2.4 Deployment of eHealth @ CMC Vellore , India by Prof. Joy John Mammen

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THIT, Chennai, India

Deployment of eHealth at

CMC VelloreJoy Mammen MDProfessor & Head

Department of Transfusion MedicineChristian Medical College Vellore

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Conflict of Interest• Advisory Board of SocIT Pvt Ltd http://www.socit.in/• Palampur, Himachal Pradesh• Provides health information management systems – currently

primarily focusing on rural health sector• No financial interest

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http://www.socit.in/

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Over a century…

1900 1924 1941

2016

The Christian Medical College, Vellore, seeks to be a witness to the healing ministry of Christ, through excellence in education, service and research21-10-2016 THIT, Chennai, India

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Year ending 2015• 2800+ beds• 2.4 million out-patients• 130000 in-patients• 9000 staff• NABH Accredited• NABL Accredited Labortories*• Over INR 1000 crores turnover• More than INR 150 crores in charity • Two locations – additional site in

progress

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History of core IT development in CMC

1970 – First data processing unit (Punch card used in payroll)

1983 – PDP-11/SN-23 mini computer+ 5 terminals (used for batch processing of jobs in billing)

1984 – First microcomputers (used for OP/IP bills, lab systems)

1988 – CHIPS started; Novell network with FoxBase / FoxPro and Access databases used for early HIS21-10-2016

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1980s – Analytical automation of labs, beginning with Biochemistry; Centralized lab reporting;

1990s – Internet services to residential campuses startedProcess automation of labs

including barcoding

1998 – PACS in Radiology (GE Centricity™ ); ethernet network across OPDs and wards to view images

History of core IT development in CMC

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2000 - 2010Oracle™ introduced in CHIPSFirst iteration of Clinical Work Station deployedAdministrative software developmentMigrated to a CISCO switched networkInterconnected campuses; SMSPatient safety: Common bar-coding systems developed for specimen collection

2011 - 2016• CMC Chittoor connectivity• Oracle™ business continuity• CMCPACS2 set up for

imaging requirements of multiple departments• Upgrade of Video-

conferencing bridge (Polycom)• Centralised storage / private

cloud storage

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Opportunities to learn

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THIT, Chennai, India21-10-2016

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Model• Reflecting core values – Institutional Vision & Mission• The Patient• Leadership• Driven by need/demand• Resource constraints– minimize external dependencies

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What does it take?• People

• Medical• Information Technology – specialists• Administration• Users

• Dr. Philip Korula, MCh (Plastic Surgery)

• Insight• Hard work• Constrained resources• External advisory resources21-10-2016

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What happens to cost?“HIT is associated with a 1.3 percent increase in billed charges (p-value: 5.6%), and there is no evidence of cost savings even five years after adoption. Additionally, HIT adoption appears to have little impact on the quality of care, measured by patient mortality, adverse drug events, and readmission rates.”Leila Agha* Boston University: Published in final edited form as: J Health Econ. 2014 March ; 34: 19–30. doi:10.1016/j.jhealeco.2013.12.005.

“We find EMRs do not reduce the rate of patient safety events. However, once an event occurs, EMRs reduce death by 34%, readmissions by 39%, and spending by $4,850 (16%), a cost offset of $1.75 per $1 spent on IT capital. Thus, EMRs contain costs by better coordinating care to rescue patients from medical errors once they occur.”Inquiry. 2011-2012 Winter;48(4):288-303. Encinosa W & Bae J. (AHRQ)

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Timelines, anyone?

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http://dilbert.com/strip/2016-10-19• In house team• Highly customised software• Change management• Changing goal-posts

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What has not (yet) worked for us• Integration of “best of breed” applications• Platform independence• Out-sourced development• Utilization of data beyond essential services•Monetizing product/data/knowledge

• Education • Research

• Image analysis, Natural Language Processing, Data Mining, UI studies, GIS21-10-2016

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What’s left…• Standards• Authentication• Unified patient identification• Obsolescence… • Continuous improvement vs Don’t fix it unless its broken!• Opportunity cost

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Acknowledgements• Dr. Vinu Moses, Professor of Radiology, Member IT Committee• CMC Consultation 2016 (IT Group)• Mr. Ebenezer Sundararaj Head of Department, IT • The Team Back at CMC

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Failure is simply the opportunity to begin again, this time more intelligently. – Henry Ford

Only those who can see the invisible can achieve the impossible. – Ida S Scudder

Healthcare

2.4 Deployment of eHealth @ CMC Vellore , India by Prof. Joy John Mammen