Feature

Seamless Integration

NCR- based Pushpanjali Crosslay Hospital has implemented IT systems right from the start. Sonal Vij tries to find out the benefits they are reaping out of IT

Being one of the few multi-specialty hospitals in the NCR region, Pushpanjali Crosslay Hospital (PCH) is one of the busiest hospitals in NCR. In such a vast organisation, IT does play a robust role for smoother functioning.

PCH was very clear about implementing IT systems right from the start about a year ago. The reasons were obvious— better patient care and management with additional administrative controls over the supporting departments including stores and pharmacy by deploying an effective solution.

One-Stop Solution

After a careful analysis, the HIS chosen for PCH was the popular InterSystems TrakCare, a connected healthcare information system. It is a web-based solution with unified clinical and administrative modules that are interoperable with legacy and future applications. With an Electronic Patient Record at its core, the advanced software brings exponential improvements to the care of every patient and to the productivity of every healthcare professional. Elaborating the proven capability of this software, Aditya Mani, CIO, PCH, says, "TrakCare is a standard product that has been successfully deployed in hospitals in India like Escorts Heart Institute, Fortis Group Hospitals (various locations), Sir Ganga Ram Hospital, Manipal Group etc."

Why not an in-house solution? He adds, "We chose not to develop an in-house product as we didn't want to re-visit the process of making an HIS from scratch which could turn out to be a long drawn affair." Elaborating on the cost viability he says, "Having been reassured that the product has been successfully deployed in various locations across the world and more importantly across key institutions in India, we didn't have to deal with the cost of experimentation which is probably the highest cost an upcoming start-up would not like to deal with."

PCH uses TrakCare hospital information system to automate virtually all major hospital areas including, inpatient, outpatient, emergency, radiology, hospital and day services, booking, pharmacy, and order entry. Patient data is stored in a single, secure electronic Patient Record (ePR), which is easily accessible to care providers throughout the hospital.

The USP

"The test results are automatically entered into the HIS directly from the equipment. This improves speed, accuracy and unnecessary time lags" - Aditya Mani CIO PCH

"Rather than accepting a pre-defined rule set created by an HIS company or its client, TRAK lets one configure the data to suit ones needs" - Dr Vinay Aggarwal CMD PCH

The HIS has tightly integrated modules and functionalities, is user friendly, requires minimal knowledge of computer and has user defined customised work flows.

Flexibility

"Rather than having to accept a pre-defined rule set that has either been created by an HIS company or by another client of the HIS company, TRAK lets one configure the data to suit ones needs," says Dr Vinay Aggarwal, CMD, PCH.

Seamless Integration

Much of the power of TrakCare derives from the fact that all of its modules share the same data model, patient-centric focus, and a single high-performance database, InterSystems Caché. So, TrakCare's modules do not require integration with one another, saving time and expense.

And because it was built as one unified system, TrakCare's modules require just one login for users, and data entered once is immediately available throughout the system. It has various benefits: simplified sharing of information, faster implementation, lower costs, and easier maintenance. In addition, the 'InterSystems Ensemble' rapid integration platform embedded in TrakCare ensures interoperability of TrakCare's modules with other applications.

Time Saving

For doctors and nurses, working with TrakCare means less time spent searching for information, and more time spent with patients. Unlike similar products, TrakCare can easily be tailored to fit the information requirements and workflow preferences without code changes.

For IT staff, TrakCare offers a unique combination of technology and implementation methodology. The innovative approach can provide the benefits of an ePR after installing the first TrakCare module.

Clinical Workflow Platform

Rather than focusing on multiple pre-defined screens, Trak gave a tool set that allows our care-providers to best use the system and improve their workflows. "Rather than taking doctors to the white-board and teaching them how to work in a process, we give them these tools to play with. We were surprised to hear how well they could use these tools as they knew their workflow better than we did and they told us how we can use these tools to their advantage. This is a radically opposite to the old school methodology where IT forces physicians to work as per a pre-defined set of screens that were designed earlier by workflow consultants who were far removed from the actual hands-on workflow," shares Mani.

