Digitalizing Hospitals: A Marathon, Not a Sprint

By Arunima Rajan

India is still in the early stages of adopting digital technology into its hospitals. We look at the challenges and benefits of digitising healthcare services.

Digital healthcare, including electronic medical records (EMR), telemedicine, and other digital tools, is playing an increasingly important role in the healthcare system in India. These technologies can improve the effectiveness of healthcare delivery. Consequently, they can help address some of the challenges faced by the healthcare system in India, such as a shortage of healthcare providers, inadequate infrastructure, and a lack of access to care in remote or underserved areas.

The Hurdles

Despite the numerous benefits of digital health solutions, many hospitals and healthcare settings still struggle to adopt these technologies due to financial constraints, lack of trained personnel and infrastructure issues. These obstacles must be addressed by increased investment in resources; skilling up the existing labour force; enhancing infrastructure capabilities; reforming regulations, and modifying cultural barriers hindering patient access.

Srivathsan Aparajithan, Managing Director of Intent Health Technologies, points out that tools for digital hospitals have been available for a long time, with hospitals implementing some form of health information systems as early as the 1990s. However, the adoption of these technologies has been uneven, with larger hospital chains taking advantage of the available building blocks more than smaller hospitals. The question remains as to how feasible it is for smaller hospitals to utilise the available technology and how much tech adoption is being practised in these hospitals.

Dr. Roheet Rao, Associate Vice President, Information Technology, Apollo Hospitals, holds a different perspective. He explains that the healthcare industry has not been quick to adopt the technology due to digital tools' complexity and specialised nature and the need to maintain strict safety standards.

Additionally, the traditional in-person doctor-patient relationship may be resistant to the adoption of digital health solutions. To effectively implement digital health solutions, it is vital to have a well-thought-out digital transformation program and IT policy that centres around the needs of patients and users. Apollo Hospitals has successfully adopted digital health solutions through a patient-centric approach and a user-driven framework for digital transformation.

Apollo addresses challenges with digital solutions in healthcare, such as siloed software and low clinical adoption, through interoperability, intelligent design, hardware tools, and automation. The company also uses economies of scale through centralisation and standardisation of infrastructure and the use of cloud-based systems to reduce the cost of implementing and maintaining health IT systems.

Electronic medical records (EMR) systems have gained popularity in India, but they face challenges such as lack of standardisation, cost, and trained personnel. Telehealth, which hospitals in India have also adopted, faces issues such as limited funding, inadequate infrastructure, insufficient staff, data security concerns, resistance to change, linguistic and cultural barriers, and limited accessibility for certain patients. Hospitals may need to allocate financial resources, provide training, improve infrastructure, and address linguistic and cultural barriers to address these challenges.

Srivathsan notes that the goal of the Ayushman Bharat Digital Mission (ABDM) is not necessarily to help individual hospitals digitise their processes. Instead, it focuses on creating an electronic health record that can be shared between providers, allowing for the portability of patient health information. Smaller hospitals, which may need more resources to invest in advanced solutions, may still be able to manually create a health record and digitise it through the use of an Ayushman Bharat Health Account (ABHA). This would allow for the seamless sharing of patient health information between providers.

Factor Affecting Digitalization

Srivathsan believes the issue with digital solutions in the healthcare industry is not necessarily the quality of the solutions but rather the lack of integration and compatibility between different solutions. While larger hospitals may have a Chief Information Officer (CIO) in place to oversee the overall architecture and ensure that different solutions work together, smaller hospitals may not have this capability. The IT manager at these smaller hospitals may also have additional responsibilities, limiting their ability to comprehend and integrate different solutions. As a result, hospitals may feel that the solutions they purchase do not provide the full benefits they claim and may switch to different vendors or solutions. Srivathsan suggests that if smaller hospitals had access to CIO capabilities, even if they cannot afford to hire a full-time CIO, it may increase the adoption and acceptance of existing solutions.

