database and other related devices computer technology.
10. IS information system: is combination of software, hardware people and sets of
rules and regulation standards of protocol used to achieve organization objective
in order to achieve the target.
11. CDR (Clinic Data Repository): Is a real time database management which keeps
records, retrieve data and consolidates data from difference clinical sources to
unify single patients.
12. IT Infrastructure: is information technology which composed by software,
hardware, networking to facilitate the activities related technology.
13. Software: Is computer programs that provide instructions to the computer and
tells what supposed to do during its activities.
14. Hardware: Is a tangible parts of computer system such as peripheral and other
devices
15. SET: Secure Electronic transaction
16. Clinical Decision Support System (CDSS) : is most important equipment which
interacting with the decision support system software and other technology.
17. Computerized Physician Order Entry (CPOE)
18. E-prescription: is a form of electronic transmission based transcription format
which has information about prescriber‟s computer to a pharmacy computer. It
replaces the hard paper prescription whereas the patients bring to the pharmacy for
buying medicines.
19. E-laboratory: Is electronic laboratory for reporting tests results for infectious
deceases used the automated system to facilitates export and exchange of data
from difference format.
20. Hospital Information System(HIS): Is integration of software hardware and
people dedicate to improve decision support systems, managing healthcare
systems integrating all module required to achieve efficient and effectiveness of
healthcare systems as expectations.

2011
21. E- Billing: Electronic billing system which is help hospital transaction via
electronically.
22. CRM: stand for customer relationship management is computer software package
which enabling and managing interaction between hospital, clients, suppliers, as
well as patients items of communication this helps hospital healthcare more better
optimization and managing reports of patients and suppliers.
23. DSS Drug support system: is computer system with combination of software and
hardware, application to support physicians to make decision making tasks related
diagnoses.
24. E-appointment: Is online appointment request by patients to meet doctors or the
doctors give to patients respectively to meet the patients next time for monitoring
progress of his life.
25. E-scheduling: Is online scheduling which is helping the patients to schedule
appointment as well as pre-register online convenience 24/7 days a week. It can
also help patients changes, cancel online appointments.
26. Internet: Interconnected computer networking world wide for share resources,
files, store, retrieve and information across communications partners.
27. Intranet: internal network within organization which enables employees,
shareholders, managers, to share the files and other data related within
organisation
28. B2B: Business to business in other words is business which enabling to exchange
transactions between intercompany/inter-organisation based selling and buying
product or services.
29. B2C: Business to customer or citizen is business transaction between organisation
and customers based the purposes of selling and buying product or services.
30. Electronic Medical record
31. Application and firewall
32. Anti-virus: is a program which protect computer against virus, so that computer
and programs cannot be destroyed by viruses attack.
33. Data base server: is a computer program which help and run the data base and
being able to distribute the database programs to other computers like client server
and perform other program like my SQL DB, oracles etc.

2011
34. Web server: is a combination of hardware software and programs which help to
deliver the contents over the internet and can be able to access by the anyone uses
interconnected net work computer system.
VIRTUAL HAELTHCARE INFRASTRUCTURE IN INDIA

2011
Interview Questions
Interviewee:
Date:
Time:
Subject:
1. What are the currents system procedures at the hospitals in general?
2. What are the challenges private and public hospitals are facing?
3. What are needed to be done for improvement of current system?
4. What are precautions can be taken in order to satisfy the patients?
5. What IT/IS can improve about infrastructure healthcare system in India?
6. India is on top 2 country items population after China do you think the
environment of the working conditions needs support of online collaboration
between patients and doctors as well as hospital portals.
7. What are businesses re-engineering can be done for satisfying population of India
healthcare system?

2011
ACTUAL QUESTIONNAIRES
NAME OF THE SYSTEM PROJECT
..................................................DATE..........................
DEPERTMENT
..............................................................RESPODENTS...................................
INSTRUCTIONS:
Complete the questionnaire as for as possible
You can choose to include your name but you are not obliged to.
When complete please fold the paper along the perforation and post to the self addressed
If it is an e-mail please automatically send your respondents
SECTION A
Please fill in the space provided
Qestion1: What do you think causes problem of current system healthcare in India?
................................................................................................................................................
................................................................................................................................................
................................................................................................................................................
................................................................................................................................................
........................Question2: What are the challenges do you encounter at the hospitals?

