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The future is in the PAST Paper based IT systems that work Dr Vijay Raaghavan Engagement Manager Ember Melcher Associate Consultant

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Who are we We are a niche healthcare consulting firm, driven by the challenge of new possibilities in healthcare and the translation of these ideas into reality. Our goal, very simply, is to make a difference, which may explain why we tend to go beyond research and analysis to adopt a more pivotal role in the manner in which we help our clients execute various interventions.

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Whom do we work for Our clientele ranges from large hospital networks and single specialty hospitals to diagnostic services providers and primary healthcare clinics. We have also served clients in public health, medical equipment manufacturers and healthcare IT solution providers. Our diversified team, as well as our advisory panel, offers years of cross- functional experience and expertise across various industries.

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It all started here FUN For a client of ours, we conceptualized a family medicine doctor clinic model and had to scale up this model across a hundred locations.

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FUN The Challenge The limitations of a stand alone practice The drawbacks of highly IT led initiative Personalized touch an extremely difficult aspect to scale across a network Doctor so close,yet so far with doctor so engrossed into inputting the data into the system, there is very little he has left with the patient who is sitting right acoss

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Point 0 FUN Patient has to be at the core of everything we do. WE Believe

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Point 0 FUN Patient has to be at the core of everything we do. Consistency of experience/service delivery

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Point 0 FUN Patient has to be at the core of everything we do. Consistency of experience/service delivery Great customer experience through empathy, dignity and responsiveness

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Point 0 FUN Patient has to be at the core of everything we do. Consistency of experience/service delivery Great customer experience through empathy, dignity and responsiveness Affordable price - Help towards reducing his overall spend on healthcare

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Point 0 FUN Patient has to be at the core of everything we do. Consistency of experience/service delivery Great customer experience through empathy, dignity and responsiveness Affordable price - Help towards reducing his overall spend on healthcare Superior clinical outcome

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Point 0 FUN Patient has to be at the core of everything we do. A TECHNOLOGY PLATFORM THAT SUPPORTED ALL OF THESE Consistency of experience/service delivery Great customer experience through empathy, dignity and responsiveness Affordable price - Help towards reducing his overall spend on healthcare Superior clinical outcome

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Lets begin from here FUN Patient

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What people said We spoke to 150 patients who very recently had completed their Physician Consultation in some cases the follow up and were very fresh to speak about their experience. This included a mix of corporate, non corporate, stand alone clinic setup FUN

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What people said 70% 20%20% I I III The doctor understood my exact problem and so the medicines began to work The doctor kept asking questions The doctor also monitored my illness even after I got well Her treatment worked well I had throat pain and when I went to my previous doctor he just saw me asked me to open my mouth and wrote some medicines.Even after 5 days I didnt find relief. I then went to Dr Sridhar he had some machine with light- he asked me to open my mouth and he examined my throat with that machine for more than five minutes. After that he wrote medicines and it worked! He asked me to come for a follow up today and even today he spent that much time. Reasons for Dissatisfaction Reasons for Satisfaction /wow 50%50% 30%30% 20%20% The doctor did not spend time listening to my problem The doctor was busy doing something else The doctor did not even touch me and feel me She just asked me one question and thats it It was like Doctor was talking to the computer and not me ! The doctor did not even put the stethescope on me The doctor did hardly touched me to feel my health problem The doctor was busy chatting with some other doctor and without even asking me the details of my pain went on to write prescription Without even listening to me that I had the problem in my right ear the doctor went on to put the scope in my left ear. This doctor didnt even ask if I was allergic to penicillin, she straight away prescribed the medicine 10%10% I I IIIIII Others

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FUN What people said 50%50% 30%30% 20%20% Reasons for Dissatisfaction Reasons for Satisfaction /wow The doctor did not spend time listening to my problem The doctor was busy doing something else The doctor did not even touch me and feel me She just asked me one question and thats it It was like Doctor was talking to the computer and not me ! The doctor did not even put the stethescope on me The doctor did hardly touched me to feel my health problem The doctor was busy chatting with some other doctor and without even asking me the details of my pain went on to write prescription Without even listening to me that I had the problem in my right ear the doctor went on to put the scope in my left ear. This doctor didnt even ask if I was allergic to penicillin, she straight away prescribed the medicine Others 70% 20%20% 10%10% I I IIIIII I I III Touch Examine Engage

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What doctors said FUN We spoke to 35 Physicians on their experience of what they felt were the good points, pain points of the consultation.We selected facilities that had IT infrastructure in most cases a laptop / Desktop with a HIS.

