Wednesday, 24 December, 2008

SIX Sigma in Healthcare

Improve Process:

1. Define the problem - that is wait time and the high number of non-emergency patients
2. Develop a solution - in an emergency room situation, this can include adding beds by expanding the department or decreasing the size of current rooms; outsourcing certain testing and radiology services; and/or adding an ‘express care’ program to deal with non-emergency patients
3. Form a plan for improving the process, measuring improvements to the process, and reducing deviations from the goal - many hospitals have found that Lean Six Sigma practices are a particularly effective way of identifying and dealing with the challenges and problems inherent to health care .
How Six Sigma help reduce Medical Errors:
Six Sigma is a process improvement method that focuses on eliminating defects by reducing variation. It relies heavily on statistical analysis of data and strong problem-solving techniques. For more than a decade, companies such as GE, Motorola and Toshiba have used Six Sigma to foster excellence by virtually eliminating errors. Only recently have health care organizations begun applying Six Sigma methods into their operations.
Areas of Benefit:I personally deployed Six Sigma in the following fields and have seen success.
Drug Infusions:
1. concentrations prepared by the pharmacy
2. how physician orders were formatted
3. how nurses calculated drip rates
Improvements were initiated, including standardizing of drug concentrations, development of tables to improve the accuracy of drip calculations. Error rates and clinical discrepancies improved significantly.
Pain Medications:
1. the pharmacy reviewed orders earlier in the process and intervened when non-standard medications were ordered
2. medications that were kept in patient areas were standardized and limited colored labels were utilized to indicate non-standardized concentrations nurses were retrained in the more problematic steps of programming the pump
3. After these improvements were there were significantly fewer errors, and if errors did occur, they were less severe and were discovered more quickly.
Diagnostic Centres:

1. Patient falls in the rehabilitation unit
2. Reducing the time a physician orders an antibiotic and the patient’s receiving it
3. Elapsed time from when a patient diagnosed with a heart attack arrives at the hospital to treatment in the catheterization lab
4. Frequency and severity of low glucose readings in insulin recipients
5. Post-operative narcotic sedation
Main Areas of Deployment Could be:
1. pacemaker billing and reimbursement
2. length of stay for percutaneous coronary intervention (PCI)
3. use of Omnicell non-narcotic
4. medical record retrieval
5. room availability cycle time,
6. lab supply management.

Sunday, 21 December, 2008

Smart Cards and Usability

What is a smart card and how is it used?

A smart card is a card similar in size to today's plastic payment card that has a chip embedded in it. By adding a chip to the card, it becomes a smart card with the power to serve many different uses.

As an access-control device, smart cards make personal and business data available only to the appropriate users. Another application provides users with the ability to make a purchase or exchange value. Smart cards provide data portability, security and convenience. Smart cards help businesses evolve and expand their products and services in a changing global marketplace. Banks, telecommunications, computer software and hardware companies, and airlines all have the opportunity to tailor their card products and services to better differentiate their offerings and brands. The combination of applications available on smart cards also may help them to develop closer relationships with their customers.

What is the potential for the smart card business?

Today, there are fewer than one billion smart cards in use. Market researcher Dataquest forecasts that by the year 2001, 3.4 billion smart cards will be used worldwide. Smart card activities are growing at 30 percent a year, predominately outside the U.S. Over the next five years, the industry will experience steady growth, particularly in cards and devices to conduct electronic commerce and to enable secure access to computer networks. Within the same time frame, smart cards are expected to be used in 95 percent of the digital wireless phone services offered worldwide. Asia, Latin America and North America are areas believed to be of greatest potential in the next three years. Globally, the uses that have emerged so far are for payphones, wireless telephony, Internet access, banking, healthcare and pay TV.

Why is interoperability crucial to widespread adoption of smart card use?

Even though there are hundreds of smart card pilots in existence around the world, users may not take a card from one country or scheme and use it in another. In order to accelerate the widespread acceptance of multiple-application smart card technology , interoperability - compatibility between cards, card-reading devices, and applications -must be achieved. To do this, the industry must examine the business and technical issues surrounding the need for standardized interfaces between cards, terminals and slots, which is the key to securing dramatic growth for the industry.

What role does "standards" play in smart card use?

Standards are required to ensure that cards and card-accepting devices are built to uniform specifications. This ensures that cards manufactured and issued by one industry sector in one part of the world can be accepted by a device in another part of the world. These cards and devices may support many different types of industries so that, for example, payment cards may be accepted in card-accepting devices at gas stations. This is possible because there are international standards in place.The International Organization for Standardization (ISO) has developed standards for smart cards. These standards were developed for use by multiple industries.

Individual industries are now developing proprietary versions of these ISO standards to support their own specific smart card applications. These are designed to conform with the standards issued by ISO. The goal is to ensure uniform standards for smart cards that will allow interoperability of cards among a wide array of industries.
What are the major benefits that smart cards offer consumers?

The benefits depend on the application. In general, applications supported by smart cards benefit consumers where their lifestyles intersect with information access and payment-related processing technologies. Some of these benefits include: the ability to manage or control expenditures more effectively, fraud reduction, reduced paperwork and elimination of the need to complete redundant, time-consuming forms, the potential of having one card with the ability to access multiple services, networks and the Internet.

You will hear the terms "chip card," Integrated circuit card," and "smart card" used to refer to a plastic card with a chip. Are these different types of technology?
There are three types of integrated circuit cards: simple memory card, hardwired logic card and microprocessor card. The term smart card is used in different ways by different organizations, but the Forum defines a smart card as a card with a chip.

What is a multiple application card?

The smart card has the capability of carrying multiple applications. A multiple application card can support different types of applications (e.g., healthcare, financial services, travel, and loyalty programs) on the card itself thereby reducing the number of cards in the wallet.For example, Visa's multiple application card plans call for a card to include a combination of Visa-developed credit, debit and stored-value functions along with member-developed Java cardlets such as loyalty programs, local transit applications or drivers license programs. This open architecture will allow Visa issuers to add applications to existing cards after they have been issued while maintaining security "firewalls" between applications.A hybrid chip and magnetic stripe card is in use with nearly 60,000 students, faculty and staff at the University of Michigan and Western Michigan. The multi-application card features personal identification and dormitory security, banking, and a wide range of stored value functions for the purchase of food, books, photocopying and vending services.

What is a contact less card?

There are two types of contactless cards. The first is a contactless proximity card in which the card is read by inserting it in a special reader. The second is a remote contactless card in which the card can be read from a distance, such as at a toll booth.

How is a chip card different from the magnetic stripe card that I carry in my wallet?

Existing magnetic stripe cards have limited capacities to carry information. A smart card carries more information than can be accommodated on a magnetic stripe card. It can make a decision, as it has relatively powerful processing capabilities that allow it to do more than a magnetic stripe card (e.g., data encryption).
How many chip cards* have been issued worldwide?

According to the consulting firm Frost & Sullivan, more than 676 million chip cards were issued in 1996. The approximate breakdown is as follows: 575 million phone; 15 million GSM; 36 million financial; 30 million dataq & ID cards, 17 million pay TV, and 3.8 million other cards.*includes memory and microprocessor cards
What is the cost of an average chip card?

Trying to respond to this question is like asking the cost of a car without defining whether it is a used VW or a new Rolls Royce. Chip cards range from $.80 to $15 depending upon their capacity and quantities.

Why is reloadability important to the development of the smart card vis-a-vis disposable cards?

