| Healthcare Information System
The Forte of Fortis
The lack of an appropriate readily available solution led
Fortis Healthcare Ltd to develop its own Healthcare Information System. This
has become the forte of the company helping it grow its business and increase
efficiency. by Deepali Gupta
In 2000, Fortis Healthcare Ltd (FHL) was looking to establish a hospital setup
that would provide world-class healthcare to its patients. The administration
identified the criticality of IT in providing healthcare that would not only
be integrated for convenience of the customer, but could also provide the required
information for the hospital to evolve over time.
FHL therefore had to put in place a Healthcare Information System (HIS). Initially
the company was on the lookout for packaged software. The lack of a suitable
offering prompted, Sunil Kapoor, Head Information Technology of the company
to develop a module in-house.
The HIS was developed piece-by-piece aligned to the specific business and operational
needs of the organization, and today it is deployed across four Fortis hospitals
and has resulted in a substantial cost benefit to the organization. It has also
decreased the scope for human error and increased workforce efficiency.
The HIS comprises a Picture Archival and Communication System (PACS), patient
monitors, and Web access to MIS and data. The PACS captures, stores and transmits
images. This results in efficient archival and retrieval and thus cost efficiency.
More importantly however, PACS makes diagnostic imaging, such as X-rays, almost
film-less. Radiologists get enhanced images on any computer on the network,
based on which they can diagnose a patient's problem.
The connected monitoring devices and Web access allow specialists to view certain
live parameters of an admitted patient from remote locations. That means that
more consultants and doctors can review a patient's condition without actually
visiting the patient on site.
In addition to the basic functionality of the HIS, FHL has also implemented
an MIS within the system. With a front-end developed in Visual Basic, 80 percent
of the MIS is browser-based. It provides business-critical data reports from
the billing and usage information and addresses the day-to-day needs of the
hospitals various departments.
For better customer support, thanks to the HIS, the company has evolved a single
window approach. Here the customer can gather required information, make an
appointment and clear bills.
The system provides the person at the counter all the technical support that
may be required to address any query a patient may have. Even the waiting times
for the facilities are made known to the patient before signing up. For example
if there is a two hour wait for an X-ray, the patient can be given the option
to either wait or return on another day.
The MIS stores critical resources, such as a doctor's case history, status of
high-end equipment, and procedures done on patients. These can help find out
the costs that have been incurred and contribution that has been generated.
The system generates the bill and breaks it into cost and contribution. It keeps
track of costs incurred at different points-of-care, such as OTs/ICU/Wards,
which in turn forms a sub-set of budget comparisons. And since it is browser-based,
it is a convenient tool for decision-makers to access critical information in
The MIS has a patient satisfaction measurement system. It analyses patient feedback
so that the business heads can take preventive and corrective action in a time.
A mail about the patient or customer feedback is generated automatically and
sent to the concerned departmental head and follow up communication between
the Guest Relations Officer and the concerned department head is tracked.
A satisfaction index is generated by the system based on
the feedback. This helps the management keep a tab on customer satisfaction
In addition to the macro level functions of the system, Kapoor and his team
have plugged in sub-modules to facilitate the daily workings of the hospital.
One such module provides a list of the essential details necessary for any medical
For example, before an Angiography, the system provides a list of pre-testing
essentials such as, the patient must have an empty stomach, and the time of
injection of the dye.
Before an operation the system provides a list of consumables that must be stocked
in the OT.
Modules such as these eliminate the scope of human error that can sometimes
have fatal consequences.
The development Process
"The IT guy at FHL never wore the IT hat," said Kapoor. What he means
is that instead of pelting IT jargon at users the IT team presented the technology
in terms of its business appeal. All the application development occurred in
the specific areas that were required. Thus alignment and aptness of the modules
were never questioned.
IT is an integral part of FHL. It forms a part of the quarterly reviews the
company conducts. So when Kapoor proposed the implementation of an MIS, "It
was approved easily. It turned out to be a sweet implementation, which has nothing
out of the box about it."
A 'fraternity' had been established between the medical and IT teams, and it
helped establish the purposes and perspectives of data interpretation. "In
fact," Kapoor said, "Towards the end, the IT team had a clearer all
round vision and understanding of the business than the employees working in
"ROI is something we did not need to justify for our projects," explained
Kapoor. The project has cost FHL over Rs 300 lakh. Kapoor does not care to evaluate
the returns it has brought.
However, he does mention that in certain projects it is the TCO that counts.
Efficiency has increased thanks to the implementation, and that cannot be measured
in terms of money. Besides most of the development done during the process will
be reused as the company establishes more hospitals around India.
Dil mange more
There are two functions Kapoor plans to implement to extend the existing HIS.
Electronic prescription: E-Prescribing will be used
to streamline the medical prescription process for physicians and patients.
In addition to enabling providers to write and transmit prescriptions electronically,
e-prescribing offers point-of-care access to real-time drug formularies and
comprehensive drug data.
Clinical decision support and management system: Integrating
medical knowledge and advances into the clinical setting is often difficult
due to the complexity of the algorithms and protocols involved.
The use of a Clinical Decision Support System (CDSS) will assist the clinician
in applying new information to patient care through the analysis of patient-specific
clinical variables. Many of these systems are used to enhance diagnostic efforts
and include computer-based programs that provide extensive differential diagnoses
based on clinical information entered by the clinician.
Other forms of CDSSs, including antibiotic management programs and anticoagulation
dosing calculators, seek to prevent medical errors and improve patient safety.
Kapoor has also considered data centralisation for FHL's four hospitals. He
admits that a central system may come in handy as the organisation expands.
However, his concern is downtime. An expensive VSAT is not something he is ready
to invest in yet, and other connectivity solutions have not proved to be reliable.
He is nonetheless providing access to his e-mail server through a VPN. If this
experiment proves successful, he intends to consolidate the databases of the
four hospitals into a single master database hosted at a central location that
will be accessible via VPN.
Deepali Gupta can be reached at: firstname.lastname@example.org