Aggregated US provider and payer healthcare ICT spending was close to $26 billion in 2004 and will grow to over $34 billion by 2008, with a CAGR of 7%. By 2008 payer spending will amount to $7.5 billion and provider spending will be at $26.7 billion. (based on forecast from Research & Reports)
To gear up for this emerging trend, CSC made a $375 million acquisition of First Consulting Group along with increasing the offshore capabilities in India.The healthcare provider market currently is cornered by CSC, IBM, Accenture,EDS and Perot systems with billion dollar deals in the bag,spread over several years.
Indian IT companies have not been strong in the US provider market primarily due to the lack of availability of HL7 certified professionals in India. However, this is changing fast. In 2007 India produced the most number of HL7 certified professionals worldwide, (120) followed by US with 60 professionals.
As the Financial services sector in US continues to reel under the mortgage crisis, the healthcare market comes as a relief to the major IT outsourcing companies.
According to analysts, Syntel and TCS can capitalize on the growing healthcare provider market in US, primarily because of their extensive experience in HL7. HL7 (Health Level Seven) standards is the primary standard for data interchange in the healthcare provider market. TCS has experience working with the NHS-UK healthcare project while Syntel has deep domain expertise built from working with Mc Kesson.
Sunday, November 25, 2007
Wednesday, June 20, 2007
Non profit Pharma in developing countries to combat AIDS?
I do not claim to be an expert on non profit organizations centered around AIDS prevention or on deployment of funds by various charities.
What I come across is a flurry of activity to raise funds for AIDS awareness/prevention and debates centered around drug patents .A typical NGO seems to raise cash from the developed World and purchases patented drugs from Big Pharma. However the very fact drugs are purchased from Big Pharma at big pharma prices (probably at discount) beats the purpose.
I was wondering if there was a model where better return on capital can be achieved.
Wouldn't one be able to procure more generics from from a low cost provider based out of a low cost location ?
What if we raised funds to create a non profit pharmaceutical company in Africa/China/India that manufactures generic ARVs ( anti retrovirals) and ships drugs to the AIDS victims....
I should probably be sending a note to the Gates Foundation !!!
Sunday, May 13, 2007
Is your health information up for sale?
The noise about HIPAA in the US and clamor for strict privacy laws in other parts of the world, is driven by the fact that healthcare information is being traded for big bucks. A series of national public opinion polls conducted by Louis Harris & Associates in US documents a rising level of public concern about privacy, growing from 64 percent in 1978 to 82 percent in 1995. Americans’ concern about the privacy of their health information is part of a broader anxiety about their lack of privacy in an array of areas.
HIPAA Privacy Regulations
HIPAA (Health Insurance Portability and Accountability Act) mainly addresses three areas, standardization of transactions and code stets used in claims processing, privacy and security of protected health information (PHI).
Under the provisions of privacy component of the regulations, a covered entity may use or disclose PHI only in the following ways:
· It may use or disclose PHI for its own treatment, payment or healthcare operations purposes.
· It may use or disclose PHI to another covered entity for that entity's treatment purposes.
· Disclosure between two covered entities for limited use for operations, such as quality assurance or peer review. Such disclosures may take place insofar as the covered entity receiving the disclosure has a treatment relationship with an individual and PHI may only be disclosed regarding treatment that occurred while the relationship existed.
Buyers of Healthcare information
The purchasers of healthcare data have been pharma companies, insurance companies, employers and strangely bankers. Pharmaceutical companies were in the hot set when consumers groups agitated against the direct marketing efforts of pharma companies, which send specific treatment intervention options to specific disease groups. Direct marketing to patients with the advent of direct to consumer marketing approach became a nuisance to privacy advocates. Other issues revolved use of use of patient information by insurers in underwriting applicants. Banks used health information in “due diligence” to ascertain if the borrower had any health reasons that would prevent his repayment capabilities.
