IT in Modern Healthcare Organizations

eINDIA Track : eHEALTH Title of Paper Author Name Email Designation Address Contact No.

: IT in Modern Healthcare Organisations : GUNJAN KUMAR : g.kumar@simil.org : HEAD - IT & AUTOMATION : SAHARA HOSPITAL (SAHARA INDIA GROUP), VIRAJ KHAND, GOMTI NAGAR, LUCKNOW : 09839129291

Over the past years, industries across various domains have experienced dramatic improvements in the productivity, efficiency and cost controls by investing in Information Technology. Technology has become ubiquitous thus evading it will impede organizational growth. Most of the organizations have envisaged Business Visibility through adoption of Information Technology and have gone to the extent of restructuring and re-aligning their operations around new age technologies. The healthcare sector may be lagging behind in IT adoption initially, but in recent past there has been a phenomenal spurt in IT spending by healthcare organizations and in due course of time they have experienced its benefits as well.

Pic: 1 Information Technology in Modern Healthcare Organisations

hcare re-align themselves with the Healthcare Progressive healthcare organizations need to re Information Technology ecosystem and be more creative on use of IT. ecosystem, IT Healthcare IT systems and associated technological innovations in Medical Equipments and devices offer a wide range of benefits to healthcare organizations by helping clinicians and staff, work more efficiently and smartly, thus delivering qualit care to quality patients and improved clinical outcom & safety. outcomes Today, every system, ranging from Radio diagnostics to Laboratory equipments, Radio-diagnostics Operation Theatre setups
(P (Pic:2 Modern Operation Theatre),

CATH Labs Patient Bed-side s,

Monitoring Systems, and other medical equipments, has IT at its core. Contrary to the , core past, instead of functioning in silos, they have evolved to be part of a synchronized nstead integrated healthcare delivery system resulting in better clinical data management and consistent clinical information across the healthcare enterprise.

Pic: 2 Modern Operation Theatre

Furthermore, IT systems also catalyze the achievement of healthcare organizations financial objectives and ensure commercial viability of the enterprise by streamlining the financial processes.

For instance, Healthcare ERP which is more often referred as Hospital Information System (HIS), gives financial insight into many concurrent activities taking place across various point-of-care at a healthcare setup and helps to monitor and take corrective measures to maintain profitability and provides desired inputs to hospital administration for making informed decision making. There is yet another dimension to IT for modern healthcare organizations which is revenue generation by extending IT enabled Value Added Services to patients and their attendants like Web Based EMR wallet, Online access to Lab and Radiological reports, online subscription to Wellness programs and Appointment Scheduling for a doctor or diagnostic service through online payments using Payment Gateways. One of the services which has gained much of popularity in western world and is also being adopted in our country is to extend Tele-Consultation to patients at home by the use of gadgets like Portable Telemedicine units and portable medical devices.

At Sahara Hospital, Lucknow, we have indigenously developed and deployed many Value Added Services for patients and as well for the caregivers. Patient Live Video Transmission Service
(Pic:3 Patient Live Video Transmission Service),

is one of

the interesting concept and most appreciated value added services that have been deployed at Sahara Hospital using IP based Streaming Cameras fixed on a mount with wheels that can be rolled across the hospital to any patient bed-side. The entire designing and deployment of this service has been done in-house by the Healthcare IT team of the hospital. Through this service, patients relatives can effortlessly view the live video feed of the patient which are in restricted access areas of the hospital like Critical Care Wards or even Post-operative areas from any location in the world through internet. To ensure the privacy of the patients, each video session is secured through a user name and password. This facility also safeguards both patients and relatives/visitors from any crossinfection as well as eases the curiosity of concerned relatives.

Pic: 3 Patient Live Video Transmission Service

One of the other most availed services is Live IP TV Service

(Pic:4 Live IP TV Service),

which

offers free of cost access to live TV channels to patients in the hospital or their relatives on their laptops (wired or wirelessly) without even connecting to the internet. For this a Video Streaming Server has been setup and multicast transmission is done through inhouse designed server software. The streaming server is further being configured to be used as a powerful marketing tool by broadcasting hospital services related information, videos of specialized surgeries performed at the hospital and other important events as well patient education content.

