The future is in the PAST Paper based IT systems that work Dr
Vijay Raaghavan Engagement Manager Ember Melcher Associate
Consultant
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Who are we We are a niche healthcare consulting firm, driven by
the challenge of new possibilities in healthcare and the
translation of these ideas into reality. Our goal, very simply, is
to make a difference, which may explain why we tend to go beyond
research and analysis to adopt a more pivotal role in the manner in
which we help our clients execute various interventions.
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Whom do we work for Our clientele ranges from large hospital
networks and single specialty hospitals to diagnostic services
providers and primary healthcare clinics. We have also served
clients in public health, medical equipment manufacturers and
healthcare IT solution providers. Our diversified team, as well as
our advisory panel, offers years of cross- functional experience
and expertise across various industries.
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It all started here FUN For a client of ours, we conceptualized
a family medicine doctor clinic model and had to scale up this
model across a hundred locations.
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FUN The Challenge The limitations of a stand alone practice The
drawbacks of highly IT led initiative Personalized touch an
extremely difficult aspect to scale across a network Doctor so
close,yet so far with doctor so engrossed into inputting the data
into the system, there is very little he has left with the patient
who is sitting right acoss
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Point 0 FUN Patient has to be at the core of everything we do.
WE Believe
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Point 0 FUN Patient has to be at the core of everything we do.
Consistency of experience/service delivery
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Point 0 FUN Patient has to be at the core of everything we do.
Consistency of experience/service delivery Great customer
experience through empathy, dignity and responsiveness
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Point 0 FUN Patient has to be at the core of everything we do.
Consistency of experience/service delivery Great customer
experience through empathy, dignity and responsiveness Affordable
price - Help towards reducing his overall spend on healthcare
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Point 0 FUN Patient has to be at the core of everything we do.
Consistency of experience/service delivery Great customer
experience through empathy, dignity and responsiveness Affordable
price - Help towards reducing his overall spend on healthcare
Superior clinical outcome
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Point 0 FUN Patient has to be at the core of everything we do.
A TECHNOLOGY PLATFORM THAT SUPPORTED ALL OF THESE Consistency of
experience/service delivery Great customer experience through
empathy, dignity and responsiveness Affordable price - Help towards
reducing his overall spend on healthcare Superior clinical
outcome
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Lets begin from here FUN Patient
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What people said We spoke to 150 patients who very recently had
completed their Physician Consultation in some cases the follow up
and were very fresh to speak about their experience. This included
a mix of corporate, non corporate, stand alone clinic setup
FUN
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What people said 70% 20%20% I I III The doctor understood my
exact problem and so the medicines began to work The doctor kept
asking questions The doctor also monitored my illness even after I
got well Her treatment worked well I had throat pain and when I
went to my previous doctor he just saw me asked me to open my mouth
and wrote some medicines.Even after 5 days I didnt find relief. I
then went to Dr Sridhar he had some machine with light- he asked me
to open my mouth and he examined my throat with that machine for
more than five minutes. After that he wrote medicines and it
worked! He asked me to come for a follow up today and even today he
spent that much time. Reasons for Dissatisfaction Reasons for
Satisfaction /wow 50%50% 30%30% 20%20% The doctor did not spend
time listening to my problem The doctor was busy doing something
else The doctor did not even touch me and feel me She just asked me
one question and thats it It was like Doctor was talking to the
computer and not me ! The doctor did not even put the stethescope
on me The doctor did hardly touched me to feel my health problem
The doctor was busy chatting with some other doctor and without
even asking me the details of my pain went on to write prescription
Without even listening to me that I had the problem in my right ear
the doctor went on to put the scope in my left ear. This doctor
didnt even ask if I was allergic to penicillin, she straight away
prescribed the medicine 10%10% I I IIIIII Others
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FUN What people said 50%50% 30%30% 20%20% Reasons for
Dissatisfaction Reasons for Satisfaction /wow The doctor did not
spend time listening to my problem The doctor was busy doing
something else The doctor did not even touch me and feel me She
just asked me one question and thats it It was like Doctor was
talking to the computer and not me ! The doctor did not even put
the stethescope on me The doctor did hardly touched me to feel my
health problem The doctor was busy chatting with some other doctor
and without even asking me the details of my pain went on to write
prescription Without even listening to me that I had the problem in
my right ear the doctor went on to put the scope in my left ear.
