Healthcare Information System The Forte of Fortis The lack of an appropriate readily available solution led Fortis Healthcare

Ltd to develop its own Healthcare Information System. This has become the forte of the company helping it grow its business and increase efficiency. by Deepali Gupta In 2000, Fortis Healthcare Ltd (FHL) was looking to establish a hospital setup that would provide world-class healthcare to its patients. The administration identified the criticality of IT in providing healthcare that would not only be integrated for convenience of the customer, but could also provide the required information for the hospital to evolve over time. FHL therefore had to put in place a Healthcare Information System (HIS). Initially the company was on the lookout for packaged software. The lack of a suitable offering prompted, Sunil Kapoor, Head Information Technology of the company to develop a module in-house. The HIS was developed piece-by-piece aligned to the specific business and operational needs of the organization, and today it is deployed across four Fortis hospitals and has resulted in a substantial cost benefit to the organization. It has also decreased the scope for human error and increased workforce efficiency. The Technology The HIS comprises a Picture Archival and Communication System (PACS), patient monitors, and Web access to MIS and data. The PACS captures, stores and transmits images. This results in efficient archival and retrieval and thus cost efficiency. More importantly however, PACS makes diagnostic imaging, such as X-rays, almost film-less. Radiologists get enhanced images on any computer on the network, based on which they can diagnose a patient's problem. The connected monitoring devices and Web access allow specialists to view certain live parameters of an admitted patient from remote locations. That means that more consultants and doctors can review a patient's condition without actually visiting the patient on site. In addition to the basic functionality of the HIS, FHL has also implemented an MIS within the system. With a front-end developed in Visual Basic, 80 percent of the MIS is browser-based. It provides business-critical data reports from the billing and usage information and addresses the day-to-day needs of the hospitals various departments. Features For better customer support, thanks to the HIS, the company has evolved a single window approach. Here the customer can gather required information, make an appointment and clear bills.

The system provides the person at the counter all the technical support that may be required to address any query a patient may have. Even the waiting times for the facilities are made known to the patient before signing up. For example if there is a two hour wait for an X-ray, the patient can be given the option to either wait or return on another day. The MIS stores critical resources, such as a doctor's case history, status of high-end equipment, and procedures done on patients. These can help find out the costs that have been incurred and contribution that has been generated. The system generates the bill and breaks it into cost and contribution. It keeps track of costs incurred at different points-of-care, such as OTs/ICU/Wards, which in turn forms a sub-set of budget comparisons. And since it is browser-based, it is a convenient tool for decision-makers to access critical information in time. Customer satisfaction The MIS has a patient satisfaction measurement system. It analyses patient feedback so that the business heads can take preventive and corrective action in a time. A mail about the patient or customer feedback is generated automatically and sent to the concerned departmental head and follow up communication between the Guest Relations Officer and the concerned department head is tracked. A satisfaction index is generated by the system based on the feedback. This helps the management keep a tab on customer satisfaction levels. Sub-modules In addition to the macro level functions of the system, Kapoor and his team have plugged in submodules to facilitate the daily workings of the hospital. One such module provides a list of the essential details necessary for any medical procedure. For example, before an Angiography, the system provides a list of pre-testing essentials such as, the patient must have an empty stomach, and the time of injection of the dye. Before an operation the system provides a list of consumables that must be stocked in the OT. Modules such as these eliminate the scope of human error that can sometimes have fatal consequences. The development Process "The IT guy at FHL never wore the IT hat," said Kapoor. What he means is that instead of pelting IT jargon at users the IT team presented the technology in terms of its business appeal. All the application development occurred in the specific areas that were required. Thus alignment and aptness of the modules were never questioned.

IT is an integral part of FHL. It forms a part of the quarterly reviews the company conducts. So when Kapoor proposed the implementation of an MIS, "It was approved easily. It turned out to be a sweet implementation, which has nothing out of the box about it." A 'fraternity' had been established between the medical and IT teams, and it helped establish the purposes and perspectives of data interpretation. "In fact," Kapoor said, "Towards the end, the IT team had a clearer all round vision and understanding of the business than the employees working in other departments." Justifying Costs "ROI is something we did not need to justify for our projects," explained Kapoor. The project has cost FHL over Rs 300 lakh. Kapoor does not care to evaluate the returns it has brought. However, he does mention that in certain projects it is the TCO that counts. Efficiency has increased thanks to the implementation, and that cannot be measured in terms of money. Besides most of the development done during the process will be reused as the company establishes more hospitals around India. Dil mange more There are two functions Kapoor plans to implement to extend the existing HIS. Electronic prescription: E-Prescribing will be used to streamline the medical prescription process for physicians and patients. In addition to enabling providers to write and transmit prescriptions electronically, e-prescribing offers point-of-care access to real-time drug formularies and comprehensive drug data. Clinical decision support and management system: Integrating medical knowledge and advances into the clinical setting is often difficult due to the complexity of the algorithms and protocols involved. The use of a Clinical Decision Support System (CDSS) will assist the clinician in applying new information to patient care through the analysis of patient-specific clinical variables. Many of these systems are used to enhance diagnostic efforts and include computer-based programs that provide extensive differential diagnoses based on clinical information entered by the clinician. Other forms of CDSSs, including antibiotic management programs and anticoagulation dosing calculators, seek to prevent medical errors and improve patient safety. Kapoor has also considered data centralisation for FHL's four hospitals. He admits that a central system may come in handy as the organisation expands. However, his concern is downtime. An expensive VSAT is not something he is ready to invest in yet, and other connectivity solutions have not proved to be reliable.

He is nonetheless providing access to his e-mail server through a VPN. If this experiment proves successful, he intends to consolidate the databases of the four hospitals into a single master database hosted at a central location that will be accessible via VPN. <In a nutshell> The company Initiated by the promoters of SRL Ranbaxy, Fortis Healthcare Limited (FHL) runs a chain of Super Specialty and Multispecialty hospitals, presently in North India. It already has four hospitals to its credit and intends to add four more by 2006. The need FHL required an in-patient system that would not only contain all relevant data concerning the hospital but also generate reports and comprise functions to make the hospitalisation experience better for both patients and employees. The solution Fortis developed an in-house HIS that consists of an MIS and several innovative modules. The advantage The new system has increased efficiency, reduced scope for human error, and consolidated hospital functions in a single window approach.