Indian Hospitals Need New Online Initiatives

Websites of Indian hospitals are hardly something to write home about. They are mostly poorly done, difficult to navigate and usually the information lies buried so deep that it tests ones patience to get the relevant information . The other day, it took me close to 20 minutes and numerous clicks to locate the address of a hospital from its website. I needed the address to send a Diwali card to a friend who works at the hospital and try as I might, I just did not seem to find the address of the hospital.

Almost all of the hospital websites that I am familiar with are largely static. Thus, they do not interact with patients or caregivers looking for specific information. They do not allow one to book appointments, download reports, interact with doctors taking care of ones loved ones, send good wishes or chat with the patients. They do not support e-commerce. Thus if I was an NRI living abroad and wanted to buy my parents an annual health check or if I wanted to pay their hospital bills on line, I just can not.

In the era of burgeoning medical travel and with Indian hospitals attracting a sizable chunk of patients from all over the world, this does seem strange. For some unfathomable reason, Indian hospitals have not invested too much on their websites or for that matter on online marketing per se. I believe it is high team someone woke up and used the net better.

It is indisputable that a certain kind of Indian consumer has fully embraced the e-revolution and their tribe is growing by leaps and bounds. With the broadband penetrating deeper, more and more Indian consumers will look at the internet for information, entertainment and commerce. They would seek information about doctors, medical facilities and would like to compare medical outcomes across hospitals. They would like to chat with doctors and customer experience executives in the hospital before making a choice. A hospital aspiring to attract these kind of patients must consider significant investments in their websites and in enhancing their online visibility.

The entire gamut of social media on the net can also be used by hospitals in interacting with their patients. At Artemis, we tried creating an online community of patients and caregivers, where members could post their hospital experiences, their recovery post discharge from the hospital, photographs showing their progress and interesting pieces of information on their disease and latest advancements in medicine. We also encouraged hospital doctors to interact with members of this community. Unfortunately the hospital discontinued this initiative once I left. The hospital was cutting costs and building an online community was considered too ‘long term’ for investments to continue.

The next level of online presence would require hospitals integrating their Hospital Information Systems (HIS) with their websites allowing patients and their relatives on line interactivity. This will facilitate hospitals inviting second opinions from experts anywhere in the world, keeping the patients family and relatives (who might be half way around the world) in the loop on the patient’s progress, interaction with their doctors and online payments. The big issue here is the online security of patient information. The hospitals will have to invest in a foolproof system, which guarantees authorised access to medical data. It would be a disaster if a hospital integrates its website with HIS and leaks confidential data.

With the current level of IT advancement, this and more is certainly possible. Indian hospitals have to look at these opportunities seriously and start investing. The returns would quickly follow

An OPD Experience

The other day my wife had an appointment with her doctor at one of the well known hospitals in town. We were to see her at 8PM, but what with under construction Metro line collapsing and the resultant traffic snarls bringing the city to a halt, we were running late. Hoping against hope of catching the doctor, we reached the hospital 20 mins late.

Luckily for us, as we arrived the doctor was finishing with her last patient of the day and agreed to see my wife immediately. She indicated that some tests were needed and while she went about doing those, I might run along and pay the bills as the billing counter would be closing. She scribbled the tests on a medical form and off I went to do the needful.

Sure enough the billing counter was deserted and the billing clerk appeared to be in a hurry to rush off. As I put in my request a surly lady (let me call her N) told me to wait. I waited patiently, and again enquired about settling the bills. My wife had by then joined me as well as the doctor had finished with her. Nothing happened. Finally, I requested an audience with the duty manager, who arrived promptly. When I explained the situation to him he asked N to open her system and do the billing and for good measure added she can ‘easily do it for one patient at least’.

N finally accepted my papers and opened her billing system. After fiddling around with the system for a while, she summoned another colleague ‘D’ for help. Apparently, N was not able to find the tests on her billing list. Apparently, she did not know where to look. Her colleague D who was supposed to be more competent on the system too, could not find the tests. As I waited patiently N in true style of a government owned medical institution ordered me to move away from the counter and wait elsewhere till she sorted out the problem. (Do not forget that I am the only guy on the counter and am not holding up anything).

