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Embracing Technology

Use of technology in various departments of a hospital can be effective in increasing the productivity. K Deepalakshmi finds out how Kovai Medical Centre and Hospital, Coimbatore (KMCH) has benefited by being tech savvy

Paperless workstation, e-cash transactions and data management systems are some of the terms being used in many healthcare related conferences and seminars. Here is Coimbatore based Kovai Medical Center and Hospital (KMCH) that is already working towards bringing these terms into practice. "The field of medicine underwent revolutionary changes in the last three decades, particularly in the field of biomedical instrumentation and treatment modalities," says Dr Nalla G Palaniswami, Chairman, KMCH and adds, "Medical professionals like me understood the power and contribution of information technology for our hospital and managing hospital system as early as 1990. This was largely due to our long exposure to American best practices."

The hospital got its first taste of IT when it installed 30 computers for administrative purposes like accounting, billing, materials, stores, purchase, and reception. These systems worked on a Disk Operating System (DOS) platform. The preference for computers increased when the Windows OS was introduced. KMCH explored the possibility of extending the application beyond data entry.

Hospital Management System

"The future is moving towards digital healthcare and health infomatics is a must know for doctors now" - UK Ananthapadmanabhan President, Kovai Medical Center and Hospital (KMCH)

A complete Hospital Information System (HIS) spanning all functional areas starting from the reception to digitisation of medical records was introduced in the Hospital in 2002. Tata Consultancy Services (TCS) was the solution provider. "Our Hospital was the beta site for TCS," recalls UK Ananthapadmanabhan, President, KMCH. The entire system is centralised and all communication is digitalised. "If an employee wants to avail his leave, the leave application comes to me through this system. There is no paperwork involved," he says. Not just human resource activities, HIS is used in every area like purchase, supply chain management, accounting, billing, clinical information and so on.

The Hospital extended its HIS to its four satellite hospitals situated in Coimbatore, Erode and Perundurai (TamilNadu) simultaneously, after it met with acceptance and success at the main Hospital.

SMS alerts are also enabled through this system. The function was programmed by Aosta Software Technologies, their present software vendor, in which the concerned staff and top management officials receive updates on various hospital issues like number of pending lab reports, number of patients staying for more than seven days, number of VIP admissions, complaints registered, rectified, pending complaints, any materials required, lab services and so on in their cell phone through SMS. "This way each one is connected to the Hospital, even if they are physically away from the Hospital," says Ananthapadmanabhan. He claims that digitising the hospital management has increased productivity ten fold.

"Earlier, when every procedure was manual, it involved a lot of paper work and consumed a lot of time. Now data entry is a one time process and can be viewed by anyone (related to the hospital). It saves a lot of manpower hours," he adds.

Even the parking fee collection is computerised. When the collection of parking fee used to be manual, there were reports of mishandling of cash. Now, since the billing is computerised, all the collection is in records. "We have noticed an increase of Rs 500 per day after the parking collection is computerised," says Ananthapadmanabhan.

Biometric Identification

Apart from papers, a hospital has several things like lab samples, physical records and so on that needed to be transported from one place to another. In order to avoid manual errors, KMCH has introduced bar coding to identify these samples and records. Also, access and attendance of all hospital staff is through biometrics. They are identified using their thumb impression. "The staff had a little difficulty in getting accustomed to the procedure, now they are used to it," says Ananthapadmanabhan.

Smart Card

The hospital in association with Aosta Software Technologies introduced a 'smart card' for its employees. The card is embedded by a micro chip that stores the fact file and other employee related details in it. KMCH was the beta centre for this project too.

e-cash facility

A patient visiting a hospital is bound to make multiple visits to the billing counter in order to make various payments like consultant fees, laboratory charges, pharmacy, canteen and so on. A crowd in the billing section is thus unavoidable. "We did a pilot study on OPD bills. About 40 per cent of it had multiple entries," says Ananthapadmanabhan. To reduce crowding at billing counters, KMCH introduced an e-cash facility. "e-cash is similar to a prepaid cell phone recharge," he explains. A patient visiting the hospital needs to deposit a sum of Rs 500 or above at the out patient billing counter. He will receive an unique code. The patient can avail all the services like cardiology, radiology, pharmacy, where cash transaction is required, by referring the code. The balance amount, if any, will be refunded at the time of leaving. Similarly, the patient will be intimated if he has to deposit more money. A detailed bill is handed over at the time of discharge. The e-cash facility was introduced last year and the concept is slowly picking up. KMCH will soon extend this facility to its other centres and its pharmacy chain.

Online Services

KMCH runs an online pharmacy portal, kmchpharmacy.com that undertakes home delivery of medicines in and around Coimbatore. Via this portal, patients can find out details of doctors (like availability) and can fix up appointments with their consultants online. On special request, the patient's medical history and data are made available online, which can be viewed by the patient using the ISP id given to them. "Since our HMIS is web-based, the patient too can view their records online, if we give the access," says Ananthapadmanabhan. Currently, this facility is available only on request.

Touch Screen Kiosk

Touch screen facility for e-cash

KMCH has installed 10 touch screen kiosks at various locations within the Hospital premises like reception, out patient area, lab reception and at each floor. The touch screen information facility provides various details like general enquiry, facilities of KMCH, tariff and so on. An in-patient can also view billing information and medical details with his unique identification number. These kiosks are self explanatory and eliminate the need for manpower. They are user friendly and do not need any training for operation. Ananthapadmanabhan claims that contrary to the belief these touch screen facilities have become very popular with the rural patients who feel uncomfortable going to the counter and communicate in spoken English.

