Healthcare IT Market Scenario - India

8/3/2019 Healthcare IT Market Scenario - India

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Healthcare IT Market Scenario India

Quazi Faizan Ahmad

Market Manager IndiaWolters Kluwer Health | UpToDate

Email : [email protected]: +91-9312932620
mailto:[email protected]:[email protected]


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Indian Market An Overview

Medical Education System in India

Teaching Institutions Major & Minor

Medical Libraries & Library Consortias

Beta Sites survey

Champions survey

Summary

Scope

2


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3

Prelude.

This is an effort to project a more realistic and ground situation,generally, on overall Healthcare market in India with a focus onHealthcare IT market.

During the entire presentation all the data are presented as it is and

references are cited wherever required.

Any classified data, during survey or elsewhere has not been reproducedhere and cannot be shared on request.

The survey was done for UpToDates market analysis and only someexcerpts are presented here.

Though, a summary is given at the end, any conclusive inference isavoided.


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Overall Healthcare market estimated at $ 40 B, and growing @ 1214%annually

59% of total expenditure is on Primary healthcare while 39% is onSecondary and Tertiary Care

Private healthcare providers accounts for almost 80% of totalexpenditure

Institutions, both Public & Private, are involved in Teaching andHealthcare deliveries

Like any market, Institutional market in India can be segmented asTeaching & non-Teaching and Private & Public

Though monitored, market is open for private investment at bothteaching and non-teaching front

4

Healthcare in India Emerging Market, a report by PriceWaterhouseCoopers, 2007 Retrieved from www.pwc.com/globalhealthcare on August 2, 2011

Indian Healthcare Sector, a report by Indian Law Offices, Retrived fromwww.indialawoffices.com on August 5, 2011

HEALTHCARE, a report by Indian Brand Wquity Foundation, 2007, Retrived fromwww.ibef.org on August 5, 2011
http://www.indialawoffices.com/http://www.ibef.org/http://www.ibef.org/http://www.indialawoffices.com/


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India has only 0.7 beds per 1,000 people, far below the global averageof 2.6.

Needs to add 2 million beds to the existing 1.1 million by 2027, and

requires immediate investments of $82 billion to make up for itsinfrastructure deficit.

Needs $50 billion annually for the next 20 years to meet the healthcare

needs of its rapidly expanding population.

5

Facts & Challenges





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Healthcare emerged as an industry for both deliveries and teaching

Private segment in India is one of the largest in the world

80% of all qualified doctors are involved in private practice

75% of all dispensaries are private 70% of hospitals and 40% of the hospital beds are private

Over 80% new investments are private

Private investment revamping the industry as funds are available readily

Infrastructure and technology improving drastically due to fast privateinvestments

Majority of leading Tertiary Hospitals are privately managed

6

Private Contribution





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Despite recent ascendancy as the hub of the IT and IT-enabled services,lagged tremendously behind other countries in Healthcare IT adoption

Unlike Finance, banking & education, Healthcare is one sector where IT

impact not so conspicuous yet

Large corporate hospitals in India spend under 1% of their operatingbudget on IT, while spending is closer to 3% in the West

Barring a few preliminary attempts to computerize basic hospital

administrative and some clinical functions, there has been littleappreciation or impetus given to HIT adoption

Major investments are towards upgrading basic infrastructure &networking

7

Healthcare IT Adoption

Current Situation:

India HIT Case Study, by Pushwaz Virk, Harvard University; Sharib Khan, Columbia University; Vikram

Kumar, Dimagi Inc. The National Bureau of Aasian Research, 2007


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Healthcare organisations are presently aggressive in adopting IT solutions

Though, official HIT adoption or implementation policies are almostnonexistent however, there are serious exploratory initiative by

government to facilitate HIT adoption through:1. Framework for Information Technology Infrastructure for Heath: A guideline

document and comprehensive roadmap that prescribe IT standard

2. National Knowledge Commission: A high level advisory body with the

objective of transforming India into a knowledge society, ranging from

education to e-governance of a working group focused on HealthInformation Technology

India has the fastest growing healthcare IT market in Asia, with anexpected growth rate of 22 %, followed closely by China and Vietnam

8

Healthcare IT Adoption

Recent Trend:

India HIT Case Study, by Pushwaz Virk, Harvard University; Sharib Khan, Columbia University; Vikram

Kumar, Dimagi Inc. The National Bureau of Aasian Research, 2007


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Healthcare is delivered at all the levels Individual Physicians, Specialistclinics, Primary Healthcare Centres, Nursing Homes/Poly Clinic andHospitals

Primary health centres are the cornerstone of the health care system

A tiered health care system that funnels more difficult cases intohospitals while attempting to provide routine medical care at primarylevel

Most in-patient services are delivered through 110 bed nursing homes,which are usually staffed by a single physician.

