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


XML


Mechanism for text based exchange of data


Ontology


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



SRS


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

Tuesday, 21 October, 2008

Ecommerce & Healthcare- in News!



E-commerce has become a commonplace practice in our lives today. Many of us have purchased books from Amazon.com, bid on items on e-bay, renewed our HFMA memberships online, or purchased airline tickets at any number of discount travel Web sites, Very lately I bought an Herbal Purgative Online. Frankly we have all probably wondered what we did before the Internet came along to simplify our purchasing experiences.




The online health channel continues to proliferate, despite increased scrutiny due to heightened security fears among consumers.One such example is Drugstore.com (Though in India, we have no good examples till date- Thanks to the Rules!)


Match 1:


In the fourth quarter ended December 28, 2003, drugstore.com achieved EBITDA (earnings before interest, taxes, depreciation and amortization of intangible assets, noncash marketing expense and stock-based compensation) of $556,000, the first such profit in the company's history.


About drugstore.com


Drugstore.com (www.drugstore.com) is an online source for thousands of brand-name health, beauty and wellness products, combined with a wealth of decision-making information and resources to educate and inform consumers to take charge of their personal health and well-being. Based in Redmond, Washington, the company is headed by President and CEO Peter Neupert, a former senior Microsoft executive. drugstore.com is funded by Amazon.com, Kleiner Perkins Caufield and Byers, Maveron, L.L.C. and Liberty Media. Drugstore.com is a trademark of Drugstore.com, Inc.




Match 2:


Described by some as a consolidator of health care web sites, HealthCentral has made itself into a force to be reckoned with irron-line retailing.
With a network of sites that includes WebRx.com, HealthCentral.com, Vitamins.com, DrugEmporium.com and RxList.com, HealthCentral has made itself into one of the most comprehensive health care providers on the Internet.




Question: Is there a Comfort factor for the customer in Health etailing?


We in health care may feel we have a strong relationship with our customers because our customers still rely overwhelmingly on our Hold-flip-read and buy operations for the services they need. Therefore, consumer confidence in our services, we think, should remain relatively high.


Think again. The Institute of Medicine's reports on medical errors sent a shiver through many healthcare consumers. Healthcare organizations should be on notice that consumers are going to be peering very closely over their shoulders in the future.Web sites offering consumers vast amounts of information about healthcare services have proliferated. For example, www.virtualhealthfair.com offers comprehensive healthcare information, including a virtual lab, "where you can learn about, understand, and interpret common lab tests," including fecal occult blood test, urinalysis, and dozens more.
But clinical information will not be the only information consumers will be seeking. They will demand specific information about the quality and cost ratings of health plans and providers. They will want to keep an active eye on their medical records, which largely have become electronic.


Therefore, Ehealth & Etailing has to be employed for the sake of convenience and customer relationship both.Healthcare organizations that want to maintain consumer confidence will have to address the virtual relationship that will become a larger and larger part of their interactions with patients and family members.




Please feel free to comment, will come up with more soon.


Monday, 20 October, 2008

Healthcare - Suggest Solutions?







Health Issues in the Philippines
Like any other third-world country, the Philippines have been struggling in some health issues and one of it is illegal drug use. A lot of Filipinos are addicted to prohibited drugs. However, the Philippine government has dealt with this issue and although there are still some recorded incidents of drug abuse, the number of drug dependents in the Philippines has gradually decreased.
Other concerning health issues in the Philippines, is malnutrition. There have been studies conducted and accordingly, most of the Filipinos that suffer from malnutrition are the poor ones. The Philippine government, thru the Department of Social Welfare and Developments along with the Department of Health has provided projects to help poor Filipinos from starvation.One such big issue is Dengue fever.
Health Care System in Thailand



Thailand has no established primary health care system- Most of the doctors in Thailand are specialists that is why it is hard to find a reliable all around general practitioner to treat you with your minor medical problems. As foreigners, you will have to go to a general hospital, wherein you will be most likely to be examined by a doctor who is specializing in one field to another. Since it is common to have different small medical problems, it is somehow difficult for a medical specialist to deal with that. The best way to do especially if you are not quite so sure about your problem is simply to seek an internist and simply take it from there. Reports have shown that the health care system heavily relies on the specialized medicine. However, there are still some major hospitals in Thailand that have family doctors or medical practitioners. Expatriates can always make use of that.


Big Question?- How to fix India's Healthcare System?



