Charak suite of Healthcare IT products: An

overview

1
 Asclepius has a healthcare IT product FOR India- Charak
Augmented with consulting, software service and implementation offering

Asclepius’ Offerings
Management
Consulting
Offered as diagnostic studies/ strategy
• New business planning workshop to build team credibility
• Business process re-design
• De-bottlenecking Gives insights into customer requirements
• Clinical workflow improvement Vital Charak sales strategy to build partnership
• Investment banking

Offered complementarily with Charak to ensure Offered as an end-to-end solution developing

completeness, while enriching Charak modules Charak suite of Healthcare interfaces etc. to ensure successful usage
Critical to ensure ‘one-stop-solution’ for IT products Key offering needed to gain customer
customer and for Charak to evolve acceptance and higher satisfaction
• Focus on clinical information
systems (CIS)
Made to Order Software• Includes HIS, LIS and IIS Implementation and
Solution (MTOSS) • International quality solutions life cycle
built for Indian clinical management
workflows • Process design, BPR
• Synergizes with Charak to • Robust solutions built on six
• Multi-product, multi-generation
support specific IT needs sigma methodology
• Six sigma software design interfacing and integration
• Training programs, workshops,
and development
change management
methodology to ensure world
• Software support and upgrade
class software
services

2
Asclepius Consulting has worked with some of the leading Indian
healthcare providers over multiple engagements
Select client list

A 1700 bed multi-specialty hospital at Belgaum, Karnataka, KLES hospital has engaged
Asclepius over multiple engagements like material management, investment banking
and cardiology EMR software

CSI is a 120 years old, 220 bed multi-specialty hospital. It is

leveraging Asclepius’s services across the HIS/ CIS/ RIS/ LIS
Church of South India
workflow, while leveraging extensively on its Process Consulting Hospital, Bangalore
services
B2F is a chain of clinics specializing in sports medicine and musculo-skeletal conditions. Asclepius
has been involved with the founding team right from the business planning level till project roll out
and associated IT initiatives. Asclepius holds a Board of Advisor seat in the company

HCG group is a chain of 15 hospitals focused only in Cancer care, supported with state of art
oncology equipments. Asclepius is supporting the group in implementing several growth strategies,
streamlining multiple IT solutions and setting up a multi-site HIS/ CIS solution

MVA is a leading 100 bed pediatrics and maternity care hospital in Patna.
Mahavir The hospital has engaged Asclepius over a multi-generation software
Vaatsalya,Patna
solution to meet the growing HIS/ CIS/ RIS/ LIS needs of the hospital

Our business model thrives on acquiring multiple engagements from our existing clients by
consistently exceeding expectations and building long term relationships
3
 Hospitals in India are adopting IT in a massive way– driven by
changing business conditions

Why are Indian hospitals adopting IT? Increasingly aware patients

“A robust IT system
Increasing legal pressures
supporting the clinical
workflow.. is the need of Increasing competition

hour.. the next wave of

Increasing time pressure on
doctors
modernity..
Healthcare
Increasing time
insurance
Accreditation
Increasingly
Get more from legal the
pressure
pressures
competition
needs
aware
same needs
from on
patients
set new
doctorsrule of
Government
of resources
••Liability
Cashless
Good
Larger doctors
Stringent
•Most ofinsurance
clinical
arebring
hospitals
process always
negligence
laystate-of-art
and down
pressed
is
very
alltechnology
documentation for
stringent
on time
needs Accreditation needs from
theI cangame..
spendhospitals
good
documentation
hospital
to
from
100%provide
NABH
money the
betterneeds
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buthospitals
–are don’t have
running time will
at close
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Government
••Increasing
I can’t carrynumber
all those of reports
patientsand across
files
••multiple
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Major
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facilities
Increasingly
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is
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is onlyshall
improve revenue
for appointments
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decide
build
and
to strong or
difference
hospital
same set
long
in
litigation
authorization
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quality based
resources and onand
enhance approval
accreditation
(Higher revenue/ quality ratings
of care Healthcare insurance needs
•Spend unnecessary inefficientsq. timeft.)in
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Moreprocrastinate
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Most
Negligence
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and cases
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My familyto
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and needs at hospitals
insurance
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personalized
optimize of
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utilization technology Get more from same set of
resources
Dr. S.K. Bhattacharya, ICMR, Govt. of India
4
Globally, IT in hospitals, undergo a transition from administrative to
clinical processes
ILLUSTRATIVE
Clinical
Features for Hospital IT
Remote
patient care
EMR Drug data
Clinical

bank Clinical Patient

EMR – Alerts
protocols monitoring
EMR – Charting Clinical decision Lab Information
EMR – Vitals support system (LIS)
EMR – Discharge EMR – Orders Emergency
Orders
summary handling
EMR –
EMR – Clinical rules
Investigations
Diagnosis Radiology Information
Admin Stores EMR – Medication System (RIS)
EMR -Flowsheets
Pharmacy

