REVIEW ARTICLE

ROLE OF INFORMATION TECHNOLOGY IN HEALTH CARE SYSTEM IN INDIA

ABSTRACT

BACKGROUND & OBJECTIVE: - Information technology (IT) has the potential to improve
the quality, safety, and efficiency of health care. Diffusion of IT in health care is generally low
(varying, however, with the application and setting) but surveys indicate that providers plan to
increase their investments. Drivers of investment in IT include the promise of quality and
efficiency gains. Barriers include the cost and complexity of IT implementation, which often
necessitates significant work process and cultural changes. Certain characteristics of the
health care market—including payment policies that reward volume rather than quality, and a
fragmented delivery system— can also pose barriers to IT adoption. Given IT’s potential,
both the private and public sectors have engaged in numerous efforts to promote its use
within and across health care settings.
Delivering quality health care requires providers and patients to integrate complex
information from many different sources. Thus, increasing the ability of physicians, nurses,
clinical technicians, and others to readily access and use the right information about their
patients should improve care. The ability for patients to obtain information to better manage
their condition and to communicate with the health system could also improve the efficiency
and quality of care. This potential to improve care makes broader diffusion of IT desirable.

METHODOLOGY:- We are taking some example of application of IT in health care in

different sector. The following technologies and terms are often included in discussions of
information technology in health care: Electronic health record (EHR): EHRs were
originally envisioned as an electronic file cabinet for patient data from various sources
(eventually integrating text, voice, images, handwritten notes, etc.). Computerized provider
order entry (CPOE): CPOE in its basic form is typically a medication ordering and fulfillment
system. Clinical decision support system (CDSS): CDSS provides physicians and nurses
with real-time diagnostic and treatment recommendations. Picture archiving and
communications system (PACS): This technology captures and integrates diagnostic and
radiological images from various devices (e.g., x-ray, MRI, computed tomography scan),
stores them, and disseminates them to a medical record, a clinical data repository, or other
points of care. Bar coding: Bar coding in a health care environment is similar to bar-code
scanning in other environments: An optical scanner is used to electronically capture
information encoded on a product. Initially, it will be used for medication (for example,
matching drugs to patients by using bar codes on both the medications and patients’ arm
bracelets), but other applications may be pursued, such as medical devices, lab, and
radiology.

CONCLUSION & DISCUSSION:- Information Technology (IT) is poised to revolutionize

healthcare trade through new thresholds in human connectivity. This paper focuses on the
expanding role of IT in three distinct but related categories: (a) design and development of
healthcare products and services, (b) delivery systems, and, (c) healthcare administration.
Through information power that IT enables, capacities of decision-makers are continually
transformed in how they link with each other, in the here and now. This not only promotes
conventional trade in services and e-commerce and facilitates worldwide convergence in
several aspects of healthcare management and organization. However, this process also
raises fears and anxieties because the pervasive nature of IT and its uneven diffusion
increase some vulnerability where policy safeguards would be needed. The process of IT
diffusion occurs at many different points of impact in the international economy. Thus, policy
choices have to cater to a wide range of national and regional needs and circumstances
concerning rights to health, rights to trade and rights to development. National policies and
international regimes need to strike a harmonious balance between these sets of rights. The
persistence of unresolved conflicts of rights and conflicts of interests point to the need for
new international arrangements to be mandated and resourced. The extent to which this can
be achieved is uncertain. This uncertainty is traceable to the ways responsibility for
healthcare, authority to design healthcare products and systems, and the power to organize
healthcare delivery remain separate or come together. The restructuring of private
investments to integrate IT with life sciences in public-private partnerships is a sign of the
growing significance of IT in healthcare. It is also a reminder of how powerfully IT could be
harnessed in pursuit of millennium development goals.

