Tag Archives: Healthcare IT

HealthIT Trends for 2011

8 Jan

Date: 8th January 2011

Author: Nrip Nihalani

About: CEO, Plus91 Technologies (www.plus91.in)

Health IT trends for 2011. What to watch out for!


Using The Internet to create Informed Patients

26 Oct

Date: 25th October 2010

Author: Nrip Nihalani

About: CEO, Plus91 Technologies (www.plus91.in)
“Using The Internet to create Informed Patients” by Nrip Nihalani at the Putting Patients First Conference in Mumbai, India on 20th October 2010

Why don’t Indian doctors use EMRs ?

18 Oct

Date: 18th October 2010

Author: Dr. Aniruddha Malpani

About: Medical Director, Malpani Infertility Clinic (www.drmalpani.com)


Why do Indian doctors continue practising in exactly the same way their seniors did 40 years ago ?

A major lacuna is the poor quality of medical records which most doctors keep. The medical record is the heart of clinical care – and yet it’s extremely poorly maintained in Indian clinics today. The majority of doctors do not even bother to store and keep their patient’s medical records – they just write down their opinion on their letterhead and hand it over to the patient. Usually, this is just a laundry list of tests the patients needs to do and a hand written illegible scrawled prescription – without even a mention made of the clinical findings or what the diagnostic impression is ! While it’s good that the patient owns his own records, what happens if the patient forgets to get his records for the next visit ? This creates a lot of frustration for the doctor, who berates the patient for his carelessness – but the damage is done ! Wouldn’t it make much more sense to keep a copy – and give one to the patient if he wants it ? Is this a lot of hard work ? Not anymore ! In the old days, one would have to make carbon paper copies or provide xeroxes, but using electronic medical records, this is now very easy to do !

Clinical care protocols are very similar in the US and in India. This is hardly surprising – after all, patients are the same the world over , and most will need the same kind of treatment. However, while most Indian doctors will provide exactly the same standard of medical care a doctor in the US does, why is there such a big difference in the way they keep medical records ?

In the US, every medical encounter is carefully documented ! Perhaps this was originally done for protecting against lawsuits for medical negligence; but today, the US government is making it compulsory for all US doctors to use EMRs – not just to improve the quality of care, but also to reduce costs ! Why don’t Indian doctors use exactly the same approach to documenting their clinical care ? Are they too busy to do so ? too lazy ? or do they feel it’s not important enough ?

Why do most doctors in India not bother to document their clinical encounters well ? Why is medical record keeping still shoddy and badly done in most practises ?

If Indian doctors understand the clinical importance of keeping good quality medical records, then why are they so reluctant to use EMRs ( electronic medical records ) ? In the past, it was true that PCs were very expensive; and that few doctors would afford them. Also, many older doctors were not very computer -literate; and the software programs which were available for medical record keeping were very doctor-unfriendly ! A combination of computer-unfriendly doctors and doctor-unfriendly software meant that most doctors were quite disillusioned with EMRs and were not willing to use them.

The good news is that things have changed dramatically ! Technology has improved; computers have improved; and Indian medical software companies such as Plus91 ( in which I am an angel investor) are realising the importance of mapping the doctor’s clinical processes and respecting his work-flow so they are now making EMRs which are doctor-friendly and which enhance his productivity !

So why aren’t Indian doctors rushing out to buy these , given the fact that they are inexpensive and can help them to improve the care they provide to their patients ?

Partly, this is because of the unhappy experiences doctors have had with Indian medical software in the past. It was the computer-savvy early adopters who were the first to lump on the IT bandwagon 10 years ago, to try to use computers to improve clinical care. Unfortunately, they burnt their fingers, which is why they are reluctant to try again.

As a consequence, most doctors do not know any one else who is using EMRs; and because they have little exposure to practise management skills during their training, they still do not understand the value an EMR can provide to their life.

Another major problem is that Indian doctors are not willing to pay for this. This is because they have been completely spoilt by the pharma companies . Because they are so used to getting everything free from pharmas, they are not willing to pay for anything at all ! This means EMR companies find it hard to sell their products – but if they do not generate revenue, how will they be able to produce good software ?