There are markets for both disposable and reloadable cards. Disposable cards work well for an event and as a collectible card. Disposable is also desirable when people are traveling or visiting a location and may only want to purchase a stored value card for a specific amount of time. If the card is a multiple application card supporting for example debit and/or credit and stored value, the customer would not want to throw this type of card away. It would be more appropriate that the stored value application be reloadable.A standalone reloadable card (as opposed to a standalone disposable card) is very attractive to some customers. This customer would tend to be someone who uses their stored value on a frequent basis perhaps for public transportation, corporate cafeteria etc. and wants to be able to reload the card on a periodic basis rather than have to buy a new card each time.

How secure and confidential are smart cards?

Smart cards actually offer more security and confidentiality than other financial information or transaction storage vehicles. A smart card is a safe place to store valuable information such as private keys, account numbers, passwords, or valuable personal information. It's also a secure place to perform processes that one doesn't want exposed to the world, for example, performing a public key or private key encryption. Chip cards have computational power to provide greater security, allowing verification of the cardholder. Entering a PIN is one method of verification. The benefit of the smart card is that you can verify the PIN securely, off-line.

Wednesday, 17 December, 2008

Health Cards called "Smart Cards"

Recently received a mail from one of my Friends Senthil asking more about smart cards and their implementation in Indian Health care Scenario. Here I am describing the use of smart cards with the technology that is usually deployed for the same.

Components of Smart card System









What all these components do?

SMART CARDS - Securely hold patient information.

CARD READERS- Work with any PC and are branded with your logo.

CLIENT SOFTWARE -Upgrades the web browser on the PC so it works with smart cards and card readers

SERVERS WITH HARDWARE SECURITY- Host and protect private information.

ADMINISTRATOR PORTAL WEBSITE- A web application that lets administrators issue and manage cards.

PATIENT PORTAL WEBSITE- A web application where patients view and update their information.

CAREGIVER PORTAL WEBSITE- A web application that lets caregivers work with information on the smart cards.

PDA & LAPTOP SOFTWARE -For working with cards in mobile and off-line environments

VISUAL BASIC & .NET TOOLS -For customizing and extending the system.

HL7 MESSAGING SERVER -For integrating with other systems.

What are the possible benefits you are passing on to your customers in case you deploy a smart card facility?

  • Enhance patient loyalty and improve patient relationships.

  • Speed up registration with less paperwork.

  • Improve communication and information sharing between points of care.

  • Let patients view and update their medical information online.

  • Convert paper records to digital format.
  • Reduce erroneous and fraudulent registration information.

  • Track and log with all changes to the patient’s information.

  • Comply with rules about information portability and privacy.

  • Maintain patient confidentiality using the best information security technologies on the market.

Benefits to the patients:

  1. Patients can access their health care information online and are better informed.
  2. Gives patients control of their medical information.
  3. Patients have added assurance that their personal information is released on a “need-to-know” basis.
  4. Reduced waiting and duplicate paperwork during registration.
What a Smart Card ought to provide?

Provide secure, re-writeable storage with more space than a magnetic stripe

• Storage is protected with multiple access levels

• On-card software can be updated “post-issuance” with new features as often as necessary

• Optional magnetic stripe for backwards compatibility with existing systems

• Manufacturing services to support mass mailings, telephone user activation and bulk-personalization

• Military grade security and cryptography.

What all You should/can store in a smart card?

Demographic information

• Employer information

• Emergency contacts

• Medicines/Prescription information

• Allergies

• Medical History

• Primary & Referring physician information

• Insurers/Payors

• Guarantor information

• Advanced Directives

• Special requests/ pastoral care requests

• Organ donor information

• Caregiver notes

• Audit trail information tracking all changes

• Custom fields

What is the best technology to deploy them in the healthcare field?

• Multi-tier server architecture based on Microsoft .NET and SQL Server

• Server applications can customized with C#, VB.NET or ASP.NET)

• Server side scripts control interactions with the smart card so no specialized smart card programming is required

• The client software is an ActiveX control that uses the PC/SC standard to communicate with smart cards.

• Dedicated security hardware on the server protects private information.

What are the Security Features while passing on critical health Info?

The cards should store certificates and keys for PKI interoperability and include hardware based cryptography features.

• The card should store a complete audit trail.

• The storage on the cards should be tamper resistant.

• The cards should support multiple PINs for patients and caregivers, with lockout features that prevent PIN/password guessing.

• Smart cards should also provide multi-factor authentication when users log-in to the portal applications.

• In addition to the smart card security features, network traffic should be encrypted using SSL.

Friday, 5 December, 2008

Ehealth- The Competitive Advantage

Defining e-health - where are we?

E-health is health's version of e-commerce: that is, conducting health business electronically. E-health is the combined use of electronic communication and IT in the health sector, both at the local site and at a distance for clinical, educational and administrative purposes (Unstoppable rise of e-health, 1999).
E-health is a broad, encompassing term that envelops information technologies and telecommunication technologies. Telehealth, the provision of health at a distance using telecommunications, is subsumed by e-health.
Unfortunately there is a lot of confusion about this new field and some vendors are getting onto the hype bandwagon by adding "e-" to old solutions. Many new initiatives remain unproven, and, like modern art, time will tell which shall endure.
Users' strategic goals and end users' needs should drive solutions and not the vendors or suppliers’ business models. However, sometimes the users' needs are latent and thus it may be very difficult for us to identify sustainable competitive advantage in e-health. We will present some ideas on an approach that we hope will help you create sustainable competitive advantage.
There is much activity in Australia in the e-health area, and we have had some success, in areas such as call centres, radiology, pathology, psychiatry, pharmaceuticals, smart cards and staff development, in particular. We are now moving beyond the stage of telemedicine trials and telehealth networks. There's a new commercial focus on electronic health records and supply chain management.
The increasing Commonwealth activity with initiatives such as HealthConnect and similar State/Territory initiatives are creating the environment for e-health to develop. Steadily business and political imperatives are emerging .

Information Exchange Standards
Telecom infrastructure supplies the medium for information exchange. We also require standards for information exchange. These are beginning to emerge, but there still remains much work to be done.
There is much talk about XML (eXtensible Markup Language) as standard for exchanging data elements, yet this requires defining the medical meta-data set so everyone can agree how to label health care data entities. Certainly there is considerable consciousness about XML in South Africa. HL7 is also being used. I am aware of its use by two large healthcare informediaries (claims handing agents), both of whom claim that HL7 still required some "customisation" for their purposes.
Other important information exchange standards include e-mail protocols, and the older electronic data interchange standards such as EDIFACT. We require standard ways of accessing databases such as SQL and MIQUEST, a healthcare data query language being used in the UK to access clinical data from practice management systems. The Electronic Health Record too, may be viewed at this level as a "standard" for storing and retrieving clinical episode and encounter data, as distinct from a particular software application or database server infrastructure.
On the whole the progress in this vital area is good and is improving all the time.

Some general thoughts are:
Buyers: e-health has the potential to improve the value proposition for healthcare consumers. This means affecting one or more of the criteria of Time, Quality, and Cost. Healthcare is a very high involvement product. Customers are very concerned about their own health. E-health is an ideal medium for shifting from a transaction-based to relationship-based product. I will shortly describe a patient intervention product where we did just this.
Rivals: Differentiate yourself from the competition by emphasising your brand or reputation. As a communication medium e-health creates opportunity to do this. E-Health is also an ideal medium to reduce inefficiencies and reduce costs enabling you to achieve competitive advantage through cost reduction.
New Entrants and Substitutes: Your power against substitutes and new entrants may come from adopting a pioneering and innovative culture, retaining the best staff, and emphasising your reputation.
Suppliers: E-health can give competitive advantage through supplier integration, with resulting cost efficiencies.
In My Next post we will examine a few examples...within these networks......
Patient-> Provider->Funder->Broker->Referrel->Medical School->

Monday, 1 December, 2008

E-Health India - Case Study

To understand the Barriers Better, Am sharing with you various Case Studies for the Same.

