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HEALTHCARE IT & TALENT MANAGEMENT

A PERSPECTIVE

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Agenda

IT trends in healthcare

Indian scenario

Targeted applications of IT in healthcare

Market size of IT in healthcare - India

Trends impacting healthcare IT

IT in healthcare – from need to necessity

Healthcare IT integration - implications on talent management

Health care IT integration - challenges

Case studies

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IT in healthcare from need to necessity

Increasing accessibility and quality

• Efficient and improved handling of high volumes of patients visits• Reaching the limited and untapped areas and reducing pressure on

limited public infrastructure

Efficient administrative functions

• Reduced patient waiting time through Efficient administrative functions

• Increased success rate in treatment and diagnosis

Mending the supply chain

• Reduce shrinkage in pharmacy operations in terms of better management and control of drug pilferage

Advanced use of diagnostic equipments

• Transition of diagnostic tools to network aware with digital outputs.• Ensure quick and efficient diagnosis

Enhanced healthcare infrastructure

• Develop innovative and efficient healthcare infrastructure beneficial for the rural and urban population

Regulatory and compliance

• The industry is governed by a high degree of regulatory compliance• IT is helping healthcare service providers to enhance customer safety

and confidentiality

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IT evolution in the healthcare industry

Key disruptive technologies

Big data Cloud

Future trends

Social media

Emerging solutions

m-health Tele-health

Tech

no

log

ies

Imp

act

■ Mobile health applications have emerged strongly over the past couple of years

■ Have the potential to bring the patient and healthcare provider closer

■ Enables patients in rural areas to access specialists at affordable costs

■ Vast potential in the Indian hinterland; several projects already underway

■ Healthcare records and apps are increasingly being stored on the cloud

■ Embedded systems are primarily being used in the US and European markets; less traction in India

■ AR can be used in training medical professionals

■ Big data can be used to processes health records from hospitals and then models outcomes and treatments

MobilityEmbedded

systemsAugmented

reality

Technology trends have the potential to change the healthcare landscape in India

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IT in healthcare – India focus

Untapped opportunity

■ Telemedicine: Poised to grow at a CAGR of 20 percent in the next five years, telemedicine as a segment is estimated to have potential worth US$500 million by 2015

■ Teleradiology: The market in India has been estimated at US$43 million in 2012 and is forecast to grow at a CAGR of about 15 percent

■ Hospital MIS: This is a relatively untapped area in India, but it holds with significant growth potential

■ Screening devices: Tablets are likely to play an integral role in capturing and analyzing sample data; further, with the advent of low-cost gadgets, activity on this front across 2013 and beyond is probable

Innovation in IT

■ Mobile applications: The spread of smartphones has led to various healthcare apps, ranging from basic healthcare information to checking patients’ ECG

■ Customized equipment: Equipment tailored to the specific needs of a patient are leading to better post-operative care. These include a remote monitoring solution for patients implanted with CRM devices

■ Over the phone counselling: “Doctor Saab Hai?” is an entrepreneurial venture which aims to provide free consultation services to consumers across India. They operate through a round the clock call center with certified doctors and nurses to handle all medical queries.

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IT presence across the value chain

Preventive care Diagnosis Treatment Management

Self monitoring devices with applications for data transmission

• Diabetes• COPD

• Tele-radiology• Tele-diagnostics

• Diabetes• COPD• Remote Foetal

Monitoring

• Mobile based personal emergency response system

• mhealth applications

• Cardiovascular conditions

• Diabetes• Epilepsy• Post ICU care• Nutrition• Fitness

• Tele-medicine initiatives

• Tele-counseling• Video consultations

• Eye care• Cardiovascular

conditions

Relatively less presence

Relatively high presence

Role of technology and communication is being explored at every aspect of healthcare delivery value chain and within multiple categories of healthcare

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The Indian healthcare market targeted application of IT

Large potential for IT

■ Indian hospitals need large scale investments in Electronic Health Records

■ Use of Big data to gather insights from patient data is also needed

Better integration with other healthcare players

■ Ballooning insurance costs has created fissures between patients, hospitals and insurance providers

■ Use of big data and cloud to cut costs, and prevent diseases needs to be fully utilized

Indian Pharma can use IT to leap to the next

level

■ IT can help in narrowing down successful drugs for research

■ IT can also be leveraged in sifting through gigabytes of clinical data to reduce time-to-market for new drugs

Cost-effective equipment

■ Indian manufacturers need to reduce cost of medical devices/equipment to increase penetration in the Indian market

Reduce costs

■ Use mobility to reduce cost of diagnostic tests

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IT in healthcare – market size (India)

Healthcare is among the fastest growing verticals growing at a rate of 17.5 percent (CAGR).