The Indian Scenario
To date the Indian healthcare sector has relatively free from this concern, as most of the medical records in the country are still physical records, safely stored away in medical records room. However this is all set to change with the advent of companies focused on aggregating health care data on Indian population. Recently, several business groups in Indian metros were approached by a company that promised to maintain electronic health records of employees at a nominal fee in addition to other healthcare services that they would provide. For many human resources managers not sensitized to concerns around privacy of health information, this sounded like a good service offering. To me however, in a country like India, with lax privacy laws, letting a third party collate patient information is scary. You might soon be bombarded by requests from various pharmaceutical companies with mailing campaigns that would be focused on solutions for your heart or kidney disorder. Others would want you to be part of clinical trial for Drug A or B. How would the Indian patient/consumer respond? Are consumer groups aware of this emerging scenario? What are the grievance redressal mechanisms in place from a legal or regulatory standpoint?
As the healthcare sector in India moves towards an electronic medical records era, this is one of the questions healthcare managers/policy makers and the patient community have to address keeping in view the global trends in privacy of healthcare information.
HIPAA Privacy Regulations
HIPAA (Health Insurance Portability and Accountability Act) mainly addresses three areas, standardization of transactions and code stets used in claims processing, privacy and security of protected health information (PHI).
Under the provisions of privacy component of the regulations, a covered entity may use or disclose PHI only in the following ways:
· It may use or disclose PHI for its own treatment, payment or healthcare operations purposes.
· It may use or disclose PHI to another covered entity for that entity's treatment purposes.
· Disclosure between two covered entities for limited use for operations, such as quality assurance or peer review. Such disclosures may take place insofar as the covered entity receiving the disclosure has a treatment relationship with an individual and PHI may only be disclosed regarding treatment that occurred while the relationship existed.
Buyers of Healthcare information
The purchasers of healthcare data have been pharma companies, insurance companies, employers and strangely bankers. Pharmaceutical companies were in the hot set when consumers groups agitated against the direct marketing efforts of pharma companies, which send specific treatment intervention options to specific disease groups. Direct marketing to patients with the advent of direct to consumer marketing approach became a nuisance to privacy advocates. Other issues revolved use of use of patient information by insurers in underwriting applicants. Banks used health information in “due diligence” to ascertain if the borrower had any health reasons that would prevent his repayment capabilities.
The Indian Scenario
To date the Indian healthcare sector has relatively free from this concern, as most of the medical records in the country are still physical records, safely stored away in medical records room. However this is all set to change with the advent of companies focused on aggregating health care data on Indian population. Recently, several business groups in Indian metros were approached by a company that promised to maintain electronic health records of employees at a nominal fee in addition to other healthcare services that they would provide. For many human resources managers not sensitized to concerns around privacy of health information, this sounded like a good service offering. To me however, in a country like India, with lax privacy laws, letting a third party collate patient information is scary. You might soon be bombarded by requests from various pharmaceutical companies with mailing campaigns that would be focused on solutions for your heart or kidney disorder. Others would want you to be part of clinical trial for Drug A or B. How would the Indian patient/consumer respond? Are consumer groups aware of this emerging scenario? What are the grievance redressal mechanisms in place from a legal or regulatory standpoint?
As the healthcare sector in India moves towards an electronic medical records era, this is one of the questions healthcare managers/policy makers and the patient community have to address keeping in view the global trends in privacy of healthcare information.
Friday, May 4, 2007
Care from the air: Telemedicine in India
The Indian healthcare industry has been exposed to various flavors of “telemedicine”, from the healthcare portal suggesting that healthcare info provided on the website uses telecommunications to provide healthcare information to patients, thus delivering ‘tele health’, to video conferencing vendors who claim to be “telemedicine” providers . At the other end there are a few genuine healthcare providers who really use telemedicine effective to provide care, minus the hype, and organizations such as ISRO which are taking an innovative approach to facilitate healthcare delivery by way of launching an exclusive health satellite. To the mind of many healthcare stakeholders there is still confusion on what really comprises telemedicine.
What is Telemedicine?
According to a Japanese definition in 1996, “it the use of any electrical signal to transmit medical information”….
