Partner Perfect

The choice of the HIS vendor is crucial to the success of a hospital's IT solutions. Rajmohan Nair helps you make the right choice in just six steps

Recently, I met a hospital administrator of a large hospital group in UAE. In the course of our discussion, he shared with me that even 11 years after implementing ICT solutions in the hospital, they were still not able to derive major benefits, especially with regards to consolidating data from different units. They had already tried three HIS applications without success! I was left wondering whether the problem was with the product, its implementation or the people involved.

Having partnered with quite a good number of healthcare institutions in emerging markets as a vendor, I have noticed that healthcare organisations, after spending months on selection and finally choosing a partner for HIS, often feel that they have been locked with a wrong associate.

Selecting a solution that is perfect for your requirement is the most important factor in a successful ICT implementation. This selection can result in service excellence for the healthcare delivery organisation. It also helps build a long-term relationship with the ICT solution provider. In my experience, there are several challenges in choosing a right company and a right product. But given that there are many companies providing healthcare IT applications—from big names to small players—how does a hospital zero in on the best match?

Step 1: Identify Your Objective

The first step a buyer should take is to finalise the objectives of the project and then, document them. This requires organisations to spend quality time and a lot of thought on probing into the expectations all the stakeholders, the processes and departments that need to be involved, and visualisation of what the end product must look like.

I have seen some organisations that have prepared detailed ICT roadmaps with proper milestones with respect to the philosophy and vision of the hospital. Some of them had even displayed these roadmaps as a summary or a balanced scored format in their departments and meeting rooms. This clarity on objectives is the first step to finding the perfect fit.

Step 2: Form a Good Team

Before going further, it helps to choose the set of right people to lead and drive this project. Generally, someone from the top management, for example, the CEO or the chief medical officer or a senior champion from the IT department or from the clinical team, leads the project as per the goal set by the management.

All stakeholders should bear in mind that this implementation is linked to the core business strategy, and not just to IT. We should also consider a senior person from the management with a good knowledge of the culture and history of the organisation to be part of the group. This person should be such that s/he is able to connect with end users. Also, a decision on who will drive this at the operational level must be taken, probably bythe hospital information manager.

Determining this third person in the team is one of the key challenges because often, organisations lack good human resources for hospital information management. Other than a few large corporate hospitals, the majority of hospitals in India don't have a good team in the healthcare ICT area. This dearth of qualified staff is due to few individuals looking at healthcare ICT as a good career, due to an absence of good pay or a clear career path. Because of these drawbacks, hospitals often end up recruiting systems managers (with hardware or networking background) or individuals with experience working as database administrators, for this post.

These candidates are then expected to be the driving factor of a clinically-driven ICT system. This is a costly error, which leads to the entire exercise failing at the implementation stage. Hospitals, keen on bringing in ICT systems as the key driver for an end-to-end revenue cycle management and clinical excellence, need to have the right set of people and form the ‘success’ team.

Step 3: Ensure that the Proposal Request is Well-Defined

Providing requirement specifications as precisely as possible is the key to a successful ICT solution implementation. The specification must be granular in nature and must define the complete picture, from the overall vision of the organisation to minute requirements such as user interfaces. Templates are available online that can be used to develop the base structure, though we cannot use the content. Depending on the organisation’s business objectives and expectations, these templates can be modified to make the requirement specifications clear and precise.

The department objectives (both short-term and long-term results), process efficiency results and the end-user requirements should be in tandem. Even if you choose only a few areas of the healthcare process, the depth and effectiveness of automation in them must be relevant — effectiveness is not measured by number of modules required. Hence, it is not the quantity, but the quality that matters. Further, you need to ask questions that are logical and that connect with the organisation’s internal processes and workflow.
Members of the management need to spend quality time with the team right from the ICT planning stage

Step 4: Involve the Top Management

At times, the top management delegates the task of HIS procurement and implementation to middle management. However, members of the management need to spend quality time with the team right from the ICT planning stage, as ICT solution implementation is a major business driver. If there’s no involvement from the top, they will be out of touch with important decisions taken at the initial stage.

