Indian Healthcare and IT: Is the romance going to last?

by Ms.Khushboo Kumari, MHA-Hospital (2010-12)

In India, one word that (most) doctors and medical professionals are skeptical about is Information Technology aka IT. Though major IT players in the market see immense opportunity in healthcare in terms of offering solutions from automating processes to streamlining clinical workflows, the user groups (doctors, nurses etc.) in healthcare sector are yet to change their mindset from “IT Vs. me” to “IT for me”.

Indubitably, healthcare has its unique challenges; still it can learn its lessons from the experience of manufacturing and retail industries which are reaping huge benefits of adopting correct IT strategy to remove process-related inefficiencies. Innovative and tailor-made IT solutions magnificently increase the efficiency, safety and quality of medical care. They help lower costs and even standardize processes. Also the information gaps during clinical analysis that persist due to missing records and informal levels of exchange of clinical data can be bridged by using EHRs and quality patient management solutions. The rate of medical and clinical errors can also be brought down significantly.

But if the advantages are so apparent, where do the hitches come from?

They arise on account of the ineffective training and change management, specifically for the medical user groups. Mostly, major chunk of modules in HMIS in a hospital remains unused. Non-usage is one huge threat that prevents top management to invest in healthcare IT.

Nevertheless there are ways out. Any change initiative in any organization needs strong determination of the administrators to be successful. Involvement of the user groups and continuous monitoring & training are other important aspects.

With corporate chains and big private hospitals opting for HIS, there appears to be a silver lining in the cloud. Accreditation and standardization needs would also encourage IT adoption in healthcare.

I would hence rest my sincerest hopes in this romance to last forever.

An insightful read

Working in various hospitals, haven't we often wondered how GOOD is the hospital, we are in..!!

What makes a hospital (or any healthcare provider) better than others- the facilities it offers or the quality of service that it provides..!

Is there any possible way that this comparison can be standardized? YES, there is. The paper speaks of parameters in terms of measuring mortality, efficiency and patient experience that can help in critical assessment.

Quite an interesting and insightful read..!

Is rationing a rational option in health care?

by Dr.Arun K. Tiwari

There are two concepts of rationing in healthcare- Conventional Rationing and Price-based Rationing.

Concept of Conventional Rationing can be animated in the function of a sand clock where scarce resource from upper half passes down through a narrow channel and gets distributed to a large base. Similarly price based rationing can be visualized in the form of a coin box telephone, where only those get to make calls who are capable of inserting coin and also in order to maintain it, they are required to keep pushing the coins.

Question regarding which type of rationing seems to be settled in favor of the conventional rationing as it is less offending towards human rights (consider emergency cases being denied for not being able to pay). Looking at various health systems across the world, Rationing is evident in various forms e.g. waiting time, exclusion of drugs from list, gate keeping or even complete denial of services like cosmetic surgeries and dentistry.

Though healthcare sector strives hard to achieve cost minimization, it becomes difficult because of two major reasons: shortage of skilled professionals, which drives the cost of labor high and second, using finished products from other sciences (e.g technology, IT, pharmaceuticals etc) as inputs to produce services, which causes a second level of cost escalation.

Nonetheless, the health systems have their own ways of reducing cost. Primary Health Care (based on the principles of equitable distribution, Community participation, inter-sectoral co ordination and appropriate technology) is the most suited low cost model advocated for most developing countries by WHO. Other prevalent approaches are those of QALY and DALY. It is out of these principles of allocative efficiency that the concept of rationing derives most of its rationality. Development of innovative financing mechanisms to mitigate the risk of catastrophic expenditure during illness is an example of expanded rationality.

There are policies in which rationing is implicitly expressed (such as NHS, UK) and in some others, it is explicit (USA). Market based or non market based means- Rationing as a policy tool seems ubiquitous in all health systems. Interestingly this happens to be the most basic of all tools known to deal with scarcity of resources.

Thus, more than the matter of its presence, it is the form of presence which ought to be subjected to debate. It is now a debate of means and methods by which this particular policy tool is used rather than the rationality and validity of the tool itself.