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FUN 1 technology ? Doctors may be reluctant to use computers ! Dont change what you dont need to Patients dont like if we didnt show concern these hospitals make us type type and type the top management is more worried about data - less worried about patients problems the system of computerization is good, but it cant be at the cost of a patients time whenever we have eye-eye contact, I am able to build a relationship with the patient Patients lose faith if we didnt understand their problem Sometimes patients get frustrated with us as we tend to focus more on the monitor sometimes patients tend to mistake us for

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FUN 2 Prescription writing ? Will it be a wiser option to retain the pen & pad and yet go digital ? ! The traditional way helps in maintaining the patient physician eye to eye contact We were very keen that we focused on options that suited the consultation requirements. DICTAPHONE KEYBOARD INPUTS PEN PAPER TECHNOLOGY PAPERLESS TABLET / PAD

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3 One page emr ? We asked to ourselves if done is better than perfect ? ! The one page EMR that we created became our audit too as well ! min 1.5 minmin 2 2 2 9 minute/patient

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3 One page emr IMPLEMENTED EVIDENCE BASED CARE The one page EMR capture system not only increased the INVOLVEMENT of the Physician on a consistent basis, but also ensured that LOT OF THINKING backed by EVIDENCE BASED MEDICINE went into DECISION MAKING. INCREASED EYE-EYE TIME Patient Particulars,Illness Summary, Vitals, Observations and Drug Therapy also meant that we could steal close to 8.5-10 minutes of the care givers time to the patient. CONSISTENCY IN DECISION MAKING Clinical Quality Head could first Audit Physicians decision making by using these filled forms as a PROXY and then could spend time with the Physician on improving practice/outcomes. 1.5 minmin 2 2 2 9 minute/patient The average Physician Patient Interaction time increased from the otherwise 1.5 minute/patient* to a 5.5- 8 Minute quality interaction that included questioning probing, examining, touch and feel * Based on the results shared by IMA, other studies !

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FUN 4 standardization ? We asked to ourselves if done is better than perfect ? ! We saw the merit for the patient,physician We went one step further to seek help of a IT Hardware that helped us quickly translate hand script into digital signals. We shortlisted iBalls take note device Benefits From a Clinician standpoint it was the same pen and paper From a patients standpoint they hardly noticed From an IT standpoint they had the xml version that could be ported to the EMR

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FUN 5 NEED TO MONITOR OUTCOME CONSISTENCY ? How do I ensure that I deliver comparable treatment outcomes across 100 locations ! Sought support from a protocol development firm. Once we got here, we realized that it was very critical to ensure that we attained consistency in clinical decision making. This is where we sought the help of a protocol developing firm and customized the same The rules

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FUN The Outcome The Clinical Head Speaks

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FUN Could retain the traditional way and yet go digital ! PATIENT SATISFACTION Solution Mix 1 technology PHYSICIAN SATISFACTION 2 3 4 5 Prescription writing Record keeping standardizing Monitoring outcomes COMPLIANCE Pen and Paper helped us in keeping it low cost Could retain a hard copy, this also became the audit tool and a bible for improvising Physician practice! Building protocol for specific conditions standardized the treatment plan The protocol driven care pathway helped us in ensuring that informed decisions were made and they were consistent across locations and physician profiles - High - - Medium -

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FUN Takeaways Systems that include all stakeholders in design work better. Protocol-based decision making does work in India. Innovation pays off.