The first case study involved a company that was primarily in the business of selling prescription drugs online. This was a pure Internet startup, rather than an existing pharmacy that added an online channel.

ePharmacy focuses exclusively on the sale of

(1) prescription pharmaceuticals,

(2) over-the-counter (OTC) pharmaceuticals,

(3) vitamins, minerals, supplements (VMS) and herbal products and

(4) related healthcare products.

The Company has invested over $10 million in state-of-the-art technology and facilities including fully automated pharmaceutical dispensing equipment that enables the company to fulfil customer orders rapidly upon receipt of the order via the Internet.

ePharmacy began selling OTC pharmaceuticals and other healthcare products through its website in May 1999 and began sales of prescription drugs and providing healthcare information in late October 1999.

With respect to prescription pharmaceuticals, the company had the ability to service over 75 million insured lives as well as the entire cash-pay market which accounts for over 20% of the prescription market.

Now Lets See the stats in the US market

ePharmacy's target markets include the estimated $120 billion U.S. prescription pharmaceutical market, the estimated $22 billion U.S. OTC pharmaceutical market and the $11 billion U.S. vitamin market. Currently, most of these products are sold through bricks-and-mortar retail pharmacies and a smaller percentage, particularly prescription pharmaceuticals for chronic conditions, are purchased by mail.

The company's long-term goal involves development of a comprehensive pharmacy services vertical portal-delivering all aspects of pharmacy services to consumers as well as business constituencies within the healthcare industry. The online pharmacy allows customers, via the Internet, to receive comprehensive drug and healthcare information, and correspond privately with pharmacists.

ePharmacy's genesis began in the middle portion of 1998, with three co-founders who believed the Internet could offer a new value and dimension to healthcare. The hiring and operations began in the early part of 1999, and then focused on creating an infrastructure (business and technical) from which to begin.

At the time of data collection, ePharmacy employed 150 workers in such departments as marketing, financing, and most importantly, operations. ePharmacy has the facilities to fill between 20,000 to 21,000 prescriptions per day, or about ten thousand in a seven and a half-hour shift. In order to operate at an efficient level, ePharmacy has a fifty-thousand square foot physical location, which houses the automated dispenser that is connected to high levels of interfacing and interconnectivity between the automated dispensing equipment and the rest of the company.

ePharmacy employs the services of United States Postal service, which disseminates their prescriptions as well as any other items such as OTC's and related healthcare products. Shipping is free for prescription orders; however, for all non-prescription items, the cost of shipping is assumed by the consumer. ePharmacy actually subsidizes a portion of the shipping in order to ameliorate the process of doing business on the web, as well as sustaining customer loyalty. Moreover, ePharmacy also provides prescription reminders through the use of email.

For example, if an individual has a prescription for a chronic drug, and the prescription is for more than a single dispense, ePharmacy advises the customer when the refill is coming to an end. In effect, the company is attempting to turn each chronic drug customer into a loyal customer by providing a service that is not readily available from traditional, physical pharmacies.

In order to fully receive service from ePharmacy, customers must provide information such as name, address, and billing information. Payment for all healthcare items usually involves credit cards, but the company also accepts check and money orders when applicable. In addition to traditional e-commerce payment, ePharmacy also accepts third party payers, such insurance companies. Insurance companies normally cover the cost of the prescription.

In that case, the customers must provide payment information for their co-pay, and also provide information concerning their insurance company, as well as their coverage plan. Naturally, the company confirms the insurance coverage and the authenticity of the prescription. ePharmacy checks the accuracy of the prescription against the patient's medical history, as well as unearthing and verifying any possible interactions with other drugs.

ePharmacy's Web site offers a reference desk to potential and current customers, which is a database of information relating to drug interaction, vitamin information, and other pharmacy-related information that the customers can access.

Further, in-house publications are also available to consumers. The company offers this service to the consumers in order to allay any questions or concerns pertaining to the online, or traditional, pharmaceutical field. ePharmacy feels this combination of products and information affords them an edge in terms of competing for consumers. The site becomes a "one-stop-shop" Web site that offers a vast array of medical and pharmaceutical information.

All information disseminated and originating from the site is fully encrypted, and where there are areas on the site where information is traveling back and forth-it is strictly one-way communication. In addition, the company utilizes secure Web pages to take all orders and to display prescription information. No personal information can be accessed by or released to any third-party, doctor, etc. without consent.

All information is stored in a secure database behind a firewall. Customer accounts are accessible over the Internet only by entering a user name and password. Presently, ePharmacy uses Secure Socket Layer (SSL) software, a security standard supported by common Web browser software, including Microsoft Internet Explorer (3.0 and higher) and Netscape Navigator (2.0 and higher).

Sensitive information such as passwords, address, and credit card information is encrypted using 56-bit encryption for transit over the Internet. ePharmacy argues that encryption makes business transactions over the Internet even more secure than purchasing by telephone. While select departments at ePharmacy have access to contact information and aggregate demographic information, only departments with necessary access can view health and insurance information. This site has additional security measures in place to prevent the loss, misuse and alteration of the information under the company's control

Moral of the Story i.e. Lessons Learnt

The business model for the online pharmacy is mainly a virtual merchant model, whereby revenues are derived directly from the sales of prescription drugs. Their hope was that due to their lower operating costs, they could offer prescription drugs at prices that were competitive with those of brick and mortar pharmacies. Hence their dominant competitive strategy was to seek a cost leadership position in the pharmacy retail sector.

However, the online pharmacy clearly sought to differentiate itself from brick and mortar-based competitors in a number of ways. Four specific sources of differentiation discussed in the interviews were:

Convenience. Consumers no longer need to leave home to fill prescriptions, since they could be ordered online and delivered to them at home. This was particularly important for homebound consumers.

Anonymity and private transactions: For many buyers of prescription drugs, the ability to ask sensitive questions in private, rather than in front of other customers or a pharmacist that they may know outside of the pharmacy, is an advantage.

Rich information: The ability to complement the provision of drugs with additional content is a distinct advantage. The online pharmacy provided detailed information about the drugs, including potential interactions and side effects.

After-sales service: The online pharmacy offered a number of after-sales services to prescription drug buyers that would be hard for traditional pharmacies to replicate. This included allowing customers to email any questions they had about taking prescription drugs, and sending automatic reminders when prescriptions should be refilled. Like many other e-businesses, the online pharmacy took advantage of the ease with which complementary products could be sold on their site. These other products added to the potential sources of revenue.

However, the online pharmacy faced many challenges. The cost of delivery had to be absorbed or added to every sale, and since quantities of prescription drugs are usually not large, little efficiency was possible for home deliveries. In addition, many people obtain prescription drugs only when they become ill, and need medication right away. For these customers, even overnight delivery represents an intolerable delay.

Several challenges result directly from the complex structure of the healthcare industry. The online pharmacy was fighting to be listed as an approved supplier of prescription drugs by the major health insurance companies. Without this, customers would not be reimbursed for their medication expenditures, making it unlikely that they would substitute the online service for a traditional one recognized by their insurance provider.

And, even if they could be reimbursed for online prescription drug purchases, the current model requiring customers to pay upfront via credit card is far less attractive for those with prescription drug coverage who only have to make small co-payments or do not have to pay at all at their local traditional pharmacy.

Many of these challenges would not apply to a traditional pharmacy that provided an integrated e-commerce offering to its customers. Indeed, the online pharmacy faced stiff competition from click and mortar pharmacies that offered immediate pick-up of prescription drugs ordered online as well as the advantages of approved coverage by insurance providers.

Indeed, as a postscript on this interview, by June of 2001, the online pharmacy has ceased independent operation, and now directed online inquiries for prescription drugs to an established click and mortar pharmacy.

How To Jazz the Party?