Pic: 4 Live IP TV Service

Achieving Transmission of Patients Vital Parameters from a moving ambulance is yet another good example of IT adoption in a modern healthcare organisation. Sahara Hospital has Ambulances that are equipped with the medical devices and IT systems for transmitting Patients vital parameters to the doctors in the hospital while the ambulance is on the move and is transporting patient from a distant location to the hospital (Pic: 5 Transmission of Patients Vital Parameters). Such systems helps in extending assistance to the Paramedical Staff in the moving ambulance from the experts in the hospital and at the same time provides sufficient inputs to the Emergency Medical Officer and his team at hospital to ensure desired preparedness to receive the patient as the ambulance arrives and commence appropriate line of treatment immediately.

Pic: 5 Transmission of Patients Vital Parameters

Universal Access to Patient Bedside Monitoring System is the Web Based accessibility system to enable doctors view from anywhere in the world real-time data, waveforms and information, which is being displayed at each bedside on the Patient VitalParameter Monitor (Pic: 6 Patient Bedside Monitoring System).

Pic: 6 Patient Bedside Monitoring System

Sahara Hospital IT team has carried out effective integration of the Information Technology and Medical Systems to make this possible. This system turns out to be life saver when the treating physician is out of hospital campus and gets a telephonic communication that his patients health is unstable or deteriorating. The doctor wherever is, can log into the Patient Vital-Parameter Monitoring system (Pic:
7 Patient Vital Parameter Monitoring System)

through a web-browser on

his laptop and can view the live status of parameters of the patient. This way he can make an informed decision basis the data & waveforms he gets on the web browser and can remotely advise the paramedic staff to administer drug or carry out a procedure with the assistance of resident doctor to stabilize and comfort the patient.

Pic: 7 Patient Vital Parameter Monitoring System

This system also boasts complex Analytics Tool and has the capability to record complete Vital-Parameters data of all the patients in the Critical Care area on a central Database Server to do online analytics of each patient. This Analytics Tool captures information which can be missed out by the most watchful eye. It analysis data received from the Patient Bedside Monitor every moment and highlights all critical events with markers automatically to be reviewed later.

Through the same web login the doctor can view all past critical & non-critical events and have further insight into the vital-parameters trend of his patient.

Another important IT enabled service commissioned at Sahara Hospital is Pneumatic Tube System (Pic: 8,9 Pneumatic Tube System). This is an excellent transportation system and is being extensively used for quick transfer of Patients lab samples, medicines and reports from one location to another location of the hospital. This service reduces time as well as additional manpower associated cost.

Pic: 8 Pneumatic Tube System

Even the simple looking Pneumatic Tube containers have technology working for them by means of embedded RFID tags at both the ends. These RFID tags give intelligence to the system and act as a homing device to send empty carriers back to their origin. This is one of the many innovative usages of technology to extend convenience to hospital staff and enhancing their efficiency.

Pic: 9 Pneumatic Tube System

Another noteworthy IT enabled service installed and setup at Sahara Hospital is Advanced Fire Detection System (Pic:
10 Fire Detection System Console).

Unlike conventional

Fire Detection systems this system comprises of a network of Fire Detectors (both above and below false ceiling) all linked to microprocessor based Fire Panels and these are further networked to Centralized Management Server Console. Through the centralized console, all the fire panels, loops and detectors are monitored. Management console is equipped with maps and location plan of all the areas of the entire hospital campus. Each detector in the campus is demarcated with a unique address with details of location where it is installed. As soon as alarm is triggered, console machine starts giving beep and immediately the Floor Plan Map pops up on the console screen with indicator starts blinking over the detector which has detected the threat. Immediately the communication may be sent across to the security personnel in that area through portable radio that a fire incidence or alarm has been triggered and the Fire Officer may be rushed to that area for immediate action and response.

