In your experience, how has IT helped improve patient care, what are your expectations from it in the

coming years?

It was Rudyard Kipling who once remarked “What do they know of England, who only England know”. In the
21st century this aphorism could be replaced thus “What do they know of healthcare who only medicine
know”. 21st Century is the age of informatics. Today’s doctor needs to be as well versed in the basics of
Information Technology as he/she is in anatomy, physiology and pharmacology No man is an island unto
himself. In the 21st century the physician or surgeon is only a member of a multi disciplinary healthcare team
which necessarily must include experts from various domains. Information Technology should necessarily be
an integral part of any modern healthcare system. Having been trained in the BC era (before Computers and
Before Christ are essentially one and the same!!). It has been my good fortune, to have witnessed the growth
and development of medical care in the last 35 years in India including the gradually increasing use of HIT. It
would be no exaggeration to state that IT has made, is making and will continue to make a significant
difference in patient care. Whether it be in the field of diagnosis, investigations, treatment, documentation,
retrieval of information, access to state of the art knowledge, medical instrumentation, teaching, research etc IT
has made a major difference.

IT in healthcare will level the playing field. It will bridge the gap between the haves and the have nots. In spite
of the obvious short term and long term benefits it is a matter of deep concern that the use of IT in the
healthcare industry is far less than its use in banking, commerce, travel, automobile or almost any other
industry. Less than 2 per cent of gross revenues are set apart for deployment of ICT, compared to 5 to 8 per
cent in most other industries. IT improves patient care, by enabling processes and systems to be introduced and
repeatedly monitored. Standard operating procedures and audit processes can be introduced in almost every
aspect of healthcare.

Viewing healthcare as an industry and attempting to achieve a sigma six though improbable is not impossible.
Using ICT should not be viewed as a dehumanising process. IT should be viewed as a tool to achieve an end.
Not an end by itself. IT has improved patient care in many, many ways. Providing real time appropriate
relevant information to every stakeholder in the healthcare industry makes all the difference. Well informed
patients and doctors can make a significant differences in the standard of healthcare. Rapid increase in
computing power is accompanied by exponential reduction in costs. Though the healthcare IT market in India
has grown 200—300 per cent in the last 10 years, it is accepted that the healthcare sector has to be more IT-
oriented. Studies indicate that the use of IT in healthcare has enormous benefits—short term and long term for
all stake holders, for e.g. a patient’s hospital stay could be reduced by up to 39 per cent with improved use of
IT.

Considering that a majority of Asian countries are still developing, do you think Asia is ready for the
rapid technological changes shaping healthcare globally?

A major advantage that developing countries in Asia have, with regards to being ready for the rapid
technological changes shaping healthcare globally, is the fact that they have no colonial legacy to ‘disinherit’
in the field of modern healthcare; for example, they do not have to ‘unwire’ to introduce mHealth. One does
not have to undo to keep up with technology simply because e-Health is still not a reality. We do not have to
follow the advanced countries. We do not have to piggy back. We can leap frog. The apparent lack of progress
in the field of healthcare during the last few decades is not a deterrent. It can actually be viewed as an incentive
so far as introduction of e-Health is concerned. We may not have achieved ‘health for all by 2000’ but the
target e-health for all by 2020 is not impossible. The exponential growth in mobile telephony and in ICT in
India clearly shows that we are more than ready to embrace technology. While it is a matter of justifiable pride
that e-Governance is slowly being introduced and that mBanking and mCommerce has also commenced it is a
matter of deep concern that the use of ICT in the healthcare industry is considerably lagging behind.

What are your comments on the scenario in India?

India is indeed a paradox. While we have world-class hospitals of excellence, these are few and far between.
They are like oasis in a desert, confined to the urban elite and the well to do. We are in a position to offer state
of the art healthcare, to those who come to us from other countries but are unable to do so for the 700 million
Indians living in suburban and rural India. The picture, however, is not totally bleak. It is reassuring to see that
the central government and several state governments have accepted Telemedicine as a means to provide
healthcare. We are optimistic that the present digital divide in healthcare, existing between the haves and the
have nots, will gradually shrink.