Please remember that your patients form the heart of your practise – and your patient’s medical records are worth their weight in gold. If you keep them carefully; update them religiously; and share them with him, you can show your patient that you have all his medical details on your fingertips. This will help to inspire confidence in your clinical skills . Patients will rave about how well-organised you are – and this word of mouth marketing will help you get more patients, as it differentiates you from other doctors.

Also, by keeping your patient’s records, you are creating a lot of patient loyalty and “stickiness” . If your patient is confident you know all about him because you have all his medical details, he is going to be very reluctant to switch doctors – after all, who wants all the hassle of explaining his medical history all over again to a new doctor ?

However , if you do not keep your patient’s records; and the patient has to start explaining everything which has happened to him every time he sees you, be is likely to lose confidence in you very quickly ! ( That doctor does not even remember my name – forget about my medical problems !)

Hospitals in India have started documenting medical care electronically; and boutique medical clinics and chains have also started doing so. This is very heartening progress – and doctors who do not start doing so soon are going to find they will start losing their patients to computer-savvy doctors ! You need to move with the times – or you will get left behind !

Informed Consent: How technology can help both doctor and patient !

6 Aug

Date: 4th July 2010

Author: Parag Vora

About: CEO, Infoseek India Private Limited (Patient Education Awareness Series)

Contact: parag@infoseekindia.com

Getting Informed consent from the patient remains a very tricky area in medical practice today . Failure to obtain valid consent is one the commonest reasons patients go to court when they are unhappy with their doctor.Unfortunately, no standardized guidelines have ever been published by the Medical Council of India, Indian Medical Association, or any other ‘reputed’ medical body. This is a huge lacuna, and the importance of taking consent has never been taught to most doctors properly, even though there has been a huge rise in medico-legal and malpractice claims in the past decade or so.

All over India there is a lot of diversity in the way consent is taken and interpreted. There have been instances where consents have been highly inadequate; and in some cases, the doctor has completely forgotten to take a consent altogether ! What makes a consent an ideal consent is still a grey area in India. The ambiguity in the consent document leads to variable interpretations that have resulted in damages to medical fraternity in the form of malpractice claims and litigations.

The Supreme Court of India has laid down certain guidelines in its various judgments for what makes a consent valid; and how it should be taken. Consent and its adequacy has been the most common issue that crops up in medico-legal situation. This is especially true in certain specialties such as obstetrics.

Initially, the concept of Informed consent was developed in order to protect the health of participants in clinical trials and healthcare research. However, in view of the importance of patient autonomy, and the need to protect doctors against medical lawsuits, it is now considered to be an important component of all aspects of health care. Though a very commonly used term, , the fact remains that it is very difficult to prove that the patient did in fact provide true “Informed consent” in a court of law in a medico-legal case.

There are many reasons for this. The limited amount of time available to counsel patients in a busy practice may make this impractical. Also, “How much to reveal” and “How to inform the patient about the risk of complications without scaring the patient away ” is another practical issue , thus making it difficult for doctors to fulfill the legal criterion of informed consent. The inadequate level of education and the language barrier poses another important and genuine problem in our country.

We all know that mere signing on the consent form is not considered to be enough in a court of in law. Similarly , doctors feel very vulnerable when a patient, inspite of being genuinely adequately informed about the risks of the procedure, conveniently claims that no explanation was given to him by the doctor, when he is on the witness stand !

All good doctors want to have a truthful, genuine, transparent doctor- patient relationship where the interests of both the parties are recognised and respected. There is adequate data to prove that giving proper information to patients has improved patient satisfaction and decreased litigation in medical practices.

As a step in streamlining the consent taking process and helping it to make it truly informed consent, to protect both doctors and patients , we are launching P.E.A.S™ Patient Consent software, which has been developed with the help of one of India’s leading medicolegal experts, Dr Nikhil Datar. This software helps manage medicolegal risk with innovative tools which enhance doctor-patient communication at the same time ! The software provides a multilingual, audio visual patient information – cum – consent taking solution for the first time in India . This allows doctors to achieve detailed, provable documentation of the consent process , without wasting his precious time .

