Abdullah Saleem, Group CIO, Omni Hospitals outlines the automation at Omni hospitals and how technology is helping expand the medical frontier.
What are your exact roles and responsibilities as the Group CIO of Omni Hospitals?
My major role is towards data security, digitization and ensuring error free treatment for our patients, by enabling the technology. Technology is a great enabler in terms of running the hospital business smoothly, clinically and non clinically both. Technology is the only component which helps the organizations to provide cost-effective treatment for their patients.
Prior to joining to Omni hospitals chain, you were there with Oham which was the first one to set up India’s first EHR company. How’s the experience and which one is the better, being a technology provider or working from the patient’s perspective?
Earlier, I was at the product side and now on the consumer side. Earlier, as a product owner, I was facing a lot of problems in terms of the customers to get the solution adopted. 100% adoption of electronic medical records was not happening in India. Though the change management for HIMSS organization was happening, it could not lift up the 100% adoption of the technologyIf you are not adopting the technology, then we will not be able to meet the goal income in terms of error free treatment of the patient.
The experience here, working in a hospital, is to understand what is the bottleneck of the organization. Why this clinical transformation is not happening? Where changes are supposed to take place to ensure that the digitization is taking place? I found 3 major gaps in terms of why hospitals are not adopting the technology. One is the solution is supposed to be developed in such a way that it is not taking much time in terms of the clinical documentation. In OPD, if a patient comes and he is cribbing on pen manually, and it takes three minutes of time to release the prescription, then the technology’s supposed to be faster than that. We found that the solution is supposed to be faster than paper. It should be developed in such a way, that it does not need daily training because doctor knows all the jargons and the clinical dictionary, they know much better than anybody else and then it should have a sub-second response. These are the three goals, which we are meeting from the product providers side.
As we know that you’ve designed a five ways methodology to deploy the EHR. Please explain what are these five ways.
Methodology is talking about stage wise deployment. The assessment is the first phase, where we have to do a proper assessment of the hospital, whether they are ready or not. Assessment in terms of the readiness of the organization and then what is their need, how & which protocol they are following. If they are following the internal protocol, then what is the protocol? Is that referring some external protocol like NCCN guideline? We do a proper assessment and that is the first stage. The second stage is adopt. We do the gap analysis, that first assessment in the gap analysis and then we adopt followed by the configuration and this customization of the solution. That is adopt and then adapt. Adapt comes again with implementation and then adoption of this solution. Then we align it. Based on the SOPs, the solution gets adopted and then assure means what is the learning we have taken ahead for the next project.
What are the key technology solutions used by Omni Hospitals and what are their use cases?
If you talk about any hospital, it has got a niche IT budget but the hospitals are not ready to pay the license fee kind of. So, the state of the art open source technology, for the hospital per se, and for Omni hospitals is also in the same directions.
For the database perspective, operating system perspective and the middleware perspective, the hospital is not ready to pay for the licenses because the open source technology community has come very strongly to make it more cost-effective to the hospital and the other organizations. Hospitals are getting that solution developed and they are paying for the subscription charges only.
Omni hospital always encourages to have the solution on open system source technology. Apart from this, the security tool comes across, which is not there in the open source. Technologies are not more effective to secure the data, to support your solution stack of the organization. There we, again come forward and take the best solution which is stable in commercial perspective. We do not compromise in terms of the quality of the data security.
From an enterprise solution perspective, we are definitely 100% dependent on open source technology.
What about the newer technologies like AI, analytics, AR/VR used in the healthcare sector?
These are the evolving technologies. The vast technologies are coming on a very large scale. It is just the beginning and the way I see that the healthcare industry is going to adopt these technologies in a much wider way, because it is going to give security in terms of securing the patient data, clinical data and personal data.
If I am talking about analytics, it means that if the data is there and the analytics, in terms of your top line, bottom line, is moving or going up or down is going to come and give a prediction that these are the action supposed to be looked at by the organization. This is the business perspective.
The other perspective is the research perspective, asca lot of hospitals do research, and there analytics is going to play a vital role to submitted papers.
In terms of AI, ML, IOT set, suppose there is a patient and he got admitted in the hospital and diagnosed with head and neck cancer and in stage four or stage two. The system supposed to tell them whether the patient is supposed to go for chemotherapy or go for surgery and then the chemotherapy. In that case, what are the medications supposed to be given based on the patient’s vitals, where the doctors can do 10- 20% adjustments in medications. So, these technologies are going to provide the quality healthcare parameters at point of care within patient and the doctors.
How digital technologies have actually helped Omni hospitals to tide over the current COVID crisis?
When Corona came in picture, we pulled our socks saying that the technology only can help our hospital to have a patient engagement. Getting engaged with the patient is very important. We immediately adopted the technology and the telemedicine and kind of applications. On top of it we said that, we will not be admitting the patient unnecessarily for mild and moderate cases until unless it is required. In that case, technology helps a lot. Patients are being self evaluated with the help of the AI, automatic appointment with doctors, then doctor review the patient and it is decided whether he should be under home quarantine or hotel quarantine.
The patients had the technology perspective, and the team of doctors, nurses, physiotherapy, and dieticians starts treating the patient remotely. The telemedicine is kind of conversation, with the doctor within the patient, within the doctor and the consultancy happening remotely and most of the patients have been now treated at home or hotel instead of hospital. In case of the patient having some critical condition, like SpO2 has gone less than 90, then immediately the alert goes to the doctor and doctor take the precaution and actions immediately and transfer the patient to the hospital. The complete monitoring has been done with the help of the technology that is telemedicine solution, and it has saved a lot of money for the patient perspective.
We did a great job while our top line. The bottom line was not impacted compared to the rate the other hospitals got impacted across the country.
