Health Care for 21st Century

Information about Health Care for 21st Century

Published on December 22, 2009

Author: vmahajan



Slide 1: Health Care An Out of the box approach for the 21st Century Vipen Mahajan Principal Consultant Leo Systems Chicago, Boston, Munich, New Delhi The Planet and the 21st Century : 2 Copyright 2002, 2009 Leo Systems The Planet and the 21st Century Alvin Toffler talked about he three waves of human civilization: First Wave ;agriculture Exists in a large part of the world, esp. developing countries. Key economic: resources brute force, violence, land. Systems decentralized, asynchronous. Second Wave: Industrial most First World countries transitioned into this during the Industrial Revolution, more so after World Wars I and II. Development in the Third World countries was essentially to transition into this “modernity”. Many emerging countries like China, India, Brazil South Africa are breaking successfully into this wave. Key resources: finance, finite, rival cannot be shared. Systems centralized, need high synchronicity Third Wave: Post industrial or Information/Knowledge First world countries 40% there, others in varying stages of transition Key resource knowledge/information. not scarce, non-rival, can be share without it being depleted. Can be replicated Systems distributed and asynchronous Waves mean multiple interlocking systems, processes, people, power etc. A wave change takes time, creates chaos, etc. in short a painful process. Changing from decentralized, asynchronous to centralized synchronous systems needs major change and is disruptive. Second wave is largely responsible for “Global Warming” and modern threats to the planet, like sustainable living etc In the 21st Century we all need to catapult into the Third Wave. Increasing population, people living longer means that Health Care is/shortly will exceed 20% of the global GDP. Affecting our species. Knowledge & Open Source: Brief backgrounder : 3 Copyright 2002, 2009 Leo Systems Knowledge & Open Source: Brief backgrounder For IT and software Open Source (OSS) is arguably closest to the doctors Hippocratic Oath as against the prevalent the Industrial/Medico-corporate ethic. Allows you to see the source (blueprints), alter/improve/modify it to suit your needs, with little restrictions. Today OSS is used widely in practically every field. New solutions sprout up everyday, challenging old concepts and proprietary/closed software. Allows you to see the source (blueprints), alter/improve/modify it to suit your needs, with little restrictions. OSS can be maintained/improved even if the vendor shuts shop. No vendor lock-in. OSS often is free (to become FOSS) so you save on license fees and maintenance charges. There are over 300 F/OSS (free open source software) in Health Care domain alone. Notable amongst them is VistA a Health Care solution, not to be confused with Microsoft Vista Windows Operating system ! VistA- an overview : 4 Copyright 2002, 2009 Leo Systems VistA- an overview Developed by dedicated teams of doctors and programmers, using Open Source collaboration and RAD development process. Enterprise level, has over 150 clinical, financial and administrative modules. Cost billions of US taxpayers dollars to develop. Available as FOSS under FOIA (with limitations) Over 1000 full-time developers and support staff who maintain it. A Healthy Open Source Community (Hardhats and WorldVistA). VistA runs the US Military’s Veterans Administration (ex-servicemen) health care system. Connects over 1300 VA facilities from small clinics to large 1000 bed hospitals in a fully integrated paperless network. Serves over 25 million Veterans Proven, in use for over 40 years VistA has had rave reviews from Time, Newsweek, Washington Post Wired etc. Vista outside VA and around the world : 5 Copyright 2002, 2009 Leo Systems Vista outside VA and around the world VistA derivatives also being used in US military, US-Indian Health Care System. WorldVistA, a non-profit for VistA outside the VA has developed WVEHR- a Vista based EHR. Medsphere, DSS and others also developing on VistA base Growth into Mexico, Germany, Egypt, Finland and recently Jordan etc. VistA andImpact of US ARRA Stimulus : 6 Copyright 2002, 2009 Leo Systems VistA andImpact of US ARRA Stimulus Health care has not benefited from the IT revolution like other Industries/businesses. In US 