An Online Physician's Consultation Service

The second case study was an online physician consultation service. Founded in July 1999 by three emergency room doctors, eDoctor has a proven business model and the only Internet malpractice insurance policy ever written.

A full 60% of the company's demand for consultations comes from abroad. The substantial traffic to the company's site has been generated without advertising or registering with a search engine. eDoctor estimates that by 2005, 10% of the 1.1 billion annual emergency room and doctor office consultations in the United States will be conducted online.

eDoctor enjoys a "first to market" advantage in this rapidly growing field. Specifically, the company provides one-on-one consultations between physicians and patients. The doctors who started the company noticed many people were coming into the emergency room because they had forgotten their prescription somewhere, and to get the prescription, they would need to see a local doctor. This niche need is the primary impetus for eDoctor, but other ancillary factors also played a role in its creation. For example, the founders believed a platform existed for a Web site that dispenses medical information and services for emergency room situations.

Further, this company would offer this service to executives or other people traveling abroad who do not have access to their regular medical outlets, or who have just forgotten a prescription. eDoctor is a liaison between the patient, local doctors, and medical services.

eDoctor's target market includes American executives traveling abroad, specifically customers who need medical advice or attention, but cannot locate or reach their primary care physician. The Web site allows consumers to contact and communicate with U.S. trained and certified doctors, and when necessary, these doctors can prescribe medication to the consumer and then overnight the product to the patient.

eDoctor has emergency room physicians that are on call, 24 hours a day, seven days a week for those customers requiring immediate attention. Conversely, the company can also set up an appointment and meet with that physician immediately (non-emergency), or if it is a specialist they are interested in, the doctors can arrange that appointment as well.

In order to receive services from the company, patients must log onto the network with a credit cared, as well as divulge medical information, personal information and other ancillary items germane to the specific visit. Since emergency consultations are the major impetus for the company, medical records are not necessary required for all patients due to the uniqueness of the situation. However, the standard medical information is required of the patients (e.g., current medication, past surgeries or ailment, and allergies to medicine).

In addition to medical information, the patient must also provide information on their primary care physician in order to relay the information and mediation to the proper outlets, as well as verify the veracity of information supplied to the company by the patient. When a non-emergency situation arises, such as a routine appointment with the company, the patient must provide the primary care information up-front before visiting the doctor-this reduces any liability indemnity as well as increases the potential for assistance.

Interestingly, if a patient is seeking an immediate medical consultation from one of the emergency medicine physicians, he or she will first complete payment for the physician's service through the secure CyberCash credit card processing system. Then, the patient will complete the registration form, which includes personal information, past medical history, and review of systems, as well as some specific questions relating to the immediate medical concern.

If a patient is seeking an appointment with one of the other physicians in another specialty, the patient will first go through the secure CyberCash credit card processing system for a credit card authorization, which will not result in a charge to the card; it will verify the validity of the credit card. The patient will then provide preliminary information (personal, past medical history, and nature of the medical problem or question).

Next the patient will be brought to the eDoctor's Appointment Center, where she will be able to set up an appointment with the chosen physician. The patient will be given an appointment ID, which will allow reentry to the site for the actual consultation with the doctor. When the patient returns for the appointment, he or she will fill out the review of systems form and then proceed with the actual consultation. The patient is not charged for the appointment-based consultation until it has concluded.

All patient information on eDoctor is fully encrypted, which means personal medical information and online consultation is secured through SSL encryption, and will not be accessible to anyone other than the company's physician. After the patient has completed the registration process (either for an immediate consultation with one of the Emergency Physicians, or when they return to the company's Web site for an appointment with a non-Emergency physician), she will be brought to the eDoctor's "Doctor's Office," where the physician, after briefly reviewing the supplied patient information, will join the patient in a secure, encrypted, "one-on-one," virtual conference room environment.

The physician will then provide the type of service requested during the registration for that visit. There is no "pre-set" format for the dialogue with the physician; the doctor may ask additional questions, depending on the nature of the medical problem, and will help guide the patient through the consultation.

If initiation of medical treatment is deemed warranted by the doctor at the time of consultation, prescription medication can be provided by "pharmacy call-in" by the physician. If the patient is traveling or away from home, the eDoctor physician can arrange delivery of U.S.-formulated prescription medication to almost anywhere in the world.

If the patient is seeking an appointment with one of the non-emergency medicine specialists, and needs to submit electronic data such as ultrasounds or x-rays, specific instructions from the physician will be provided at the time of the consultation. At the conclusion of the online consultation, the company's doctor will provide the patient with detailed discharge instructions. Patients may print these by clicking with the mouse on the browser's print button, or else "copy and paste."

Moral of the Case Study on E-Doctor

This e-health firm relies primarily on a brokerage model, serving as an intermediary service that connects patients with physicians for secure e-mail or Internet-based video consultations. Patients can either choose their preferred physician, if their doctor has registered with the service, or allow the service to select a physician for them. Physicians are paid by the e-health service, which retains some portion of the fees paid by patients.

Their primary competitive strategy is a differentiation-focus strategy, allowing them to offer a premium service mainly directed at a particular segment of the market, the international business traveler. As a broker, they must have a strategy to bring both "buyers" (patients) and "sellers" (doctors) into their business.

They promote their services to physicians, and also use patients to "pull" their preferred doctors into the service. Given their need to create a critical mass of physicians and patients registered with the service, this service benefits from their "first mover" advantage, since it is unlikely that doctors will want to sign up with more than one such intermediary.

Particularly for international business travelers, their service is differentiated from the alternative source of medical consultation by their ability to offer:

English-language physician consultations in countries where English is not the native language
Access to a US trained physician while traveling abroad, including secure email to a patient's regular doctor if enrolled in the service

Access to prescriptions for familiar drugs which can be delivered almost anywhere in the world
Immediate access to a physician when needed. The physician consultation service also faces a number of challenges. Like the online pharmacy, lack of physical presence is a problem when patients need immediate in-person attention or immediate medication. Even with prescription drug delivery, the delays may not be tolerable.

In addition, as with the previous case, the reimbursement issues raised by lack of recognition by health insurance companies makes it difficult for patients to choose in preference to a traditional in-person physician consultation. Even though many travelers need to pay in advance of services anyway when obtaining medical treatment abroad, they still are able to obtain reimbursement from their insurance companies. This is not necessarily the case for online consultations. Hence the target market is limited to those who can afford to pay outright for their healthcare, or receive this as an executive perquisite from their companies.

State licensure requirements are another barrier being addressed by this firm. In this case, the strategy to have consumers recruit their own physicians is a smart way to try to pull in doctors already licensed in the states from which patients seek services.

Other challenges faced by this firm follow from their focus on travelers and from their reliance on Internet-based communications only. Internet access may not be available in all locations, or may be so poor that services such as Web-based video do not work.

Moreover, there is little possibility to use many of the available phone-based remote diagnostic instruments now becoming more common in telemedicine. Even if Web-based interfaces were developed for these instruments, it is not clear that travelers would always have them on hand.
Despite these problems, the online physicians service has not yet succumbed to the bust afflicting so many other Internet start-ups.

Its first mover advantage, ability to offer some service immediately without the need for physical delivery, focus on linking patients to their own regular and trusted physicians where possible, and clear focus on an unmet need of business travelers are all possible explanations.

Will come up with more..Subscribe and stay glued!