In a JAMA paper in 1995 Telemedicine has been defined “as the use of telecommunications to provide medical information and services. It may be as simple as two health professionals discussing a case over the telephone, or as sophisticated as using satellite technology to broadcast a consultation between providers at facilities in two countries, using videoconferencing equipment”.
A broader definition from University of Virginia is “the use of telecommunication technology to deliver healthcare services and health education to sites that are distant to the host site or educator”
The American College of Radiology has however defined the detailed ACR standard for Teleradiology, which includes definition of teleradiology, besides goals, qualifications, qualification of personnel, equipment guidelines, licensing, communication, quality control.
Applications
Clinical applications could be utilized in the following areas effectively, though one could argue that telemedicine could be used for any specialty.
Cardiology
Radiology
Homecare
Pathology
Endoscopy
Nephrology
Ophthalmology
Surgery
Emergency care
Many of these have specific applications and interfaces built around these specialties, which differentiate them from generic telemedicine applications.
Telemedicine worldwide
The history of telemedicine dates back to 1971, when the Alaska Biomedical Demonstration Project linked 26 sites using NASA satellite technologies. The Nebraska Psychiatric Institute is mentioned as the pioneer in some papers citing the use of closed circuit television in 1955 as “telemedicine”. In 1967, Mass Gen linked up to Logan airport using 2 way audiovisual microwave circuit. The developed world has made major strides in utilizing telemedicine for healthcare delivery.
Telemedicine in India: the drivers
The drivers for adoption of telemedicine could vary from country to country based on various factors. Some of the factors that would expedite the telemedicine revolution in India are:
Topography
Think of a patient in Tinsukiya, Assam or Aragonda, Andhra Pradesh who requires a consultation with a specialist at Bangalore or Mumbai. The cost of travel and the travel it self could be a deterrent to the poor patient in these rural settings. Even if a specialist is available at the nearest town, reaching the interiors of such a far flung village would be a challenge. This is where telemedicine could be utilized as an effective medium for healthcare delivery. India with a diverse collection of landscapes with mountains and valleys and high altitudes, telemedicine could well be a boon for the patients.
Travel Time /Cost
There is a shortage of specialist/ super specialist professionals in India, especially in rural areas. It might not be good time management on the part of the specialist to travel all the way to the rural areas without having enough patients to be attended to there. Travel time can be cut down dramatically while the expertise is made available in real time via technology. The specialist’s physical presence becomes necessary only when a surgical procedure is planned. In reality even surgical procedures are being conducted with guidance from the specialist who is at a remote location. For a patient cost of travel is a major worry especially if she has to fly in to a specialist care center in a city.
Pressure to reduce costs
Cost of healthcare and questions on who will bear the burden of care are issues across the world, developed countries included. The incidental expenses related to patient care, i.e. the cost associated with factors other than the actual medial care such as travel, accommodation for relatives, food etc also contribute substantially to the cost of treatment. In a country where health insurance is yet to catch up, cost of acre is borne by patients, in many cases by selling property and livestock. If hospitals can reduce these costs associated with treatment it would go a long way in reducing the burden of care on the patient. Telemedicine seems to the answer.
Availability of healthcare facility/ Transportation
It is no understatement if I say that healthcare delivery in rural India is not adequate. The government has limitations and so does private enterprise. Setting up a full fledged care facility at a remote location might not always be economically or operationally viable. Even if there is a healthcare facility with bare minimum resources, transportation might be a challenge. Various studies have documented the inverse relationship between distance and outcomes particularly in Acute MI and Ventricular Arrhythmias.
Training
Telemedicine is an effective medium to impart knowledge to professionals within a healthcare organization. This becomes relevant in corporate hospitals chains spread across the country wherein they could share and institutionalize best practices across the group. Telemedicine could also be utilized to provide public health education to the remote corners of India.