10% mortality caused by the Health Care systems. Health care costs are galloping, making OECD economies un-viable. In Feb 2008, Obama Admin. passed $120 B ARRA act to stimulate/ streamline/modernize Healthcare through a nation-wide IT driven EHR. EHR systems proliferate, rarely talk to each other, with little standardization, much like a tower of Babel ! Obama’s CTO, Aneesh Chopra, examining if VistA could become a platform for national health care IT standard, in an IAC meeting, which has members like IBM, Dell, Oracle, CISCO etc. The jury is still out. 21st Century Technology enablers : 7 Copyright 2002, 2009 Leo Systems 21st Century Technology enablers Open Source slashes/eliminates software costs Internet slashes network costs 3G, WiMax, DSL etc allow rapid, affordable deployment of digital networks. Probably the cheapest infra-structure investment. Virtualization/Cloud/Utility/Grid computing slashes server costs. Thin Clients, net books, net-computing, PDAs, cell/smart phones slash personal computing costs Even the BOP can afford IT based solutions! An entrepreneur, with an idea can compete with an IT giant ! 21st Century Paradigm shifts : 8 Copyright 2002, 2009 Leo Systems 21st Century Paradigm shifts IT usage widespread in OECD nations IT affordable even for the BOP, i.e. 6 Billion people can be covered with IT access. Cell phones being added in tens of millions per month, in developing countries. Knowledge doubles every 2 years Distance and elearning revolutionize the spread of Knowledge, and the way we learn. ERP/CRM help to manage networked organizations of all sizes IT integrated supply/distribution chains power global commerce. 21st Century Health Care Paradigm shifts : 9 Copyright 2002, 2009 Leo Systems 21st Century Health Care Paradigm shifts Recession proof with large unfulfilled demand. Global Health Care capacity shortage Health care Accounts for nearly 20% of OECD countries GDP. VA and Vista has shown that IT driven systems result in better Health Care at lower costs. Tele-medicine, ship information not bodies! Runaway OECD health care costs make “Medical Tourism” viable Global Health Care systems/supply chains? The Indian Health Care Scene : 10 Copyright 2002, 2009 Leo Systems The Indian Health Care Scene Manpower shortages, India has 0.5 doctors and 0.6 nurses per 1000. vs. OECD’s 4-6 and 10. The problems gets worse in rural areas. Manpower and facilities acute shortages, more so in rural areas. Most health care provided by private sector. Govt hospitals in a poor state. Spurious drugs are a serious problem Rich, time tested age old alternative medicine systems, Yoga for example, need research and integration with modern systems An Opportunity for India : 11 Copyright 2002, 2009 Leo Systems An Opportunity for India An out of the box, innovative approach needed to address the needs of the BOP (Bottom of the Pyramid: CK Phralad). In a decade China, with 25% of world population, has become an Industrial Power house, and leading cause of global warming. With 20% of the global population can India contribute its bit as a leading, non-polluting resource to global health care (GHC)? Indian Scene Creating Health Care Manpower Capacity : 12 Copyright 2002, 2009 Leo Systems Indian Scene Creating Health Care Manpower Capacity With a billion plus population we have enough “raw manpower” to build a world class health care system, in fact one which can become a GHC to meet global demand too. 300,000 applicants for the 30,000 odd seats in Medical colleges. What needs to be done to increase the capacity to say 150,000 ? Distance and elearning, to meet teaching staff shortages. Can we have a few hundred thousands “barefoot doctors”, technicians, developed under short sandwich courses? They will staff the local Primary health care centers, linked by tele-medicine to centers staffed by conventional, more qualified providers/consultants and supported by secondary/tertiary/specialty hospitals Similarly for other providers. Extend the system for India/alternative health care systems like Ayurved, Yoga etc. Made possible with Open Source. Indian Scene Creating Hospital s etc Capacity:Standard Modular Facilities : 13 Copyright 2002, 2009 Leo Systems Indian Scene Creating Hospital s etc Capacity:Standard Modular Facilities Develop standard modular designs of facilities, and with a few variations, and mass produce them, in a “factory” production mode, assemble them on standard sites. This approach will slash to costs by 30-60%, and the lead time to create the infrastructure. Much like how the Chinese are able to build a 500MW power plant in 9 months while we cannot even design and send out tenders for the project. After Pearl Harbor, in WW-II, the US was able to overhaul their factories to defense production in 6 months. Producing aircraft carriers, in assembly lines in 9 months vs older ways of 10 years ! Maybe because the Chinese leaders are all engineers while we have few leaders with industrial/manufacturing expertise. Indian Scene Creating Capacitywith IT driven Processes and Management : 14 Copyright 2002, 2009 Leo Systems Indian Scene Creating Capacitywith IT driven Processes and Management Designed standard modular facilities. Design best practices, ground up for optimizing the operations of these facilities. Develop SOPs for the same, with performance metrics, for management planning and control. Train all fresher’s in these SOP’s to start at high EHR Level/stages. To achieve high quality. Replicate these facilities, by anchoring them with staff experienced in the standard SOPs. Use IT for all aspects, paperless systems with realtime planning, monitoring and control. Indian Scene Managing withEHR/HIS and ERP/CRM : 15 Copyright 2002, 2009 Leo Systems Indian Scene Managing withEHR/HIS and ERP/CRM Standardize on a EHR - VistA. Why VistA? VistA has a proven track record and a brand name Proven, Open Source. Extensible/Expandable The Window of Opportunity is small. It will take many years to develop and test a proven new system ground up. Cloud based, scaleable for a National/Global EHR network. All citizens to have a common readily accessible EHR database, designed with adequate security and safeguards/privacy. Link a cradle to grave EHR to Nilekani’s Universal Identity system. The EHR integrates to other systems, like Insurance and billing, payments, reimbursement etc. Pharma industry supply chain powered by CPOE, EHR and ERP/CRM/Supply Chain Software. Next Steps:An Implementation Guide : 16 Copyright 2002, 2009 Leo Systems Next Steps:An Implementation Guide We will setup a social networking group for VistA health care. Join it, to carry forward this discussion, and become a watering hole for like minded people to meet virtually, share thoughts and resources. Undergo an elearning exposure to VistA as well as the hands-on experience of using Vista’s GUI provider interface (that is what the doctor sees and uses on his computer), so he is comfortable with it. We use web-conferencing, Skype and emails to keep in touch. Develop eLearning based courses for training and re-learning/CME. Develop a VistA based server data centers for small hospitals, Primary Health Centers, General Practioners. Bootstrap tele-consulting, by providing part-time work to doctors for rural patients. All the time building upon the portable electronic health records of the public, so they have flexibility of choosing a provider for further consultation. Create a level playing field for the tele-consulting area. Practioners can work from home, and do not need expensive real-estate to setup their practices. His would further reduce their costs, and reduce the entry barriers for fresher’s to start their own practices. Develop standard, modular facilities designs and building standard practices. Training people in these and then commissioning them. Funding GHCP : 17 Copyright 2002, 2009 Leo Systems Funding GHCP Start developing manpower to meet global HIS and EHR systems adoption. Develop standard practices and modular facilities. Aggressively build capacity and promote Medical tourism thru select world class Indian hospital chains. The 1990’s Y2K crisis triggered of the Indian IT sectors. leverage US $16b infusion to boost the Indian EHR/HIS boom through man power exports. Master tele-medicine with rural markets, EHR and modular facilities Grab the global OECD and BOP markets. Join the Global Movement : 18 Copyright 2002, 2009 Leo Systems Join the Global Movement To read about VistA as a starter visit For more information and news enroll at: The know more about the author of this presentation see blogs at: Contact Vipen Mahajan at: [email protected] Skype ID – vmahajan Cell phone: +91-981-890-4703 India Delhi:+91-11-41635329

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