Friday, 28 November, 2008

Health Market Potential and Strategies- A Study

General use of the Internet for health points to a great demand for health-related information. For example, almost half the Internet users in 1997 reported looking for health information or support (FIND/SVP, 1997). A survey of 2,000 Internet users estimated that more than 24.8 million people sought online health and medical content in 1998, an increase of 44% from 1997 ("Double Mastectomy," 1999).
E-health web sites have enjoyed growth that has outpaced general Internet use. For example, in 1999, general use of e-health sites grew 176% to almost 11 million (Media Metrix, 2000). According to Newsweek, the Web is currently a source of health or medical information for more than 50 million Americans. Patients and their families do more actual web surfing than investors, students or people who purchase online (Watson, 2001). Data from Forrester Research (Yonish, Ranguelova, Shrier, & Broadben, 2001) indicates that women are twice as likely as men to visit health sites. In addition, Internet users diagnosed with a serious illness in the past year, whether young or old, visit medical information sites more frequently than their healthier cohorts.

A 1999 study reported in Nature documented more than 15,000 health information Web sites categorized at the prime tier of both the Yahoo and Netscape directories. Yet, health information on the web is not limited to simple non-interactive informational sites. For example, there are many specialized online support groups that offer active mailing lists. Rice (2001) reported that a search on yielded 278 health-related mailing lists. In 1995, the last date individual newsgroup readership figures were provided (Rice, 2001); half of the top 10 Usenet newsgroups were concerned with health topics.

In addition to being a source for health or medical information, the Web is also a site for health-related commercial activity. With respect to online health purchasing behavior, of those who go online three times per week (defined as active Web users), more than 6 percent purchased nonprescription health products, almost 9 percent purchased prescription medications and just under 6 percent bought some type of formal healthcare service (Yonish et al., 2001).

To date, an estimated 2.5 million consumers have actually used a medical practice Web site, but more than 35 million report that they would like to (Guglielmo, 2001). Physicians are hearing this message. Up to 37 percent of all physicians already have some kind of Web presence and a quarter of net-connected physicians use e-mail to communicate with patients (Guglielmo, 2001).

Health commodity items are perhaps the easiest to transition from traditional hard copy catalogs to online publications. Traditionally, health providers must work through a company sales representative or distribution middleman in order to purchase medical equipment and supplies for their clinics or offices.

The web offers an opportunity for staff to shop on the web for everything from hospital beds to bedpans and tongue depressors. This category refers to all items that are tangible and require physical transportation for delivery.

There are two separate sets of potential clients for medical equipment and supplies. The first are industry members. These would include hospitals, doctors' offices, outpatient health centers, home health agencies, nursing homes, and medical laboratories.

Any organization that provides direct or indirect patient services is able to purchase equipment and supplies necessary to supply that care through these web sites. The second set of clients for this category is comprised of the care recipients. This would include the actual patient or a family member or non-professional caretaker of a patient.
There is a host of medical equipment and supplies that are directly purchased by the actual patient such as special functioning beds, wheelchairs, canes, glucose monitors and strips, blood pressure monitors, or bulk items such as wound care dressings and bandages. It appears that the preponderance of e-commerce sites currently being developed are directed at businesses rather than individuals, which is logical given current computer dissemination and utilization trends.

Payers of health services obviously play a pivotal role in the entire health system. Currently, most health insurance companies are utilizing the web for informational purposes. However, some companies are utilizing e-commerce in one of two ways.

First, following the traditional independent agent structure of the insurance system, insurance companies use the Web to enable agents to order policies for their clients electronically. Second, insurance companies are utilizing the Internet to bypass independent agents, and sell health insurance policies directly to the end consumer.
Some sites provide consumers with electronic forms to speed up the process of obtaining health insurance. Other sites go a step further and actually support the online purchase of health insurance.

Consumers use a wide range of prescription and over-the-counter medications for prevention and treatment purposes. Medications include anything traditionally provided in the health section of a supermarket or drug store or products supplied only through a physician's prescription.

E-commerce sites offering medication products are emerging in three distinct forms:
[1] online sales of over-the-counter medications that are delivered directly to the consumer;

[2] ordering of prescription medications on-line that can be picked up by the consumer or delivered directly to the home or office and;
[3] direct marketing with on-line consultation service for a specific product available by prescription only.

The Internet serves as an innovative source for the actual acquisition of medical care and services. The purchasing of medical diagnoses, treatment recommendations, ongoing care management, or a simple second opinion from a licensed health provider falls in this category. These services could be theoretically purchased from a physician, nurse, nurse practitioner, physician assistant, psychologist, social worker, or speech/physical/occupational therapists. Currently, the handful of forays into cybermedicine appears to be coming from a few enterprising physicians who have set up medical practices on the Web.

In these practices, patients log onto the Internet, type in a description of their symptoms accompanied by a credit card number and are then connected to a real doctor who offers a diagnosis as well as a prescription if warranted. This new service is often touted for its potential to solve the issue of access for people who are unable to see a physician in her office due to geographic, economic or time constraints. However, the practice of medicine is a highly regulated business and this modality of service raises a number of perplexing questions ranging from licensure requirements to efficacy of care.

Additionally, there are worries that Internet-based clinical service provision opens the door to increased probability of misrepresentation of health provider credentials, as well as patient attempts to fake illness in order to obtain prescription drugs.

Though health information on the web is obviously popular and an important application, it is not challenged by the many stringent health guidelines and requirements that confront the other categories of e-health firms. Specifically, online pharmacies and clinical providers face the same strict legal and delivery-based barriers that confront traditional health firms.
We will Discuss barriers to all this in my next post.....Cheers!

Thursday, 20 November, 2008

Issues E-Health strategy can address

The eHealth strategy aims to address a number of issues currently being faced by people who provide care to patients and those who support them. The key issues can be summarised as follows:

• Improved ability to access information that is integrated and accurate
• Better support for clinicians and care providers from across the health system to interact more efficiently and effectively with each
• Support for clinical and managerial decision making
• Greater capability for managing patient flow through improved planning and scheduling
• Support for location-independent health service delivery.

Principles of Implementation:

The principles for the implementation of the eHealth Strategy are:

• Build on what exists today and re-use viable capabilities in place
• Establish solid functionality and information, and then build new capabilities
• Introduce new and extended capabilities in phases, and realise benefits incrementally
• Identify solutions that improve quality of care and patient outcomes, while easing the workload burden on care providers
• Implement simple and practical solutions that can be refined over time.

Well donno about others but portfolios that need to be workon according to me are:

Portfolio 1: Information Integration and Communication (
is focussed on providing integrated patient information to care providers )

Portfolio 2: Core Systems Implementation

Focused on selecting, developing and implementing core systems incorporates:
• Medications reporting
• Emergency information management
• Diagnostic imaging
• Community health, mental health and chronic disease management
• Patient management and coordination

Portfolio 3: Foundation Projects

Implements functionality and information management practices that provide a foundation for the eHealth program, including:
• Information management
• Unique patient identifier
• Unique provider identifier and service catalogue

Portfolio 4: Managing and Delivering the eHealth Program

The Initiative covers:
  • Business and clinical alignment
  • Business transition and sustaining the change
  • Benefits realisation
  • Program management office and architecture

Well the risks areas are however,

Inability to secure sufficient funding to invest in eHealth and associated change activities

• Inability to meet expectations – both internal and external (including community, external providers, industry /vendors, politicians)

• Capacity of Kayaguru Health to deliver a program of the complexity of the eHealth program

• Solutions designed (both technology and processes are not relevant to clinicians and do not add value to their roles / clinical practice

• Inability of the organisation to absorb change (magnitude / rate)

• Not delivering early enough or fast enough

• Perceptions of Information Division credibility and reputation.

Tuesday, 18 November, 2008

E-health and E-learning

Resource generation

The growth of e-health services has given rise to the need for a new breed of healthcare professionals, healthcare administrators and healthcare technologists.