INTRODUCTION

Information technology (IT) has the potential to improve the quality, safety, and efficiency of
health care. Diffusion of IT in health care is generally low (varying, however, with the
application and setting) but surveys indicate that providers plan to increase their investments.
Drivers of investment in IT include the promise of quality and efficiency gains. Barriers
include the cost and complexity of IT implementation, which often necessitates significant
work process and cultural changes. Certain characteristics of the health care market—
including payment policies that reward volume rather than quality, and a fragmented delivery
system— can also pose barriers to IT adoption. Given IT’s potential, both the private and
public sectors have engaged in numerous efforts to promote its use within and across health
care settings. Additional steps could include financial incentives (e.g., payment policy or
loans) and expanded efforts to standardize records formats, nomenclature, and
communication protocols to enhance interoperability. However, any policy to stimulate further
investment must be carefully considered because of the possibility of unintended
consequences.
Healthcare is one of the most essential services in any society. Yet it is the most neglected
one across the developing world. A recent report in the newspapers indicates India’s public
expenditure on healthcare is a measly 1% of its GDP, making it one of the lowest ranked
countries in the list. Even as this document limits the discussion to the still-evolving Indian
healthcare industry, the issues raised here are no less relevant to other developing nations
Any debate on the state of healthcare as an industry in India will most likely lead to its
comparison to the healthcare infrastructure of the developed nations. While it is a foregone
conclusion that a socialistic system like the National Health Service (NHS) that is prevalent in
the UK and Canada, will never succeed in India. Much of India’s
healthcare actually resembles the US healthcare system in its formative stages. Of course
the obvious conclusion of such a comparison is how much India lags behind the US.
It took most of the later half of 20th century for Healthcare to evolve and mature in the
developed world. While the US went from the “pay-for-your-services” or the “Indemnity”
model through the “defined benefits concept” of the Managed Care era, and then to the now
somewhat popular “defined contribution” models of Consumer Directed Health Plans, the
Indian healthcare industry has stopped
evolving beyond the “Indemnity” model. At MindTree we feel that what India must devise
today is a model that builds on the developed nations’ healthcare models, while retaining a
strong indigenous
component to suit its unique needs. India, while adopting technology, processes or
healthcare models should keep in mind a few key factors. Its huge and diverse population,
limited resources and as the World Health Organization (WHO) puts it “commitment to health
equity as part of development oriented to social justice”. The western models have been
devised by the developed world for the developed world and will not work in the Indian
context (especially the rural sector). The current
trend to blindly mimic the US healthcare system, especially by the nascent TPA industry, can
be potentially harmful to the still evolving Indian healthcare industry. A quick look at some
facts and figures: > Size of Indian healthcare industry is estimated at Rs 1000 billion. Of this,
pharmaceuticals account for Rs 200 billion (CII-McKinsey study) > On an average, Indian
families spend Rs. 600 per month on healthcare which is 11% of the household income
(WHO Report) > India's health expenditure is 5.2% of its GDP, whereas most established
market economies spend 7-10 per cent of GDP on health. US on the other hand spends over
14 per cent. > Ratio of public to private health expenditure in India is 13% and 87%
respectively. Health insurance is extremely marginal as indicated by "Out of Pocket"
expenditure percentage of 84.6% - this means that the financial structure of the industry is
still in the primitive stages. (WHO report)