What are the parameters of telemedicine usage and how is Omni Hospitals conforming with the Telemedicine guidelines?
The solution we made as per the telemedicine guideline because that is already embedded into the system. Government guidelines are incorporated and kind of a consent form has been put online where the doctors and the patients are accepting it. This is also accepted by the government guidelines and there’= is no big challenge.
How does Omni Hospitals use collaboration technologies for telemedicine?
The solution was developed very properly with all the notifications in terms of clinical or non-clinical notifications. Non-clinical notification goes to the stakeholders who are responsible for that and the clinical notification goes to the concerned doctors.
The solution was integrated and embedded on the main solution stack rather than running it as a standalone solution. The solution we made has been integrated with our main enterprise solution, so that the clinical or non-clinical collaboration related notifications are flowing through concerned stakeholders to ensure that the patients are being taken care of based on the needs and criticality of the patient.
Which are those collaborative solution that you are using at Omni hospital?
We have not used any third party applications other than our main solution stack. Suppose the collaboration between the patient and the doctor is a face-to-face or audio to audio or any kind of chatting between the patient, the patient is again, uploading the screenshot whenever the doctor is asking for, the video consultation or audio consultation or chat-based consultation is supposed to be written and then handed over to the patient. The provider portal and patient portal is there. These are the two platforms which have collaborated very easily between the patient and the doctors and the ownership of this collaboration lies with the hospital to ensure that this technology is enabled for the doctors and the patient as well. The technology is available, you have to just drag and drop and implement it.
All these collaboration tools like Skype, Zoom and GMeet, the APIs are available, they integrate with this API, but why should we depend on those because sometime what happens is these third party applications get disturbed in terms of bandwidth. These need high bandwidth whereas the internally made solution has a specific control and bandwidth. If the thin bandwidth is there, even with 4mbps it will work seamlessly.
How does Omni Hospitals use data-enabled evidence-based solutions?
It is a part of the EMR solution. There is an evidence based treatment protocol. The doctor is entering the detail of the clinical data and doing the face to face into the system or of a patient who is being a consulted on the telemedicine.
If he says the sign, symptom and diagnostic and based on that, the evidence-based treatment protocol, the treatment template gets activated and this clinical pathways is asked to capture different questions and detail and based on that, doctors control the medication and tests required, and decide what will be the treatment protocol.
System will immediately prescribe with the help of the doctors. That is where this solution is being built on the evidence-based protocol driven EMR. It is part of the EMR.
What is the future of clinical analytics in healthcare? What are the challenges in successful implementation?
I am talking from Indian market perspective and the Indian health care industry. The biggest challenge is the IT budget and IT spends. There are very few hospitals beyond the corporate hospitals, that are having IT budgets.
The data guideline is coming from Government for digitalization, for clinical data digitizing perspective. I am sure that very soon there will be a mandate which hospitals need to follow to have clinical applications, if they are to remain in hospital business.
The second challenge is the acceptance of the technology by the organization and the clinical usage. For that again, there is huge change management required in terms of technologies, which can help to enable quality health care. If they want to improve their business, they have to adopt the technology. AI,ML, RPA are going to come on top of it and healthcare cannot ignore all these technologies. If you are going to ignore it means you are compromising on patient care and patient safety.
How is the Hospital Information System integrated with ERP or other enterprise applications as well as how does it leverage analytics?
If you are talking about the clinical data or non-clinical data, both are important. Any clinical data, which is being captured by any system within the organisation should be collaborated in a place as a longitudinal record. Suppose if there are some embedded systems, for example, CT scan, MRI, ultrasound machines are there, they capture a lot of clinical data. If that clinical data, which is not going to be transferred to a longitudinal record, then it does not make any sense and you cannot say you have EMR. You cannot ignore any clinical data of a patient to keep it in silo. If you are going to keep it silo then the complete treatment plan for that patient will go haywire.
The importance of the solution integrated in the organization, beyond the organization and to maintain the longitudinal record of patient clinically is very important.
The Second part is integrating the financial data. Suppose the ERP we have and every debit and credit card based billing is happening for the patient, the services are being rendered by the patient and all those data is supposed to go and be posted into the ERP solutions to maintain the P&L account and balance sheet and a trial balance. Definitely, this is an important part and I do not see any challenge to integrate, but rather it has to be integrated.
Due to the IT budget constraints, there are very few hospitals that are having the ER., They have probably implemented SAP. For accounting purpose most of the hospital has implemented Tally, which is again affordable for all the hospital. They do the integration for all the financial transactions which is going to go and sit in the front time with ERP solutions to look at their financial performances on a daily basis, weekly basis, monthly rates, and so on and so forth.
How did you drive the quality process conformance at Omni Hospitals?
People, process, technology. So, the right people, right process mapped with right technology, and that is how I enabled the quality d which give the quality outcome.
No matter how costly technology we have bought,it takes up only 30% of your deliverable. Suppose there is a business deliverable and you are acquiring a high quality, top class technology but on top of it, you are compromising on right people and process, then technology will not work for the hospital. If the right people, the right process and falls in place, and we have a technology, it will make magic for the organisation.
What is your IT agenda for 2021 and beyond?
Our agenda is very clear that the adoption of the technology which has been pushed by the COVID era, and we are willing to take the advantage of it and make the Omni Group of hospitals 100% paperless hospital . Though we have achieved maximum, but whatever has been left out we need to fill up. Because the patient has agreed to accept the tele-medicine based solution, if it is demanded by the patients and the doctors, then the healthcare providers definitely will put their best to make the complete 100% digitized platform for that. If the 100% percent platform is there, then your predictive analytics, reporting mechanism of every corner of the hospital will be available and you can correlate and can put their thought process and plan for next three years of growth.