Step 5: Allocate a Proper Budget

Often, the budget planned at the beginning shrinks by the time the project reaches implementation stage. The management should avoid doing this as implementation can easily go haywire without enough resources to support it. An unrealistic budget and/ or insufficient allocation of resources prove detrimental to a project and may cause additional problems, both in the short-term as well as the long-term.

Wrong allocation of resources and budget is equally detrimental to the organisation. For example, the organisation may eventually spend more for the hardware and less for the software. Any investment made on ICT will be mediocre if the right approach is not taken while going in for a new system. For instance, if staff members assigned to HIS project procurement do not spend time during the procurement process and try to hasten the process by packing demos and vendor interaction within a short time frame, the results will be disappointing. Hence, along with dedicating the right budget, it is important to allocate the right monies and time in right measure for each stage of planning and implementation.
ICT is a valuable tool to capture financial performance, attain patient satisfaction, and achieve clinical excellence

Step 6: Look At Quality Not Quantity

For the last two decades, there has been an appreciable advance in the usage of HIS/HIMS applications in India. From a buyer’s perspective, a decade back, when we were to ask the CEO of a large or a medium-sized hospital about ICT solutions for the organisation, the reply would have been, “We are fully computerised. However, we are not getting the right benefits from the system.”
In reality, the definition of a fully computerized system would have been front office billing, patient tracking in the wards, pharmacy and back office financial management systems. Many of these elements may not have been integrated. The management would not have been able to differentiate or assess the level of ICT maturity. There was low awareness about how ICT could help the management achieve better control — it is a valuable tool to capture financial performance, attain patient satisfaction, achieve clinical excellence and thereby gain competitive advantage.

If they are asked the same question today, the reply probably is: “Yes, we are managing information system in the billing, inventory, diagnostic and laboratory departments, and more. Our HIS has been integrated with a leading financial application. Our doctors have started using EMR and our IT staff is able to provide MIS reports. We are in the process of upgrading and we have to put lot of effort from our end to make this happen.”

Today, hospitals have tasted the fruits of successful HIS implementation and known its failures as well. Hence, it is important to know that there is a larger implementation cycle. Some buyers are ready to accept that it is not the product or implementation that makes a successful ICT solution, but the joint effort of the hospital management that makes all the difference.


1. Arrive at the true cost

Calculate the true total cost of ownership (TCO) of the different products you are considering. The technology you select and associated components will also play an important role in pricing. Consider the license cost of the software—is it on premise or is it on demand? The true TCO of any large HIS solution covers license, customisation, project management, training, additional software associated with infra for on-premise solution network bandwidth and IT staff.

2. Look at complementary products

Consider each vendor’s other business application offerings. HIS is often sold alongside such as EMR, RIS/PACS, CDSS and analytics. Decide now if you plan to extend ICT maturity into different stages of EMR maturity to narrow your vendor options. For instance, if you choose a solution with a specialty EMR, then an EMR that can be scaled to CDSS be will be the obvious choice. Finally, check out the basic standards and statutory requirement, such as ICD code and HL7, localisation and inter-operability.

3. Consider SaaS

It is to wise include a Software-as-a-Service (SaaS) solution in your assessments. The SaaS model is soon going to be the next adoption for any business software application, including healthcare ICT. SaaS offerings not only have a lower total cost of ownership, but they are also easier to deploy than on-premise solutions. They can also be implemented faster. Besides, SaaS-based data security standards are fast evolving for the benefit of hospitals.

Spreading Knowledge: 21CI Team Member, a Visiting Faculty at a Prestigious Business School

Tushar Ratanghayra

Tushar Ratanghayra, Head Business Support at 21st Century Informatics completed a course on Healthcare IT for  PGP HCM Program at Welingkar College. The visiting faculty and Students (the batch size of 27 of working professionals consisting of Doctors & Para Medical Members of Clinical fraternity) at Welingkar College on a photo shoot of this exciting batch!