Secondary Care is provided at district level while Tertiary Care is limitedto few major cities only

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Healthcare Providers





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Summarily :

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Level Public Private

Primary PHC and its Sub-Centers Traditional Practitioners

Secondary District Hospitals Private Clinics Small Nursing Homes

Tertiary Teaching Hospitals Private Clinic Nursing Homes

Corporate Hospitals


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The government provides and manages the majority of the servicesthrough a hierarchical network of Primary, Secondary and TertiaryHospitals at various rural and urban areas

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Public:


Structure of Government Healthcare Services

Primary Care(in rural areas)

22,271 - Primary Healthcare Centers 137,271 - Sub-Centers

Secondary Care

(in smaller towns and cities)

1,200 - PSU (public sector units) hospitals

4,400 - district hospitals 2,935 - community healthcare centers

Tertiary Care(In Major Cities)

117 Hospitals (mainly attached with medicalcolleges)

Healthcare Indicators, a report by Ms. Srimoti Mukherji, Commercial Specialist at The U.S. Commercial

Service in India, Retrieved from www.trade.gov on July 28, 2011
http://www.trade.gov/http://www.trade.gov/


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A fee-levying private sector, assumed to be more responsible, co-existswith public healthcare

Consist of individual private practitioners at Primary level and nursing

homes, charitable hospitals and corporate hospitals at Tertiary level Numerous and fragmented, an estimated 45,000 Hospitals & Nursing

Homes (Secondary & Tertiary)

Average size of private hospitals/nursing homes is 22 beds, which is lowcompared to other countries.

12

Private:


Average size of Private Hospitals & Nursing Homes

> 200 Bedded = 1% 100-200 Bedded = 5%

30-100 Bedded = 10%


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There is no minimum quality standard laid down by Government Accreditation of healthcare providers is voluntary

The most respected accreditation for healthcare providers in India are:

1. NABH (National Accreditation board for Hospitals & healthcare Providers):

an initiative by the government under Quality Council of India to establish& operate accreditation programs for healthcare organizations

2. Joint Commission International: An independent international body involved

in the provision of accreditations for healthcare organizations

Under both of them PoC tool is recommended but not compulsory

As of date there are only 101 Hospital (94 private) and 16 hospitals(allprivate) have been accredited by NABH and JCI

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Healthcare Providers Accreditation

http://www.nabh.co/main/ Retrieved on August 23, 2011

http://www.jointcommissioninternational.org/ Retrieved on August 23, 2011
http://www.nabh.co/main/http://www.jointcommissioninternational.org/http://www.jointcommissioninternational.org/http://www.nabh.co/main/


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Medical Education System

There are 2 bodies under Ministry of Health & Family Welfare whichgoverns & monitors Medical Education in India

1. Medical Council of India: The council affiliates to all medical colleges

in the country to conduct Under-Graduate & Post-Graduate medical

courses2. National Board of Examination: The board gives recognition to

medical colleges & Hospitals to conduct Diplomat of National Board(DNB) examination

Besides, Directorate General of Health Services is an attached

office which renders technical advices on all medical and publichealth matters

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Governing Bodies

http://mohfw.nic.in/ Retrieved August 6, 2011
http://mohfw.nic.in/http://mohfw.nic.in/


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Medical Education System

Major courses are offered by MCI & NBE

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Courses available

CoursesDuration(Years)

Doctors Profile [after the course completion]Governed

by

Graduate 5 Intern, Resident [student] MCI

Post-Graduate

Diploma 2

Resident, Registrar, Junior Doctor, Consultants Assistant

[student] MCI

Post-GraduateMasters

3 Consultant MCI

DNB 3 Consultant NBE

Super Specialty 2 Consultant MCI

Doctorate 3-5 Consultant MCI

http://www.mciindia.org/ Retrieved August 8, 2011

http://www.natboard.edu.in/ Retrieved August 10, 2011
http://www.mciindia.org/http://www.natboard.edu.in/http://www.natboard.edu.in/http://www.mciindia.org/