Billing Insurance

Discharge Inventory
Administrative

management
Admission

Registration

Time
After successful automation of administrative processes, Indian hospitals are
increasingly adopting clinical processes
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While the benefits of automating administrative activities have been
established, IT enabling the clinical processes yields higher benefits
ILLUSTRATIVE

Potential benefits from IT Demonstrated benefits of hospital IT

85% faster admission, transfer &
discharge
Typical benefits
from CIS 40% faster diagnosis time

30% reduction in medication

dispensing error

20% faster inventory re-stocking

Typical benefits 20% reduction in Average Length of

from HIS Stay

80% reduction in billing errors

40% growth in patient volumes

33% growth in profit margins

If you cant measure it, you cant manage it !

Source: Typical impacts measured by IT implementation in a North American Pediatric hospital

6
 A strong IT system is increasingly demanded by the hospitals to
build robust processes and achieve efficiencies

“Every patient should get the

same excellent care across
the entire hospital”
KLES, Belgaum
“I could manage the show when the
hospital was small, now I need to
delegate with… repeatable and
replicable processes”
Franchisee hospital, Apollo Group
• Processes are vital to standardize
care and achieve efficiencies
• Large hospitals have been able to
leverage IT to build these
processes

“..if only, my MBBS doctor • While mid sized hospitals have

could be reliable enough to reaped benefits through HIS
take some roles of the implementation, CIS solutions can
senior doctors” achieve higher efficiencies by
Cardiac specialist, Patiala
“..I have to stay up till automating clinical processes
midnight to manage the show
here..(its) inefficient and
unreliable”
“..only large branded hospitals Raj Hospital, Ranchi
can afford accreditation”
Ruban Memorial, Patna

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The product – Charak - is an end-to-end IT solution for the entire hospital
with sufficient depth to meet the needs of an involved user
ILLUSTRATIVE  Covers end-to-end treatment cycle

Clinical
• From pre-admission to diagnosis, orders,
treatment, monitoring and discharge
 Integrates with multiple hardware
• Mobile phones, digital pens, voice recorders,
Ancillary systems

Infrastructure
bed side devices
modules
 Is accessible remotely
Administration

• Available on internet, with thin client solution

 Built on six sigma quality and international
standards
• Compliant to HL7, DICOM, IHE guidelines
 Provides process control
MTOSS • Through protocols, pathways and clinical
decision support
 Supports research
Specialty
modules • For clinical procedure evaluation, evidence
Value added based medication etc.
modules  Is specific to specialties
• E.g. different work flows for gynecology vs.
Core
modules cardiology
 Meets the documentation needs for accreditation
and cashless insurance process
The software comprise over 100 modules – majority available as standalone
solutions – working seamlessly with existing IT solutions

Existing IT system

Charak modules
ADMINISTRATIVE INFRASTRUCTURE
CLINICAL MODULES ANCILLARY MODULES
MODULES MODULES
Admission, Discharge Orders and Medication Clinical Decision
Interoperability
Transfer (ADT) Record Support
Scheduling Documentation & Notes Clinical Protocols Hardware Options
Charting and Management
Material Management Privacy and Security
Flowsheets Information Systems
Event-based Billing Alerts/ Reminders Device Integration System Monitoring

LIS/ RIS Research

9
The administrative IT solution (HIS) covers the entire administrative
needs of the hospitals

Go to Patient

OPD Billing
Register IPD Billing Event log book
patient

Admit patient Day Procedures Investigation Material Tracking

Billing

Pharmacy stock
Discharge patient Package Hospital Services review
Estimation

Transfer patient Cashless Pharmacy billing Administrator

Insurance

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 Event based patient care system
ILLUSTRATIVE