Designing Personalised Clinical Templates for the EMR

5 Jun

Date: 05th June 2010

Author: Aditya Patkar

About: Marketing Head, Plus91 Technologies (www.plus91.in)

The working of a clinic can be divided into two parts. The administrative portion deals with the business part of a medical practice , such as accounting, insurance, billing , and inventory management. The scale and complexity will depend on the size of the clinic, and is much simpler for single physician clinics, as compared to group practices, for example. The other part is the clinical aspect , where the data captured is clinical in nature. Reports can be created using both these types of data.

Traditionally, clinics have focussed only on  the administrative uses of medical software, using primarily the appointment and billing modules to help schedule patients and collect payments. The ability of the computer to improve the clinical care of the patient has never been explored properly in India so far.

Why is it so challenging to develop software which a doctor will find clinically useful ? This is because doctors are not able to write their own software – and most software programmers don’t have enough domain expertise in medicine to be able to understand a doctor’s thought processes or a clinic’s work flow.

How hard can it be to convert the doctor’s paper form into an eletronic template ? This can be quite a challenge for many reasons ! For one reasons, there is little standardisation in clinical record keeping. Each doctor loves to develop and design his own medical forms. Doctors take pride in their clinical skills, and each of them does things in their own idisyncratic fashion. Trying to provide this kind of customisation is very difficult for a programmer, because it means spending a lot of time understanding the doctor’s needs, and then implementing them in the program. Not only is this expensive, it’s also very time consuming, because doctors are often too busy to spare the time needed to sit down with the programmer. Even worse, many doctors are not articulate enough to explain to the programmer exactly what it is they want the program to do. This is because they have often not analysed their own work flows and clinical thought processes, and are quite hazy about these. While they are good at doing what they do, they often are not analytic enough to be able to describe this in writing. Thus, while they are very good at finding faults with the program, they are often not articulate enough to be able to provide solutions ! This often ends up causing a lot of frustration for both doctor and programmer !

This is why we have developed a clever model  which provides prefilled  generic templates; and allows the doctor to customise these to suit his own needs, so that he does not need to call on us for making any changes he many need !

A doctor who needs an EMR should understand the following basic rules, so that it’s easy for us to convert his paper forms into electronic templates painlessly.

  1. How many forms he uses ( for example, an orthopedic surgeon may have a special form for each joint)

2. Whether this form will need to be modified for followup visits

3. Because electronic templates are much more flexible than paper forms, they can be designed much more cleverly. A good doctor will help the computer programmer to design easy to use templates. Thus, those parts of the form which  are used most often should be brought to the top; while those which are not essential can be relegated to the bottom.

4. Elecronic forms can be “intelligent”, so make use of this. For example, if the answer to : Swelling Present ? is: No, then no further fields related to this question will be displayed. However, if it is Yes, then additional fields reqeusting more information about the swelling will be shown.

5. Remember your question flow when designing the template . This will help you to get used to it quicker and will allow you to pay attention to your patient even while you are capturing data . A good computer program will follow your process, allowing you to become more productive.

6. Finalise your templates and stop tweaking and modifying them all the time – this just wastes time. Some doctors keep on changing their templates, and I still haven’t been able to install their program for them !

7. Unlike a paper form, which only allows you to enter information in a linear sequential format, electronic forms have lots of clever options, such as drop down menus. Not only do these minimise your writing, they also ensure that you remember to collect all the information you need from the patient !

Plus91 has a whole range of templates , individually designed for each specialty, using inputs from its panel of doctors. Your best option would be to start with this; and then change it, depending upon your personal preferences. Plus91 technology is flexible, and allows you to make these changes for yourself ! Of course, we can also do this customisation for you, if you’d prefer us doing so.

At Plus91 , we focus on improving both your practise management and clinical workflow processes in an integrated manner. This means that all the data collected, whether it be in the administrative section or the clinical templates , is captured in the same seamless workflow, cutting down time and effort.

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