2011
................................................................................................................................................
................................................................................................................................................
................................................................................................................................................
................................................................................................................................................
........................
Question3: What solutions to each of the problems do you proposed?
................................................................................................................................................
................................................................................................................................................
................................................................................................................................................
................................................................................................................................................
........................
SECTION B
Tick the most appropriate
Question1: The major causes the processing delays in the hospitals are:
1. Incomplete documents
2. Payment or unrespectable appointment
3. Delays the results from the laboratory
4. None above correct
Question2: Which are the following are TRUE?
1. Healthcare system need to be innovative often
2. Waiting queues at the clinics and hospitals are permanent
3. The private hospitals are efficient and effectiveness
4. The public hospitals are effectively and efficiency
Question3: How quickly improvement healthcare system is:
1. Every year visible expansion in IT/IS
2. Monthly basis in IT/IS infrastructure
3. Half year IT/IS and infrastructure

2011
4. None above are collect
SECTION C
Question1: Services from the hospitals
are:1. Very good
2. Good
3. Not bad
4. Very bad
Question2: Doctors, Nurses, IT equipment from the Hospitals are
1. Matching
2. Exorbitant
3. Cheap
4. Ok
Question3: Infrastructure healthcare items of beds and services are:
1. Need innovation
2. Improve
3. Leave like that
4. All above are collect
Question4: Are you ready online healthcare service items collaboration with doctor with
e-appointment, e-scheduling e-billing distance consultant
Yes No
Question5: Do you have internet access?
Yes No
Question6: If yes how long are you connected per day
Less than 1hours More than 1hours Less six hours
More than 12 hours
SECTION D

2011
Question7: ranking the following activities according to the time you spend at Hospitals
1.................................................% consultation
2.................................................% raising queries related healthcare
3.................................................% waiting appointment
4.................................................% payment
LIST OF FIGURES
FIGURE DESCRIPTIONS PAGES
1 Information Technology 'Clicks' Healthcare in India 18
2 Information Systems in Indian Healthcare industry markets
size
20
3 HL7 distribution information systems across the hospitals 21
4 Laboratory Integration System 22
5 Indian healthcare system private hospital cutting edge technology 22
6 Integrated seamless healthcare delivery system 23
7 Challenges of Healthcare Services in India 28
8 Opportunity of IT in healthcare system 28
9 Statistics result of by using EHR 30
10 EHR Architecture 30
11 Statistics result of by using EHR 31
12 Statistic’s healthcare system in India 31
13 Three Tiered Government Healthcare Infrastructure 32
14 India healthcare estimation market overview 36
15 India healthcare estimation market size 36
16 Statistics Of Healthcare Infrastructure In India 37

2011
REFERENCES
[1].Abdul, S. S. (2009, February 2). The challenges, Problems And Strategies of Electronic Medical record
Implementation. Retrieved October 4, 2011, from
http://www.ub.uit.no/munin/bitsstream/10037/10037/1/thesis.pdf
[2].Bali, R. K. (2008). International Journal for healthcare Technology management. New York: Harcourt
Brace& Co, Philadelphia:5.
[3]. Bhat, R. (1983, September 1). The private public Mix in healthcare in India. Healthcare policy and
planning , pp. 97-105.
[4]. G, F. (2009). System in Context Building IS. In C. Approach, Lecture Notes. UK: Brunel University.
[5]. G.D Schiff, J. K. (2003, August 2). Linking laboratories and pharmacy. Opportunities of reducing
Errors and improving care , pp. pp 893-900.
[6].Jalal-Karim, A. (2008). Sharing and viewing Segments of Electronic Patient Records Services. London:
School of Design and Enginnering, Brunel University.
[7]. RCGP. (1998). 1998. Retrieved 7 2011, on November, from www.schin.ncl.ac.uk/rcgp.
[8].Saleem, T. (2009). Implementation of EHR/EPR in England: A model developing countries. Journal of
Healthcare Information in Developing countries , 3 (1) 2-12.
[9].Sanjay P Sood N. Nmabueze, V. W. (2010). Electronic medical records. A Review Comparing The
challenges in Developed countries , IEEE 1-10.
[10]Young, E. &. (2006). The India Brand Equity Foundation. The Healthcare Sector Report .

2011

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