Post on 13-Nov-2014
Charak suite of Healthcare IT products: Charak suite of Healthcare IT products: An overviewAn overview
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Asclepius Consulting is a Healthcare IT venture global and Indian doctors, software personnel and management consultants
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Dr. A. K. KeshriMS, Civil Surgeon, Bihar
Pratyusha PallaviGE Healthcare/ SP Jain
HL7, DICOM Expert
Dr. Rolika KeshriMS, Obs/ Gyn, PMCH
Dr. Suneel MajagiMS, KLE hospital
Sachin PrasadIITD/ IIMB, Boston Consulting Group
Aravind Hiremath
• BE (CS) -Karnataka• GE Healthcare
• Over fifteen years of experience in design & development of global healthcare software products
• Focused on Diagnostic equipments & CIS with expertise in Healthcare Standards (DICOM, IHE & HL7)
Satyajeet Prasad
• IIT Kharagpur• IIM Lucknow• GE Healthcare
• Over eight years of experience across the globe in implementing high end software solutions
• Expertise in six sigma, HL7, IHE and Healthcare IT solution delivery in Asia, US, Australia and Europe
Vishal Ranjan
• IIT Delhi• IIM Calcutta• A.T. Kearney
• Over five years of management consulting experience with MNCs in setting up businesses and devising growth strategies
• Expertise in BPR, process improvement and business planning
Team
• Hand-holding the client organization during transition
• Training programs and workshops
• Change management• Annual maintenance
support and regular upgrades
• New business set up• Business process re-
engineering• Customer relationship
management• Organization structure • Business planning• Growth strategy• Investment banking
• Synergizes with Charak to support specific IT needs
• India focus & domain expertise to deliver complete solutions
• Six sigma software design and development methodology to ensure world class software
• World class healthcare IT systems built for Indian clinical workflows
• Focus on clinical information systems (CIS)
• Includes HIS, LIS and IIS solutions
• Robust solutions built on six sigma methodology
Asclepius Consulting is a vertically integrated Healthcare IT company with end-to-end IT solutions for Indian hospitals
Offerings
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Hospitals in India are adopting IT in a massive way– driven by changing business conditions
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Why are Indian hospitals adopting IT?
Get more from same set of resourcesGet more from same set of resources
•Most good hospitals are running at close to 100% utilization
•Attempts to improve revenue from same set of resources (Higher revenue/ sq. ft.)
•Specific focus to reduce ALOS, increase efficiency and optimize utilization
Get more from same set of resourcesGet more from same set of resources
•Most good hospitals are running at close to 100% utilization
•Attempts to improve revenue from same set of resources (Higher revenue/ sq. ft.)
•Specific focus to reduce ALOS, increase efficiency and optimize utilization Get more from same set of Get more from same set of
resourcesresourcesGet more from same set of Get more from same set of
resourcesresources
Healthcare insurance needsHealthcare insurance needs
•Cashless insurance lay down very stringent documentation needs across care process
•Major losses in collections due to difference in authorization and approval
•Most corporate customers insist on supporting cashless insurance
Healthcare insurance needsHealthcare insurance needs
•Cashless insurance lay down very stringent documentation needs across care process
•Major losses in collections due to difference in authorization and approval
•Most corporate customers insist on supporting cashless insurance
Healthcare insurance needsHealthcare insurance needsHealthcare insurance needsHealthcare insurance needs
Accreditation needs from GovernmentAccreditation needs from Government
•Stringent process and documentation needs from NABH
•Increasingly patients shall decide hospital quality based on accreditation ratings
•Huge resources required for meeting accreditation needs
Accreditation needs from GovernmentAccreditation needs from Government
•Stringent process and documentation needs from NABH
•Increasingly patients shall decide hospital quality based on accreditation ratings
•Huge resources required for meeting accreditation needs
Accreditation needs from Accreditation needs from GovernmentGovernment
Accreditation needs from Accreditation needs from GovernmentGovernment
Increasing time pressure on doctorsIncreasing time pressure on doctors
•Good doctors are always pressed for time
•Increasing number of patients across multiple facilities
•Spend unnecessary inefficient time in documentation and repetitive activities
Increasing time pressure on doctorsIncreasing time pressure on doctors
•Good doctors are always pressed for time
•Increasing number of patients across multiple facilities
•Spend unnecessary inefficient time in documentation and repetitive activities