Examination Procedures Monitoring Lab Radiology Others Discharge

Emergency

OPD

Day care

IPD

• Deluxe room admit time – 28/9/07 9:00
am
• History – Cardiac patient, asthmatic
• Physical - BP-130/85 28/9/07 9:10 am
• Provisional diagnosis – Stone in Gall
bladder
• ICU entry time – 29/9/07 4:00 pm
• Payment –Rs. 1400 (due)
• ICU exit time – In ICU
• Oxygen start time – 29/9/07 4:10 pm
• Oxygen end time – 29/9/07 4:50 pm
• Dr. S. Kumar entry– 29/9/07 4:20 pm
• Dr. S. Kumar exit– 29/9/07 4:25 pm
• X-ray – 28/9/07 9:00 am
• Payment – Rs. 110
• Report – Awaited
• Alert sent to radiologist – 9:45 am
• Ultra-sound - 29/9/07 7:00 pm
• Payment – Rs. 350
• Report – Received 30/9/07 8:00 am

Such an event based patient care system can integrate the clinical and administrative
events throughout the patient care process
The elements of electronic medical record (EMR) comprise all
relevant information from the clinical processes

 Past and present history

 Problems and complaints

• Patients go where the hospitals
 Physical examination
‘know them’ – for preventive check
 Systemic examination up, emergency, surgery as well as
standard cure
EMR number  Diagnosis
RIMS072201223 • EMR generates a single
 Investigation reports consolidated record for all relevant
Aditya Goyal
07 NOV 2005
patient information – valuable
 Radiology images
B +ve during the stay
 Flowsheets & device data
• The EMR should be readily
 Surgery notes available – through internet, mobile
phones, across hospital facilities
 Progress notes

 Medications

 Discharge summary

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All the relevant activities – for the doctor, the patient, the admin staff-
can be accessed through a central switchboard

Go to Patient

Patient summary Billing & Material

Alerts
status

Medication Events record

History & Physical
administration
record
Doctors
Diagnosis notes Device data and
images

Surgery notes Research notes

Lab reports

Care plan & Protocols Charting Discharge summary

Doctor Notes Flowsheets Follow up advices

13
All notes from doctors, nurses, labs etc. can continued to be
captured on paper – and seamless integrated with Charak

The digital pens allow minimal change in clinical practices – at OPD, during wards rounds,
discharge, follow ups etc.

14
 The critical data available remotely on mobile phones and hand-held
The critical data is available remotely on mobile phones and hand-held
devices
devices

View list of patients with critical details

Get alerts on patients in wards/ ICU

View key patient data (BP, ECG)

Give medicines and lab orders

Advise treatment remotely

Know appointments, schedule-for-day

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Charak can extract data from any digital medical device - bed side
devices, digital X- rays, CT scans -and integrate it with patient record

• The Charak team has extensive experience in

interoperability of clinical software – across
devices, CIS systems, Labs and Radiology
systems

• Charak conforms to HL7 standards, hence shall

seamlessly integrate with all new hospital software
appearing in future

• Charak is built on DICOM standards to ensure

easy transfer of digital radiology images

• Charak has specific solutions for image viewing

and interfacing with standard PACS solutions

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 Asclepius adopts robust business process re-engineering frameworks
to improve upon existing processes while minimizing changes

To-be process mapping

Do you charge for

How is the doctor dressing services
recommending or for cotton &
discounts gauze?
accounted for?

What is the stock

of all paracetamol
How do you handle put together?
multiple deliveries
against a single
Purchase Order?

17
 Together with the consulting services, the software can meet several
documentation needs required for NABH accreditation
Accreditation needs from NABH Support from Support from Process
Charak Consulting
Access, Assessment & Continuity of care (AAC)
◑ ●
Patient Rights & Education (PRE)
● ●
Care of Patient
◕ ◑
Management of Medication (MOM)
● ◑
Hospital Infection Control (HIC)
◔ ◑
Continuous Quality Improvement (CQI)
◑ ◕
Responsibility of Management (ROM)
◑ ◔
Facility of Management and Safety
◑ ◕
Human Resource Management (HRM)
◑ ●
Information Management System (IMS)
● ●
● High support
○Low support

18
The software generates relevant MIS for the hospital to check
aggregate hospital performance

19
The proposed aims to minimizes the total cost of ownership by
taking care of all the relevant costs accruing to the hospital

Very competitive license costs Illustrative

Lowest customization cost
Professional process consulting
Thin client solution implies minimum
hardware requirements
Easy integration with multiple devices
Seamless interfaces with existing systems
Integration with DICOM devices
Expertise in integrating HL7 devices
Free upgrades with AMCs
Negligible run time license costs
Minimal costs for additional user licenses
High quality lead to low debugging costs
Local service network for AMC
Remote performance monitoring
Easy integration with future HL7 solutions
Easily scalable to additional facilities and
expansions

