Would a hospital Benefit Financially from Going Paperless?

By Arunima Rajan

Is it possible for an Indian hospital to go paperless?

Dr *Sulochana had ample chance to assess her clinic's operational efficiency when her business wasn't hitting her revenue target last year. "The pandemic gave me the liberty to analyse my practice. I wanted to invest in technological solutions but wasn't sure whether it was a financially prudent decision to go entirely paperless," she says. 

For many, the term smart hospital elicits ideas related to AI, IoT, data analytics and electronic health records. But does it make financial sense for a CXO to make long term investments in digital health solutions?

Vikram Thaploo, CEO of Apollo Health, points out that digitising health records in healthcare facilities is the need of the hour, mainly because it improves patient outcomes, increases accountability, helps in evidence-based policymaking, and reduces financial costs by reducing the use of paper. "Several medical clinics and hospitals are adopting electronic records and eliminating paper records which have resulted in a sudden shift to digitisation. Other than enhancing the current operations, this is an essential investment towards the future. Not only does it enable advanced analytics, but it also opens the door to newer possibilities like AI and IoT. Though a sudden shift from paper records to digitised records may be hard for some, the benefits obviously can't be overlooked. Apart from financial and environmental factors, digitisation of records can help healthcare institutions to streamline data through a data-driven approach.

"Though the data on how much Indian hospitals spend on papers is not available, according to a health IT consulting firm report, at an average cost of USD 0.04 per page, a 1,500-bed healthcare facility spends close to $3.8 million on printing every year. The reliance on paper products results in billions of dollars spent annually by the healthcare industry, with estimates putting this figure as high as $300 billion a year. By going paperless, indeed, a significant difference can be made," he adds.

Do Indian hospitals have a huge carbon footprint? The Public Health Foundation of Indian works with Health Care Without Harm to help Indian healthcare facilities to deliver healthcare without harming the environment and provides them with tools to evaluate their carbon footprint. Poornima Prabhakaran, Deputy Director, Centre for Environmental Health at PHFI, points out that capital cost might be high initially, but healthcare facilities can save by decarbonising their facilities over the years.

Juhi Bhandari, Assistant Director, Administration, Hinduja Hospital seconds her views. She points out that it does make financial sense for a hospital to go paperless. "However, going paperless is a byproduct of the adaptation of technology and going digital. There will be some cost for sure when you embrace technology, so you replace one cost with another. There are multiple benefits like increasing the reach, awareness and credibility when you go digital. You can save costs by reducing paper as well as human resources. At Hinduja Hospital, we are trying to use digital technology to reach patients for registration, appointments, payments, diagnostic reports, interim bills. There were benefits like reducing human resources, saving time (no queues), better patient experience, and saving paper. Even though our paper is getting saved, that of the patient may not be, since even though the hospital doesn't insist on hardcopy, the patient insists on printouts. For younger hospitals, it's easier to adopt EMR than older hospitals like Hinduja, where senior physicians are wary to adapt to new technology. Technological solutions, though recommended, reduce the interaction between the patient and the doctor," she adds.

Cost Savings

Arjit Bhargava, Vice President, Global Business Development, MSB Docs, points out that the financial cost of paper is not just the paper and ink but also the loss of productivity, lost/ damaged documents and storage costs. "It's difficult to ascertain the actual cost for a private hospital since there are different operating models for different models, but our estimates suggest that using paper can be up to 80% more costly than the digital counterparts. Using digital solutions can help improve the user experience and help hospitals off-board patients, after their treatment, which is currently a tedious and time-consuming process. It also helps optimise the time spent by doctors as they can review these documents at their convenience and sign them off via their phone. So between faster inventory turnaround, better customer experience and improved efficiency with internal stakeholders such as doctors, staff and medical transponders, there are immense benefits hospitals achieve by going digital," explains Bhargava.

Solution Providers

Rustom Lawyer, CEO and Co-Founder, Augnito, says that the administrative cost is about 18-20% of the total expenditure. Augnito is a cloud-based speech-to-text software that guarantees error-free medical documentation by converting human voice to written text in real-time.