This is where I lost it and told her to shut up and seek help in organising my bill. The duty manager again materialised and after murmuring some instructions in N’s ears hurried away. N than started calling up some folks to figur out where and how to bill. Another guy sauntered up and tried finding a solution, he too seemed completely at sea. He disappeared just as quickly.

Finally after waiting for close to half an hour to get a service billed, I was handed over an invoice. And than it was discovered that while the procedure has been billed, a canula used during the procedure has not been billed and the entire pantomime of finding it in the system and billing the same was repeated.

“We are really having a serious problem with our front office executives. They are all new as the trained ones have all moved on to greener pastures and other hospitals. Even the duty managers, who would earlier get involved and sort out these problems deftly are new” admitted a friend of mine who works in the hospital. He also added that training people in understanding medical terminology and gaining proficiency on the Hospital Information System (HIS) takes time and by the time a new set of people are reasonably proficient, they move on. ( mostly to call centres, which pay a lot higher).

While I can understand the hospital’s problems, a bad patient experience is something most hospitals can ill afford. N and D and the duty manager had a problem understanding the medical terminology, they also lacked the empathy and a caring attitude that is a must for folks who work in hospitals. In this day and age, you can not be rude with patients. Moreover, as I pondered over this I realise that a small error in billing can have some very serious consequences. For, instance whatever tests are billed, will be run by the lab. If these are not what the consultant ordered…you can imagine the problems.

Considering all this, I would like to believe that investing in employee retention is far better than having a crop of new recruits manning customer touchpoints in the hospital. Cutting people costs in a hospital can really prove a lot more expensive than what a hospital might have bargained for.

Hospitals are all about people's skills

I have rarely come across an industry, which requires a range of skills, which are wider than what one sees in the people, who work in hospitals. A hospital actually is an amazing aggregation of skills and talent, which one would hardly see in any other human enterprise.

Among the medical folks, there are doctors who are hugely knowledgeable, highly educated and supremely skilled in the art and science of medicine, there are nurses and paramedics, who symbolise compassion and care and there are support folks who provide critical support for running the medical function in the hospital.

Amongst the managerial teams, there are managers who handle the front office and interact with patients and their attendants. They are the face of the hospital, well trained, well groomed very presentable folks, who help put patients at their attendants at ease. They usually have very good communication skills, are people with immense patience and a sunny optimistic disposition.

A hospital also needs a lot of technical support and thus you find high tech bio medical engineers, who ensure that all the equipment in the hospital works flawlessly. Imagine what can happen if an equipment in the OR or in the ICU malfunctions at a critical moment. Much like doctors, their role requires quick thinking, complete mastery of technical matters and planning for any eventuality. Most bio medical engineers are rarely seen and heard in the hospital but behind the scenes they control the levers of the hospital.

These days a modern hospital runs on state of the art software, which connects every hospital function. A doctor can not write his notes or ask for medicines till the orders have been punched in the Hospital Information System (HIS). The nurses can not dispense medicines unless requisitioned through the HIS. A patient can not be admitted or treated unless the relevant files and records have been created in the HIS. While most hospitals do have a back-up manual system, it is rarely used largely because an IT team employed by the hospital ensures that the HIS is rarely down. These people are often quintessential techies, with very sound knowledge of hospital systems and processes.

At a 180 degrees of separation from these folks are people who look after functions such as Food & Beverages, Housekeeping and Security. They are all trained individuals as much an expert in their areas as any techie. They interact with patients and their attendants and hence also have superb skills in handling patient grievances.

While all of those mentioned above contribute towards keeping the hospital humming, another set of people are those who manage the business side of things and have a completely different set of skills. These include the sales and marketing folks, who represent the hospital to an external environment, purchase managers and store keepers, who ensure that the hospital is well stocked with all the essential supplies and the finance guys, who keep an eye on how the money is being spent. People in all these functions have unique strengths. The finance guys are very good with numbers, the sales people drive innovation and have good communication skills and the purchase folks have tremendous negotiation skills and an uncanny smell for a deal.