However, large corporate hospitals in India spend under 1 percent of their operating budget on IT, while spending is closer to 3 percent in the West.

2009 2012 2013 2018E0

200400600800

1000120014001600

274.2381.3

609.5

1450

USD Million

CAGR 22%

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Trends impacting healthcare ITSegment Description Key trends that impact IT

Provider• Hospitals• Ambulatory• Other Healthcare

• Hospital systems transitioning from best of breed to integrated enterprise solutions

• Greater need to store, secure and utilize patient data to improve patient outcomes

• Greater push to share data across providers & create patient health records. (e.g. patients, technology vendors, government)

Payer• Integrated payer and

providers for profit.• Not for profit.• Specialist

• More sophisticated data management required to improve medical & performance management

• Greater focus on cost reduction particularly in reducing cost of non core IT

• Payer IT systems need to accommodate new products

Pharma • Infrastructure or Applications

• Proliferation of clinical data from multiple sources requires improved analytic tools

• Pharmaceutical players exploring new models for R&D (e.g. greater use of electronic data collections during clinical trials)

• Greater use of IT to enable sales and marketing

Connectivity

• Financial (e.g. claims)• Administrative (e.g. practice

management, referrals, pre-certification)

• Clinical (e.g. laboratory, Rx)

• Portion of claims that are electronic continues to increase

• Desire for greater technical sophistication to reduce cost and rework (e.g. auto remediation)

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Healthcare IT integration – challenges

Buyer Side

• Doctors are not IT savvy; used to manual systems

• Different modes of training for nurses, doctors and other personnel

• Nature of the profession is such that it generates lot of paper documents

• Data security constraints

• Sector hesitant about the transparency brought about by IT

• Budget constraints

• Connectivity issues in remote regions

Challenges to IT

adoption

Supply Side

• Vendor market highly fragmented and unsophisticated

• Most existing products have evolved from custom solutions and many have only basic features

• Lack of implementation and post implementation support

• Lack of awareness on how IT can plug revenue leakages, improve profitability

• Lack of modular packages

• Lack of standardization of processes and workflow

• Limited IT talent with domain expertise

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Advances in technology will likely impact on healthcare human resources on following thrusts:

1. Changes in efficiencies brought about at local institutions leading to the removal of some positions and creation of others

2. Changes in types of medical care provided, such as gene therapy and minimally invasive interventions, which will have an impact on shifting of medical healthcare professionals from one subspecialty to others

3. Decentralization of the healthcare delivery system, which will shift significant resources from tertiary care facilities to primary and community care institutions and home healthcare

4. Shift in where patients receive their care - at home and in the community setting, rather than in big tertiary hospitals - will lead to a geographical shift in healthcare professionals from big cities to community and rural settings

Healthcare IT IntegrationImplications on Talent Management

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Case studies

India

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Healthcare Inclusion – TelemedicineArvind Eye Care Systems

Solution name: ADRES 3.0 (Aravind Diabetic Retinopathy Evaluation Software)

Implemented In: Diabetic centres/diabetologists office/laboratory/general physician clinics/hospitals in India where ophthalmologists are not available

Benefits: Till 2011, 15,000 diabetic patients benefitted

Cost: ~INR500 per patient per sitting

Potential for the solution: Timely treatment can prevent vision loss from diabetic retinopathy, which otherwise is challenging due to lack of awareness of the disease, lack of availability of resources and specialists

Revenue model for the solution: The local diabetologist can generate revenue through consultation charges from patients for obtaining fundus photographs and the eye centres can charge the patients for diabetic retinopathy diagnosis

Ongoing cost: Internet connection - monthly rental of INR 1,350 per month (up to 2 Mbps); salary of trained ophthalmic technician INR 10,000 per month; salary of network administrator INR 40,000 (part time) and maintenance cost of the solution

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Picture Archiving and Communication Systems (PACS) Solutions

Teleradiology Solutions India Pvt. Ltd.