Significantly lower total cost of ownership

(TCO)
Asclepius offers world class IT solutions – with high quality and
international features – at a very affordable total cost of ownership

• Six sigma quality leading to

• Built by Indian doctors negligible bugs
• Extensive depth in features • HL7 and DICOM compliant
• Extracts data from devices • Conforms to IHE and NABH
• Extensive configurability guidelines

• Integrated ecosystem • User- centric design

• Shows radiology images • Extensive domain expertise

• Allows remote data access • Team of doctors, process

consultant, GE Healthcare

• Very affordable prices • Low customization costs

• Cheap hardware required • In depth process analysis

• Zero run time license costs • Collaborative implementation

• Remote performance monitoring • Provide hand-holding, drive change management

• Free upgrades with AMCs1

Free uprades or first 30 customers only1 21

 Charak can create significant improvements across your hospital

Patients Doctors Hospital

I ME Sub-optimal
wideresource
Well Long
defined appointments
waiting time Extensive paper work
E T Hospital resource
RE
(At OPD,and
Computer
(OT notes, generated reports
discharge summary, utilization
scheduling
surgery, wards, discharge) optimization
E Forders) (OR, wards, doctor’s time, labs)
R
MO E
Delayed emergency Repetitiveactivities
activitieswith
Quick response at the Automated Limited
V E N U
resources
response
Golden Hour
(Patient instructions, pharmacy, billing
status report only
H E R RE
High resource utilization
(Doctor’s time, beds, OPD hours)
BETT
(Missing data, triage, ambulance) estimations)
HIG . F T.
QUA ER
Multiple investigations Multiple coordination
Centralized planning and Poor
Peasy S Q
ERmetrics to measure hospital
hospital
Extensive evaluation
computer
oldL
Standardized care plan
(Similar
ITY O
tests conducted due to
records)
missing (OR planning, duty allocation,
scheduling
appointments)
(No
generated MIS
performance)

C A F
Consolidated Rclinical
Multiple
Elabs, reports,
visits
(Visits for consultations,
data Multiple
Alerts follow ups
and Exception based
(Check patient conditions, order
Transaction
Wastages based material
and pilferage
available
follow remotely
ups) status,Reporting
room occupancy)
(OR material, tracking
stores items, pharmacy)

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 No. 8, 1st Floor, 15th Cross,
100 Ft Ring Road, J.P. Nagar, 6th Phase,
Bangalore – 560078
Tel: +91 80 4165 0200
+91 99720 22250

www.asclepiusconsulting.com
All rights reserved. These pages are to be used for selected audience only. Distribution, quotations and duplications — even in
the form of extracts — for third parties is only permitted upon prior written consent of Asclepius Consulting.

23
• Additional slide on competition

24
While the HIS market has highest competitive intensity, the CIS market has
fewer players owing to high investment in building market knowledge
Competitive landscape
• E.g. 21st Century, Karishma, Shobha • E.g. Santosh Services, Patna
• Largely stable HIS solution developed over • Primarily billing solution built at Rs. 50-75,000
multiple installations in India and Middle East per hospital
• Install-base primarily in 500 bed plus • Consistently poor on quality and scalability –

Sm
s ed
hospitals together with Middle East markets despite built in close collaboration with the

al
er siz

l
• Investments in EMR products largely through hospital

un v
ay d-
pl mi

or en
service route leading to limited functional • Easy replacement market, provided hospital’s

ga d
an d
expertise readiness

di se

ni ors
ze ’
In cu
• Compete on product relevance and quality, • Compete on Features Quality and Scalability

d
fo
scalability in clinical space, internet based

‘n
IS

ex
H

delivery

td
oo
r
D
ee inte

n
es a
p rn

ic di
r v ’ In
cl a
in tio

se al
• E.g. IBA, Perot, Siemens
ic n

• E.g. Wipro, IBM, Intersystems

e tr
al al

ar eu
• Strong proven clinical product from
pr pl

• Leverage strong admin solution built over multiple

ftw y n
od ay

international market. Frequently, sell services delivery. Significant depth in clinical

so str
uc er

software packaged with healthcare devices

du
ts s

products. Supported with strong on-ground sales

• Typically over-designed clinical solutions
‘I n
f ro

force and market reach

m

built as ‘strip-down’ version of US market • Not a priority sector for these players. Most
product solutions build on the product from US markets
• Price points unviable for mid-sized hospitals
only
• Compete on close feature match, lower • Compete on better market understanding and
costs and better reach industry relevant features
25