"On a high level, a large healthcare group of 2000 beds could save INR20-30Cr a year with the adoption of digital tools like Augnito. To give you an example, NM Medical, a leading diagnostics chain in Mumbai, was one of our first Augnito clients. 4 senior radiologists started using Augnito. The latter were otherwise dictating and getting their reports typed by transcriptionists. According to the centre, within three weeks of starting, the turnaround time has improved by nearly 50-60% as the doctors were able to edit and finalise their reports within minutes of going through the study. Earlier they would have to proofread the typed up reports hours later when they had already moved on to other cases. The increase in speed and accuracy of the reports led to an increase in the satisfaction of the doctor's experience at NM Medical. Apart from the financial upside, Augnito also significantly reduced the HR management problems. With Augnito's Speech Recognition, doctors now have a reliable partner in reporting 24X7, which means that they can complete more reports in less time without being dependent on anyone else. Like the Jaslok Hospital in Mumbai, renowned hospitals have boosted the turnaround time of their discharge summary process through the successful adoption of Augnito," he explains.

Current solutions

Narayana Health has built an Advanced Health Information Platform which delivers automation across the clinical, front and back-office operations. "The platform includes a comprehensive hospital information management system which is built on cutting edge open-source technology backbone, a multitude of mobile apps which put technology in the hands of the doctors and patients alike and a robust advanced analytics engine which delivers real-time clinical and business insights. A paperless hospital promotes several best practices, patient safety being the most significant of all. However, a hospital that relies on investigation reports, prescriptions, doctor instructions on paper does have a higher risk of errors and lapses during patient care. The digitalisation of clinical processes lends itself to real-time information exchange and collaboration, which reduces the inefficiencies and risks associated with traditional paper-based processes. With the increasing proportion of patients covered by insurance together with upcoming regulations around patient privacy and the nation-wide integrated digital health infrastructure, it is hard to see a future for hospitals which continue to resist investing in digital technology," explains Jagadeesh R, VP Products, Narayana Health.

Shortage of Digital Health Technology Solutions, which give good ROI?

Jagadeesh also points out that, as in most industries, resistance to change is the most significant challenge faced by most hospitals in India. "Other factors include lack of incentives, absence of standardisation and a severe shortage of technology solutions which represent a good return on investment. As long as digital health technology continues to be seen as a necessary inconvenience and the IT department is relegated to the cost columns of the balance sheet, it is hard to foster an environment of digital innovation in healthcare. A healthy ecosystem of new-age solution providers who are backed by robust investments can only be created when healthcare providers start to treat digital health technology as a strategic tool in their arsenal, which opens new channels for revenues, delivers significant cost savings on top of improved patient safety."

Clinician Perspective

Umme H Faizal, a Junior Resident in Kolkata, thinks a paperless hospital is too much to wish for in a country like ours, considering that physicians are overworked and are no match for the sheer volume of patients that they see in a day. "Transitioning to a digital system would require a lot of effort and time to learn and unlearn things. I don't think we have that sort of liberty right during a pandemic," she explains. She adds that she writes 50-60 prescriptions in a day.

Dr Srinivas Rajkumar T, a consultant psychiatrist, points out that a system improves by removing bottlenecks that affect the system's performance. "Digitising without paying attention to the doctor-patient ratio, lack of paramedical staff will paradoxically slow the healthcare services. Limited availability of gadgets and computers will make things worse. A paperless system might have advantages in the long run in maintaining records and ease of access, but it should be implemented only after assessing feasibility in every setup. High volume Govt hospitals can't go paperless overnight.

"While in AIIMS, on regular OPD days, I used to write 60-80 prescriptions. This is a very high count for a psychiatrist. Other specialities may be seeing 3-5 times the numbers I see," he explains.

Why does he think a paperless system won't work in India? What are the barriers? "Availability of computers, liberal workspace, funds and technical team to manage the infra is still a luxury for many government hospitals. Mere digitisation without improving the system's efficiency will only worsen the turnaround time for patients," explains the General Secretary, RDA, AIIMS 2020-2021.

But are paperless hospitals better for patients? "A paperless system will limit the number of patients a doctor can see. Walk-in services may become difficult to avail. If the initial difficulties are managed well, in the long run, a paperless system will improve patient care by virtue of continuity of care, easy review of records. Digital records enable reminders and other measures to ensure regular follow-up if implemented," adds Rajkumar.