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Teaching Institutions

Various institutions, both public & private, are engaged in teaching

These can be defined as Major & Minor as:

1. Major: Institutions (both Public & Private) set up mainly for the purpose of

teaching and are affiliated by MCI. These institutions also have a hospital

attached2. Minor: Institutions (both Public & Private) set up mainly for the purpose of

healthcare delivery but are also recognized by NBE to conduct DNB

examinations

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Major & Minor

DNB is a prestigious certificate considered equivalent to PG Masters

Some Major Teaching hospitals also have DNB courses

All major corporate hospitals have DNB courses since it helps them retainingquality residents and also positions them as academic oriented qualityhealthcare provider


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An institution in India can conduct medical teaching for any of thecourses offered by MCI as long as it meets the minimum requirementdefined by MCI

A total 396 institutions in India have been affiliated by MCI to conduct any

medical teachings

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Major

1. Graduate2. Post Graduate Diploma3. Post Graduate Masters

4. Super specialty5. Doctorate

An institution may offer one or more than one courses

All these institution have a full fledged hospital attached

http://www.mciindia.org/http://www.mciindia.org/


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Major

Accordingly these institutions may be defined as Level-1, Level-2 or Level-3institutions

1. Level -1: Institutions offering only Graduation courses

2. Level -2: Institutions offering both Graduation & Post Grad Courses but mayor may not have super specialty program

3. Level -3: Institution offering either Post Grad, Super Sp or Doctorate but noGraduation program

Rational of levels:1. Level -1: These are smaller institutes thus, invest less on training and

development as well as on library2. Level -2: These are the large and the major teaching institutions and also

have good library budget3. Level -3: These institutions are generally involved in major research works so

has only subject oriented library


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Following are the numbers:

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Major

Total Teaching Institutions 396

Public 208

Private 188


Courses Public Private Total

Graduate 154 181 335

PG Diploma 124 85 209PG Masters 149 114 263

Super specialty 78 25 103

Doctorate 4 0 0

Numbers according to Courses:


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Numbers according to Levels:

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Major

Courses Public Private Total

Level -1Only Graduate

38 68 106

Level -2Graduate + Post Grad

115 113 228

Level -3Either Post Grad, Sup Sp or Doctorate

but No Graduation

84 7 91



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An institution in India can apply for and conduct examination forDiplomate of National Board (DNB) as long as it meets the minimumrequirement defined by National Board of Examination (NBE)

A total 204 institutions in India have been recognized by NBE

An institution may offer one or more than one courses

NBE may de-recognized any institution thus, numbers keep changing

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Minor

Total DNB offering Hospitals (2012) 204

Public 33

Private 171

http://www.natboard.edu.in/http://www.natboard.edu.in/


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Every medical teaching institution is required to maintain a library The librarys richness in public institutions depends on the funds made

available by the Government

For private institutions (Major), there is a minimum requirement

guideline by MCI: Level -1 Institutions: Minimum 100 journals subscribed in first 5 years

including at least one third of them should be international Title

Level -2 & Level -3 Institutions: Minimum 7 Journals in each specialty

including minimum 4 international Title

Digital library has not been mandated by MCI

For DNB besides textbook, institution is required to maintain a digitallibrary with DELNET network and should have at least one internationaland one national journal in each specialty

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Librarys basic requirement


MCI Guideline for Medical college with 50 admissions
http://www.natboard.edu.in/http://www.natboard.edu.in/


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Institutions traditionally maintains a print library as it is also easy toproduce during audit by MCI

Almost 50% medical libraries has 1-10 computers only

In many institutions a digital library is limited to open access resources

Most of the institutions are lacking necessary infrastructure to maintaine-resources

Only few (25%) medical libraries in India has a separate digital librarywith electronic database, full text e-journals etc

Consortia based e-resource subscription is gaining popularity as manyconsortia have formed

Most of the digital library with e-sources are part of any consortium

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Librarys current situation

Farahi and Gandhi, Adoption of information technologies in medical libraries in Karnataka, India andIran: A comparative study, International Journal of Library and Information Science Vol. 3(2), pp. 38-45,February 2011


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India does not have a very rich tradition of consortia arrangements orresource sharing amongst libraries

Post 1990s, a few efforts have been made in different levels to provideshared web-based electronic resources amongst the research, academic,and technical libraries in India