This industry needs people who can understand any two of healthcare, business and technology. Historically the healthcare industry has been the last adopter of technology, the same has been the case with healthcare education. Even till today, many of the medical, dental, nursing, pharmacology and other healthcare degrees do not have courses on information technology; ecommerce is only a far cry from reality. Courses in hospital and health administration have increased in the last 5 years or so.
When the e-health services industry started about 3 year ago, companies relied heavily on people already employed by hospitals and on people employed by other similar companies. The industry has grown to such a size that people from non-healthcare backgrounds are being recruited and trained. Interestingly, a lot of youngsters with traditional healthcare degrees such as MBBS and BDS are exploring career options in healthcare administration.
The irony of this trend is that the need for basic healthcare facilities in rural areas is going to get even worse than it currently is. As technology is pervading more into our education system, learning is becoming “anywhere and anytime”.
E-learning enables students to study and appear for exams at their convenience from any place they want to, as long as they have a good internet connection. Some forward thinking companies such as Medvarsity have started offering healthcare courses to healthcare students and practitioners. It is helping medical students to prepare for higher studies through online courses.

Health care players and their key information needs


A patient can be defined as a person who receives medical examination, treatment, guidance or care from a health care professional. The contact between the patient and the health care services initiates the process of care. The patient is therefore the most important party in the health care system. A patient needs knowledge about basic health issues, access to information specifically relevant to his/her condition, awareness of health system and the options available.


The practitioner is any healthcare professional and is distinguished from a provider. The patient gets in touch with the physician (general practitioner or specialist) for consultation, which may include medical investigations, treatment or supervision of the plan of care. In e-health, it is practitioners who are engaged with clients or other practitioners in the delivery of health care. A practitioner needs access to best, up-to-date medical knowledge available pertaining to their patients.


Include healthcare service providers (hospitals, medical and academic research institutions), diagnostic equipment providers, informatics and computer suppliers, professional associations, health management organizations, insurance companies, the Ministry of Health, Communications (or equivalent) and pharmaceutical companies. A provider needs expertise to promote and sustain healthy life and social practices among its clientele. In a triangle, all the three sides are essential to complete the whole. Similarly in healthcare services all the three key players are vital. As e-health is the result of convergence of telecommunication, information and health care technologies, technology in general turns out to be the linking factor between these three key players. Successful implementation of e-health requires clear understanding of the roles these three are expected to play. Hence development of certain protocols and strict adherence to them becomes essential

Friday, 14 November, 2008

The Inside Story- e-Health

The scale of e-health services in India has been very small so far, mostly limited to health awareness through portals, telemedicine and customer service using the internet. Even with such a small scale of operations, some significant changes are being made nationwide that will strengthen telemedicine initiatives and the healthcare industry as a whole. The most important initiative being, the standardization of exchange of health information between different entities within the healthcare sector.

The Ministry of Health & Family Welfare and the Ministry of Communications and Information Technology are jointly creating a national health information infrastructure, for easy capture and dissemination of health information. To support this infrastructure, necessary steps are also being taken in creating a legally safe environment that will protect the privacy and confidentiality of health information. Steps are also being taken to educate various stakeholders of the healthcare industry about the need for complying with health information standards The above-mentioned initiatives of the government are indirectly going to bolster the growth of cross border e-health services. Healthcare is becoming more and more regulated in developed countries such as the USA. Healthcare payers and providers are willing to outsource work easily to countries/companies that comply with health information standards and have a robust legal framework for privacy and security of health information.

In principle, telemedicine has bridged the urban rural divide by taking healthcare to interiors of India. There are more than 150 telemedicine initiatives today. On an average close to 6 (range of 2-10) telemedicine encounters take place per day in each of these centers. These figures are very low considering the dearth of healthcare services in the same areas of India. However, a start has been made. These figures are only going to increase, as the technology costs are falling regularly. Eg. Telecommunication costs have reduced by 3 times since the last two years.


In the domestic arena, e-health services are being offered by existing healthcare provider organizations such as hospitals. They have e-enabled their services to offer either better customer service or increase their access to rural areas. The average investment for a telemedicine center has been close to 25 lakhs. Healthcare portals and corporate websites do not cost more than 5 lakhs to develop.

In the international e-health services arena, the funds invested are much larger. There are currently close to 50 stable healthcare service providers, of which close to 30 offer medical transcription while the remainder offers medical billing, coding and health insurance services. Considering an average investment of Rs. 2 crores4 for a medical transcription company and an average of Rs. 5 crores for other healthcare services providers, an amount of 160 crores has been invested in companies that offer cross border e-health services. Domestic e-health services have not resulted in any savings of foreign currencies by reducing the need of domestic patients to go abroad for treatment. The purchase of health services also hasn’t been affected very much. But there are enough indicators to indicate that it will increase. Healthcare concepts such as “preventive healthcare and disease management”, which are also offered via the internet, are catching up in the urban markets.

Wednesday, 5 November, 2008

If you are a Health Professional - Which EMR to buy?

Your degree is in medicine, not computer science. Why then are so many physicians finding themselves focused on software these days? Government, payers and market forces are all pushing physicians to consider an Electronic Medical Records (EMR) strategy. As if practicing medicine weren't challenge enough, now you need to adopt a new layer of technology infrastructure…

At the same time, the value in going digital with your patient records is increasingly clear and the technology has come of age. Just like a practice management system optimized your patient schedule and improved your receivables, today's EMRs promise to automate your clinical workflows. An EMR can reduce time spent charting, provide more efficient patient visits and help meet regulatory requirements.

The good news is that selecting an EMR doesn't require in-depth technical knowledge. Instead, you simply need to roll up your sleeves and run a disciplined selection process - knowing what criteria to consider is half the battle.

Here we present ten best practices for selecting an EMR system. While there are hundreds of software packages on the market, you can fairly quickly narrow them down using these processes and criteria.

1. Take ownership of the decision. Your EMR software will impact how you practice medicine, so this is not a process that should be delegated to back-office staff or the local "computer guy." While your staff should play a key role in selection, this process demands medical expertise and leadership that only the physician can provide. What if your computer guy selected a system based on an underlying database he liked, but failed to recognize that the system forces you into rigid workflows that change how you interact with your patients? Take ownership of the selection process to avoid buying the wrong EMR!

2. Determine your own requirements. Too many physicians let software salesmen drive the selection process. Only you know how you should practice medicine. Therefore, it's critical to map out your ideal workflow and how you interact with office staff to complete a patient visit. Do you want to limit the system to electronic charting, or do you want and end-to-end solution that extends all the way to claim management? At the same time, realize that your interactions with software vendors are good opportunities to learn new best practices and workflows that could improve the way you work. Based on your initial requirements and those that arise during the selection process, build a comprehensive list of features and then prioritize them based on what will provide the most value to your practice. Realize that you can phase in new modules over time.

3. Get the right EMR for your specialty. Most EMR products are designed to serve a wide range of medical practices while others are designed for specialties. There are benefits and drawbacks to each approach. The narrow focus of a specialty EMR vendor allows them to design their systems around the unique needs of physicians within their target market. For example, an OB/GYN EMR would have special screens designed for ante partum visits. This results in a more familiar workflow for the specialist and less customization of the software. At the same time, specialty vendors may be challenged to generate enough revenue enough to support the wide range of ongoing development required by client demand, government mandates and device integration.

Large, broadly-focused vendors may have more resources and broader reach, but may not offer specialty features and workflows. Ask the larger, more generic vendors how they will meet your unique requirements and request references from customers within your specialty.

4. Integrate practice management. In addition to EMR functionality, consider how you want your system to support medical billing, patient scheduling and practice management. Do you want all of these functions in one complete suite, or should your EMR interface with existing systems? There are advantages to managing clinical and practice management functions in a single system. For example, an integrated coding engine can help physicians to develop more accurate claims during the encounter, reducing the need to "down code" or have staff scrub the claim later. Meanwhile, health alerts made available during scheduling ensure a higher quality of care and patient compliance. On the other hand, many practices have already made significant investments in their existing practice management systems or third party billing services. Simple integration may suffice.

