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Healthcare Hi(gh)way to IT

Rolling out a unique solution for healthcare providers, Apollo Hospitals and IBM have developed a national health data network called as 'Apollo Health Hiway' to provide a diverse set of software applications for the healthcare segment. Manjusha Morgaonkar analyses the journey of a healthcare company into healthcare IT

Will technology improve healthcare delivery? Over the years there has been an endless debate on this topic without any solid conclusion. As of now, the scene in India is that there are very few super-speciality hospitals that have adopted Hospital Information Systems (HIS is also known as ERP for hospitals) automating their business operations, bringing in better patient record systems and management. That leaves about 1,500 mid-sized hospitals catering to the masses high and dry without similar applications and services to simplify their operations, handle medical insurance and explore revenue opportunities. But now, a first of its kind collaboration in healthcare industry between Apollo Hospitals and IBM have initiated national health data network which makes it possible for every healthcare professional to access a world-class IT application that will allow them to create, store, manage and share clinical, administrative, and financial information, access knowledge resources to enhance performance. The project named 'Health Hiway' is all about bringing in efficiency in day-to-day processes in a healthcare system thereby impacting the key performance indicators— patient services, clinical outcome and the financial health of the user companies. This helps in creating satisfied patients and creates knowledge for the community.

What is Health Hiway?

"Apart from simplification of IT application, this project will set the standards for communication and exchange of data between various entities in healthcare chain" - Mohammed H Naseem Vice President–Healthcare IBM India

"Health Hiway applications can be customised to facilitate learning and transformation to enable users to get the most out of various software applications" - Ashvani Srivastava President– Strategic Initiatives Apollo Hospitals

Health Hiway is a technology interface for seamless inter-operability and portability of patient data between service providers and payers to ensure quality of clinical care, as well as cost effective third-party claims processing. Apollo's Health Hiway is a developing national health data network- information highway for healthcare companies that provide various software applications to the healthcare segment with the initiative from Apollo and IBM. "The value proposition of Health Hiway has been derived out of Apollo Hospital's experience in the healthcare sector and IBM's experience in healthcare technology ," says Ashvani Srivastava, President, Strategic Initiatives, Apollo Hospitals. These applications helps healthcare service providers manage costs by streamlining processes in areas like hospital Enterprise Resource Planning (ERP), health insurance claims processing, clinical decision support, knowledge solution, e-learning solution, ClinicConnect- Practice Management System, tele-radiology, and Healthcare Jobs. Learning content is also delivered online through workshops covering topics like productivity enhancement, quality and latest developments in care delivery. This application at Health Hiway enables the hospital staff to manage operations of clinics, nursing homes, small hospitals and Electronic Medical Records (EMRs) across India. Apollo Hospitals and IBM aim to bring affordable and easy to use information technology to doctors, which would allow them to focus on doing their work, connect with other doctors and patients, rather than manage IT infrastructure. The prime advantage of this tie-up is that doctors need not get involved with buying servers or software to run any of the applications that you need, not even hire people to manage the server, infrastructure and applications. Data center managed by IT personnel available 24x7 ensures that applications are ready to use for healthcare segment anytime.

The second advantage is that it is a highly secured network, using tools like multiple firewalls, anti-virus software, intrusion detection systems, to prevent any malware from attacking the applications. Other features are data encryption, a key application, which ensures financial information or patient data is encrypted with a 128-bit key and traceability, so that all applications would have 100 per cent traceability to account for any unauthorised access to data. This assures reliability with hosting servers at data centre.

The Beginning

Over the years, there have been many collaborations with renowned IT companies to provide and deploy their software applications to other segments like hotel, aviation and educational institutes. But collaboration of a hospital with IT industry is the first of its kind in healthcare segment to reach out to the masses. To make such a fascinating mark in IT sector, Apollo Hospitals joined hands with IBM with the vision of building an 'information highway' and to set a trend connecting healthcare industry in India. Apollo Hospitals found this project to be attractive as the project impacts the way healthcare is delivered. It required a domain expert like Apollo to partner with a technology leader IBM to support the project with their expertise of working in both their respective sectors. IBM brought in its wide experience in the healthcare sector and supports the project as a technology and infrastructure partner. And as Asia's healthcare powerhouse, Apollo Hospitals provided an understanding of what a hospital requires in terms of IT applications to make sure that they are compliant with technology and standards. According to Srivastava, "Over the years, we have understood the challenges for hospitals issues in managing information, patients data, supply-chain and costs of processes and quality of care and the effect that it has on efficiency in the system, due to non-adoption of information technology." For these reasons the Hospital collaborated with IBM. Srivastava further adds, Apollo plans to bring various entities together in the healthcare environment, use collective industry knowledge and build a network using world-class technology. But majority of the healthcare environment in India is occupied by the small and mid-sized players who act as a first point of care and subsequent referrals for the large tertiary-care hospitals. There are also public health infrastructures managed by the government, catering to the healthcare needs of the masses and even payers are playing a major role and becoming increasingly important as we move towards a more evolved market in healthcare insurance. Therefore, the Hospital is believed to have the domain expertise that helps them understand the IT needs and customise solutions accordingly. Mohammed H Naseem, Vice President, Healthcare, IBM India says, "The uniqueness of this project comes in two aspects - demystification of IT for end users, and effective execution from industry leaders. Information Technology has failed to demonstrate value proposition in its current form. Health Hiway will not only provide predictable outcome from software applications, it will also make it affordable. Apart from simplification of IT application, this project will set the standards for communication and exchange of data between various entities in healthcare chain."

