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Computerization & EMR implementation in hospitals in developing countries using indigenous solutions
Dr Deepak AgrawalAssistant Professor, NeurosurgeryJPN Apex Trauma centre,All India Institute of Medical Sciences,New Delhi, India
A cost benefit analysis
CASE STUDY (JPNATC)
Two buildings (5 floors + 8 floors)8 specialties, 175 beds
Till Sep 2006 No networking No internet No PACS No HIS/EMR
CASE STUDY (JPNATC)
Dual network (wired & wireless) Computers with internet in all patient
areas Server-client architecture with
standalone facility Thin clients PACS
CASE STUDY (JPNATC)
NETWORKING Wired network (52 nodes)
6 months Cost US$ 15744
Wireless network (full campus) 3 weeks Cost US$ 2042
Total Networking cost= US$ 17786
THIN CLIENTS-TCO
US $ 1000
Computers
110 Thin Clients US$ 58510 6 servers US$ 28787 6 Network laser printers US$12766
Total hardware cost= US$ 100063
SOFTWARE
Vista EHR Open source (free to download & use!) Developed by US government Rated No 1 HIS/EMR software in the
world Installed in all US Veterans hospitals Full enterprise solution
Software (Vista EHR)
Installation, Customization & support done free of cost by local vendor
Total software cost= US$0 Mantainence= US$51060/year
PACS
7 license GE PACS solution (Centricity®) with 5 year maintenance contract
Total cost US$ 5100/ year
Computerization Assistance Team & Support
(CATS) Hardware & Printer issues Username & password issues Training on HIS & PACS Resolution of end-user issues
CATS
Data entry operators Especially trained for CATS Presently 7 CATS personnel
Neurosurgery, Ortho & Surgery, Emergency medicine
Mobile computing
Current status
HIS (Vista EHR)) Registration ADT (admission, discharge & transfer) CPRS (Computerised Pt record system)
Computerized casualty note, admission note, operation note & discharge summary
Lab interface functional Appointment system Full digital archival of all patient records
Interfacing of Lab equipment
Current status (PACS) Running on Wi-fi
CT,MRI & X-ray (Including portable Xray’s) are available in near-real-time
Any pts imaging can be seen on any computer (ward, ICU, casualty, OT)
75% FILMLESS!!
PACS @ home
COST BENFIT ANALYSIS
FIXED COSTS Networking US$ 17768 Hardware US$ 100063
TOTAL US$ 117831
COST BENFIT ANALYSIS
Recurring costs/ year
Software US$ 51060/ year PACS US$ 5100/ year
TOTAL US$ 56160/ year
COST BENFIT ANALYSIS
TOTAL COST of COMPUTERIZATION OVER 1 YEAR
US$ 174009
COST BENFIT ANALYSIS
Cost Savings Annual cost of films at JPNATC
(2006-2007) Approx US$153191
Saving with PACS @ 75% filmless US$ 106382/ year
COST BENFIT ANALYSIS
Total saving in the very 1st year of computerizationUS$ 46808!
OTHER BENIFITS
Tangible benefits Access to Data Electronic patient records Laboratory Interfacing
Intangible Benefits Improves Efficiency & quality of pt care Decreases errors Archival of patient data
CONCLUSIONS
A very high level of computerization is possible in India using non-proprietary technology and methods
Can be done very cost-effectively
Computerization has to be implemented by doctors themselves in order to succeed
THANK YOU