Few important consortia's among medical libraries are

1. UGC-INFONET E-Journal consortium

2. ERMED Consortium (Electronic Resources in Medicine)

3. HELINET (Health Science Library and Information Network)

4. NTRMED (NTR MEDNET)

5. A country wide license of the Cochrane Library by ICMR for every Indian

Besides, National Medical Library is a free to all medical reference library

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Consortias

Jiban K. Pa and Prabir Kumar Das, Progress Through Partnership Consortia Based e-Resource Subscription Initiatives in India, Library Documentation & Information ScienceDivision, Indian Statistical InstituteSatish S Munnolli, An Overview of Health Science Information System in India: Librarians Point of View, Advanced Centre for Treatment, Research & Education in CancerKumar & Murthy, Consortium for Medical Libraries in India Abroad: A Study, 6th Convention PLANNER - 2008, Nagaland University, Nagaland, November 06-07, 2008


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1. UGC-INFONET E-Journal consortium UGC has initiated the UGC-INFONET E-Journal consortium

The largest consortium in India with a vision to reach every university

Under the consortium, about 494 full text scholarly electronic journals in

Medicine and open access databases like PubMed Central, Biomed Central,High wire Press and Public Library of Science, Directory of online journalsetc can be accessed

Open to all UGC Funded (Public) University

UGC affiliated (Private) universities can also join @ Rs. 5,000.00 per annum

and enjoy prices as low as 60-90% Access through IP address validation

Currently 294 universities are member of this consortia

25

Consortias

GUIDELINES FOR UGC-INFONET Digital Library Consortium during the XI Plan Period (2007 - 2012), UNIVERSITY GRANTS COMMISSION, BAHADUR SHAHZAFAR MARG, NEW DELHI

Kumar & Murthy, Consortium for Medical Libraries in India Abroad: A Study, 6th Convention PLANNER - 2008, Nagaland University, Nagaland,November 06-07, 2008


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2. ERMED Consortium (Electronic Resources in Medicine) ICMR (Indian Council of Medical Research), established ERMED-India

Consortium to support Biomedical Research & Development in India

Initially, 39 centrally funded Government Institutions including 10 Director

General of Health Services libraries, 28 ICMR Libraries and AIIMS library

were given membership

Today, its the largest medical e-resource consortia

Now also open to select private teaching institutions on cost sharing basis

1812 Tittles available through various publishers

26

Consortias

Jiban K. Pa and Prabir Kumar Das, Progress Through Partnership Consortia Based e-Resource Subscription Initiatives in India, Library Documentation & Information ScienceDivision, Indian Statistical InstituteSatish S Munnolli, An Overview of Health Science Information System in India: Librarians Point of View, Advanced Centre for Treatment, Research & Education in CancerKumar & Murthy, Consortium for Medical Libraries in India Abroad: A Study, 6th Convention PLANNER - 2008, Nagaland University, Nagaland, November 06-07, 2008http://www.nmlermed.in/ Retrieved on August 21, 2011
http://www.nmlermed.in/http://www.nmlermed.in/


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3. HELINET (Health Science Library and Information Network) Set up 2001 by Rajiv Gandhi University of Health Sciences, Karnataka

Today largest consortia for Private Institutions

Covers 666 institutions including Medical, Dental, Pharmacy, Nursing and

other allied sciences colleges in the state (Karnataka) Major e-resources available

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Consortias

Satish S Munnolli, An Overview of Health Science Information System in India: Librarians Point of View, Advanced Centre for Treatment, Research & Education in Cancer

Kumar & Murthy, Consortium for Medical Libraries in India Abroad: A Study, 6th Convention PLANNER - 2008, Nagaland University, Nagaland, November 06-07, 2008

http://www.rguhs.ac.in/HELINETHOSTCONSORTIUM/homehelinethost.htmRetrieved on August 21, 2011

1. Science Direct2. Ovid3. MD Consult

4. Annual Reviews

5. Springer6. Thieme7. Verlag

8. Taylor & Francis

9. Blackwell10. Bentham11. Ebrary

12. Oxford University Press
http://www.rguhs.ac.in/HELINETHOSTCONSORTIUM/homehelinethost.htmhttp://www.rguhs.ac.in/HELINETHOSTCONSORTIUM/homehelinethost.htmhttp://www.rguhs.ac.in/HELINETHOSTCONSORTIUM/homehelinethost.htm


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4. NTRMED (NTR MEDNET) Set up in 2005, this is the Digital Library Consortium (named as NTR