Increasing time pressure on Increasing time pressure on doctorsdoctors
Increasing time pressure on Increasing time pressure on doctorsdoctors
Increasingly competitionIncreasingly competition
•Larger hospitals bring state-of-art technology to provide better facilities
•Technology is leveraged to build strong processes and enhance quality of care
•More and higher paying patients are attracted to those at forefront of technology
Increasingly competitionIncreasingly competition
•Larger hospitals bring state-of-art technology to provide better facilities
•Technology is leveraged to build strong processes and enhance quality of care
•More and higher paying patients are attracted to those at forefront of technology
Increasing competitionIncreasing competitionIncreasing competitionIncreasing competition
Increasingly legal pressuresIncreasingly legal pressures
•Liability of clinical negligence is all on hospital
•Documentation is only protection from litigation
•Negligence cases are typical adjudged unfavorably against hospitals
Increasingly legal pressuresIncreasingly legal pressures
•Liability of clinical negligence is all on hospital
•Documentation is only protection from litigation
•Negligence cases are typical adjudged unfavorably against hospitals
Increasing legal pressuresIncreasing legal pressuresIncreasing legal pressuresIncreasing legal pressures
Increasingly aware patientsIncreasingly aware patients
•I can spend money – but don’t have time
•I can’t carry all those reports and files
•I can’t wait for appointments and long queues
•My family need personalized care
Increasingly aware patientsIncreasingly aware patients
•I can spend money – but don’t have time
•I can’t carry all those reports and files
•I can’t wait for appointments and long queues
•My family need personalized care
Increasingly aware patientsIncreasingly aware patientsIncreasingly aware patientsIncreasingly aware patients
Hospitals have been able to achieve multiple benefits from adopting IT
ILLUSTRATIVE
“..leads to better control of the organization through robust
processes”
“..reduces missed/ incorrect charge slips across multiple
service points in the hospital”
..implements scientific management practices like
budgeting, customer relationship management, medical audits,
SOPs”
“.. reduces the missing documentation for insurance
communication leading to better collection”
“..ensures better planning and higher resource utilization for key
revenue sources e.g. OT, surgeons, devices etc.”
“..better material tracking lead to reduction in wastage, pilferage
and inventory in books”
“…reduced medical errors leading to lower litigation costs”
“…increased coordination leading to better planning and lower
unpredictability ”
“…frees up the doctor’s time from paper work and
administrative activities, improves the quality of patient care and significantly improves
hospital bottom-line”
Potential benefits from IT
• 85% faster admission, transfer & discharge
• 40% faster diagnosis time
• 30% reduction in medication dispensing error
• 20% faster inventory re-stocking
• 20% reduction in Average Length of Stay
• 80% reduction in billing errors
• 40% growth in patient volumes
• 33% growth in profit margins
Source: Typical impacts measured by IT implementation in a Pediatric hospital
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Globally, IT in hospitals, undergo a transition from administrative to clinical processes
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Billing
Registration
Admission
Discharge
Pharmacy
Stores
Insurance
Inventory management
EMR – Discharge summary
EMR – Diagnosis
EMR – Medication
EMR – Investigations
EMR – Orders
EMR – Vitals
EMR – Alerts
Clinical decision support
Clinical protocols
Drug data bank
Lab Information system (LIS)
Radiology Information System (RIS)
Remote patient care
EMR – Charting
Time
Cli
nic
al
Ad
min
istr
ati
ve
A scalable and modular solution is needed which can support the hospital all through its growth and future needs
Admin
EMR
ClinicalFeatures for Hospital IT
Emergency handling
EMR -Flowsheets
Patient monitoring
Orders
ILLUSTRATIVE
Clinical rules
Ad
min
istra
tion
Clin
ica
l
An
cilla
ry
sy
ste
ms
Infra
stru
ctu
re
mo
du
les
ILLUSTRATIVE
Core modules
Value added modules
Specialty modules
MTOSS
The product – Charak - is an end-to-end IT solution for the entire hospital with sufficient depth to meet the needs of an involved user
Covers end-to-end treatment cycle• From pre-admission to diagnosis, orders,
treatment, monitoring and discharge Integrates with multiple hardware
• Mobile phones, digital pens, voice recorders, bed side devices
Is accessible remotely• Available on internet, with thin client solution
Built on six sigma quality and international standards• Compliant to HL7, DICOM, IHE guidelines
Provides process control• Through protocols, pathways and clinical
decision support Supports research
• For clinical procedure evaluation, evidence based medication etc.
