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.

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