Aim: Set up an efficient system which understands radiologist availability, work-load and other statistical parameters and assigns the radiologist accordingly

Challenges faced by the customer:• Non-transparent, cumbersome process, resulting in communication errors• Non-optimal radiologist assignments and inefficiencies and delays• Lack of collaboration between physicians and radiologists or between radiologists

The solution: RADSpa, Radiology workflow Intelligence system

Customer Benefits:• Improves efficiency of radiologists (more reports per day) and quality of reports• Faster availability of radiology images• Effective communication between peer radiologists, physicians and hospitals• Ability to provide radiology reporting to remote low-bandwidth sites with optimized

image transfer• Automated quality assurance process• Voice dictation feature helps reduce report turn-around time

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Rural Patient – Metro Doctors ConnectiClinic Healthcare Private Limited

• Conceptualized and founded jointly by Mr. Sanjoy Mukerji, Ex-Chief Commercial Officer of Vodafone India and Mr. Varun Berry, Managing Director, Britannia Industries Ltd.

• Tie up with local hospitals in tier 2, tier 3 cities to facilitate consultation of rural patients with doctors in metros through a simple video call

• USP – Onsite physical and virtual consultation by reaching out to people directly through local doctors, thus giving it a human touch

• Case of 2 year old Vishal from Karnal

• Case of 23 year old Jyoti

• Currently reaching patients in over 40 remote towns in India

• Long term vision to have 'iClinic consult facility' in every hospital in tier 2, tier 3 towns and villages

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Case Studies

Global

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Remote Paediatric ConsultationQueensland Telepaediatric Service

• Commenced in Nov 2000 through the University of Queensland’s Centre for Online Health (COH) in collaboration with the Royal Children’s Hospital (RCH) in Brisbane

• Provides specialist consultations to children and their families living in rural and remote areas of Queensland via videoconference

• Paediatric sub-specialities offered include post-acute burns care, cardiology, diabetes, neurology, oncology, orthopaedics, psychiatry and surgery

• Follows a unique referral model – Telepaediatric coordinators

• Technology handling of clinicians kept to a minimum at both regional and Brisbane sites with majority of equipment operated by the telepaediatric coordinators 

• COH also introduced a videoconferencing unit dressed up in the shape of a robot – Roy the Robot – for remote consultations directly at the bedside

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Mobile communication between doctorsMobile Doctors Network (MDNet), Ghana

• Challenge: Only 2,000 physicians serving a population of nearly 24 million inhabitants in Ghana

• Solution: Ghana Medical Association (GMA) launched MDNet in 2008 with support from New York University in collaboration with a mobile telephony provider in Ghana and Switchboard5 (a US-based non-profit-making organization)

• Provides free mobile-to-mobile voice and text services to all the physicians in Ghana currently registered with the Association

• A one-way bulk SMS service was also enabled, allowing GMA to send information to doctors about national emergencies and meetings, as well as to contact doctors within a particular speciality

• Mobile phones chosen as the mode of communication as most doctors in rural and urban areas of the country already use in their daily practice

• Technology: Physicians were provided with over 1,600 free SIM cards that worked with any brand of mobile phone and allowed doctors to make voice calls free of charge to doctors within the MDNet programme

• Switchboard extended the service to Liberia in 2009, and was in discussions with the Ministry of Health for its possible implementation in Kenya

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Using technology to recruit, manage and retain healthcare talent

• Strong health IT – one of the most significant incentive to attract quality physicians and other health professionals

• Healthcare organizations are increasingly using talent management software to recruit for efficiency as well as fit, as opposed to earlier systems which were focused on things like payroll, compliance and process automation

• Example – Software for applicants and their references

• Human Capital Management (HCM) systems enable an organization to transform from “tracking” to “managing” the workforce on a more holistic level

• Use of technology that provides potential candidates an easy end-user experience to access and navigate information

• Leveraging a variety of platforms, including mobile devices as many of these target candidates are not in front of computers during their normal workday

• Online/virtual training for clinical procedures – very efficient and cost effective

• Example – Wadhwani Foundation & Narayana Health

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Challenges

• Building competencies, finding and retaining skilled personnel for successful application of healthcare technology

• No single solution available that will work in all settings

• Clinicians have been known to be resistant to change

• Lack of training, not being comfortable with using technology, HCI (human computer interaction) factors, lack of trust on technology

• Bringing broadband to rural India is a hindrance for telemedicine, as is equipping rooms with expensive and hard to use equipments

• Shortage of Healthcare IT talent in the industry

• Security of critical infrastructure becomes more difficult

• Weak storage infrastructure

• Compliance issues

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Recommendations

• Effective channelization of the corporate CSR component

• Coordinated efforts by Ministries of Health, Education, Finance and Information Technologies and Communications

• Corporates and private players need to take lead for mHealth

• Computer literacy and training

• Increased use of cloud computing and mobile technology

• Tele presence in ambulances

• Encourage PPP in healthcare IT implementation, education and training

• Policies, standards or guidelines need to be formulated

• Government funding needs to be improved in this area

• Conclusion