MEDNET) of NTR University of Health Sciences

Available to all affiliated colleges

Also member of ERMED

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Consortias



http://ntrmedmednet.edu.in/ Retrieved August 6, 2011

5. The Cochrane Library

ICMR funded The Cochrane library from 27 January 2007

The Cochrane Library is freely available to all residents of India who has

internet access
http://ntrmed.com/http://ntrmed.com/http://www.rguhs.ac.in/HELINETHOSTCONSORTIUM/homehelinethost.htm


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National Medical Library Under administrative support from Director General of Health Sciences and

supported by WHO, National Medical Library has set up a network of health

science libraries in India

Has 6 Regional Medical Libraries and 8 Resource Medical Libraries in the

country

Also the national focal point of HELLIS Network set up by the WHO in

Southeast Asia in 1982

Open to all Medical, Para-Medical & Allied Professional

Also member of ERMED

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Medical Reference Library



http://www.nml.nic.in/ Retrieved on August 21, 2011
http://www.nml.nic.in/http://www.nml.nic.in/http://www.nml.nic.in/


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Beta Sites Survey

11 Beta Sites, which are the sites of Reference Value, selected for survey

Criteria of Site Selection:

Various independent studies has reported leading hospitals in the country

11 leading hospital selected and surveyed

A standard questionnaire used for data collection

Information collected through websites, personal visit and telephonic calls

Data collected are linked here while Graphics or Matrix format used topresent finding in the following slide

30


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Beta Sites Survey

1. Teaching/Non-teaching

Among all Beta Sites, all teaching Sites are

Public and Non-Teaching Sites are Private

2. Courses Offered

All teaching sites offer UG, PG & Sup Specialtycourses while Private sites only Minor Teaching

with DNB

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Findings

Beta Sites Surveyed

Teaching 5 Public

Non-Teaching 6 Private

Courses Offered

PublicUnder Grad, Post

Grad, Super Specialty

Private DNB


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Beta Sites Survey

3. Size

Among all Beta Sites, Public Hospitals are

largest where average beds are over 1600

while Private Hospitals have less than 600

beds

4. Doctors

Number of residents found to be more

than consultants in Public sites than moreconsultants in Private sites

32

Findings

0

500

1000

1500

2000

25003000

Public Private

0

200

400

600

800

1000

Consultans Residents

Public Private


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Beta Sites Survey

5. Full time Consultants

Among all private Beta Sites, all consultants except the ones who are part of management

are part time/visiting where as, in public Beta Sites all consultants are full time

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Findings

100%

0%Public

Full Time Part Time

6. Full Time Residents

All residents in both Public & Private Sites are full time

8%

92%

Private

Full Time Part Time


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Beta Sites Survey

7. Library

All public Beta Sites, have full fledged

setup for both print & digital library while

digital library is not present in every

private Beta Sites

8. E-resources

Electronic resources found in every Public

Beta sites while 2 private sites (Lilavati &

Bombay Hospital) does not subscribe any

e-resources

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Findings

Library

Site Print Digital

Public 5 5

Private 6 3

Resources

Site Print e-resources

Public 5 5

Private 6 4


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Beta Sites Survey

9. Internet Access

Department wise access to internet is the most common among all the sites while wifi is

found in only 2 sites. Thus the e-resource is most frequently accessed through the

available computers in each departments office

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Findings

Internet Access

Access viaPublic

(total 5 sites)Private

(total 6 sites)

Only Library 0 1

Department wise 2 5

Through LAN 3 5

Computer in every chamber 0 0

wifi 2 0


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Beta Sites Survey

10. Common e-resource

Science Direct & MD Consult found to the most common e-resource among all the sites

while many other resources are also subscribed by Public Sites

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Findings

Common e-resource

Common e-resources Public Private

Science Direct 5 4

MD Consult 5 4

BMJ 5 1Oxford Journals 2 0

Ovid 5 2


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Champions* Survey

Criteria of Site Selection: A total of 60 champions identified in four cities basis their average weekly

usage

Champions with higher usage preferred

Total 17 interviews were done All of them are at consultant level

A standard questionnaire used for data collection

Data collected are linked here while Graphics or Matrix format used to

present finding in the following slide

37 * Users of UpToDate with over 50 hits per week


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Champions Survey

1. Average Usage

Of all the champions survey, average

weekly usage is 22

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Findings

Average Weekly Usage

City Interviews Usage

Delhi 5 18

Mumbai 2 24

Bangalore 5 22Chennai 5 16

2. How got the subscription

Over 80% reported to have purchased

online while few got as a gift by Friend or

Pharma companies

82%

12%

6%

Self Purchase Pharma Friend


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Champions Survey

3. Preferred place of use

Doctors were allowed to choose multiple

options where he use UTD mostly.