There is a two-way causality between health and economic development. Countries, which are economically well developed, tend to invest more on healthcare.
Greater investment in healthcare also leads to longer life expectancy, less morbidity and increasing work productivity that results in economic progress.
Over the last two decades, life expectancy at birth in India has increased by approximately double the increase in life expectancy in middle income and high-income countries.
However, the average Indian life expectancy is 15 years less than that of a citizen of a high-income country. Notice the low levels of public expenditures on health in India compared to middle income and high-income countries.
The ratio of India's purchasing power parity-adjusted per capita income to that of middle-income countries is 52 per cent and that of high-income countries is 10.6 per cent. The ratio of India's purchasing power parity-adjusted health expenditure per capita is 35 per cent of middle-income countries and 3.6 per cent of rich countries.
Even allowing for some wasteful expenditure in developed countries, we are certainly under investing in health. Notice the low levels of public expenditures on health in India compared to middle income and high-income countries.
The number of physicians per 1000 people has remained unchanged in India over the last twenty years. Another unique feature in the country is the usage of public health services by the bottom 20 per cent of the population (classified by income), which is only marginally higher than the top 20 per cent of the population.
Hence, there is urgent need to rejuvenate the public healthcare system to ensure that the poor get access to essential medical services.
Though the budget resources are scarce, there is certainly a need to double the public expenditure on health, given the long-term benefits. The emphasis should be on prevention and making essential public health services available to the poor.
About 88 per cent of the pregnant women are anaemic. India is unfortunately leading the world in this risk factor. The surprising issue is that this is not related to income distribution.
Other aspects such as low birth weight babies and child malnutrition are close to the poverty line numbers. While deadly diseases such as Tuberculosis and HIV are receiving public attention, the long-term consequences of in utero problems have been neglected.
India does not have a functional western model to follow in healthcare. The non-price rationing by queuing in Canada/ Britain and the price-based rationing in the US are not functioning effectively. India has its own system with private healthcare practitioners, who are largely unregulated, playing a significant role in meeting the healthcare needs of people.
More disclosure on the part of the private clinics and hospitals must be made mandatory so that the public can assess the quality of medical care and get some understanding of the track record of practitioners and hospitals.
Research has shown substantial medical expenditure occurs during the last two years of a person's life. A broad based hospitalisation catastrophic insurance must be offered to protect individuals in their old age.The benefits clearly defined and properly enforced can minimise fraud and delays in these programmes. Last but not the least, more collaboration is needed between doctors and economists to jointly pursue research and make health economics a robust discipline for specialisation.
Any other Ideas lemme know- Shout at drruchibhatt@yahoo.co.in

Thursday, 9 October, 2008

The Golden Future- Healthcare-IT & E-health


An ideal healthcare portal


India’s huge population poses problems for the nation’s healthcare sector. E-health is a solution that can bring together all the major sectors such as development agencies, health industry experts, public health specialists, policy makers, academicians, technology developers and civil society practitioners to provide schemes that are useful to common people.


Aims of an Indian health portal


Ambulatory care


One of the most profound changes seen in many countries around the world is a shift from a hospital based healthcare system to a more ambulatory system with home care, day care clinics and same day surgeries. We are now treating patients in ways that were thought impossible a few years ago. It is now possible for a patient to come to hospital in the morning, have a coronagraph and be home that same day! You can also have your intravenous antibiotics at home or have adjustment to your anticoagulation regimen on an out patient basis.


Chronic diseases management


The incidence of chronic disease is rising in part due to an aging population and more efficient treatment.
With chronic diseases, our management aims to stabilize the patient, keeping him in that state while also slowing/stopping more functional deterioration and preventing further complications. To achieve these goals it is mandatory to have a high level of coordination in the care team, but it is also important to actively involve the patient himself.


Knowledge management


The healthcare sector is one of the most information driven industries and the amount of information that must be dealt with on a regular basis is growing every day. Also, with the advent of the internet, access to information is easy. It is now usual to have patients come to their appointment with printed documents found online.


Classical Electronic Health Records approach


Most of the Electronic Health Records available on the market today are not patient-centered but rather ‘hospital-centered’. As such they were not designed to easily address the challenges raised by the new paradigms found in the healthcare sector today. One of the consequences is that the care activities delivered outside hospital walls are difficult to integrate. Another major consequence is that no tools or functionalities are available to integrate the patient as an active member of the care team.


Evidence based medicine


The e-health system enables the doctor to check international research and data to confirm their diagnosis. This helps reduce confusion in a patients treatment, especially in developing countries.


Virtual healthcare team


The most important benefit of e-health in India is that it has enabled several patients to discuss their problems online, i.e. through the internet.


