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All rights reserved. These pages are to be used for selected audience only. Distribution, quotations and duplications — even in the form of extracts — for third parties is only permitted upon prior written consent of Asclepius Consulting.
Case study– Obstetrics & Pediatrics
Patient logs into the Patient logs into the website or makes a phone website or makes a phone
call for an appointmentcall for an appointment
I rregular menses
Anita Roy
[email protected] 9899720801
Gynaecology
Dr. D. Prasad
20 OCT 2007
21 OCT 2007
Patient is given reminder Patient is given reminder about the appointment and about the appointment and current status of the queue current status of the queue
on her mobileon her mobile
SMS- 15 min delaySMS- 30 min delaySMS- 1 hr delaySMS- 2 hr delaySMS- 4 hr delaySMS- 1 day delay
Patient gets a unique Patient gets a unique registration number for registration number for
all subsequent visitsall subsequent visits
RBN20071021012 ROY O +VE
17 NOV 1969HOUSEWIFEMRS
ANITAMARRIED
C-56, FIRST FLOOR
ARDEE CITY
NEW DELHI
DELHI
110016
2210221
997202225
ANITA@GM
DILEEP
ROY
HUSBAND
9972022251
Patient meets the relevant Patient meets the relevant doctor, fee is collected based doctor, fee is collected based
on relevant price liston relevant price list
Charges calculated based on Doctor’s SpecialtyDoctor’s SeniorityVisiting doctor’s own OP ratesDate of last visitCross-referral chargesPatient category discountsCorporate/ Insurance rate listsPatient’s income category
Charges calculated based on Doctor’s SpecialtyDoctor’s SeniorityVisiting doctor’s own OP ratesDate of last visitCross-referral chargesPatient category discountsCorporate/ Insurance rate listsPatient’s income category
31 yrs 11 mon 8 d Female OPD
--1
Suspected pregnancy
3 w
Past cycle 10-12 / 24-25 days Para 1 + 0. Last child age 3 yrs. 2 month amm
Mother with asthma
Obstetrical and menstrual History
Past Medical & Surgical History
NA
98
Per abdmonial examination shows a lump arising from the pelvis 8-10 week size. Per vaginal examination shows uterus 14-16 week size mobile
I rregular menses with bulky uterus suggestive pregnancy
80
Anita Roy
Family History
Duration of present complaint
Doctor takes the relevant Doctor takes the relevant history, conducts systemic history, conducts systemic examination and records examination and records
provisional diagnosisprovisional diagnosis
Doctor takes the relevant Doctor takes the relevant history, conducts systemic history, conducts systemic examination and records examination and records
provisional diagnosisprovisional diagnosis
31 yrs 11 mon 8 d Female OPD
--1
Suspected pregnancy
3 w
Past cycle 10-12 / 24-25 days Para 1 + 0. Last child age 3 yrs. 2 month amm
Mother with asthma
Obstetrical and menstrual History
Past Medical & Surgical History
NA
98
Per abdmonial examination shows a lump arising from the pelvis 8-10 week size. Per vaginal examination shows uterus 14-16 week size mobile
I rregular menses with bulky uterus suggestive pregnancy
80
Anita Roy
Family History
Duration of present complaint
My Templates
History & Physical
Obs & Menses
I nfertility
I rregular menses
Hysterectomy
Ovarian cancer
Pregnancy
Rupture uterus
Vaginal discharge
Family
Ellipsis
Asthma
I nfertility
Diabetes
Cardiac
J aundice
Prov. Diagnosis
Fallopian Tube
Vesicular stone
Uterine fibroid
Pregnancy
Systemic Exam
Orders
Follow up
Based on the provisional Based on the provisional diagnosis, additional diagnosis, additional
investigations and medications investigations and medications are ordered using templatesare ordered using templates
Pregnancy is confirmed after Pregnancy is confirmed after the USG – radiology reports the USG – radiology reports and images are available to and images are available to
doctor at her computerdoctor at her computer
Anita Roy
31 yrs 11 mon 8 d Female Room #6 Bed #3
Full term pregnancy1
Irregular menses with pain in lower abdomen since 21/04/2007
Bulky uterus since 21/04/2007
Chest X Ray received at 22/10/2007 10:05 AM