Patient-Centric Approach

The hospital has implemented a solution for electronically storing all medical records which has helped simplify access to all medical records of patients. There are over 50-odd daily registrations. Records include clinical activities, diagnostic reports, medication and surgery history. Detailed medical record of a patient like height, weight, blood pressure conditions and other related details of the patient are stored. Details about his previous laboratory records, diagnostic records, clinical notes, treatment details based on patient's medical condition, billing as well as health insurance claims are stored.

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 anyone to get the results. He can view the results on the computer screen by a single click, provided he/she is authorised to view the same. All the departments are linked to the system. Also, customisation can be done at hospital level as well.

Bar-Coding System

PCH makes use of 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 PCH, s/ he gets registered and a unique registration number is given to him for his lifetime. Each subsequent visit of the patient is linked with this unique registration number. Once the consultant advices investigations, the patient goes to billing counter, where the respective investigations are ordered and when patient goes to sample collection counter, the technician gets all relevant information by just scanning the bar-coded labels. He then executes the orders and 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. Mani says, "Nearly 80 per diagnostic tools/ equipment in the laboratories are interfaced, PACS too is interfaced. The test results are automatically entered into the HIS directly from the equipment. This improves speed, accuracy and unnecessary time lags. It also removes the human intervention and ensures security, integrity and accuracy of reports."

Backups

The system is quite secure. There are parallel backups and authentication/ authorisation rights are made. Also, there is two to three levels backup. The hospital has also implemented disaster recovery plan, which will be implemented in the next six months. The application's database is stored on a clustered, redundant storage array. Therefore, as soon as data is entered, the backup is made at the same time, i.e. in real time in the same location, on shadow server apart of the routine daily backup schedules.

Increased ROI

There is direct cost saving of the paper as one doesn't have to maintain medical records in files and papers, though the hospital still has not achieved this in full. Since the entire data is electronically stored, it minimises paper usage. The records are maintained for years together. This system also minimises the discharge time of a patient which in-turn helps in optimal utilisation of beds. Ideally, if the doctor puts their own records manually, when the doctor requests for a discharge, the records for the discharge summary of a patient is already in place. Whenever the turnover of the patient is faster, a new patient can come in and occupy that bed. So, if the average length of patient stay reduces, the same bed can be utilised and the ROI automatically goes up.

Another advantage is related to patient management activities like admissions, billing and discharge.

Standard Databases

PCH makes use of standard terminology in its HIS. Standard terminology ensures that the nomenclature is universally accepted. Shares Dr Aggarwal, "This not only mapped our medical tourism vision that our patients will carry data that is recognisable across the world, it also enabled us to enforce good best practices like insuring we code every discharge as per ICD10." He adds, "This can enable our care providers to analyse the vast data we will create over the years rather than re-investing in collation of data at a later point in time which often translates into a massive effort and cost." Another ROI index that often is ignored by CIOs.

PCH decided to import as many standard databases as it could, like CIMS (for drug data and interactions), ICD10 (for disease coding), CPT (for procedures and assessing degrees of complexity and costing) and SNOMED.

Scalability

The ability to modify rule set (system parameters of TRAK care application) also lends the advantage to replicate this rule set across different organisations within the hospital network (akin to cut and paste logic) making the scale up as hospital network fast and effortless. Mani says, "Moreover, one may choose to collaborate and share these rules with our hospitals or other hospitals using similar software (equivalent to sharing best practices). Such a situation is almost impossible to implement in an environment where the logic in the software is 'hard-coded' or fixed."

The Road Ahead

PCH is in the process of integrating the HIS with personal health records that patients will be in control of. They will be able to access online records. This will be in place in another six to nine months. "Also, key stakeholders will have access to certain functionalities with a web portal and touch screen kiosk," concludes Mani positively.

healthcare@expressindia.com