He also notes that interoperability, or the ability for different systems to share data, is an important consideration when creating a portable health record for patients. However, it is not the primary consideration, as a hospital may not necessarily need to share data from a clinical perspective with other hospitals. Additionally, hospitals may be hesitant to share data as they see

it as a way to create a relationship with patients. Instead, Srivathsan believes that the main reason for low adoption rates is the lack of understanding among hospital administrators and management about utilising digital solutions effectively. While interoperability is essential, it may not be the primary driving factor behind adopting digital solutions in hospitals.

Overcoming Challenges

Kalyan Sivasailam, Co-Founder and CEO of 5C Network, draws on his own experiences to develop innovative approaches for tackling obstacles in solutions implementation. He says that one of the main challenges in implementing teleradiology solutions at hospitals and diagnostic centres is persuading the administration to abandon their traditional radiodiagnosis processes and adopt the technology. Many hospitals and diagnostic centres rely on individual doctors for their radiology reports and are hesitant to change their current approach. However, when the benefits of artificial intelligence technology were demonstrated to these hospitals and the expedited reporting process was shown, they became convinced and adopted the platform. As a result, the company works with more than 2000 diagnostic centres from 300+ cities in India.

The adoption of digital technologies, including telemedicine, online clinical support, and smart devices, has been emphasised during the COVID-19 pandemic. Still, there is a need for further policy support to empower the adoption of the digital healthcare ecosystem.

Bhagwati Prasad, COO, Koita Centre for Digital Health, IIT Bombay points out that there are several ways that hospitals can accelerate their journey towards digitization. For example, SMS-based workflows can be easily implemented for tasks such as queue management, sending appointment reminders, collecting feedback, and prioritising critical patients. QR codes can be used for a variety of purposes, including identifying patients and their samples, avoiding medication and testing errors, streamlining workflows, and tracking assets. Telemedicine, virtual reality, and augmented reality can be used to provide effective care remotely and for training clinical personnel. Digital pens and speech-to-text solutions can also be used for digitization without disrupting clinicians' workflows. Small and medium-sized hospitals can consider using open-source health management information systems, such as Bahmni, to digitise their operations. Prescriptions can be easily converted to electronic form using electronic prescription software. Once hospitals are digitised, their data can be converted into insights to help them operate more efficiently. Hospitals should choose modern tools that provide a good user experience and are compatible with mobile phones, tablets, and touch screens. Government and philanthropic organisations can also play a role in capacity building, incentivizing the digitization of health records, and increasing awareness about initiatives like the Ayushman Bharat Digital Mission.

Private Hospitals Digitalization 101

Pramod Kutty, CEO & Co-founder Connect2MyDoctor, says that there are several factors that private hospitals in India should consider when deciding to adopt digital solutions for healthcare delivery. The most crucial factor is the product's features and capabilities, as this will determine the effectiveness of the hospital's healthcare. Other essential factors include data security and compliance, flexibility to manage the platform based on ongoing demands, an agile and quick response mechanism, a cost-effective business model, and the team behind the solutions and the road map ahead.

According to the Pramod Kutty, the platform follows the telemedicine standards set by the Medical Council of India in March 2020 and has also achieved HIPAA and ISO 27001 compliance. The company prioritises data security and considers it a core aspect of everything they build and do. All data belongs to the patient and provider, with Connect2MyDoctor serving as a custodian of the data. To ensure data transfer security, the company uses HTTPS and a 2048-bit SSL certificate for encryption in transit. Additionally, all data is backed up using AES-256 encryption.

The CXO adds that Connect2MyDoctor offers support for the deployment and use of their platform, delivered over the cloud. This support includes onboarding, training, and documentation for customer support teams, doctors, IT staff, and billing teams. The company also provides customer support services from 9 am to 6 pm, five days a week, to help with patient operations and support. Technical support is available as needed.

While digital healthcare technologies have the potential to transform India's healthcare system, many hospitals and clinics still need more resources to adopt these solutions. Overcoming these obstacles will require increased investment in resources and training for personnel and greater collaboration between government, private sector, and civil society organisations. As more healthcare providers evaluate digital health solutions, they must consider these factors before investing in a particular solution.