Speech Recognition

Data feeding in the Hospital is carried out using voice recognition software. This software recognises the speech of a person and converts it into a Word document. "I do not have a stenographer to get my work done," says Ananth-apadmanabhan. Though, the system is currently used for administrative purposes, KMCH proposes to introduce speech recognition in the areas of medical records in the future.

Outsourcing Energy Management

KMCH has employed technology in energy management too. "We save upto Rs 25 lakh on our electricity bills every year through effective energy management. This is directly reflected in the profit margins," claims Ananthapadmanabhan. Though, energy conservation is a collective approach, the usage of technology is worth mentioning here. Hospital has identified ten high energy consuming load centres and the power consumption of those load centres is monitored through a Local Area Network (LAN) based on line energy management. The Hospital approached Conzerv, an energy management consulting firm for its energy planning. The monitoring of the Hospital's day-to-day energy usage is outsourced to this Bangalore based firm. Conzerv observes energy consumption through web based system and troubleshoots if there is any unusual change in consumption pattern. This firm also takes care of energy audit of KMCH. "We have been consistently managed to keep the power factor as 0.99, and claim a rebate from the Government," says Ananthapadmanabhan.

Telecommunication

KMCH uses Primary Rate Interface (PRI) standard for telecommunication service. Unlike the conventional method, where a call is transferred to the recipient through the operator, in PRI technology, each telephone line can be used as a direct line as well as an intercom. This eliminates the need for separate telephones. "If you make a call an extension, any number from the trunk pool is seen in the receiver's end. In case of PRI your unique telephone number will be seen," explains Ananthapadmanabhan. It is easier to keep track of telephone expense in this method as the call details of each number are known.

The Hospital also has Interactive Voice Response System (IVRS) service. It is a phone technology that allows a computer to detect voice and touch tones using a normal phone call. The IVRS can respond with pre-recorded or dynamically generated audio to direct callers on how to proceed.

Clinical Records

On the clinical side, the Hospital is well equipped with the latest equipment. These equipment are interfaced with the network that can be viewed from any terminal. DICOM (Digital Imaging and Communications in Medicine) standards are met in the networking and transmission. The Hospital uses Digital X rays for diagnostic purpose instead of conventional films. Would Picture Archiving and Communication System (PACS) be the next in KMCH? "PACS is an expensive option. We will go for it only after reviewing its capacity utilisation in our hospital. We may not go for it now," says Ananthapadmanabhan.

KMCH is also examining the necessity for EMR (Electronic Medical Records). At present, it does not have a full fledged EMR. It provides the medical details of in-patients alone. Ananthapadmanabhan feels there is a need for a common format of EMR in all hospitals. "Just like a passport, a patient should have only one EMR," says he and adds "Only such a record will help the patient when he visits different hospitals." He feels that such a system can be made a reality only if the application is distributed to all the hospitals by the Government, may be at a subsidised rate considering the size of the hospital.

The Road Ahead

KMCH is already equipped with Closed Circuit Television (CCTV) for surveillance purpose. The Hospital plans to update its surveillance with additional technology. CISCO, a leading company in electronic surveillance has developed a new interface with an ability to recognise the face of a person and send alert if that person is entering the premises. "According to this system, the photograph of the suspect has to be fed into the computer. The interface will check the faces recorded in the surveillance camera. If it matches with the suspect, we can be alerted," explains Ananthapadmanabhan. KMCH plans to install this new surveillance method.

Challenges

Adopting a new technology is not an easy task. The main challenge lies in accepting the change and getting accustomed to it. Training plays a major role in it. Most of these technologies require basic knowledge of handling a computer.

The hospital provided basic training to its staff before implementing the major changes like HIS. "Changing the mindset is also very important in implementing these solutions," says Ananthapadmanabhan. He feels some times doctors find these changes difficult as they are less inclined to use computers. "Health infomatics can be made a part of the curriculum in MBBS," he suggests. In his opinion, "The future is moving towards digital healthcare and health infomatics is a must know for doctors now."

Benefits

Most of the above mentioned technologies are not restricted to healthcare. In fact, they were prevalent in other industries much before it was embraced by healthcare. "We should have an open mind for embracing technology. A closer look at them will reveal if it can be modified for hospital purpose," says Ananthapadmanabhan. Touch Screen facility is available in railway stations and airports. The same concept, with little modification has become a useful device in the hospital. "The e-cash facility was inspired from prepaid cards," reveals Ananthapadmanabhan.

Implementation of these technologies has improved the productivity by reducing the processing time. All the communication is now recorded and thus has enabled quick reference of past records. "Most of these technologies are one time investment. After the payback months, the savings become profit," says Ananthapadmanabhan. Above all, the swift response, lesser processing time and user friendly approach has earned a good response from the patients. They have been a key factor in making the hospital more patient-friendly. "We invested as much as Rs 30 lakh on IT infrastructure when we started the Hospital," recalls Dr Palaniswami. It was considered a huge investment and many people wondered why the Hospital did it. "Today, we have emerged as one of the best wired group of Hospitals in the country as well as a role model (in this field) for many hospitals to emulate," concludes Dr Palaniswami

k.deepalakshmi@expressindia.com