Dose of Standards
By Amit Tripathi
Mumbai, Jul 9, 2007

A couple of months ago, Apollo Hospital announced its plans to roll out what it termed as "Health Highway", which will deliver software specific to the healthcare segment in India. On the one hand, this initiative implies that this industry is becoming Information Technology (IT) savvy, but on the other, it manages to camouflage the troubles on the ground level.

The adoption of IT is one fact, and developing a mindset to adopt best practices is another. The moot question is to what extent are hospital managements ready for it? Let's examine this.

Most medium-sized hospitals of our country that I visited to probe, use some locally developed Hospital Information Management System (HIMS). The IT heads say that this requirement is due to the fact that a hospital's processes are mostly dynamic. This is actually true, since the processes in a hospital lack standardization-unlike, say, the processes in a Banks, Financial Services and Insurance (BFSI) or manufacturing company.

Look at medicines: it's amazing to discover that different hospitals may have different names, say, for a packet of glucose. Equally amazing is the diversity in the nomenclature for diseases and the treatment associated with them. Thus, the checkup procedure, say, for tuberculosis, may differ from one clinic to another. All this makes the choice for a customized or locally developed application much more apt. No wonder that hospitals undertake 30-40% customization of their core applications even when they buy packaged HIMS. So in the case of an HIMS developed in-house, one can well imagine the immense scope to incorporate features as and when the need arises.

However, it would be imprudent to accept lack of standardization as the only culprit: another reason for this is hospital administrations' step motherly treatment to IT. The heads of IT departments in hospitals usually lament that the top management leaves too much at the IT solution providers' disposal. This provides them a free hand to incorporate changes without even understanding the specific processes of a particular hospital.

Add to all this the lack of support from the vendors. Some IT heads complain that seeking support for their systems from vendors is becoming increasingly expensive. Vendors too are shying away from working on systems that aren't branded products.

The remedy, healthcare experts feel, lies in adopting standards in the 4 broad processes of material, patient, facilities, and treatment management. The effort to this end is already underway. Non-profit Indian Confederation for Healthcare Accreditation (ICHA) is developing an accreditation system for the benefit of all the stakeholders in healthcare, namely "providers", "receivers and users", "payers and funders", and "educators and regulators". Chief Executive Officers (CEOs) of many hospitals feel that the IT Infrastructure for Healthcare (ITIH) framework developed by the Government of India, years ago, must be speedily implemented.

It might be a good idea to ape what western countries have done in this regard. Healthcare and insurance are interlinked, and as is the practice in Europe and North America, adopting the specifications of standards, such as Health Insurance Portability and Accountability Act (HIPAA) and Health Level 7 (HL7), may save us from the pangs of reinventing the wheel.