A good hospital will always have good Human Resources and training personnel. They are the ones who ensure harmonious working relationships amongst a very varied and highly skilled workforce. They make the rules, which govern the conduct of individuals in the hospital, play a critial role in rewards and recognition systems, act as agony aunts and handle conflicts. To my mind the most important skill they bring to the table is an ability to get on with people, understand differing point of views and manage aspirations of a very diverse bunch of people.

If I was to select two critical skills, which an individual who aspires to work in a hospital must possess it has to be compassion and communication skills. Anyone, who works in a hospital must have loads of compassion towards fellow human beings, an innate ability to see things from the patients perspective and take decisions with empathy and with an utmost regard for the plight of the patients. The ability to communicate well with language or through a meaningful silence or by just a touch, would be a close second. Be it a doctor, a front office manager or a sales person the ability to communicate the right thing at the right time to the right person is an immensely valuable gift.

The HIS Devil in Healthcare Experiences

Information technology is meant to enhance the quality of service and experiences delivered in a hospital. Once a patient is registered in the hospital, the subsequent visits can than be recorded and the visit log used for either customising the services or improving the experiences. It also helps the hospital maintain patient records, which can be pulled out at the push of a button. These can help the medical teams see a fairly complete patient history and allow correct diagnosis.

More intelligent systems are now deployed at state of the art hospitals, which even provide aid to physicians in diagnosing and treating a patient's condition. They also ask a question and alert the doctor if they spot an anomoly. For example if a drug prescribed to be administered is contra indicated or if it has been given by another doctor on duty two hours ago, the system can raise an alert and inform the doctor. These systems are great to have.  

The only hitch with all this is that HIS systems being used by most hospitals in India deliver far less than what they promise. I have been part of various tech committees set up to evaluate these products and oversee their implementation and I must say that there exists a big gap between what is promised, what is delivered and ironically what ends up being used. 

Here is what goes wrong.

The HI systems are just unable to cope with the OPD volumes of a busy hospital. In India patients do not show up a few minutes before their appointed hour. They usually come late and expect instant service. Quite often the doctors also come in late and invariably the HI system is under constant pressure to push the patients through. The queuing system is mostly non existant. In some hospitals nurses double up as patient care executives with little knowledge of how to tackle the HIS. Patients start venting their ire on the hapless nurses and everything breaks into utter chaos. 

The doctors are still quite at sea with the computers and myriad HIS screens. Can one really blame them? In medical colleges I am not sure if they have an elementary course in managing a computer. They also train mostly in government run busy hospitals, where they have to see 100 or more patients in an hour. Now to connect with a computer is difficult for them and in the opinion of many, an unnecessary ordeal. The patients always bring their files and the doctor if necessary can scan their history from those files. 

The billing systems are unable to cope with the multiple billing requirements and rules that need to be followed. The billing is thus rarely accurate and lot to be billed is left out. The hospitals take a hit and in meetings after meetings these points are highlighted, audit committees get to have a field day and the head of operations and the head of IT a great fight.

The clinical systems are even a worse nightmare. The nurses who are supposed to use them are completely ill equipped to handle them. They have been trained all their lives to use neatly filed multi coloured charts to monitor the condition of a patient. To force them to use laptops and state of the art HIS is pretty much like asking me to try my hand at surgery. This is just not going to work till we have nurses far more educated and better trained than what we have now. Rushing them through a typical two weeks or less training programs and  expect them to master all this is unfair.

The surgeons are far more comfortable in the OR rather than in front of a computer screen filling in post operative notes or dictating in a Dictaphone, which will be transcribed by a guy whose knowledge of medicine will fit on a postage stamp.

The HI system is also touted as a great management tool as it can spew out all manner of reports. The HIS sales team merrily demonstrates the system's capabilities by generating sample reports during their sales presentations. The managers usually fall for this. Once the system is implemented the reports become the first casualty. The system usually produces raw data, which is than manually analysed and reported. What fun!

This piece is not meant to deride the HIS systems per se. On the contrary it is a lament on how the systems are used in modern hospitals in India. The way forward can not happen without HIS smoothly running the hospitals of the future. However, to reach there we need better and more Indianised Hospital Information systems, tightly defined hospital processes, and IT savvy doctors and nurses and a bottoms up approach.

The image is from www.flickr.com