Indian healthcare industry: Current Market and Potential

If you analyze the above statistics, the general population on an average is willing to spend
as much as Rs. 600 per month per family. The statistics also underline the fact that nearly
85% of the time, this money is spent out of pocket. This shows that the average Indian is
willing to spend on healthcare provided the service they get is of high standard. Now,
considering that there are more than 140 million upper and middle class people in India, and
that they have a far greater ability to spend on
healthcare than the per capita national average of Rs. 600, the potential of health services
sector is immense. Further, the middle and upper income class is growing at over 4% per
annum with combined annual income of over Rs 8200 billion. These people have confidence
in healthcare products and services offered by private hospitals and they are willing to pay for
quality services. The rural sector poses a different challenge altogether. Any solution to this
challenge will need sustainedparticipation from government-private-NGO consortiums. Now
given all these, why is it that India lags behind the developed nations in this industry? Why is
it that Indians do not have access to high-quality, cost-effective healthcare on-demand? Is it
poverty? Is it education or political empowerment or is
it simply wrong policies? The mutual reinforcement of poverty and ill-health is something we
all understand. There is growing evidence of how asymmetrically resources, efforts and
outcomes
are distributed between the well-to-do and the poor, both in the urban and rural scenario.
Benefit incidence studies consistently show that people living in poverty receive less than a
proportional share of public funding for health, relative to the populace above the poverty
line. At MindTree we believe that all the above factors lead to the continuation of this
crippling problem. But the problem is not unsolvable. The solution exists if we look at how
developed nations have handled this. Remember that they had the same issues that India is
facing now, maybe 3 or 4 decades ago. It is just that they were
enterprising and solved the problem, and India needs to start doing the same. Developed
nations are strong in the three “enablers” in the healthcare industry when compared with
India. The “enablers” are the Health Insurance Sector, Information Technology and Political
Will. Firstly, they have a vibrant health insurance sector (especially the US), which makes
risks spread to a much larger base and makes high-end services affordable to a large section
of the population. Secondly, they have embraced information technology in a very effective
manner. Thirdly, they have the political will through which they demand accountability from
their healthcare industry. Any resident Indian who has traveled abroad, got sick and seen a
doctor there will vouch that the Indian doctor is as efficient and capable as his international
counterpart (and a lot cheaper too). So the problem is not with the quality of
Problems plaguing the Indian healthcare industry Indian healthcare industry – The
way forward
doctors. What the Indian doctor lacks is the policy, procedure & technology infrastructure
around the delivery of care. That is why, at MindTree, we believe that this problem may not
be as difficult to handle as we normally think it to be. Let us now take a deeper look into what
India lacks in the three “enablers”.