Is specific to specialties• E.g. different work flows for gynecology vs.
cardiology Meets the documentation needs for
accreditation and cashless insurance process
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Charak has some of the most business relevant & less commonly available features
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ILLUSTRATIVEILLUSTRATIVE
Together with the consulting services, Charak meets a large part of the documentation needs required for NABH accreditation
Accreditation needs from NABH CharakProcess Consulting
Access, Assessment & Continuity of care (AAC) ◑ ●Patient Rights & Education (PRE) ● ●Care of Patient ◕ ◑Management of Medication (MOM) ● ◑Hospital Infection Control (HIC) ◔ ◑Continuous Quality Improvement (CQI) ◑ ◕Responsibility of Management (ROM) ◑ ◔Facility of Management and Safety ◑ ◕Human Resource Management (HRM) ◑ ●Information Management System (IMS) ● ●
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● ○High support Low support
Asclepius adopts robust business process re-engineering (BPR) frameworks to improve upon existing processes while minimizing changes
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To-be process mapping
How do you make pricing decisions – what is your cost to
serve?
How do you make pricing decisions – what is your cost to
serve?
How do you calculate the stock of all paracetamol
medicines put together?
How do you calculate the stock of all paracetamol
medicines put together?
Can you give a single purchase order for the deliveries for the entire
year?
Can you give a single purchase order for the deliveries for the entire
year?
How is the doctor recommending
discounts accounted for?
How is the doctor recommending
discounts accounted for?
The administrative IT solution (HIS) covers the entire administrative needs of the hospitals
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The elements of electronic medical record (EMR) comprise all relevant information from the clinical processes
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• Patients go where the hospitals ‘know them’ – for preventive check up, emergency, surgery as well as standard cure
• EMR generates a single consolidated record for all relevant patient information – valuable during the stay
• The EMR should be readily available – through internet, mobile phones, across hospital facilities
Past and present history
Problems and complaints
Physical examination
Systemic examination
Diagnosis
Investigation reports
Radiology images
Flowsheets & device data
Surgery notes
Progress notes
Medications
Discharge summary
EMR numberRIMS072201223
Aditya Goyal07 NOV 2005B +ve
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All the relevant activities – for the doctor, the patient, the admin staff- can be accessed through a central switchboard
All notes from doctors, nurses, labs etc. can continued to be captured on paper – and seamless integrated with Charak
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The digital pens allow minimal change in clinical practices – at OPD, during wards rounds, discharge, follow ups etc.
The critical data available remotely on mobile phones and hand-held devices
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View list of patients with critical details
Get alerts on patients in wards/ ICU
View key patient data (BP, ECG)
Give medicines and lab orders
Know appointments, schedule-for-day
Advise treatment remotely
The critical data is available remotely on mobile phones and hand-held devices
Charak can extract data from any digital medical device - bed side devices, digital X- rays, CT scans -and integrate it with patient record
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• The Charak team has extensive experience in interoperability of clinical software – across devices, CIS systems, Labs and Radiology systems
• Charak conforms to HL7 standards, hence shall seamlessly integrate with all new hospital software appearing in future
• Charak is built on DICOM standards to ensure easy transfer of digital radiology images
• Charak has specific solutions for image viewing and interfacing with standard PACS solutions
All the patient data is available on simple clicks
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41/F D Sinha
All patient data and investigation reports can be readily reviewed by the doctor through clinically relevant screens
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The software generates relevant MIS for the hospital to check aggregate hospital performance