Pic: 10 Fire Detection System Console

Besides above mentioned systems and technologies, in a modern healthcare setup, Hospital Information System (HIS) is desired to integrate all business functions of the healthcare enterprise. This integration helps improving information distribution and synchronizing the activities across the hospital or healthcare setup thus optimizing on output achieved from all resources, whether it is human, medical equipment or infrastructure. HIS is a tool to integrate and automate the functional processes of different departments of the hospital for the benefit of Patients as well as the hospital management. Apart from streamlining billing processes in the hospital, there are several other benefits which can be achieved by deployment of HIS. At Sahara Hospital, HIS is being deployed with the mix of innovation and creativity to achieve the following 1. Workflow at Pharmacy has been streamlined with the use of technology by incorporating Barcodes and Display systems to reduce the waiting time for OPD Patients 2. Patients Lab Samples barcoded for efficient tracking and quicker results from integrated Lab Equipment 3. To avoid tracking of physical movement of patients MRD files, provision has been incorporated into the HIS so that MRD files in the form of soft-copy is authorized to the doctor/paramedical staff requesting for the file. This helps the MRD officials to avoid misplacement of physical files 4. Intelligent features has been built-in into the HIS system during ordering of drugs/medication to the patient by Doctor/Nursing staff. The feature has been added to intelligently calculate and display the quantity of drug to be issued from the pharmacy on the basis of dosages defined. The system automatically multiplies the tablets/capsules but doesnt multiply Syrups/injections etc. 5. Advanced features of gathering feedbacks and marketing hospital services is done through Patient Relationship Management interface 6. Several other types of tracking may be done like - tracking outside referrals to the hospital for marketing purposes, tracking of outstanding payments from Corporates/TPAs and tracking of samples received from outsourced agencies

7. Needless to mention the options of booking appointments online through web for Doctors consultation and services/procedures 8. MIS reports have been designed for assisting management for analyzing hospital revenue and making future projections

While most of the benefits of IT adoption for healthcare organizations are known to the stakeholders, still most of the organizations are unable to leverage the real potential of IT and to add to it, they are most of the times not even aware of this shortcoming.

To reap real benefits of IT, Information & Communication Technology systems need to be thought of as one of the FIRSTS in the planning phase of a modern healthcare setup. Most of the hospitals still believe that IT is mostly to do with Hospital Information System or Hospital Management System or streamlining the billing & financial system; it is the New-age Modern Healthcare Organizations that have started thinking much more comprehensively. The Three Mantras for the New-age Healthcare Organizations ARE 1) The extent of Technology deployment depends on how far your Networks can reach; 2) the Bouquet of IT systems & services you can deploy and offer, largely depends upon how your Networks and IT infrastructure performs; and 3) the assurance of the continuity of services depends upon how redundant & secure your network channels are. These Mantras hold true for both Campus based and Multi-location setups and of any scale, that is small, medium or large. The contemporary healthcare organizations have started adopting intelligently designed Medical Grade Networks which uses the right mix of Fiber Optics, Gigabit Copper cabling and wherever desired Wireless Networks - for mobility and portability. (Pic:
Fiber Optic & Copper Cabling System) 11

Pic: 11 Fiber Optic & Copper Cabling System

The art is to strike a balance between optimum data throughput by use of appropriate transmission medium and switching technology while ensuring the Network Security by deploying Firewalls, Content Filters, Intrusion Detection/Protection system and Network Admission Controls. (Pic: 12 Network Core Switches)

Pic: 12 Network Core Switches

At the time of building new infrastructure, when most of the hospitals plan for different hospital services like Electrical systems, Air Conditioning systems, Medical Gases etc., modern healthcare setups plan for Information & Communication Technology systems since inception. PLANNING AND FORECASTING ARE THE KEYWORDS TO SUCCESS. Smart planning with flexibility & scope for accommodating changing technology & future expansions is the way towards Excellence. A new perspective to IT in modern healthcare organizations is to bring along almost all the different services together in the IT domain thus maximizing their potential and making them part of integrated healthcare IT delivery system. Broadly speaking Telecommunications system, Internet services, Patient Bedside Monitoring system,

Pneumatic Chute System, Patient Live Video Transmission system, Hospital Information System, Medical Equipment Integration, Information kiosks, Hospital Paging & Annunciation system, Nurse Call System, CCTV Security system and many more would work as a Single Integrated System. To host and support these multiple services a wellplanned Data Center or Server Room is a necessity for any modern setup to ensure central deployment of software applications and services.
Setup) (Pic: 13 Server Room / Data Center