Pharma Order: Autrin at 21/10/2007 6:10 PM
Radiology order: ECG order at 21/10/2007 6:10 PM Appears at emergency with full term on 22/10/2007 11:30 PM
Excessive menstrual bleeding since 18/10/2007
GENERAL EVALUATION:
Fetal Cardiac Activity: Normal at 141 BPM.Fetal Lie: LongitudinalFetal Presentation: CephalicPlacenta: Anterior, Grade II.Uterus: NormalCervix: ClosedAdnexa: Not seen.Amniotic Fluid: NormalBIOMETRY:BPD: 6.4cm consistent with 38 weeks, 2 daysHC: 33.1cm consistent with 37 weeks, 5 daysAC: 37.0cm consistent with 40 weeks, 6 daysFL: 7.7cm consistent with 39 weeks, 3 daysCI (BPD/OFD): (70-86) 83FL/BPD: (71-87) 82FL/HC: (20.6-23.4) 23.3FL/AC (20-24) 21HC/AC: (0.87-1.06) 0.89
I mages
Anita Roy
41 yrs 11 mon 8 d Female Room #6 Bed #3
Irregular menses with pain in lower ...1Pregnancy 1st trimester. Routine investigations
Routine investigations are Routine investigations are ordered using templates and ordered using templates and results are compiled centrallyresults are compiled centrally
The hospital reminds the patient The hospital reminds the patient of the next appointments – and of the next appointments – and
gives education material for gives education material for each trimester- using pre-each trimester- using pre-
defined templatesdefined templates
Anita Roy
31 yrs 11 mon 8 d Female Room #6 Bed #3
Full term pregnancy1
Irregular menses with pain in lower abdomen since 21/04/2007
Bulky uterus since 21/04/2007
Chest X Ray received at 22/10/2007 10:05 AM
Pharma Order: Autrin at 21/10/2007 6:10 PM
Radiology order: ECG order at 21/10/2007 6:10 PM Appears at emergency with full term on 22/10/2007 11:30 PM
Excessive menstrual bleeding since 18/10/2007
Patient Education
Asthma during pregnancySince asthma is a very common disease affecting millions of people, it is not strange that lots of mothers-to-be would be suffering from asthma as well. Asthma often worsen during pregnancy, especially in conditions that are already severe. There are others who improve during pregnancy, especially if their disease was mild before they became pregnant. Another third experience no change. Cases where asthma or asthma attacks become worse, they mostly occur during 24 to 36 weeks of pregnancy. Only about 1 in 10 women with asthma have symptoms during delivery.Medication - to take or not to takeContinuing to take asthma medications during pregnancy is a must. One can do worse damage by not taking them.Today there are many excellent medications for treating asthma and allergies. Although no medication can be proven entirely safe for use during pregnancy, the patient and the doctor can work together to develop a treatment plan that carefully balances medication use and symptom control, and assures that the potential benefits of the medication outweigh the potential risks of the medication and of uncontrolled asthma.Can one take allergy shots during pregnancy?Allergy shots do not have an adverse effect on pregnancy, so they can be continued. As always, your allergist will monitor your dose to lessen the risk of an allergic reaction to the shots. These reactions are rare; however, such a reaction could be harmful to the fetus. Allergy shot treatments should not be started for the first time during pregnancy
Asthma
Medicine
Allergy
Dietary
Exercise
Patient appears at Patient appears at emergency without any emergency without any
records – triage records – triage conducted at the ERconducted at the ER
Severe pain
60
40
99.1 125
10080
Full term pregnancy Under hospital supervision
31 yrs 11 mon 8 d Female Emergency
Full term pregnancy-4Anita Roy
Attending doctor views Attending doctor views patient history allergies, patient history allergies,
radiology reports, radiology reports, medications, past lab results medications, past lab results
and other specific instructionsand other specific instructions
The admitting doctor The admitting doctor consults with the attending consults with the attending
gynecologist on phonegynecologist on phone