The formation of the Telemedicine Society of India, the Medical Informatics Society of India, the publishing
of several journals dedicated to e-Health etc. all augur well for the future though we have a long way to go, but
then so do scores of other countries. The Government of India has launched the Health Management
Information System (HMIS) portal to convert local health data into real time useful information, management
indicators and trends which could be displayed graphically in reports.

Real time data provided by web-enabled technologies will strengthen monitoring, enabling policy makers, to
make better decisions for public health delivery. Enhancing the information flow at various levels and
providing useful and timely inputs for programme development and monitoring. And midcourse interventions
in policies would be a direct spin-off. Several multinational companies like GE Healthcare, Intel, Hewlett
Packard, Cisco Systems, Qualcomm, Microsoft, Google, IBM, Computer Sciences Corporation (CSC), Perot
Systems, TCS, HCL and Satyam, to name a few, have all entered the health space.

These new healthcare models initiated by the IT companies, while delivering quality care will explore the
possibility of innovative new technology that are simple to use, cost effective, portable and power independent.
Challenges in integrating IT into the healthcare system in India are many. They include lack of Standards, lack
of in-house IT expertise, reluctance of medical, nursing and other staff to change, fear of technology failing
(paper systems appeared more reliable), poor support from vendors, reluctance of vendor to make changes in
software when requested. These can be addressed by leadership and strong message from the top , ownership
by the departments and long term vision, Health Administration acting as facilitator and recognising IT as a
felt need in health, recognising champions among the health personnel, customising IT solution to needs of the
users, confidence building, good co-ordination and communication between vendors and users. Reasons for
relative failure in IT implementation initiatives in Indian hospitals are many. They include customisation of
software used to computerise manual processes without proper refinement in policies and procedures; lack of
proper implementation methodologies (detailed process study and refinement strategy). To make the
management aware about time and efforts required for successful computerisation and not using standard inter
operable, scalable software.

How do you see the adoption of PHRs and EMRs in Asia? Do you think Asian hospitals are prepared to
shift toward the trend?

Universal adoption of Personal Health Records (PHRs) and Electronic Medical Records (EMRs) is a
challenging and daunting task even in the most advanced countries. The very fact that we have started talking
about it in India is itself a good sign. It was Confucius who once remarked “a journey of a thousand miles
begins with the first step”. The concept of Personal Health Records (PHR) continues to gather steam as several
healthcare and insurance providers established connectivity with PHR platforms like Google Health and
Microsoft HealthVault, which allows their members to access and store personal health information online.
Microsoft also continued with its strong strategic alliance plans to promote several of its healthcare offerings.
The development of a common strategy and roadmap for e-health standards development, to support
interoperability and the adoption of electronic patient records is crucial. One of the barriers in the adoption of
international e-health standards in hospitals, is the priority given to internal process functionality.
Standardisation of data and processes across hospitals will go a long way in enforcing the use of PHR, EMR
etc. A Hospital Information Management System (HIMS) should essentially interconnect all departments of
the hospital seamlessly and attempt to minimise operations on paper. No doubt it will take a long, long time
before PHRs and EMRs become a reality in India, but it will certainly happen.
What are the areas of Healthcare IT that you think need to be further developed?

With the exponential increase in mobile telephony and the imminent deployment of 3G, it is imperative that
broad band wireless technology be exploited and used to develop mHealth. While mBanking, mCommerce,
mEntertainment is becoming a reality we need to develop mHealth. Pilot studies carried out by Apollo
Telemedicine Networking Foundation in conjunction with Erricson in Tamil Nadu, Bhutan and Bangladesh
have shown that mHealth can be a reality in India. The number of ‘Hospital on Wheels’ are very few. This
needs to be considerably increased, with facilities for real time two way audio video contact with a tertiary
center. Virtual skills laboratories where a large number of medical and surgical procedures are simulated on
virtual patients are now a reality in advanced countries. We need to have such learning centres. To achieve all
this, IT should be a part of the medical curriculum. Similarly, Applications of IT in Healthcare should be
taught to all IT students.