Strategy for Global Health Care for the 21st Century


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

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Strategy for Global Health Care for the 21st Century

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