Doctor advises admission, Doctor advises admission, patient appears for patient appears for
estimation and finds out the estimation and finds out the deposit amountdeposit amount
The provisional diagnosis The provisional diagnosis and the estimate are sent to and the estimate are sent to
the cashless insurance the cashless insurance company with the necessary company with the necessary
pre-authorization form pre-authorization form
Patient is allocated a room Patient is allocated a room based on the patient choice based on the patient choice
and availabilityand availabilityMRN2345566Asha Goyal , F/21Uterine FibroidDr. B.Prasad
MRN2345566Asha Goyal , F/21Uterine FibroidDr. B.Prasad
OT is scheduled for the OT is scheduled for the patient based on the patient based on the
availability of the visiting availability of the visiting surgeonssurgeons
Anita Roy
41 yrs 11 mon 8 d Female Room #6 Bed #3
Irregular menses with pain in lower ...1
Nurses place the ward charges Nurses place the ward charges directly to the patient account directly to the patient account
at the point of care – rather at the point of care – rather than making paper chargesthan making paper charges
All orders for the patient are All orders for the patient are consolidated for quick review consolidated for quick review – thus minimizing follow up – thus minimizing follow up
needsneeds
The relevant lab results are The relevant lab results are consolidated in clinically consolidated in clinically
useful forms for the doctoruseful forms for the doctor
Order Flag
Pre-op checklists given to Pre-op checklists given to nurse using templates – nurse using templates –
patient is monitored through patient is monitored through flowsheet and chartsflowsheet and charts
ITEMSSystolic BP
Diastolic BP
Primary surgeon : Dr. D. SinhaProc surgeon : Dr. R. GuptaMonitoring staff : ShyamalaMonitoring start :10/11/2007 11:00 am
120
100
80
60
40
Anita Roy
41 yrs 11 mon 8 d Female Room #6 Bed #3
Irregular menses with pain in lower ...1
OT notes during the OT notes during the surgery prepared using surgery prepared using
templatestemplates
After the surgery, the After the surgery, the patient is monitored and patient is monitored and
medication record medication record preparedprepared
Anita Roy
41 yrs 11 mon 8 d Female Room #6 Bed #3
Irregular menses with pain in lower ...1
The patient account balance The patient account balance is periodically reviewed and is periodically reviewed and
additional deposits are additional deposits are requested, if neededrequested, if needed
Direct material are tracked Direct material are tracked to the patient consumptionto the patient consumption
Consumption is tracked to Consumption is tracked to the departments, based on the departments, based on budgetary guidelines; while budgetary guidelines; while the inventory is tracked at the inventory is tracked at the stores and sub-storesthe stores and sub-stores
Discharge summary is Discharge summary is automatically prepared automatically prepared and specific follow up and specific follow up instructions are given instructions are given
using templatesusing templates
ANITA ROY
HOUSEWIFEFEMALE17 NOV 1979
Emergency arrival with labor pain
Routine investigations to establish surgical fitness – USG, CBC, routine urine, blood sugar, serum, SGPT
Full term pregnancy requiring Cesarean section
Cesarean section was conducted. Infant and mother recuperated sufficiently. The postoperative period was uneventful. Some bleeding seen, mostly in the anterior uterine wall.
Discharge bill is immediately Discharge bill is immediately consolidated based on all the consolidated based on all the
charges made through the charges made through the patient staypatient stay
Baby is automatically Baby is automatically registered in the hospital registered in the hospital
for subsequent visitsfor subsequent visits
Pediatrician assigned, Pediatrician assigned, history and vitals history and vitals
maintained as medical maintained as medical recordrecord
1
0 yr 0 mon 2 d
Nil Nil
-
Nil
-
Born of LSCS. Uneventful birth.