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The software supports extensive research capability for the doctors to evaluate care protocols and analyze evidence based medication
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The software can been leveraged to a drill-down dashboard framework to “report by exception”
• Effective Surgical Revenue (ESR)• Effective Bed Revenue (EBR)• Effective Diagnostic Revenue (EDR)• Operating costs
Effective Surgical Revenue (ESR) = No. of surgical procedure X Avg. revenue per surgeryEffective Bed Revenue (EBR) = Avg. Length of Stay X Avg. Bed Occupancy X Avg. Bed Rate X Available BedsEffective Diagnostic Revenue (EDR) = No. of diagnostic procedures X Avg. revenue per diagnosis
• Average revenue/ patient• Market share• % of repeat patient • Patient satisfaction index1
• ROCE• Operating Margin• PAT growth• Cost of Capital
• No. of partner patients• No. of referrals from spoke to hub• Operating margin at partner sites• No. of technology transfer initiatives underway
• Attrition rate• No. of employee
training days• No. of full time
doctors• Employee
satisfaction index1
• No. of case sheets generated
• No. of research papers published
• No. of technology initiatives underway
(1) Satisfaction index measured through periodic neutral surveys conducted by external agencies
Level I dashboard(CEO & Board)
Level II(Mid Management)
Operating costs• Consumable costs• Salary costs• Rental costs• Pharmacy costs• Marketing costs• General Admin
costs
Operating costs• Consumable costs• Salary costs• Rental costs• Pharmacy costs• Marketing costs• General Admin
costs
Level III(Process)
Consumable costs• Direct material• Overhead material• A- Category
material purchase• Avg. direct consm
per patient
Consumable costs• Direct material• Overhead material• A- Category
material purchase• Avg. direct consm
per patient
ILLUSTRATIVEILLUSTRATIVE
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Charak can create significant improvements across the hospital
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Long waiting time(At OPD, surgery, wards, discharge)
Delayed emergency response
(Missing data, triage, ambulance)
Multiple investigations(Similar tests conducted due to missing
old records)
Multiple visits(Visits for consultations, labs, reports,
follow ups)
Sub-optimal resource utilization
(OR, wards, doctor’s time, labs)
Limited resources(Doctor’s time, beds, OPD hours)
Poor hospital evaluation(No easy metrics to measure hospital
performance)
Wastages and pilferage(OR material, stores items, pharmacy)
Patients Hospital
Extensive paper work(OT notes, discharge summary,
orders)
Repetitive activities (Patient instructions, pharmacy, billing
estimations)
Multiple coordination(OR planning, duty allocation,
appointments)
Multiple follow ups(Check patient conditions, order
status, room occupancy)
Doctors
Well defined appointments and scheduling
Quick response at the Golden Hour
Standardized care plan
Consolidated clinical data available remotely
Hospital wide resource optimization
High resource utilization
Extensive computer generated MIS
Transaction based material tracking
Computer generated reports
Automated activities with status report only
Centralized planning and scheduling
Alerts and Exception based Reporting
No. 8, 1st Floor, 15th Cross,
100 Ft Ring Road, J.P. Nagar, 6th Phase,
Bangalore – 560078
Tel: +91 80 4165 0200
+91 98800 46849
www.asclepiusconsulting.com
This proposal is exclusively intended for the personnel at Frontier Lifeline, Chennai. Distribution, quotations and duplications — even in the form of extracts — for third parties is only permitted upon prior written consent of Asclepius Consulting.
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• Additional slides
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Charak modules
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The software comprise over 100 modules – majority available as standalone solutions – working seamlessly with existing IT solutions
Existing IT system
ADMINISTRATIVE MODULES
ADMINISTRATIVE MODULES
Admission, Discharge Transfer (ADT)
Admission, Discharge Transfer (ADT)
SchedulingScheduling
Material ManagementMaterial Management
Event-based BillingEvent-based Billing
Orders and Medication Record
Orders and Medication Record
Documentation & Notes
Documentation & Notes
Charting and Flowsheets
Charting and Flowsheets
Alerts/ RemindersAlerts/ Reminders
Clinical Decision Support
Clinical Decision Support
Clinical ProtocolsClinical Protocols