5. Focus on ease-of-use. Medicine is complex enough without software making things more difficult. Therefore, it's critical to find a system that makes each encounter easier, not harder. The system must be highly intuitive and easy-to-use. The simplest way to evaluate ease-of-use is to use a demo copy yourself. Try to manage a common process such as documenting a frequent diagnosis. Did you figure it out right away? These days, the right software should make it easy. Features that can augment ease-of use include on-line help functions, tablet or stylus interfaces and voice recognition. Ease-of-use will be especially important when staff turns over and you need a new employee up-to-speed quickly.

6. Assess support and upgrades. You'll need them. Leading vendors provide support 24 hours a day / 7 days a week. You'll most certainly want weekend support if you work like most physicians, and you might want nighttime support too, even if only while reviewing records. Consider also how that support is delivered. Are you up for talking to foreign call center staff? Do you want help on-site? And remember, when it comes to software, support isn't just technical assistance; support often includes access to new features, bug fixes and major upgrades. Assess the vendor's track record in delivering consistently high quality new releases of their software. After all, you'll likely pay for them annually.

7. Consider vendor viability. An EMR isn’t all you're buying. You're also entering into a long-term software vendor relationship. It's critical to assess the software company's viability - not just if they survive, but how… Sure, healthy margins in the software business keep most established vendors afloat, but what about the vendor's "strategic viability" in a market that is poised for dramatic consolidation? Can and will they invest in new development? Will they continue to meet regulatory requirements and support new standards? Will they sell out to a larger company that soon thereafter "sunsets" their product? All of these situations could have big implications for you. Make sure you assess the vendor's reputation, financial well-being and their vision for the future.

8. Be smart about your budget. With EMR prices ranging from Rs 50,000 to Rs. 50 lakhs you can quickly narrow down your software search based on price. However, this approach will more than likely limit your ability to find the right system. While software does not have to be expensive to be good, never buy on price alone. The more sophisticated buyer will consider the value of the system (as measured by return on investment), rather than thinking in absolute dollars. More expensive systems typically meet the latest standards (e.g. CCHIT), offer more sophisticated features and integrate with third party devices such as heart monitors and imaging systems. They may also include very sophisticated decision support protocols to standardize care across large groups or delivery networks.

9. Consider your deployment strategy. With faster Internet connections and new technologies, it's now possible to access your medical records entirely over the web. These software as a service (SaaS) or Application Service Provider (ASP) options lower up-front costs, simplify maintenance and provide the ease-of-use of a web application. SaaS vendors have invested heavily in security, HIPPA compliance and data redundancy to provide a highly secure EMR platform. At the same time, a SaaS system requires a consistent, high-speed Internet connection. If the connection is slow, the practice will be less efficient. If the connection goes down, so too will the ability to access patient records. Think hard about the tradeoffs between a SaaS solutions and the more traditional path of installing and maintaining your own IT infrastructure. There are tradeoffs either way.

10. Don't forget the technology. We put this last for a reason. We do not think that development languages and databases should drive a software selection process in health care or any other industry. Instead, we advocate that you assess underlying technology from a defensive standpoint. For example, reimbursement procedures and regulatory requirements change often. So a system must be built on technology that is flexible and enables the vendor to release frequent, quality updates. It is also important to assess the support requirements of systems with questionable "architecture." Acquired and interfaced solutions may require redundant databases, while preventing seamless integration. Avoid purchasing an EMR with exceedingly rigid or soon-to-be-obsolete technology.

Best practices are critical for selecting the right software for your practice. While we could suggest many more criteria for your process, managing to these ten best practices will get you most of the way to finding the right system. Good luck!

Tuesday, 4 November, 2008

Understanding E-healthcare Better!

Recent polls show that more than two-thirds of online health consumers would prefer to obtain healthcare information from those they know and trust, namely their physicians and hospitals

Services what we need and Deal with in E-health:

Internet strategy and return on investment analysis
Inter/Intranet site and application design, development, and hosting
Health content integration
Physician find and referral databases
Customer relationship management systems & Human resources management systems
HIPAA privacy & security system analysis and development
Dynamic systems: news & events, content authoring,
Database integration
Secure patient document imaging systems

What are Meaningful Returns?

Healthcare marketing
To date, analysis of healthcareƕs primary focus on Internet consumer marketing leaves little to be impressed with. As healthcare organizations review their expenditures in web technology against their expectations of attracting and converting web users to patients, the results are disappointing.Need to pnder in here.

Revenue Generation

Partner referrals and streamlined interaction
Your greatest source of new patients are from your referring physicians and partner organizations. Help your company devise strategies and technologies to improve referrals while
streamlining administration.

Patient service

Improving your patients' experience with your organization or practice creates long-lasting relationships. Implement technologies that improve patient communication, education, and their experience with your organization while reducing administrative time and costs.

Increase your marketing reach and conversion rate
Attracting consumers and converting them to patients is the name of the game. The web affords the millions searching for and finding healthcare providers a chance to get to know you. We need assistance to our organization in driving web traffic, encouraging repeat visits and converting Basic browsers to interested patients.

The recent woes of the e–health care players already show how hard it is to make a go with this model. In an environment where success requires a formidable level of entrepreneurship, our institutions will have to find a way to transform our cultures to compete against players unburdened by missions that go beyond generating maximum shareholder returns.

Sunday, 2 November, 2008

PDAs in Healthcare -Passe or in Vogue

The PDA is a very small and portable, handheld computer, which has many more functions than a calculator, and the capacity to store information much like a Personal Computer (PC). Basic functionality available on most PDAs includes an address book, schedule, calendar, note pad, and e-mail. The PDA is convenient to use in clinical and field situations for quick data management, and the information can be synchronized with a PC . By means of a wireless network, information can be exchanged anytime from anywhere to and from a PDA, and the network will provide immediate access to all kinds of necessary clinical and administrative data .
Health care professionals need access to information several times a day, and the PDA has the potential to provide this. For the PDA, there are numerous documents and medical software applications available, with a wide variation in quality. A large number of medical students take advantage of the PDA for educational purposes and patient care with great satisfaction. Loaded with suitable functions and software applications, the PDAs are now meeting the need for having access to up-to-date information on a just-in-time basis, thus making the PDA a qualified support tool for personnel and students in health care.

The frequency of PDA use varied among different personnel and students in health care. Most of the users were male, with some exceptions among students and faculty. Medical residents used PDAs more than physicians, but there were also reports of a similar frequency of use amongst the two categories, and some physicians used a PDA when teaching medical students. Several special software programs have been created and tested for PDA use. Clinical Decision Support Software (CDSS) has been tested among medical students, and most students agreed that CDSS enhanced their learning, and they became especially fond of their access to Cochrane reviews, history, and physical examination functions. The same decision tool was used by physicians when prescription of pharmaceuticals and safety were evaluated. Physicians using the CDSS for prescription of non-steroidal anti-inflammatory drugs made fewer unsafe treatment decisions than those not using this software. In another study, nurses tested CHOICE, a PDA-based support system for preference-based care planning . The system supported nurses in eliciting patient preferences for functional performance at bedside.

The PDA seems to be a feasible and convenient tool, with one of its top advantages being the speed with which one can retrieve information on the spot. Accessibility to updated information can be improved when using a PDA, which provides an opportunity to check for the latest medical information in a convenient way. Access to drug and medical information might improve patient care and make it more effective and, hopefully, time-saving. In the present scenerio,PDAs improve decision-making and point toward positive changes in patient treatment, a conclusion in line with a previous review. The possibility of checking medical orders and patient identification by using, for example, a PDA with a bar-code system, can reduce errors.I am pretty convinced that there is a need for the PDA and that this is a tool for all professionals and students in health care.