Maternal grandmother with a history of asthma
18
6.2
Nil
Nil
Education material on Education material on baby care given using baby care given using
templatestemplates
Baby Nutrition TipLearn what healthy nutritional needs your new baby or infant has. The below tips will help you decide what feeding schedules and baby food is age appropriate for you child. When Can Baby Drink Water?Nighttime Feeding WeaningHow Often Should You Breast Feed Baby?What Mom Should Eat While Breast FeedingStoring Homemade Baby FoodBaby Clothing Tip These baby clothing and apparel tips will help you pick the right clothing styles that are safe, comfortable, and seasonally appropriate for your baby. Read how you can make the most of your baby clothing budget and not over buy certain items. Baby Behavior Tip
Learn all about your babies cries? Is she hungry, sick, or just need attention? Find more information and tips about why your baby fusses, smiles and acts the way she.
Patient Education
Reminders for immunization Reminders for immunization and birthday wishes given and birthday wishes given
for entire 5 yearsfor entire 5 years
Immunization due RBN071020013
The patient logs in the The patient logs in the hospital website to download hospital website to download
discharge summary, lab discharge summary, lab reports, bills and seek reports, bills and seek
appointmentsappointments
Welcome Ms. Anita Roy
The documentation generated –for The documentation generated –for clinical as well administrative clinical as well administrative
workflow – closely meets the HL7 workflow – closely meets the HL7 and NABH guidelinesand NABH guidelines
Extensive graphical Extensive graphical reports and excel–like reports and excel–like queries are generated queries are generated
based on the billing databased on the billing data
The reporting tool is The reporting tool is leveraged to carry out leveraged to carry out
patient research based on patient research based on clinical conditions clinical conditions
Asclepius Consulting Asclepius Consulting collaborates with the collaborates with the hospital to generate hospital to generate
specific dashboards to specific dashboards to Report-by-ExceptionReport-by-Exception
Operations
Customers
Investors
Partners
Employees
Innovation
DASHBOARD METRICS
• Effective Surgical Revenue (ESR)• Effective Bed Revenue (EBR)• Effective Diagnostic Revenue (EDR)• Operating costs
• ROCE• Operating Margin• PAT growth• Cost of Capital
• No. of partner patients• No. of referrals from partners• Operating margin at partner sites• No. of technology transfer
initiatives underway
• Attrition rate• No. of training days• No. of full time doctors• Employee satisfaction
index1
• No. of case sheets generated
• No. of research published• No. of technology
initiatives underway
• Average revenue/ patient• Market share• % of repeat patient • Patient satisfaction index
Operating costs• Consumable costs• Salary costs• Rental costs• Pharmacy costs• Marketing costs• General Admin costs
Operating costs• Consumable costs• Salary costs• Rental costs• Pharmacy costs• Marketing costs• General Admin costs
Consumable costs• Direct material• Overhead material• A- Category material purchase• Avg. direct consm per patient
Consumable costs• Direct material• Overhead material• A- Category material purchase• Avg. direct consm per patient
Average revenue/ patientMarket share% of repeat patient Patient satisfaction index
Attrition rateNo. of training daysNo. of full time doctorsEmployee satisfaction index1
ROCEOperating MarginPAT growthCost of Capital
Effective Surgical Revenue (ESR)Effective Bed Revenue (EBR)Effective Diagnostic Revenue (EDR)Operating costs
Operating costsConsumable costsSalary costsRental costsPharmacy costsMarketing costsGeneral Admin costs
Operating costsConsumable costsSalary costsRental costsPharmacy costsMarketing costsGeneral Admin costs
No. of partner patientsNo. of referrals from partnersOperating margin at partner sitesNo. of technology transfer initiatives underway
No. of case sheets generatedNo. of research publishedNo. of technology initiatives underway
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J.P. Nagar, 6th Phase,Bangalore – 560078
Tel: +91 80 4165 0200 +91 99720 22250
www.asclepiusconsulting.com