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‘Our focus is to make healthcare more accessible to the poor and oppressed’

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Vivek Singh, Technical Architect, ThoughtWorks, outlines his company’s plans for the Indian market, the opportunities and challenges in the Indian healthcare IT space, their products to improve the public health sector in India and more, in conversation with Lakshmipriya Nair

As a global software firm, how is the Indian market different from the other countries of the globe?

201604ehm27The domestic and commercial market in India for software services was predominantly focussed on buying packaged software until a few years ago. We are seeing that trend changing towards digital strategies, something that’s quite prevalent on the global front. The work ThoughtWorks is engaged in with the local market can be broadly classified into three areas:

  • Where companies are building new channels of engagement with their customers and creating new experiences
  • Where companies, leading in their space, have challenges in scaling solutions or enhancing core capabilities
  • Where companies who have invested in software packages want to ‘squeeze’ value from investments

The other ways in which the Indian market differs from the global market are listed below.

  • India, predominantly remains a cost-conscious market to date
  • IT is still looked at, as a commodity play. Atleast for some if not most businesses.
  • Custom software development and management require Indian technologists groom themselves in a specific set of niche development skills
  • The choices available to consumers combined with economic changes see companies re-evaluating their growth strategies
  • The mobile-first generation of India is entering the workspace making organisations to rework their their IT systems and policies
  • The rise of the Indian unicorns in the start-up space is shaking up industry domains

When it comes to public health, ThoughtWorks believes in the advantages that open source products bring to the space. The challenge, here, comes in the form of an invalid perception that open source also means ineffective, poor quality, limited support and unreliable. This is not the case in some other countries and could be a reason for slow adoption of open source products within the public health space.

How has the healthcare IT space evolved in the last 15 years, especially in India?

The overall IT industry has evolved dramatically over the last 15 years, with digitisation and customisation taking centre-stage. Organisations have moved from single applications for specific tasks, at the lowest cost point to using integrated suites of products.

This change is a new phenomenon and at a nascent stage within the public health industry. Today organisations are slowly, even hesitantly moving towards integrated management information systems. These are systems that incorporate billing, pharmacy and lab processes.

There is a curiosity revolving how IT could support patient care, as well. For example, the latest conversations are around PHRs or personal health records, where patients receive a simplified view of their records.

National and regional governments are gradually investing in expanding the depth and complexity of health information systems, which gather both aggregate and transactional information in order to understand and react in a timely fashion to what is happening in the overall health system.

Tell us about the products that you create for public health organisations in India? How will they help make public health more accessible, equitable and efficient?

The ThoughtWorks Global Health team contributes to a suite of products that make IT in healthcare services both, affordable and accessible.

Bahmni, an easy-to-use Hospital Information System and EMR, is a seamless integration of three critical systems: patient medical records, laboratory management and billing. Bahmni provides views of a patient’s’ clinical summaries and reports.

Healthcare needs to be accessible to those living in rural India, where the doctor to patient ratio is abysmally low. Bahmni enables these doctors to be more effective and provide better care. How? Because Bahmni can be deployed with minimal knowledge of technology, if and when necessary. It has also been designed to operate efficiently in areas with limited bandwidth and infrastructure.

ThoughtWorks is also building a Shared Health Record system (SHR) which allows public hospitals to share and exchange patient data. The primary objective of the information exchange is continuous integration, aggregation and communication of clinical  information. This system will enable timely and consistent communication of diverse data between the entities – patients, healthcare providers, hospitals etc, and facilitate analysis and decision-making.

SHR aims to provide different benefits for various groups. From the standpoint of public health reporting or policy formulation, the health ministry will process patients’ clinical data to understand trends within a region or at national level.

Also for funding purposes, administrators can view utilisation reports and analysis to improve efficiency and process optimisation. Doctors, researchers and practitioners can avail clinical decision support through patient data and timely reports.

SHR also allows for integration with a national reporting system for dashboards like DHIS2, a flexible, web-based open-source information system with visualisation features including GIS, charts and pivot tables. The former integrates with any electronic medical record or EMR that follows standard protocols thus not requiring governments to spend on new systems but rather integrate existing EMRs. Our general approach is to support integrating systems.

ThoughtWorks is an active contributor to OpenLMIS, a logistics management system for healthcare commodities. This platform helps track the availability and movement of medication and medical products across the organisation. It ensures that medication and medical products are available at any location, any time.

ThoughtWorks has worked on Cycletel Hamsafar, an SMS-based family planning tool, empowering women to own their destiny. We have also worked with Motech on a few of their mHealth suite of products.

How cost-effective is your product, since making public health services in India more affordable is pivotal?

ThoughtWorks has designed Bahmni to be a cost-effective solution for hospitals that don’t have big IT budgets. A few of the characteristics that enable Bahmni to be the economic choice for public health systems are listed below.

  • Bahmni is an open source solution and carries no license fee
  • Bahmni is highly configurable in order to meet the specific needs and workflows of the clinical environment. However, a majority of the configuration does not require software developers, and can be completed by a staff member with basic IT skills and minimal training. Ongoing modifications can be made autonomously, without having to seek assistance from software designers like ThoughtWorks.
  • Bahmni is designed to be hosted on low-end and low-cost servers and does not require expensive hardware. Since Bahmni is web-based, it can be accessed from anywhere in the hospital by any computer with a browser.

Which public health institutions in India use your products? How does it help to streamline their operations?

Bahmni, a ThoughtWorks product was conceived during discussions with Dr Yogesh Jain of JSS. Possible Health identified Bahmni as a system to help Bayalpata Hospital in Nepal to manage data collection and form a reliable and easily accessible database of patient information.

The other places and hospitals in India where Bahmni is being used are Jan Swasthya Sahyog in Bilaspur, Society for Education, Action and Research in Community Health (SEARCH) in Gadchiroli, at Lok Biradari Prakalp at Hemalkasa and at The Banyan in Chennai.

Further away, in Haiti, ThoughtWorks worked with Partners in Health to help the latter develop a world-class system, increasing hospital efficiencies and ultimately delivering a better level of service to patients. ThoughtWorks has been quite active in the global health space.

We are in partnership with the Ministry of Health in Bangladesh where we’re implementing the SHR system across various facilities in rural Bangladesh. The accessibility of patient records across public hospitals, clinics and community health workers that came from this implementation was listed as a key accomplishments for 2015 in their health bulletin.

Additionally, ThoughtWorks used the OpenLMIS platform to build a customised solution for an international NGO who deployed the solution in multiple countries in Africa. This solution prevents outage of medical stock, manage medical inventory to ensure continuous availability of the medical products.

What are your plans for the Indian healthcare market in the new fiscal?

Our focus across the global and Indian markets is to make healthcare more accessible to the poor and oppressed and ThoughtWorks continues to strengthen technological solutions in that direction. We are constantly working on increasing our implementation capacity in India. This is because by augmenting our capacity to deploy open source products we will directly impact
open source adoption in a positive way.

ThoughtWorks is also investing time and design into the development of a complete, open source healthcare suite with multiple products.

Any significant tie-ups with the healthcare sector in the offing?

ThoughtWorks partners with various organisations on a variety of solutions and in various capacities. For example, one of our technologists is currently on secondment as a technology consultant with a large international non-governmental organisation or INGO to help transform their technology solutions.

We are in conversation with national NGOs to collaborate with state governments and charitable hospitals to increase the impact of technology in public health. We are also active participants in discussions and strategic alliances with healthcare ecosystem players such as leading hardware and diagnostic tools.

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