Management Information Systems
Management Information Systems
Device IntegrationDevice Integration
InteroperabilityInteroperability
Hardware OptionsHardware Options
Privacy and SecurityPrivacy and Security
System MonitoringSystem Monitoring
LIS/ RISLIS/ RIS ResearchResearch
CLINICAL MODULESCLINICAL MODULES ANCILLARY MODULESANCILLARY MODULES INFRASTRUCTURE MODULES
INFRASTRUCTURE MODULES
Significantly lower total cost of ownership (TCO)
The software aims to minimizes the total cost of ownership by taking care of all the relevant costs accruing to the hospital
Very competitive license costsLowest customization costProfessional process consulting
Thin client solution implies minimum hardware requirements
Easy integration with multiple devices
Seamless interfaces with existing systemsIntegration with DICOM devicesExpertise in integrating HL7 devices
Free upgrades with AMCsNegligible run time license costsMinimal costs for additional user licenses
High quality lead to low debugging costsLocal service network for AMCRemote performance monitoring
Easy integration with future HL7 solutionsEasily scalable to additional facilities and
expansions
Illustrative
Admin
Clinical
Ancillary
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ADMINISTRATIVE MODULES
AD1 Patient Admit, Discharge, Transfer
AD2 Patient Registration & Identification
AD3 Scheduling and Appointments
AD4 Room management
AD5 Event based Billing
AD6 Pharmacy management
AD7 Hospital services management
AD8 Material management
AD9 Cashless insurance management
CLINICAL MODULES
CL1 Documentation
CL2 Notes
CL3 Charting and Flowsheets
CL4 Medication admission record
CL5 CPOE/Order Entry
CL6 Alerts
CL7 Event manager
CL8 Patient discharge & education
CL9 Workflow and checklists
CL10 Clinical configuration
CL11 Drug databank
CL12 Clinical Protocols
CL13 Clinical Decision Support (CDS)
CL14 Clinical collaboration
ANCILLARY MODULES
AC1 Whiteboard
AC2 Inquiry and MIS
AC3 Printing
AC4 LIS
AC5 RIS/PACS
AC6 Rules Engine
INFRASTRUCTURE MODULES
IF1 Security and Privacy
IF2 User Organization
IF3 Remote service-RM&D
IF4 Interfaces
IF5 Hardware options
IF6 Notification engines
Infra
RECOMMENDED MODULE IMPLEMENTATION PLAN
Enhanced Admin
AD6, AD7, AD8, AD9
Core Admin
AD 1, AD2, AD3, AD4, AD5
Protocols & CDS
CL12, CL13, CL14
Printing and Reporting
AC1, AC2, AC3
LIS, RIS and PACS solution
AC4, AC5, AC6
Core Infra
IF1, IF2, IF3
CPOE & Drug Databank
CL5, CL6, CL9, CL10, CL11
Core EMR
CL1, CL2, CL3, CL4, CL7, CL8
Multiple Hardware
IF4, IF5, IF6
Admin
Clinical
Ancillary
Infra
Enhanced Admin
AD6, AD7, AD8, AD9
Core Admin
AD 1, AD2, AD3, AD4, AD5
Protocols & CDS
CL12, CL13, CL14
Printing and Reporting
AC1, AC2, AC3
LIS, RIS and PACS solution
AC4, AC5, AC6
Core Infra
IF1, IF2, IF3
CPOE & Drug Databank
CL5, CL6, CL9, CL10, CL11
Core EMR
CL1, CL2, CL3, CL4, CL7, CL8
Multiple Hardware
IF4, IF5, IF6
The prices of these solution are contingent to specific needs of the hospital
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R1 R2
R3 R4
• Release #1: Core administrative processes with requisite ancillary and infrastructure modules
• Release #2: Documentation and charting EMR solution with additional administrative processes
• Release #3: CPOE, Alerts and workflow together with hardware options and notification engines
• Release #4: LIS/ RIS solution together with rules engine, clinical protocols and clinical decision support
Cost for 100 bed hospital
Rs. 2-5 lakhs
Rs. 10-15 lakhs
Rs. 22- 25 lakhs
Rs. 32- 40 lakhs
Specific pricing arrangements can be developed to make the overall cost affordable to the hospital
Dashboard reporting
• Six sigma quality leading to negligible bugs
• HL7 and DICOM compliant
• Conforms to IHE and NABH guidelines
• User- centric design
• Extensive domain expertise
• Team of doctors, process consultant, GE Healthcare
• Built by Indian doctors
• Extensive depth in features
• Extracts data from devices
• Extensive configurability
• Integrated ecosystem
• Shows radiology images
• Allows remote data access
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• Very affordable prices
• Cheap hardware required
• Low customization costs
• In depth process analysis
• Zero run time license costs
• Remote performance monitoring
• Collaborative implementation
• Provide hand-holding, drive change management
• Free upgrades with AMCs1
Asclepius offers world class IT solutions – with high quality and international features – at a very affordable total cost of ownership
Free uprades or first 30 customers only1