When a 28-year-old woman was admitted sometime back to a hospital for management of atrial fibrillation (irregular heartbeat), the doctor prescribed aspirin and a beta blocker—a drug that counters the effects of adrenaline. However, when the prescription was being entered into the hospital’s computer system, an alert popped up, after the system matched the prescribed medicines with the details of the patient—who happened to be pregnant at that time. It noted that the woman was allergic to aspirin and that beta blockers were associated with stunted growth in babies.
The above is just one instance narrated in the 2015-16 annual report of Apollo Hospitals Enterprise Ltd, which operates a network of hospitals across India. And the system, Healthcare India Pharmaceutical Registry, which generated the alert—and prevented what could possibly have been a medical mishap—is just one of the multiple initiatives by the company to infuse cutting-edge technology in delivering quality healthcare over the years.
“It is all coming together in realizing our vision of connected health. We are using technology to ensure that the patient and the health system are well-connected. When I say health system, I also mean the support services that help our operations deliver better efficiency," says Arvind Sivaramakrishnan, chief information officer of Apollo Hospitals.
Today, the 70-hospital chain uses a slew of tech tools including electronic medical record (EMR), analytics, personal health record (PHR), a “hybrid cloud" computing model and mobility applications—not only to knit its sprawling operations in an efficient web but also to continuously monitor and improve medical outcomes. And the outcomes are benchmarked against globally acclaimed institutions such as the Cleveland Clinic, Massachusetts General Hospital and Mayo Clinic, among others.
Information technology (IT), according to Sivaramakrishnan, plays a key role in ensuring effective delivery of high-quality healthcare. And while Indian hospitals have traditionally been behind their Western counterparts in adopting IT, large private hospital chains in the country— Manipal, Fortis, Max, Narayana Health and others, besides Apollo—are now emphasizing tech usage.
According to a January 2017 report by India Brand Equity Foundation, healthcare providers are focusing on the technological aspect of healthcare delivery to “standardize the quality of service delivery, control cost and enhance patient engagement".
For Apollo Hospitals, IT is increasingly enabling a complete view of patients. “When clinicians use powerful solutions like EMR and PHR, they are able to get a complete, 360-degree perspective of the patient’s state of well-being. I’m not saying ‘the state of illness’ but ‘state of well-being’ so as to include the patient’s family members as well," says Sivaramakrishnan. In the Indian context, he stresses the need to be engaged with the patient’s family, the primary caregivers.
To buttress his point, he cites the example of diabetes. “We ensure that the doctors, the patients and the family members are well-connected in a system we call ‘managed care’. Through this, you can avoid unwanted complications and hospitalization," says Sivaramakrishnan. The key here, he notes, is to ensure that the patient and the family are “well-briefed on the state of health" and how it should be monitored continuously.
Another area where Apollo Hospitals has done significant work this year is in better patient feedback. Using a combination of Web-based and mobile device solutions, the company manages both “anonymous as well as quoted" feedback, according to Sivaramakrishnan. “When we do that, we get the honest pulse of the customer that is heavily powered by technology," he says. The results are correlated with the clinical findings and the patient’s information, and analytics is performed on the behavioural pattern. “This helps us improve our services," he says.
The company has also implemented digital EMR to enable the doctors and nurses to have a “higher level of coordinated care", says Sivaramakrishnan.
Besides doctors and nurses, he says, Apollo Hospitals has rolled out solutions for all the ancillary service providers such as the nutrition dieticians. “Care coordination in a hospital is important to ensure that the clinical outcomes are very good. It is a very heavy focus area for us, besides ensuring that our hospitals are operating at high levels prescribed by HIMSS (Healthcare Information and Management Systems Society of the US). Our big hospitals are already at Level 6 and we are striving towards reaching the highest one, Level 7, possibly within the next one year," he says.
Apollo Hospitals has a team of about 600 people in the IT function across the country, with a small core team at its central data centre in Chennai that “keeps everything together", according to Sivaramakrishnan. As such, most of the tech is developed in-house, though it uses “the best-in-class in the industry whenever there are any gaps" in terms of talent or tools.
To optimize bandwidth and speed of application access, the firm has adopted a hybrid cloud approach—a blend of its private cloud and the use of other public clouds. “We use a lot of (Microsoft’s) Azure cloud; for human capital management, we use the Oracle Cloud and for EMR, we are on the private cloud set up in our own data centre at Chennai," says Sivaramakrishnan. Cloud computing is a model in which companies pay for equipment or software on a pay-per-use or subscription basis.
Sivaramakrishnan says that in all hospitals, each role, business profile and vertical (segment) is powered by mobility and big data. “This is how we are driving digital adoption across the board," he says.
The company carefully stores and mines the millions of data points it collects from patients, including from AskApollo.com, its integrated patient engagement platform, and Apollo Prism, the PHR application that, says Sivaramakrishnan, is more like “a digital health diary".
“Through Prism, we have close to 10 million distinct patient data on it, which is the information that is shareable from an individual patient context," he says. “All this rich data enables us to derive insights for putting in place evidence-based and fact-based protocols that we can, in turn, put back into our clinical and operational systems to constantly fine-tune and improve the medical outcomes."
Apollo Hospitals is also experimenting with newer tech domains such as the internet of things (IoT). “We are looking at IoT both within the hospital and outside. Fitbits, for example, are one level of IoT. But the second level is to look at IoT as a connected healthcare environment. Connecting the diagnostic and other healthcare equipment with intelligence built in—that is how we are looking at IoT, so that it helps our operational and clinical teams make better decisions," explains Sivaramakrishnan.
Industry analysts opine that there will be a growing demand in terms of “digitalization of services" in healthcare, following similar trends in industries such as entertainment, retail and hospitality. “Hospitals will soon need to be serving patients across the digital care continuum—to be able to provide the same level of in-hospital care even outside of the hospital, on demand. In the future, connected care will simply be about being able to build such a digital care continuum and an ecosystem focusing not just on treatment, but also awareness, prevention and rehabilitation," says Ashwin Moduga, research manager for health insights in the Asia-Pacific for International Data Corp. (IDC).
To describe the connected health scenario, IDC uses the term “Intelligence Wellness Net", in which technologies such as IoT, predictive analytics and artificial intelligence will play an increasingly important role.
While most hospitals in India have been facing the legacy roadblocks of internal acceptance of technologies and change management, the biggest challenge in the immediate future, according to Moduga, will simply be about “building digital transformation as a function inside of a hospital".