Today, Server Virtualization is the way forward to ensure investment protection in various hardware & servers and to also achieve consolidation. The most generic IT systems deployment in the Server Room for any modern healthcare organization is centralized Anti-Virus Server, Mail Server, File Server, Active Directory Server, HIS Application Server, Database Server, PACS Application Server and SAN Storage etc. (Pic: 14 Servers for various Healthcare IT Applications)

Pic: 13 Server Room / Data Center Setup

Pic: 14 Servers for various Healthcare IT Applications

The good news is that all these can be virtualized as a Private Cloud. For different application software requirements there are plenty of economical solutions for small, medium to large size organizations basis the budget they have. At times intelligent freeware solutions or open source solutions can do wonders vis--vis expensive solutions from large vendors. It is always insisted that organizations should look at IT holistically. Modern Healthcare organizations will opt for well-designed and integrated Healthcare IT systems which includes Hospital Information System, Laboratory Equipment Integration through LIS, RIS, PACS, Tele-Medicine, Centralized & Remote Patient Monitoring System, Patient and Sample Tracking using Bar-Code and RF ID tagging, Video Collaboration of Doctors, Capability of sending Vital Parameters of the Patients from Ambulance at remote locations. More advanced organizations will also opt for Tele-Radiology, TelePathology, Robotics Surgery, remote annotation feature during surgeries and many more. These integrated IT systems will help aligning business processes of healthcare setups leading to seamless & hassle-free patient care experience.

The key take-away is: AS OUR WORLD IS GETTING INSTRUMENTATED, INTERCONNECTED, INTELLIGENT AND INNOVATIVE, IT IS NOT THE TECHNOLOGY THAT WILL COST MUCH, BUT IT IS NOT USING TECHNOLOGY WHAT MAY COST MORE

References:
1) 2) 3) 4) 5) 6) 7) 8) 9) 10) 11) 12) 13) 14) Pic: 1 Information Technology in Modern Healthcare Organisations Prepared by Author using image from http://mi6410.wordpress.com/ Pic: 2 Modern Operation Theatre - http://www.or-tv.net/or3g.htm Pic: 3 Patient Live Video Service Photograph shot by Author at Sahara Hospital, Lucknow Pic: 4 Live IP TV Service Photograph shot by Author at Sahara Hospital, Lucknow Pic: 5 Transmission of Patients Vital Parameters Photograph shot by Author at Sahara Hospital, Lucknow Pic: 6 Patient Bedside Monitoring System From catalogue of Philips Bedside Monitor Pic: 7 Patient Bedside Monitoring System Console Photograph shot by Author at Sahara Hospital, Lucknow Pic: 8 Pneumatic Tube System Photograph shot by Author at Sahara Hospital, Lucknow Pic: 9 Pneumatic Tube System Photograph shot by Author at Sahara Hospital, Lucknow Pic: 10 Fire Detection System Console Photograph shot by Author at Sahara Hospital, Lucknow Pic: 11 Fiber Optic & Copper Cabling System prepared by Author Pic: 12 Network Core Switches Photograph shot by Author at Sahara Hospital, Lucknow Pic: 13 Server Room / Data Center Setup Photograph shot by Author at Sahara Hospital, Lucknow Pic: 14 Servers for various Healthcare IT Applications Photograph shot by Author at Sahara Hospital, Lucknow

AUTHOR:

GUNJAN KUMAR
(HEALTHCARE Technology, Infrastructure and Practices Consultant)
Tech. Qualification: Bachelor of Engineering (BE); MBA in Information

Technology; IBM Advanced Certificate in Software Engineering

Current designation: HEAD IT & AUTOMATION (SAHARA HOSPITAL,

LUCKNOW)
More than 11 years of experience of Consulting, Designing, Solutions delivery and Managing Healthcare IT systems & solutions Key Skills: 1) Conceptualization and Planning for integrated Critical Healthcare Services as well as IT & Automation infrastructure; 2) Project Management; 3) IT Infrastructure Designing, Validation & Execution monitoring; 4) Operations & Management; 5) IT Strategy & Policies; 6) Strategic Analysis and Internal Consulting; 7) Business Process Re-engineering adopting new-age Technology Extensive experience in bringing in Effective, Efficient and Scalable solutions by ensuring right mix of Knowledge, Technology and Practices.