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Patient Experience in the Digital world

In January 30 2020, India recorded its first case for Corona Virus popularly known as Covid19. Since then India has seen a series of lockdowns and as we inch towards somewhat of a partial recovery, the question around the state of our healthcare system has become centre stage again.

Since the 1940’s where the Bhore committee gave its recommendations for developing the healthcare structure in India, as a nation we have been playing catch up with demand far exceeding the supply in terms of doctors, diagnostic equipment, hospital beds and medicines.

In addition the wellness programs have been struggling and preventive measures have not been very successful. In this context the corner stone of the healthcare system in India has become the hospital.

What determines a successful healthcare intervention is patient experience. Today with the advent of telehealth and the guidelines given by Medical Council of India, it becomes even more important for hospitals to focus on patient experience and add to the growth of the industry.

What determines a successful healthcare intervention is an excellent patient experience #Healthcare #DigitalHealth

What is Patient Experience?

Private hospitals have long tracked patient satisfaction ratings, but they didn’t always carry great significance. While all hospitals want happy patients, most hospitals have been historically plagued with the “doctor knows best” mentality — a mentality where clinical outcomes outweigh “touchy-feely” indicators such as patient satisfaction or overall patient experience.

However, in recent years, some leading institutions in India have begun to focus more heavily on providing an outstanding patient experience. Drivers for this include growing consumerism and transparency for healthcare services and increased interest from both consumers and providers in patient-centred care.

Why Patient Experience is important to Hospitals?

Healthcare consumers increasingly view their experience with a provider as a key consideration for determining if they’ll return to or recommend the provider, largely because it remains one of the few ways consumers can differentiate providers. Over the past few decades, clinical outcomes have improved dramatically, and patients no longer view favourable outcomes as a key differentiator as these are expected. What remains is the patient’s overall experience, which encompasses everything from customer service to patient-centeredness and care coordination among providers. 

Also given the growth of Tele Health, it would become even more important for hospitals to focus on patient experience in order to create a favourable experience and create the hook that would bring patients and others in the community back to the hospital.

The key is how you make the patients feel

Key Parameters of Patient Experience in a Hospital

While there are many parameters that determine patient experience, we have tried to list down a few key ones that might influence the satisfaction index more than the others.

  1. Patient Appointment Experience
  2. Patient Online Portal
  3. Social Media and Digital Out Reach
  4. Facility for the In-Patient Service and Emergency Service
  5. Patient’s Access to medical Records
  6. Patient Information
  7. Clinical Outcomes
  8. Value Added Service

“The art of medicine consists of amusing the patient while nature cures the disease”

Voltaire

While many of these parameters are difficult to understand or assess, as part of this report we have identified Social Media as a parameter that we would like to evaluate. In order to do so, we have identified 6 Hospitals across India. These hospitals are

  1. AIIMS
  2. Apollo Hospitals
  3. Fortis
  4. Manipal Health
  5. Narayana Health
  6. Kokilaben Dhirubhai Ambani Hospital

We have tried to mix it up between hospitals from the government sector and private sector and also among general hospitals and super speciality hospitals. Below is our analysis of the key parameters between the social media presence of these major hospitals.

I believe that Social media is an indicative parameter. It shows whether there is a foundational maturity in the digital program of the hospital. Also, a lot of patient experience is visible by the comments and interactions with the hospital’s social media channels.

The findings of our analysis are captured in the report below.

Download the Report

Would be happy to discuss and see how you can build your digital experience for patient engagement. Do write in to discuss.

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Healthcare Technology

Why is there no AI in Healthcare India?

Just a few days ago I was on a webinar on Healthcare. The topic was the use of AI in Healthcare and the implications of Ethics in the same.

While all panelists spoke eloquently about the topic, I was trying to recall where have I seen AI in action in India. Unable to find too many instances, I spoke to my good friend and the editor of the New Age Healthcare Website Dr Sumeet Kad. Below is a recording of our interesting conversation.