METHODOLOGY & DISCUSSION: - Today, less than 10% of the Indian population is
covered by some form of health insurance. However, this sector is rapidly growing. Industry
experts predict that the health insurance market size will grow to Rs 130 billion by 2005.
Given its sheer size, India is one of the most promising countries in the world for the
development of its health insurance market.
Some organization strongly feels that the robust insurance sector will provide the necessary
financial foundation for the healthcare industry to thrive. Some organization foresees that
health insurance industry is poised for serious growth in India. It is expected to be the main
driver for raising quality consciousness and increased demand for better standards, hospital
accreditation and sophisticated
patient information systems. Some organization believes that Indian corporates will be a
market segment for private insurance providers, developing the market for third party
administration of insurance packages. It is expected that the major international health
insurance players will establish networks of affiliated hospitals and may seek direct
involvement in the development of new facilities, especially cost-effective diagnostic centers.
Some organization has worked closely with major healthcare players in the US healthcare
insurance industry. The essence of this experience is that the success of an insurance
company is directly proportional to the amount of data it can capture during the healthcare
delivery and particularly at the point-of-care that will drive the IT revolution in most hospitals
across urban India. (This subject is covered in the remainder of this document) Some
organization also believes that although the healthcare insurance sector is very promising in
the urban healthcare market, it will not play any significant role in developing the rural
healthcare market. The government has come up with different rural healthcare schemes but
we believe that this will not take off in the current shape and form; unless a level-playing field
is established by the government so private insurance players find the rural market lucrative
to enter. The penetration of Information technology in the Indian healthcare industry, if
notnon-existent, is abysmally low. Some organization believes that investment in information
technology is critical to any healthcare organization’s survival - it is true today and will be
more so in the coming decades. Overwhelming evidence exists in developed nations that
investments in information technology (IT) and business transformation (BT) have impressive
payoffs throughout the healthcare system.
Health insurance sector Information technology
fact, technology investments and deployments are distinguishing factors between hospitals
and health systems that are economic winners and those that are faltering. Hospitals and
health systems that invest in IT (and BT) have better control of expenses, higher productivity,
and more efficient utilization management. More importantly, they channel otherwise wasteful
expenditure towards building healthcare infrastructure of the country either through private-
public cooperation or through a government-NGO-private consortium. However, the Indian
healthcare industry is plagued by the “ROI” syndrome when confronted with IT investment. In
developed nations, any doctor’s practice no matter how small, has access to a PC and an
Internet connection. They have to maintain detailed medical records and by law are required
to archive them for a couple of decades. In India we have this
strange problem around the way the general populace goes about getting healthcare. There
is a general apathy towards one’s own health. Most Indians go to the doctor only when they
have very bad symptoms and have to be hospitalized. Hardly a few would go in for regular
checkups or preventive visits. This problem is especially acute in the rural areas. On the
other hand, if the doctor plans to do something to improve the quality of life of their patients
by providing preventive care awareness their
efforts are often humbled by the system. Consider this scenario; a well-meaning doctor in a
regular outpatient clinic invests in a PC, the associated software and support staff to maintain
a patient’s medical record. A patient’s medical record is complete only if all morbidity
occurrences, medications & outcomes are recorded diligently and chronologically. In most
situations, after the first visit, the patient may or may not come back to the same doctor,
which in turn will create a gap in the patient’s medical record rendering it useless. The doctor
on the other hand is stuck with his investment and does not realize any ROI either in terms of
adding higher value to the patient care which will translate into better earnings or improving
patient health, or the satisfaction of providing timely interventions which make the patient
remain loyal to the doctor. Some organization believes that this ROI lose-lose predicament
can be solved. In fact with a little bit of enterprise this can be quickly turned into a win-win
situation, as we will understand in a while. Pharmaceutical companies vie for the doctor’s
time to push their drugs. However, if one takes into account that half of the time Medical
Reps (MR) will not actually speak with the doctor (due to the appointments being cancelled
by the clinic or the doctor being too busy to see the MR etc.) and if they do, 90% of
conversations are less than two minutes in length (with mental contact often being 10-15
seconds), it is clear that this very significant expenditure is not operating as effectively as one
may have hoped. Also, the doctor expects to be remunerated for the time spent listening to
the medical rep. To avoid this bottleneck, Pharmaceutical companies have introduced an
increasingly popular way of doing this drug related marketing activity called eDetailing.
eDetailing is emerging as an effective means for pharmaceutical companies to reduce their
sales force expenses - without losing sales - and interact with the physicians by giving value
additions. For the pharmaceutical company, eDetailing allows the MR to be more productive
and make more effective sales calls each day (virtually and face-to-face) while building
stronger and more trusting relationships with the physicians - by handing them control. This
interactive exchange meets the physicians' needs in terms of content and time - and is a
value-add to them. Some of the current eDetailing activities being initiated by some
pharmaceutical companies utilize integrated video-conferencing capabilities, Internet access
and high-speed telecommunication lines that allow physicians to interact with distant sales
representatives at any time. Our ROI dilemma is solved when the Pharmaceutical
organization leases this desktop/palm PC to the doctor. In return the Pharmaceutical
organization recovers this investment by reduced face-to-face calls and can make the doctor
feed valuable point-of-care related data back to the Pharmaceutical companies. Even better,
if the patient agrees to take part in this marketing, (by way of participating in clinical trials or
drug-efficacy programs) they might be compensated with free samples or by getting a direct
discount from the Pharmaceutical organization on their products. This same PC then can be
utilized to capture patient records, connect to the
insurance companies’ systems and transact with other healthcare delivery organizations.
Once this model becomes popular, government/independent regulatory bodies like IRDA can
bring in interoperability standards to capture and exchange healthcare data (like EDI, HL7 or
ANSI for transactions and ICD or CPT for codification of diseases, diagnoses and procedures
as in the US). This is a workable option for everyone. The Indian IT industry on its part needs
to whole-heartedly participate in this by offering a special “Rupee” price list for the Indian
healthcare industry to develop,
maintain, reengineer or deploy new solutions. The Indian IT industry is perceived to be
neglecting the domestic markets. This attitude must change fast in order to make a lasting
difference for India’s future generations. Following the May 2004 Elections, India has a new
government in place. The new
United Progressive Alliance (UPA) government's Common Minimum Program (CMP) has
placed greater focus on the two social sectors of education and health. The document
mentions that the UPA government will rise public spending on health to at least 2-3% of the
GDP over the next five years, with exclusive focus on primary healthcare. Foreign Direct
Investment (FDI) in the insurance sector also has increased over the past few years. Many
global players find the Indian healthcare market
conducive to do business. The UPA government also states that a national scheme of health
insurance for poor families will be introduced. The government will step up public investment.
The new health minister has already mentioned that he wants government spending on
healthcare to increase substantially, with special emphasis on improving facilities in rural
areas. The budget announcements are positive for the sector.