Since 2004, when the healthcare team was formed in IBM, IBM has been doing market research to understand the Information technology need of large number of fragmented mid-size hospitals in India. Partnership with Apollo brings the best domain knowledge from the leader in this industry, combined with proven Information technology from the world leader. The Health Hiway project was successfully launched in April 2007. This will benefit the healthcare providers, payers and most importantly enhance the quality of care for the patients with standard based interoperable solutions which will help bring cost containment, yet more importantly help use this data for patient care and subsequently for research and analytics.

IT Potential

Apollo and IBM adopt simple mathematics to tap the healthcare IT sector. According to Naseem, only six per cent of healthcare is through organised sector, remaining 94 per cent is completely fragmented. If IT is adopted by this large segment, it will make them profitable, improve quality of care, and they will be better equipped to compete with large corporate hospital chains. Currently, this segment is using IT, but results are not very encouraging. Says Srivastava, "The philosophy behind Health Hiway solutions and services is simple- easy-to deploy, easy-to-use and easy-to-pay. Though Health Hiway offers solutions and services for the healthcare sector, the biggest beneficiary will be the small and mid-sized player."

Applications and Services

Health Hiway's wide range of applications caters to the mid-sized hospitals (50 to 200 beds), physicians, practitioners, Third Party Administrators (TPAs), diagnostic centres and others in the business of healthcare delivery. To target this user group it has designed the applications and services according to the capability for the users at the low cost. Health Hiway offers a suite of hosted applications that will be available as pay per use, which means as and when the services are subscribed by the healthcare professional they have to pay for service used till the period is over.- "As the solutions are made available to the healthcare providers for the first time on Software as a Service (SaaS) model - a model of software deployment where an application is hosted as a service provided to customers across the Internet, which will help users to subscribe online instead of buying it, that helps to reduces high upfront costs of deployment," says Srivastava. For the end user, there is minimal investment in any hardware, software or people to run and manage these applications. Srivastava adds, "Health Hiway applications can be customised to facilitate learning and transformation to enable users to get the most out of various software applications."

Some of the applications currently on the Hiway are:

Claims Xchange: It is an online claims proceeding platform that facilitates providers and payer to communicate online to submit and settle claims. Traditionally, the process requires constant exchange of combination through fax and telephone. Claims Xchange provides almost paperless claims settlement process. The Xchange offers per authorisation, enhancement, claims submission and claims settlement to TPA partners and keep a track on their feedback and responses. Healthcare personnel responsible for checking a patient's insurance eligibility and submitting insurance claims to TPAs and Insurance companies can subscribe this service. Even if the healthcare providers belong to a hospital, nursing homes, clinics or diagnostic services, they are sure to benefit from the use of this service. Besides this healthcare Payors like TPAs and Insurance companies responsible for approving patient's claims submitted by providers can also subscribe this service.

ClinicConnect: A practice management module, ClinicConnect helps clinician and practioners, manage their day-to-day operations. This online software helps them create patient data and exchange it with their peers in a secured environment to better manage the patients health. ClinicConnect is of great value as it contributes to creation of electronic patient record. The clinician benefits immensely with the functionality provided through this solution, as it helps him track his patient's health and manage his practice better. Clinic Connect enables a doctor to do patient relationship management in terms of maintaining patient records, alerts and emails, doctor scheduler, billing the customer, claims generation, clinical information- visit record, medication, medical history records and community- integration with diagnostic centres.

But how far are doctors open to using and adapting new technology? According to Srivastava it is the new generation of doctors who are quite open to change. "The new generation of doctors are keen to involve IT in their practice as they have been exposed to these systems during their education. They appreciate the benefit of IT in their practice and patient management. The doctors now understand the fact that IT is a strong tool that will help in enhancing quality of care."

Challenges

While developing this conceptual framework of Health Hiway, Apollo Hospitals had a challenging and insightful learning in studying administrative, clinical and operational processes and the impact of effective usage of data across the healthcare system. Srivastava says, "Apollo's learning from putting together the standards framework is through the Information Technology Infrastructure for Health (ITIH)- a set of standards, guidelines and laws that help simplify transactions between various healthcare entities undertaken by Department of Technology (DIT), Ministry of Communications and Information Technology (MCIT), with the support of the project Implementation Agency, Apollo Health Street Limited (AHSL).

This in-depth research was conducted in 12 key cities in India like Delhi, Mumbai, Kolkata, Chennai, Bangalore, Hyderabad, Ludhiana, Pune, Ahmedabad, Lucknow, Coimbatore, and Cochin that have remained some of the key starting steps towards designing the Health hiway model." Though the operational challenges for a smaller operation are different than those in large enterprise provider environments, "But the knowledge and learning that we have acquired over the last 25 years has been a great enabler in designing the solutions and services on the Health Hiway," adds Srivastava. "Challenges come from how we make application preconfigured, how we create a business model or operational model which hospitals can find it attractive and how we convince them to adopt these new service applications, and these are what we are completely aware of," says Naseem.

Future Plans

There have been many recent developments in Health Hiway. The new solutions at Health Hiway now include applications and services across revenue management, learning and CME, performance management including decision support and knowledge management. "In the near future, we are looking at deploying clinical information systems in a way that is probably first of its kind in India, by using our method of implementation on a hosted environment and the way it will be marketed i.e pay per use as opposed to buying the software/ application," says Srivastava. Currently, 250 users across 75 providers are using Health Hiway and further have plans to connect over 10,000 doctors and 500 providers over the next 18 months. "Five years from now we would like to tap every hospital in this segment," says Naseem.

manjusha.morgaonkar@expressindia.com