My comments on the Care2x list at sourceforge
I noticed that there is considerable interest in Care2X deployment in India, so i thought i will share my thoughts and our experiences.
A. Number of implementations of Care2x are not substantial, and also not much publicised
B. There is considerable amount of customization needed to make Care2X suitable for local needs
C. Most importantly, Care2X is a comprehensive solutions for HIS needs, but in India we are stuck with a unique problem of not having enough IT savvy medical and support staff to efficiently use the system. This is both because of lack of time and education.
However, Care2x is a powerful system which can help integrate the various departmental data in a single solution, not to mention the world wide support available from dedicated developers. We, at vaatsalya, promote care2x on our website and are keen in developing it further.
Now coming back to whats possible and what we are doing.
We have looked at the HIS needs in India, considering the fragmented health care industry and broken it down into following sections
A. Rural/Semi-urban single practice: Typically a single doctor working in a 300-400 sq. ft. with basic amenities. Typically, doesnt even have an X-ray or a lab. Here we need a very basic system which can capture the clinical information, along with demographics and a referral system to higher centres is needed.
a) User friendly
b) Affordable/low cost of adoption
B. Polyclinic practice: 2 or more doctors working together sharing common staff, typically 15 – 25 beds. Doctors and nurses are typically pressed for time, and WILL not enter data into the computer. Has access to pharmacy, X-ray and laboratory, and needs a system to capture clinical (Inpatient, Outpatient), demographic, laboratory, pharmacy, radiology information and a referral system along with billing and insurance linkup.
a) User friendly and training for front office staff to double up as data entry professionals
b) Low cost of adoption and scalability
c) Extensibility to add more modules
C. Multispeciality Hospital: 2 or more specialists working together, sharing resources, typically 20 – 40 beds. No time available for any one. Full fledged hospital with inpatients, ICUs, Operation theatres. Need a high end system which can be deployed across the hospital which enables data sharing in realtime, has operation theatre module, scheduling, pharmacy, billing, insurance, radiology and possibly tele-radiology and clinical research modules.
a) 24/7 IT support and training of dedicated data entry personnel
b) Low cost of adoption and scalability of system
c) Extensibility to add more modules
D. Tertiary Care Hospital: I dont need to dwell on this, these guys typically have a large IT team which basically tells the management how to create more jobs for the IT teams! Very few players in this segment, concentrated in metro cities.
E. Network of Hospitals: Hospitals run by corporates or missionary organisations or by non-profit groups. This is where there a large impact to make a difference, in addition to A and B above.
These networks usually have highly efficient hospitals, which provide excellent care, have extremely dedicated teams and are extremely progressive. However, funding is a constant worry, but groups manage to do an excellent job within resources available. Network hospitals range from stand alone polyclinics to large tertiary care hospitals, and the main requirement is efficient sharing of clinical, laboratory and radiological information along with billing and insurance. In addition to the HIS for the hospital network, what is needed is a management console (what i like to call the hospital resourse planning software, HRP) which can help in monitoring all the different aspects of the hospitals, and not limited to clinical care. I would include resource planning, salary, stock and inventory, pharmacy, scheduling, appointment management, health education, outreach, tendering, reporting etc.
So, now that we have broken down the segments, this is what we are doing about it. We are looking at open source solutions suitable for each segment and customise it for individual hospitals. We have identified a few IT service providers, and depending on the skill sets available and the expertise, we work with them to customise the software. We realise that there is a large talented IT pool, but what is happening is that the IT companies are handing out solutions that they can build as opposed to building solutions that the hospitals need. At Vaatsalya, our goal has been to leverage both our clinical and IT experiences to design affordable, and scalable systems which are doctor friendly.