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Healthcare Technology

Healthcare India among the top 100 Health Tech Websites in the World

Healthcare India has been again listed in the top 100 Health Tech Websites and Influencers for 2020. It has been a great comeback for us considering only a couple of months ago the site was hacked. The hacker not only added himself as admin but also created 1 lakh junk pages and google had blacklisted the site.

Due to the efforts of Ganesh Acharya our Chief Media Officer we were able to come back, and back into the top 100.

Healthcare India as a forum was created to address the lack of access, poor quality, and improved outcomes for millions of Indians. We believe this is possible only through technology and better processes. This new recognitiion helps us to strive harder to improve healthcare in India.

Also a shout out to our friends from HCIT and New Age Healthcare for being listed in the top 100 as well. Making India proud.

Below is the list of the top 100 Websites and influencers.

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Healthcare Technology

New guidelines launched for Telemedicine Practice by Medical Council of India and Niti Aayog

One of the perplexing questions that have baffled technologists for long is why the regulators have not approved the use of teleconsultation for doctors. In the past, I have felt the need for Tele-Consultation or Telemedicine, tremendously to improve care in India.

Here are my reasons

  1. As a doctor, I used to see the 8 hours of works heavily imbalanced. I was free for the first 5 hours of the day but loaded towards the evening. The last three hours and especially the weekends would be packed and I would be overworking at that time. If I had to balance that time well, was If I could equally load the patients throughout that 8 window period. But as I would have to meet the patients and they might require someone to bring them to the clinics.
  2. Our health infrastructure, both in terms of people, beds and devices, is based in the cities. Our rural areas are underserved and they need to make the trip tot he cities for any healthcare service. Sometimes even to take a blood test or an X-Ray. While they might need to make the trip to avail of lab facilities, through Tele Medicine, this problem should be solved.
  3. India needs cheap access to care. Most consultations are expensive as they take into account the investments in infrastructure, rent, etc. With Telemedicine, one has to only pay rent for platform and bandwidth charges. The overall cost of consultation should come down.

While I have argues for this for long, the regulations until recently did not allow for telemedicine or teleconsultation.

The breakout of Covid19 has changed everything. With social distancing emerging as the best defense against Covid19 it is obvious that the next step was the guidelines for telemedicine from the Medical Council of India.

On 25th March 2020, the Medical Council of India along with Niti Aayog has released the Telemedicine Practice Guidelines. The document can be found here

In summary, these are the key areas covered by the document.

  1. Guidelines for Telemedicine in India Elements specific to Telemedicine
  • Appropriateness of Telemedicine  
  • Identification of RMP and the patient
  • Appropriateness of technology/Mode of Telemedicine
  • Patient Consent · Patient Evaluation · Patient Management: Health education, counselling and medication Duties and responsibilities of RMP in general
  • Medical Ethics, Data Privacy & Confidentiality  
  • Documentation and Digital Records of Consultation
  • Fee for Telemedicine

 2) Framework for Telemedicine

  • Patient to Registered Medical Practitioner  
  • Care Giver to Registered Medical Practitioner  
  • Patient to RMP through Health Worker at a Sub Center or any peripheral center
  • Registered Medical Practitioner to another RMP / Specialist

3) Guidelines for Technology Platforms enabling Telemedicine

I would recommend that everyone should read these guidelines. It’s a great read for startups and technology providers planning to build these platforms and healthcare providers planning to develop their telemedicine services.

As always questions and clarifications are welcome.

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Healthcare Technology

The role of telemedicine in Home Healthcare in India

On National Telemedicine Day, republishing this older post from 2016, on the implications of Telemedicine on home healthcare in India.

Healthcare has evolved from a simple physician-patient equation to a highly complex process wherein the entire setup is managed by a team. This becomes all the more true as one moves across the spectrum of primary to tertiary care with the latter being provided in large hospital facilities.