Benefits


For patient


Improved information about their disease/illness


Access the internet from anywhere and get updated reports


Not restricted to keeping prescription details with a hospital


Online medical advice available from renowned doctors


Reduced travel expenses for treatment


For doctors


Improves the healthcare system


No manual writing of prescriptions


Time saving and efficient


For government


Able to monitor the healthcare system of the country


Get to measure the number of patients examined by a doctor daily


Data captured for various regions


E-health services are gradually being adopted by healthcare provider organizations in India. The growth of e-health services has given rise to the need for a new breed of healthcare professionals, healthcare administrators and healthcare technologists.


http://india-insights.co.uk/

Pharma Business & Marketing- Ehealth

















There are two basic classes of population from the point of pharmaceuticals view. The attitude of these two classes is so divergent that the behaviour which they display towards consumption of medicine is very different.These two classes are sufferers and non-sufferers. Sufferers tend to become hypochondriac and they ensure that they comply with the medicines while non-sufferers believe that nothing is wrong with them and perhaps will go wrong to their health till they cross the border of sufferers.


As demographics of India are creating a very powerful force for growth of every industry, pharma is not an exception. Healthy population as well as sick population is continuously getting updated on medical issues through Internet.


Now the population who consumes medicine whether it pharma or nutraceutical consists of both sick and healthy patients. They exhibit their behaviour of exhibiting their choice in selection of medicines. Coupled with Internet education and their awareness, they feel, they are making the right choice even in high involvement and high-risk products. As a result, they have created a new class of medical consumers.


Patient On-Chat ,Patient Online, Newsletters & Emails:


Out of almost 41 million people who are supposed to be diabetics in India, you will observe that hardly 4 million patients are taking adequate care of themselves through medicines while others might be taking care of their health through alternate medicines or other traditional methods. Having such vast gap between what can accrue through pharma industry what is not really creating in the market for the industry needs to be noticed by all marketers. What should my mind matters is intense and exhausted patient education. It's possible through patient communication.


The Question?- How to communicate with these learned medical consumers?


Answer: ADTC advertising and communication.


Points to keep in mind to make this an Effective Tool:




  1. Quality of product


  2. " Safety of product even at higher dosages


  3. " Continuous availability of information about the product


  4. " Continuous promotion of the product


  5. " Continuous credibility creation and continuous improvement of the product


Consumer looks into packaging, clear directions on label, safety instructions, warnings andother regulatory instructions. He also looks at price and competitive products. Besides, this he may look at bulk pack as one of his convenience if it's day-to-day purchase and consumption.



In order to develop specific action plan marketer needs to carry out following survey:Awareness, understanding existing use of any substitute or a competitor (may not be from the same category), buying patterns, usage and attitude patterns, trends of markets, regions, logistics and capacity to stock these products for different outlets.



PR ,Marketing and Communication Strategy:Pharmaceutical companies should have communication strategy besides main strategy.



sOME eXAMPLES:



Drugdiscoveryonline.com, pharmaceuticalonline.com are good with Newsletters.



SurveryRX is a web based platform that enables a company to conduct online medical market research with physicians across multiple sites in a secure environment.



Today's Featured one: Informed Horizons, LLC - Medical communications company committed to keeping physicians and patients up to date with the latest advances in pharmaceutical research.





Monday, 6 October, 2008

Ecommerce: From and Through a Healthcare Portal

In today's on-line environment, eCommerce is already changing the healthcare industry. Current business-to-consumer sites include Drugstore.com and PlanteRx, which provide sales of prescription and over-the-counter products to consumers. WebMD and drkoop.com provide information and product promotion to consumers and doctors alike.
Non-contractual business-to-business healthcare web sites that provide sales of medical supplies to institutions are Neoforma and Medibuy. Chemdex and SciQuest are non-contractual in respect to the sales of lab supplies to pharmaceutical Research and Development companies.

Ecommerce in Hospitals: eCommerce has been identified as a leading practice in the healthcare supply chain.The 'big things' hospitals include:

  1. Electronic requisitioning
  2. Electronic replenishment
  3. Electronic fund transfers
  4. Contract database management

Implementing leading practices within the supply chain enables hospitals save on costs, allowing funds to be redirected into patient care. Once there is a critical mass of hospitals using eCommerce, suppliers become able to make changes to their systems enabling even greater efficiencies

Econsultancy & E commerce:When healthcare consultancy is provided on a health portal, Its a hard sell..Coz people log on to internet only coz it's Free. Build of a next generation eCommerce site IS NECESSARY that should combine high levels of functionality along with advanced content management, merchandising and search facilities to meet customer and business needs.

One such website is of William Ramsom & son.

Key Features:

Built on the new eibCommerce platform using Microsoft Commerce Server 2007, the site integrates with key strategic partners: Mercado for dynamic merchandising functionality, EPiServer for advanced content management and Datacash for secure payments. The site utilises advanced search functionality so that customers can shop by need, ingredient, brand and life stage. In addition the “My Cabinet” functionality enables shoppers to easily view their account history and previous purchases.

