Feature

IT Personalised

Way back in the 80s, Fortis Escorts Heart Institute had developed an in-house Hospital Management System for appointments and patient records. Today, it using IT systems developed by Medtrack, finds out Sonal Vij

No matter how old or big is the player in the healthcare industry, as the business expands and the healthcare needs diversify, the organisations have to match these growing needs and it is impossible to think a 'hospital' without IT as the backbone in the future.

An Appreciable Achievement

The definition of 'IT' has undergone a rapid change in itself. So today, you may laugh off the notion that 'IT equals having computers', but this is what it meant almost two decades ago and hence Delhi-based Fortis Escorts Heart Institute and Research Centre (EHIRC) today have every right to boast of the fact that way back in 1980s they actually developed an in-house HMS for appointments and patient records. That was the time when half of India was alien to even the world of electricity! Till the late 80s, it was a Fox Pro based system. In 1992, Oracle was introduced and till late 90s it was Oracle and power builder. "The organisation was huge and growing rapidly. Now, there were more requirements. There was the need for many imaging systems. There had to be a lot of capabilities to be built, which was not possible in the old system," says Ravinder Sharma, Manager-Information Technology, Fortis Escorts.

IT from Australia

At present, the company uses Medtrack 5.0. In early 2000, Medtrack was introduced. Explaining the choice over an in-house system, JS Puri, VP- IT, Fortis Healthcare, explains, "Why invent a wheel if someone has already invented it? Medtrack has a good track record. It is used in many good hospitals abroad. It is more suited to the healthcare industry needs."

Right now, EHIRC spends 3.5 per cent of its turnover on IT.

The Fortis Acquisition

Doctors are informed about patient admission by sms

What were the changes after the acquisition by Fortis in 2005? "There was a lot of process reengineering that took place. Everything was integrated and converged into the corporate portal," adds Puri. Among the various functionalities of Trackcare used, the major ones are front office, diet, ward, laundry, equipment, OT and so on.

Beneficial Choice

The positive fact about this system is that it allows customisation to the end-user. "We can do localisation on our own and add as many fields as we want," says Sharma. Unlike other industries, there is no limit to the number of fields that need to be added.

Bar Coding Benefits

EHIRC has incorporated an advanced solution of bar coding for the tracking of patient details and the related diagnostic samples. When a patient comes for the first time in the hospital, s/ he gets a unique registration number for lifetime. For OPD, every subsequent visit of the patient is linked with this unique registration number. Front-office executives generate bar-coded sticker for the patient, generally containing patient's name, registration number, and other important details alongwith the consultant details.

For further investigations, the patient goes to billing counter where the respective investigations are ordered. When patient goes to the sample collection counter, the technician already gets all relevant information by just scanning the bar-coded labels. In-turn the system generates bar-coded labels for the sample containers, which avoids the chances of any human error. Even in pathology labs, the technicians only scan the labels on sample containers to get all relevant information automatically fed into HIS. "Even diagnostic tools/ equipment are interfaced. Test results are automatically entered into the HIS directly from the equipment," adds Dr Raajiv Singhal, Director, EHIRC, New Delhi. This reduces the chances of human intervention and ensures security, integrity and accuracy of reports. For IPD patients, a band containing the unique bar code is pasted on the patients' wrist and all the data is fed using that number.

Health Records & More

Saving all medical records electronically helps simplify access to the records. Records include clinical activities, diagnostic reports, doctor's advice, medication and surgery history. The software allows the hospital to track all the medical records of a patient, right from the day the patient first visited the hospital. If a doctor at any point of time wants to view the patient records or patient investigation results, he doesn't have to wait for the nurses to get the results. He can view the results on the computer screen anywhere in the hospital.

In the case of OPD maintaining, electronic records are not a necessity but in case of IPD, it is necessary for maintenance of complete health records. Justifies Dr Singhal, "In the OPD, doctors have to see a lot of patients in less time. We can't expect them to key in everything and issue e-prescriptions to the patients." In IPD, the doctors enter the notes during the rounds. Soon entering the OPD records will be made mandatory in the hospital. The hospital also makes use of PACS and is now increasing its accessibility. Right now, EHIRC is in the process of integrating the PACS with cath lab and ECHO.

Patient Friendliness

"Test results are automatically entered into the HIS directly from the equipment" - Dr Raajiv Singhal Director EHIRC, New Delhi

"We choose Medtrack as it has a good track record and is more suited to the healthcare industry needs" - JS Puri VP- IT Fortis Healthcare

Maintenance of medical records is the biggest advantage to the patient. "Who wants to walk in a facility with three kilogram file full of records?" asks Dr Singhal. All the records are maintained electronically for the doctors' reference. By a single click of the button, the records are available. Fortis patients can also access all their reports online. There is also a sms service which can make life simpler for the parents who receive messages on their mobile phone one day prior to their scheduled appointments. This helps in retaining the customers as well. There is also an auto-sms facility which reminds all its customers as to when their next visit is due. Also, as soon as a patient is admitted, the doctor is informed about the admission via sms.

It contains patient details, the complaints and the admission reasons "This helps the doctors to take a decision. Even if a doctor is not available, s/ he can tell other doctors the desired treatment and if the doctor thinks that it's urgent, they can come," shares Sharma. In most cases, the doctors call up the residents and co-ordinate the emergency treatment. "The treatments starts immediately and adds efficiency," opines Sharma. As and when the patient is moved from one ward to the other or to critical care unit, both the doctors as well as the patient get the sms.

Security

Since patient records are crucial, a good back-up system is indispensable. "There are multi-tier backups for data and applications. All server based applications data backups are taken year-end, month-end and daily basis. On top of this, there is transactional backup every three hours," informs Puri.

There are backup restoration activities done for every 'full backup' on a daily basis to validate the completeness of backup. All 'location specific' backups are kept on different physical locations to avoid any incidents of loss due to fire or physical damage.

Centralised Appointments

Since one doctor sits in multiple locations, the appointments are lined up for the doctors using a centralised system. In the central appointment system, the patient calls only one single number and asks for a doctor. The centralised system pools in the data from all the locations. "The doctor gets the SMS giving details about the appointments half an hour in advance. Also, the doctor is informed (about the time of his first appointment) right in the morning. So that s/he can plan the day accordingly," shares Sharma. The collated data of the number of appointments per location also goes to the doctor.

Challenges & Future Plans

Trackcare also has an integration tool 'ensemble' which enables connectivity of the instruments to the HIS. This will be enabled in the near future. Right now, the instruments are interfaced using the vendor software(s) as well as the in-house developments. This poses a problem since two machines of different brands don't talk to each other. The cost right now to marry these is quite high. Once ensemble is in place, this cost will reduce. With the rate that Fortis Network is growing, standardisation of the IT systems is the need of the hour.

"We are aiming at integration of pan-Fortis-IT system. This project is at a pilot stage," informs Dr Singhal. The group has tied up with an IT giant for this project. The gap analysis is on for three months and by the next two years, there will be a standardised medical information system. He explains, "Then, whether a patient walks in the Noida facility or Malar facility, the unique ID will be valid pan-Fortis. His/ her records will be available across all the hospitals." This is also going to be a major challenge, since two years is quite a long duration for technology to pace and advance and the organisation would have to be on its toes by keeping abreast, that too while standardising (in terms of IT) all the facilities. It is definitely an uphill task.

sonal.vij@expressindia.com