A single patient in the being prepared for surgery for instance can have a cardiologist (to advise about his stent),  an endocrinologist (to set his pre operative Blood Sugar levels to Normal), an anesthetist as well as the surgeon. After the surgery, the care will be continued wherein new members will be introduced eg the Physiotherapist, the dietitian as well as the General physician for follow up as the patient goes home.

The challenge is to merge this disparate care to a holistic approach and hence avoid a blunderbuss of medicines which can cross react and add iatrogenic problems to the existing set being faced by the patient.

In a large hospital, it is a given that all the concerned specialists will be in the same location and will (hopefully) exchange notes on the drugs and protocols to be followed.

However in smaller setups, the caregivers maybe in different locations or significant time gap of their presence may exist. In such a scenario, information exchange is a challenge and Information technology provides the tools to meet these challenges.

download

IT systems have been shown to help reduce medical errors especially when advanced tools like CDSS (Clinical Decision Support Systems) are included. Many hospitals do use such tools though not yet in India. But even where they are used, such tools would be expensive in disparate locations, not only in terms of money but also in the break in and learning period of using such systems effectively.  Most hospitals would be expected to provide uniform IT systems wherein transfer of data becomes easy although it is rarely the rule as purchases have mostly been done by different departments and also at separate time for separate locations wherein even a version change may disallow transfer of data.

In Home care, which is now felt to be a growing need as the elderly population is increasing rapidly, many tools, gadgets and even Robots have been shown to improve care provision to the patient. They provide a supplemental (although that is getting to be very comprehensive especially for robots) role and have to be monitored through electronic means creating the new field of Home based Telecare.

Data interchange and sharing in such a situation becomes even important. This interchange would expectedly have to cross many locations and also problems of disparate systems. The problem of Healthcare IT standards have to be solved for this. Herein proper, connectivity, conformity of data structure and uniform messaging has to be in place. The basis has to be a common EHR structure.

Once uniformity allows seamless access to data across different locations, telemedicine becomes a living reality and as simple as any patient management process wherever and whatever the distance separates the patient from the care provider. However the machines and other tools whichever use any sort of electronics can be converted to provide digital output so that the data is streamed to various locations. It goes without saying that the same sort of uniformity would be required.

healthcare-case-study-w850

 While this is an ideal world situation, large sections are already happening – ECGs were among the first to be referenced using Tele-Medicine. Holter monitoring started even before the internet was commonplace.  The patient carries around a portable device that records his ECG continuously and especially when possible angina occurs.

A special device allows a patient to  send his (single lead) ECG by phone. He just calls the number and places the devices close to his chest – the ECG signals are transmitted as audio signals.

Recently in a study,  EEG data of 1782 patients were sent from a tertiary care hospital in Tanzania to neurologists in India for analysis and interpretation. The EEG’s were recorded in digital format and placed on web server to be ready by clinical neurologists. This is done using ECHOSpa software and email but a backup system was established using other system with suitable encryption. A total of more than 1000 EEGs were reported in between April 2014 to Dec 2015 for patients of all ages. All cases were reported within 24 hrs of recording. The back-up system was used in 60 cases.. Quantitative EEG characteristics were classified into various categories hemodynamic parameter, Type of surgical operation, Bio spectral characteristics, Type of cases (Normal/Abnormal). Their sensitivity, specificity and accuracy in determination of depth of anesthesia were yielded by comparing them with the recorded reference signals in awake, sleep anesthesia,and the frequency of waves were recorded.

It was found that the Tele-Medicine could be used effectively for diagnosis and getting a second opinion. But at the same time care had to be given to the security of patient data as well as the encryption of the systems being used.

The detailed study can be found on this ink.

About the author

purva_pic

Purva Gupta is a graduate in Hospsital and Health Management from IIHMR Delhi. Please direct all questions and comments on this article to purvagupta456@gmail.com .

(Note to readers: Healthcare India has not checked the validity and authenticity of this research. This article has been published on statements from the author on its originality and authenticity. Healthcare India is not liable for any misrepresentation in this article.)

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