This doctor didnt even ask if I was allergic to penicillin, she
straight away prescribed the medicine Others 70% 20%20% 10%10% I I
IIIIII I I III Touch Examine Engage
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What doctors said FUN We spoke to 35 Physicians on their
experience of what they felt were the good points, pain points of
the consultation.We selected facilities that had IT infrastructure
in most cases a laptop / Desktop with a HIS.
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FUN 1 technology ? Doctors may be reluctant to use computers !
Dont change what you dont need to Patients dont like if we didnt
show concern these hospitals make us type type and type the top
management is more worried about data - less worried about patients
problems the system of computerization is good, but it cant be at
the cost of a patients time whenever we have eye-eye contact, I am
able to build a relationship with the patient Patients lose faith
if we didnt understand their problem Sometimes patients get
frustrated with us as we tend to focus more on the monitor
sometimes patients tend to mistake us for
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FUN 2 Prescription writing ? Will it be a wiser option to
retain the pen & pad and yet go digital ? ! The traditional way
helps in maintaining the patient physician eye to eye contact We
were very keen that we focused on options that suited the
consultation requirements. DICTAPHONE KEYBOARD INPUTS PEN PAPER
TECHNOLOGY PAPERLESS TABLET / PAD
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3 One page emr ? We asked to ourselves if done is better than
perfect ? ! The one page EMR that we created became our audit too
as well ! min 1.5 minmin 2 2 2 9 minute/patient
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3 One page emr IMPLEMENTED EVIDENCE BASED CARE The one page EMR
capture system not only increased the INVOLVEMENT of the Physician
on a consistent basis, but also ensured that LOT OF THINKING backed
by EVIDENCE BASED MEDICINE went into DECISION MAKING. INCREASED
EYE-EYE TIME Patient Particulars,Illness Summary, Vitals,
Observations and Drug Therapy also meant that we could steal close
to 8.5-10 minutes of the care givers time to the patient.
CONSISTENCY IN DECISION MAKING Clinical Quality Head could first
Audit Physicians decision making by using these filled forms as a
PROXY and then could spend time with the Physician on improving
practice/outcomes. 1.5 minmin 2 2 2 9 minute/patient The average
Physician Patient Interaction time increased from the otherwise 1.5
minute/patient* to a 5.5- 8 Minute quality interaction that
included questioning probing, examining, touch and feel * Based on
the results shared by IMA, other studies !
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FUN 4 standardization ? We asked to ourselves if done is better
than perfect ? ! We saw the merit for the patient,physician We went
one step further to seek help of a IT Hardware that helped us
quickly translate hand script into digital signals. We shortlisted
iBalls take note device Benefits From a Clinician standpoint it was
the same pen and paper From a patients standpoint they hardly
noticed From an IT standpoint they had the xml version that could
be ported to the EMR
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FUN 5 NEED TO MONITOR OUTCOME CONSISTENCY ? How do I ensure
that I deliver comparable treatment outcomes across 100 locations !
Sought support from a protocol development firm. Once we got here,
we realized that it was very critical to ensure that we attained
consistency in clinical decision making. This is where we sought
the help of a protocol developing firm and customized the same The
rules
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FUN The Outcome The Clinical Head Speaks
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FUN Could retain the traditional way and yet go digital !
PATIENT SATISFACTION Solution Mix 1 technology PHYSICIAN
SATISFACTION 2 3 4 5 Prescription writing Record keeping
standardizing Monitoring outcomes COMPLIANCE Pen and Paper helped
us in keeping it low cost Could retain a hard copy, this also
became the audit tool and a bible for improvising Physician
practice! Building protocol for specific conditions standardized
the treatment plan The protocol driven care pathway helped us in
ensuring that informed decisions were made and they were consistent
across locations and physician profiles - High - - Medium -
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FUN Takeaways Systems that include all stakeholders in design
work better. Protocol-based decision making does work in India.
Innovation pays off.