Analysts peg the Indian healthcare industry to reach $155 billion in terms of revenue by 2017. But are hospitals really using their money effectively? Narayana Hrudayalaya (NH) most certainly has been. The NH Group of Hospitals has been delivering on its promises of providing high quality, highly affordable healthcare services.
In this interview, the hospital chain's founder Dr. Devi Shetty talks about what IT can do to help lower the cost of healthcare in India and improve patient care by maturing beyond just being a driver for back-office work.
CIO: What do you think are the two biggest challenges of India's healthcare industry?
Dr. Devi Shetty: The greatest challenge is we need two million beds. There isn't that kind of a capital investment available in our country. There is a clear disparity in the expectations of the government. On one hand, the Indian government wants the cost of healthcare to go down, and on the other hand, they look at the healthcare industry to generate additional revenue for the government.
CIO: How does IT help tackle these challenges?
Dr. Devi Shetty: IT helps in reducing the costs of various operations in every service industry. Take a look at the number of financial transactions happening at NASDAQ--within a few minutes, billions of dollars exchange hands. The cost of transaction is virtually nothing. Another good example is supermarkets. Goods are bought, sold and maintained in huge numbers, and still there is hardly any transaction cost. This is possible only because entire services are run on efficient IT platforms.
All over the world, in healthcare, penetration of IT is extremely poor. I am not talking about using IT as a glorified typewriter for producing discharge/admission summary, data collection, and claim processes but 'patient care'.
CIO: Does IT bring in innovation in patient care at Narayana Hrudayalaya?
Dr. Devi Shetty: Firstly, at Narayana Hrudayalaya, we want to create a robust IT platform to control the finance department and quality of services. Post that, we want to get into patient care and outcome.
We are perhaps one of the few hospitals in the world where a balance sheet is created on a daily basis. A sophisticated ERP system on a cloud solution houses all the financial details about all the group hospitals.
CIO: You've been a poster boy for IT in the healthcare industry. Why do you think your peers don't use IT as much as you do?
Dr. Devi Shetty: The doctors who are at the helm of affairs in the healthcare industry and influence the policy/decision-making process belong to my generation. We grew up in a time when there were no computers. So, when we don't understand something, we are scared of it. Basically, since we are not comfortable, we don't want to make a fool of ourselves. Also, there is a hidden fear that it may reduce our importance.
CIO: How does one mitigate that problem?
Dr. Devi Shetty: It can be mitigated by introducing solutions which have the 'Wow' effect and which can be used by us without typing. Today, the technology is available to make it happen.
CIO: You have always been an advocate of low-cost healthcare. Where does IT figure in the scheme of things?
Dr. Devi Shetty: One cannot reduce the cost of healthcare without the use of IT. Actually, no service industry can reduce costs without the help of IT. IT is the matrix that holds the entire delivery system. IT cannot cure, but it can make healthcare safer for the patient.
For example, in the U.S., every year, close to 10,000 people die due to prescription errors. Hospitals must have a policy that prescriptions should be made only using specialized software that can make prescriptions. This is already available.
No doctor in this world has the presence of mind, round the clock, to calculate drug interaction accurately every single time.
We need the power of IT to reduce the cost of operations. Our IT initiatives give us a profit and loss account on a daily basis. Every day at 12 noon, our senior doctors/administrators get an SMS on their mobile with the previous day's revenue, expenses, and profit/loss margin.
As doctors, we know exactly what is happening with our organization. For us, looking at the P&L account at the end of the month is like reading a post-mortem report. You can't really do anything about whatever losses you have. But looking at the account on a daily basis is a diagnostic tool; you can take remedial measures. With doctors, you can't change their behaviour by preaching. You produce the data. You tell them exactly how many days the patient stayed there before the operation, how many days in the ICU, how many days post-op, and what the cost of material used for the operation was. All this information cannot be generated without the help of IT. Narayana Hrudayalaya has invested heavily in IT, and we are now reaping the benefits.
CIO: How has IT helped in the impressive expansion plans of Narayana Hrudayalaya?
Dr. Devi Shetty: First of all, I cannot think of the healthcare industry without IT. We have 17 hospitals spread across the country. I haven't even visited some of these after the inauguration. But I have a clue of their day-to-day proceedings. We have a complaint management system (CMS) that keeps track of all the problems a particular hospital faces in a day. We don't discourage complaints. We instead celebrate them. So, it helps me in calling out the bluff of the COO of a particular hospital if he says things are fine, while in reality, I know that there were 184 complaints registered that day.
When we started the CMS, we registered 200-300 complaints a day, but now, it is down to about 60 to 80 complaints. This is the power of information.
CIO: Seventy percent of India's population lives in rural areas, but 80 percent of doctors, and 60 percent of hospitals are in urban areas. That opens the door for telemedicine. What is its status and scope in India?
Dr. Devi Shetty: Right now, it does not have a big impact. One area where it works is radiology, but we do not have many senior radiologists in our hospitals. A single radiologist interprets the CT and MRI for all the group hospitals. We have treated over 53,000 heart patients in remote locations of India, and we believe that eventually very few patients will go to the hospital. They will visit one only in case of surgery. For medical problems, they will stay at home, use handheld devices to diagnose (ECG, blood tests etc.), and video conference with doctors.
Right now, it is happening in a very informal manner. For example, if the patient-doctor relationship extends beyond the confines of a clinic/hospital, the patient might be comfortable in interacting with the doctor over video conferencing.
We have a warfarin clinic based in Hubli managed by an ex-patient. All the patients treated in this clinic get the INR test done and SMS the report to him. He replies via SMS again with the dosage and intake timings after inspecting the report. All these are happening in a very informal manner.
CIO: When and how long before it happens formally?
Dr. Devi Shetty: I think these are all very chaotic developments. Eventually, with low cost connectivity, I expect things to change.
Also, there is no legal protection for the doctor. In the case of telemedicine, a doctor does not physically prescribe an antibiotic, and as result it is not legal. The government needs to frame laws for telemedicine for it to operate smoothly.
CIO: How do you maintain the balance between affordable healthcare and sustaining a successful business model?
Dr. Devi Shetty: Charity is not scalable. However, good business principles are. At Narayana Hrudayalaya, this is what we always keep in mind.
CIO: Where is healthcare in India heading to?
Dr. Devi Shetty: India will become the first country in the world to dissociate healthcare from affluence. Within ten years, every Indian will have access to high-tech healthcare with dignity. India will prove to the world that the wealth of a nation has nothing to do with the quality of healthcare its citizens can avail.
This is possible only because we produce the largest number of doctors, nurses, and medical technicians in the world. Outside the U.S., ours is the only country to have the largest number of USFDA-approved drug manufacturing units in the world. We have everything going for a phenomenal healthcare delivery model. The only missing link is that patients do not have enough money for healthcare. That will be addressed soon too. For example, around 10 years ago, we convinced the state of Karnataka to launch a health insurance plan called 'Yashaswini Micro Health Insurance', which operates on a premium of five rupees per month. Today, we have close to 4,000,000 farmers who have availed the benefits of this insurance scheme. Over a period of 10 years, more than 450,000 patients have undergone various types of operations, including major heart operations, at a cost of just Rs 5 per month.
We are now trying to convince our policy-makers to float a scheme through which every mobile phone subscriber in India pays 20 rupees over and above the regular bill, thereby enabling us to create the most robust and scalable health insurance program in the world.
Poor people in isolation are very weak, but together they are very strong.
Ershad Kaleebullah is a correspondent for CIO India and ComputerWorld India. Send your feedback on this interview to firstname.lastname@example.org. Follow Ershad on Twitter at @r3dash.