Maximum usage were reported at home

while usage in the library was lowest

39

Findings

4. Best utility of UTD

Doctors chose multiple option for what he

thought UTD is best suited for. Majoritythinks it helps them in their own learning

followed by conferences and as tool for

patient management at Point of care

25%

12%

7%

37%

19%

Office

at POC

Library

Home

Travelling

29%

45%

26% Conferences

Own Learning

PoC tool forPatientManagement


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Champions Survey

5. Value of UpToDate

Mostly doctors agreed that UpToDate saves

time for them and helps in better

treatment decisions

40

Findings

6. Topics availability

Majority 77% said sufficient topics available

or they mostly find a relevant topic while23% often do not finds a relevant topic

24%

19%

24%

15%

18%Better TreatmentDecisions

Answers ClinicalQuestions

Saves Time

Avoids costlyerrors

Improved PatientCare

37%

40%

23%

0%Sufficient Topicsavailable

Mostly find arelevant Topic

Often relevantTopics are notavailable

Never found arelevant Topic


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Champions Survey

7. UpToDate Quality

Mostly 94% agreed that topics are updated

and relevant

41

Findings

8. Features

Easy Search Option scored highest 33%

among the favorite features while DrugInformation and Calculators scored lowest

53%

3%

41%

3%Topics areupdated andaccurate

Often topics andnot updated & notrelevant

Finds informationon all advancetopics

Generally onlyGenericinformation

17%

15%

33%

15%

20%

What's New

Calculators

Easy SearchOption

Drug Informationby LexiComp

Quick & updatedinformation


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Champions Survey

9. Treatment Recommendations

Only 35% use UTD treatment

recommendations

42

Findings

10. Quality of Treatment Recommendation

Majority 76% are satisfied with the UTD

Treatment Recommendations

35%

18%

47%Yes

No

No Answer

76%

18%

0%

6%Mostly Satisfied

Mostly NOTSatisfied

Does understandUTD GradingProcessNo Answer


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Champions Survey

11. Whom he recommends UTD

UTD is recognized to be good tool for both

consultants and residents

43

Findings

36%

38%

14%

12%

Residents

Consultants

Students

Research Scholars


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Summary

The Indian healthcare industry is poised to grow at a compounded annualgrowth rate over 12%

Being lagged behind, Healthcare IT market in India is fastest growing inAsia at around 22%

Private contribution in the growth of Indian Healthcare industry isgrowing rapidly both in medical teaching as well as healthcare delivery.

While majority of the leading hospitals are corporate, public teachinghospitals are still best in the country due to continued funding forresearch & development by the government

Due to the permission by government to conduct DNB courses, manyprivate hospitals have emerged as a minor teaching institutions as ithelps them retaining quality residents and also positioning themselves asa quality healthcare provider

44


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Summary..

Investment in the library resources are higher in public institutions dueto dedicated government funding while even the leading privateinstitutions have a stingy approach in this area.

Both Major & Minor private teaching institutions invest in libraryresources only as much as they feel mandatory

Government has not mandated e-resources and so the institutionstraditionally prefers print

A trend of forming consortium is on rise and few strong medical consortiahas emerged in the country

Even the leading private hospitals in the country prefer to have part timeconsultants of multiple specialty rather than full time consultants in fewspecialty

45


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Summary..

Private Hospital prefers having few full time residents and more parttime consultants

The library facilities in private Beta site are underprivileged andgenerally they operate within fixed budget which does not segregatebetween print and digital

The majority of good users of individual subscription have purchasedtheir own account

UpToDate mostly found to be used at home or in office and is usedmostly for self learning and for the conference preparation

UpToDate has not yet recognized as a Point of Care tool and also thereare infrastructure limitations preventing UpToDate being used as a Pointof Care tool

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Summary..

UpToDate is generally not used at Point of Care due to high number ofpatients in waiting as well as, I am the Best mindset of the physicians

Most UpToDate users in India are satisfied with the utility & quality ofUpToDate

Though probing around price was avoided at moment, there were manysuggestions to price UpToDate rationally for the local market and tomake it more cost effective

Documents

Healthcare IT Market Scenario - India