Ecommerce & E-health Records:How to assure the privacy and Security of information communicated?

  1. How to develop and Deliver effective services?
  2. How to overcome bandwidth limitations?

Research and Strategy should be focussing upon:

  1. Assessing customer perceptions of the risks and benefits of eCommerce in the life sciences
  2. Determining the percent of product orders placed online by product category
  3. Quantifying the customer value of eCommerce purchases by calculating the amount, frequency, and recency of online orders by product category
  4. To Explain the influence of pricing on the online ordering process and customer’s use of online ordering tools to obtain pricing information
  5. Specifying customer preferences for page load times, product locators, and Web site speed during the check-out process
  6. Detailing the types of information customers need to facilitate their online ordering
  7. Identifying the types of assistance customers need to facilitate their use of a Web site’s eCommerce functions
  8. Measuring customer satisfaction with key online ordering tools
  9. Highlighting Web site features that help customize the eCommerce experience
  10. Revealing Web site features that encourage repeat eCommerce business
  11. Evaluating the connection between receptivity to eMarketing and eCommerce activities

Innovation is a key part of any modern healthcare system and this innovation takes place at many levels and across multiple disciplines. Healthcare providers have access to new treatment procedures, drugs and diagnostic equipment. However, there is one area where the healthcare sector has failed to deploy technology and expertise that is widely available and used to improve the efficiency of organisations in the financial services, manufacturing and retail sectors. While most healthcare providers have experimented with ‘ehealth’ they have been slow to build the core IT services and instigate the change management programs that have to be in place before online healthcare services can be deployed.

Wednesday, 1 October, 2008

Giving Chat facility on a Health Website




The biggest reasons why hospitals in India and abroad are giving chat facilities to their visitors are:

1. Reduce operational expense

2. Enhance customer service

healthcaremagic.com, healthizen.com in India have also joined the lead. Abroad also, various sites like offshoremd.com, chatmag.com, geocities.com, offshoremd.com etc are doing the same stuff.

Even Health insurance plans – driven by the rapid growth of individual health coverage increasingly turn to customer service technologies that sophisticated retail businesses, ranging from consumer products to financial services, have employed successfully for years, most notably Click-to-Chat, or “Chat.”

Why is Chat, a good Idea?

Chat technology enables health plan members to communicate online with customer service reps
through real-time text messaging, rather than over the phone. Because Chat technology allows
service reps to handle more than one customer simultaneously, and provides customers with a
detailed record of online text “conversations,” companies are able to reduce operating costs and
improve the customer experience with Chat.

Is it Risk Free, say for a new or upcoming health website?

Well, When improperly configured or inappropriately staffed, Chat technology can degrade the customer experience, erode brand confidence, and even drive a customer to a competitor.

Doctors on Chat and the HR significance?

This doctor was good on a telephonic and personal interview, should be good to handle my online patients = Strict No No....

Chat Doctors and Voice doctors (ON CALL DOCTORS) have distinct personalities and skill
sets, and they shouldn’t be expected to perform each other’s jobs. Proper recruitment, training
and supervision are critical. “The best DOCTORS may sound good over the phone but that may be coz they prefer social interaction and enjoy talking on the phone.

How to recruit and differentiate?

if he is just a "good to talk to" doctor on call, the moment he completes a call, he’ll turn to his
colleagues and continue talking.

Chat doctors are exactly the opposite. They prefer written communication, are extremely focused, and don’t like interruptions when working.”

What can spoil the Chat pot pourri?

Leaving Customers Waiting Too Long – Like a frustrated radio listener who switches to
another station when there is “dead air,” an online customer will often terminate a Chat session
when too much time elapses between questions and answers. Well-designed Chat solutions are
staffed with trained agents and employ automatic system interventions that shorten customer
wait time and reduce abandonment of the Chat session.

For eg. " This question requires, Expert opinion, let me put you to a specialist."

or, "Consulting our Gynaecologists team, Please be patient!"

Website Design and Chat windows

Making Chat Icons Difficult to Locate – This can be a down-hiller! Strategic placement of the Click-to-Chat button on a company’s website can turn shoppers into buyers, enable faster resolution of customer service issues, and strengthen brand loyalty. Chat entry points placed on logical pages, such as those containing billing or statement information, often lead to faster resolution of questions and more satisfied customers. Conversely, hunting for a Chat icon leads to a poor customer service outcome.

The best place links are given below:




Some which I find Boring:







New services launched- Developing innovative Medical and Healthcare content

After completing over a decade in Healthcare consulting, HealthCursor is now providing Medical content services to all its clients across th...