Political will
The announcements are expected to drive demand for healthcare services by providing
better access to masses and encouraging private participation for setting up and expanding
existing facilities. Fiscal incentives on life saving medical equipment are expected to
encourage the continuous upgrading of technology.
More healthcare facilities will opt for quicker replacements of medical equipment and state-
of-the-art technology. We welcome this trend and hope that the government will implement
more policies to improve the face of healthcare in India. Emerging technology trends in the
next decade Changing scenarios in the insurance industry, demands from corporate India,
economics of administering and delivering healthcare and politics are creating a much-
awaited change in the Indian healthcare industry. Another contributing factor is
advancements in pharmaceutical/life sciences and information technology. MindTree predicts
that among the above forces that will provide major impetus to the Indian healthcare
revolution, IT will play a critical role in shaping the future of Indian healthcare industry.
MindTree believes that vigorous introduction of Information technology in the healthcare
continuum will ensure that both the urban and rural sectors of India have access to
affordable, quality healthcare on-demand. We feel that the major applications & technological
advancements that will shape the Indian healthcare industry in the coming decade.
Computerization at point-of-care
Absence of computerization at point-of-care (be it at an urban clinic/hospital or a rural
primary health center) severely hampers the data capturing process necessary to determine
medical efficacy, outcomes management, to prevent medical errors etc. MindTree believes
that automation is paramount and can happen in one of two ways:
1) Insurance-driven approach: Insurance companies and corporate India will seek direct
involvement in the development of new ambulatory facilities, costeffective diagnostic
centers and Physician networks. These entities will band together and form Integrated
Delivery Networks (IDNs). Standardized electronic transactions will facilitate efficient,
cheap and real-time access to data throughout the IDN. MindTree foresees that this
standardization will happen both voluntarily and through government legislation. All
these will result in physicians/hospitals capturing and maintaining patient medical
records including other patient-doctor encounter related data as well.
2) Pharma-driven approach: Pharmaceuticals will aggressively promote eDetailing by
providing physicians with PCs. Pharmaceutical companies will dictate thecapturing and
maintaining of health records in a standard format to facilitate data mining. Alternately,
physicians that do cashless transactions will utilize this PC to work with Insurance
organizations/TPAs. Working with multiple such Insurance organizations/TPAs will in itself
ensure that the transactions are made in industry standard formats. MindTree believes that
any standardization in the Indian healthcare industry will gravitate to using one or more of the
available
1) messaging and coding standards (HL7, ICD, CPT, ANSI etc.).

US is now realizing that its aging population will exert extreme pressure on its healthcare
system, so much so that there is a chance of a complete break down. Advancement in the
medical field combined with better quality of care will increase the life expectancy of the
general population. Together with the population growth rate, this would mean that with time,
more and more people would require longterm healthcare. This puts tremendous pressure on
the already weak healthcare delivery and financing system. If appropriate actions are taken
now and a robust healthcare infrastructure is created within the next decade, India will not be
left without alternatives. Groundaltering changes in the healthcare industry can only occur
when a variety of market forces recognize it as a common problem and then unite in
agreement to solve the problem.

PREPARED BY: - Jaishree Soni, NEERAJ Sharma, (STUDENT), INTERNATIONAL

INSTITUTE OF HEALTH MANAGEMENT RESEARCH, NEW DELHI