Technological Challenges while Implementing EMR and its solutions

The adoption of EMR has always been a matter of concern for HIMSS. EMR adoption lags behind other industry sectors significantly in the US and other developed countries and it is at very primitive levels in emerging economies like India. In June 2009, a HIMSS Task Force published a report on EMR Usability. In this report, the task force listed many causes for the low adoption such as cost, resistance to change, fear or avoidance of technology, ingrained patterns of behaviour and reliability and usability of the software.

In this talk today, we will hear about an important factor in boosting the EMR adoption – the way the IT systems handle the EMR software life cycle. The speaker is Devesh Rajadhyax who heads the R & D efforts at 21st Century Informatics. Devesh is a post graduate in Engineering and is working in Healthcare IT Systems since 1997. He has played various roles earlier, including architecting solutions and heading product development. The company he co-founded, 21st Century Informatics, is focussed on transforming the way IT systems are used by Healthcare organizations through innovation. Devesh is going to talk about a new approach to EMR software.

In his talk, Devesh argues that the traditional business software approach of looking at IT systems, which involves a rapid expansion of functionality during Implementation is not suitable for EMR. Certain characteristics of EMR and its users demand a new Evolutionary Approach to the handling of the life cycle of EMR systems. This approach is well supported by the advancement in cloud computing technology and emergence of the SaaS model. A wide acceptance of Evolutionary Approach can mean higher rates of adoption of EMR by Healthcare organizations.

Mapping the Implementation

My experience with implementation of effective clinical transformation comes from a medical institute specialising in diabetes. The institute is equipped with state of the art medical technology and it conducts advanced research and takes educational initiatives
By Rajmohan Nair, Head – Sales (Partner), 21st Century Informatics

There were various challenges faced by an institute in implementing IT solutions, as they were a new medical centre. The team there was not very IT savvy and this was basically a specialty centre, where research was also being conducted. Hence integration challenges of specialty Electronic Medical Records (EMRs) and revenue cycle management was also considered.

They were also aware of the difficulties they would be facing while evaluating options to implement an EMR especially in the start-up stage. The industry reports made them take a very cautious approach – the report indicated that many organisations discovered post-implementation problems in their EMR. The EMR does not integrate well with other existing or new IT systems, it is not tailor-made for the organisation’s unique business needs. It brings down clinical workflow and creates dissatisfaction.

The centre decided to implement a tightly integrated EMR that provides the benefits of realising the required cost reduction and achieving the desired efficiency improvements in patient care. The applications they were aiming for not only had to capture data at the point of care, but also had to support the doctors in decision making.

Approach taken

With the primary objective of optimising the clinical operations, 21CI’s highly trained consultants proposed business process consulting study, in other words an ICT roadmap creation and solutions deployment. 21CI’s business process consulting and business process blue print document provided an in-depth understanding of clinical and business processes that helped the medical centre build an ICT roadmap. Next, we mapped the organisation’s unique ICT needs and based on the business process blueprint, and we configured our 21CI apex health information system.

A range of solutions were deployed under 21CI Apex Health Information System and proper training was provided to the key users. Clinic Information System (CIS) with day-care facility and laboratory Information system and Electronic Medical Records (EMR) and Picture Archiving and Communication Systems (PACS) were deployed.


One year after the date of implementation, 21CI and the medical centre jointly evaluated the benefits achieved. The study found that the centre had attained ICT-enabled revenue cycle management with diabetes management as the core pillar. This had the potential of improving care processes, delay diabetes complications, and provide adequate healthcare. A major benefit was that the time needed to service clinical processes was transformed from a semi-automated to process-driven automation. There was a reduction in transaction cost, and this resulted in a saving of almost 30 percent. The overall quality of patient service was improved, leading to increased patient satisfaction. There was an improved and effective billing capability. This eased clinical reviews and accelerated disease prevention interventions

ICT Processes in Healthcare Organizations at Welingkar College

Tushar Ratanghayra, Head Business Support at 21st Century Informatics teaches a course on ICT Processes in Healthcare Organizations at Welingkar College. The visiting faculty and Students at Welingkar College on a photo shoot of this exciting class!

Being Wrong: the great source of knowledge

TEDx Youth@Academy 2011 Simanta Das