To overcome barriers, the challenge is to provide the right support and to create suitable functions and software applications for various health care professionals in various specialities.I tried and study all such barriers and challenges offlate. Most of these barriers seem to be more behavioral than technical in nature. To overcome these barriers, guided practice, explanations, and adequate training time are needed, and access to technical support is necessary. Other barriers, such as short battery life and small memory capacity, should be easily overcome by constantly expanding technology. The PDA can also improve learning for students in clinical practice and health care professionals. A recent study stated that healthcare professionals in Sweden learned about new medical developments sooner with a PDA than without one, in which case there might exist medical developments that they had not learned about at all. This is a good news. These important data confirm that a PDA is suitable for both students and professionals to improve learning.

Saturday, 1 November, 2008

Conclusions- Ehealth Practice and Application

Well, offlate I received a Huge amount of Inputs from the readers on my blog, Thanks to Didar, Ajay, Pankaj, David, Nitin and all of you. I am hereby drawing certain conclusions out of those Case studies which I received and studied.

Steps required for Such Conclusions:

(1) Create a framework for country studies.

(2) Identify focal points – regional and national (WHO and Member State).

(3) Set up an interdisciplinary and interministry expert group.

(4) Select/appoint a national consultant.

(5) Carry out research on the basis of the framework.

(6) Monitor, review and finalize the study.

(7) Identify gaps.

(8) Build capacity.

(9) Devise strategies.

(10) Establish task group to carry forward initiative.

High-quality infrastructure is one of the most important prerequisites for fostering the growth of the e-health industry. (The main determinants of the e-business environment for health are technology, connectivity, bandwidth availability, telephone charges, power supply and real estate.)

India is aware of the crucial role of infrastructure and is opening up to private sector partnerships on a large scale in order to strengthen it. The infrastructure needs to be developed further. There is also a need for quality incubators (initiators) to promote entrepreneurship, and more biotechnological facilities such as the Indian Institute of Science, Bangalore. Technological barriers hinder the progress of cross-border trade. There is a need for sufficient internet bandwidth. The cost of internet access has to be brought down, outdated applications must be eliminated, and interoperability across different platforms needs to be promoted.

As legal support plays a major role in creating an environment conducive to compliance, the legal framework needs to be user-friendly and easy to implement at all levels. However, currently, no effective legal framework exists in India for cross-border trade. There is lack of clear definition with regard to the legal requirements and implications of getting into businesses such as contract research, medical transcription, medical coding and billing, all of which deal with confidential health information. In 2001, India promulgated the Information Technology Act for the purpose of facilitating e-governance and ecommerce in the country. The Act also seeks to curb cyber crime and regulate the online environment.

This poses a serious threat to health-care companies outsourcing work to India.

Also a very low level of awareness of country-specific healthcare regulations, such as the Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a turn-off.

As far as Manpower is concerned , the workforce was found lacking in domain knowledge of health-care administration and financing, despite the considerable amount of BPO work being done in this area. The supply of health-care professionals does not meet the demand. Also all of us know about limited acceptance of Indian health-care qualifications in developed countries.

Why our E-health models don’t scale and lag?

The promotion of remote diagnosis for US-based patients by Indian doctors in India would require the doctors to hold United States Medical Licensing Examination (USMLE) certificates. This makes the BPO model in this area of health care restrictive. If Indian health-care professionals want to demand high-end work and higher prices, they will need to be certified by US industry associations, such as the American Health Information Management Association (AHIMA) and American Academy of Professional Coders (AAPC) for medical coders. A good understanding of health informatics could revolutionize the way health information is captured, stored, analyzed, applied and shared.

All said, There is still plenty of room for Indian e-health service companies to enter areas such as telemedicine, clinical trials, disease management, and management of health-care knowledge, as well as that of electronic medical records.

Keep on rolling Guys.

Friday, 31 October, 2008

Challenges to Healthcare on Internet

The use of technology to assist in the delivery of quality patient care covers a vast area from biomechanical devices to robotics to the electronic medical record to email. Sometimes, the term "E-health" has been used very loosely to include any electronic healthcare-related activity. Points to be considered are:

1. E-health is not a surrogate for the clinician. It does provide the means to extend the reach of the provider beyond a face-to-face patient encounter, with the advantage of expanding the delivery of limited resources and expertise. For instance, using electronic images and pictures, diagnoses may be made from a remote location, either within or outside the facility.

2. E-health provides delivery of useful medical information via the Internet, kiosks or other electronic means that may facilitate patient education and provider decision-making.

3. E-health facilitates collaboration between providers and other caregivers through file sharing, email and electronic medical record systems.

4. E-health does not replace existing infrastructure applications. Instead, it facilitates those processes to expedite delivery and improve the quality of the services provided both locally and remotely. It operates within the walls of the health facility and across geographic boundaries.

5. E-health is not another name for e-commerce in the healthcare industry. However, the facilitation of business processes among employers, employees, insurers, suppliers, clinicians, patients, administrators and regulators may include examples of E-health.

6. E-health is not the routing hardware or the networking software, but it uses those to deliver the information needed to achieve the primary goal.

7. E-health uses these means, as well as other telecommunications services, to deliver the information and processes necessary for the ultimate outcome of patient care: improved health status.

Health information, products, and services have the potential to both improve health and cause harm. Organizations and individuals that provide health information on the Internet have an obligation to be trustworthy, protect users’ privacy, and adhere to standards for best practices for on-line commerce and professional services in health care.

Wednesday, 22 October, 2008

E-Health - Data incorporations through Technology

Delivery of healthcare is critically dependent on access to data, however much of this data resides across many data repositories and organizations, and is often highly protected and private.

The Environmental Drivers

Restructuring of the Health System (world wide) to meet the demands of ageing populations (major economic impact)

Funding agencies driving multi-disciplinary research initiatives and solutions to healthcare priorities and data sharing needs

Increasing pace of growth of the scientific knowledge base (e.g. genomics data) increased need for linking data across disciplines

Development and application of high-cost medical technologies and need for Cost/benefit analyses (global benchmarking)

Declining availability of specialist skills and thus improving productivity through advanced systems becomes a priority

Private-sector healthcare providers taking over more routine procedures from Public providers and data access issues

How do we answer a Health Query?

Identification of the real question

Design of the study

Collection of the data

Analysis of the data

How Easy is Health Data Incorporation into various Modules?

There are a hell lot of issues, like:

Patient Data is usually spread across several databases like:

• Hospital administration and clinical databases

Pathology and Pharmaceuticals databases

Absence of a common person identifier

• New identifying number or ID per institution or service provider

Privacy and Security

• Patient concerns

• Legislative requirements

• Data ownership concerns

No way to easily manage access to data in multiple databases

• Involves significant time and manual handling of data between computer systems

Data quality and consistency

• Data entry errors

• Non-standard coding and formats

Current Efforts and Practices

Data Linkage Units

National Data Network (NDN)

Various software solutions

Electronic Health Records

Clinical Information Systems

Current Technological Breakthroughs and Advances

Web Services

Easy federation of data and services


Mechanism for text based exchange of data


Relating concepts using semantic descriptions

Discipline based

Need domain expertise to define the ontology of data sources and fields

Removes ambiguity and provides base line agreement on terms

Integration of heterogeneous data sources

Wrapper technology allows any data or service to be incorporated

Query optimizer

Targeted at life sciences


Integrates data sources and analysis tools

Flat File, XML and relational data base

Any command line analysis tool

Integrates over 1000 data sources and 250 analysis tools

Wide usage in biotech and pharmaceutical industries

Meta data driven approach

Web service based with powerful web service API and web interface

Use Meta data to describe

The data source

How data elements interact with the system

The behavior of data

Relationship between data

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