Telemedicine for Competitive Advantage
Telemedicine is a technology enabled marketing tool as well. It makes it possible for hospitals to address the needs of patients who might not have otherwise used their services. Slowly by steadily telemedicine is being utilized as a tool for competitive advantage, which would over a period of time, lead to a divide in the healthcare industry along the lines of “telemedicine haves and have nots”.
The players:
The two major players in the Telemedicine space in India are Apollo Hospitals and Asia Heart Foundation. Between the two, several remote villages have realized the benefits of technology enabled care. The organizations are now in a position to share the expertise available in in-house with neighboring countries too. The missionary zeal with which these hospitals operate will ensure that distance will not be a deterrent to patient care. The public sector too is taking steps in this direction. According to Dr. Alok Roy, Asia Heart Foundation, several lives were saved by telemedicine intervention in far flung villages, which might not have been otherwise possible.
Issues:
Beneath the glossy reports of telemedicine successes, there are many stories of hard work, dedication which happen behind the scenes to make this all happen. Making Telemedicine work is not as sweet as the reports. Some of the issues involved are outlined below:
Connectivity
Connectivity for Telemedicine is a major concern as many of the remotes villages do not have basic telephony. Thus an exclusive satellite from ISRO to service healthcare needs is revolutionary and will change the dynamics of telemedicine in India very soon. Satellites provide almost 100 percent uptime, making it the best medium for countries such as India with diversity in terrain. The bandwidth available with various connectivity options are provided below.
POTS – 20 kbps
ISDN – 128 Kbps
T1 - 1.54 Mbps
Cable modem – 1- 27 Mbps
T3 – 44 Mbps
ATM - 155 Mbps
Small Foot print Satellite Dish – 400 kbps
Low orbiting Satellite
Asynchronous: – 6 mbps
Synchronous: 14 kbps – 2 Mbps
Wireless Terrestrial: 1- 26 Mbps
Standards
As Telemedicine becomes ubiquitous, a challenge to be addressed is adherence to standards. A few years down the line, when corporate mergers and acquisitions become commonplace in the healthcare sector integrating to leverage investments made be a major roadblock to integrating services. Integrating disparate systems could be expensive in the long term, unless standards are followed from day one. HL7 and DICOM are two standards that are critical for the success of Telemedicine in India.
Security & Privacy
Security and Privacy are no serious concern in India at the moment as consumerism in healthcare is yet to take the proportions in the developed world. However this is set to change soon. As patients become more aware, thanks to the Net, these concerns will have to be addressed. European and US standards for Privacy and Security are being incorporated by vendors in those countries.
IHE
Integrating the Healthcare Enterprise initiative is a US initiative by leading trade organizations in the US. The role of IHE is the integration of healthcare information, promotion of existing standards ( eg HL7, DICOM, CORBA, XML) and implementation profiles for transactions used to communicate images and patient data within Hospital Information systems Radiology Information systems ( RIS) and Picture Archiving and communication systems ( PACS). These initiatives will make the move towards a Telemedicine enabled Electronic Health Record.
Legal & regulatory
Who is liable is a Tele medicine assisted remote surgery ends in a disaster due to loss of connectivity? The surgeon? The Satellite provider? The software/hardware provider? What is the legal status of a telemedicine based diagnosis in a medico legal framework? Many of thee questions have not been raised in India as we are still in the honey moon phase of Telemedicine, when all news is good news.
Management Issues
Strange as it may sound the major areas of concern in Telemedicine implementation is not technology perse, but the organization’s preparedness to handle the management and human resources issues related to the same. Telemedicine is a labor intensive process which involves co ordination with sending and receiving stations and the staff technical, clinical and support staff at the centers. Management buy in is slow in most organizations. Training the doctors, nurses and technicians on a continuous basis is critical, more so as employees turn over is increasing in the healthcare setting. The success definitely depends on the management’s commitment to a long-term strategy to achieve competitive advantage utilizing telemedicine.
What is Telemedicine?
According to a Japanese definition in 1996, “it the use of any electrical signal to transmit medical information”….
In a JAMA paper in 1995 Telemedicine has been defined “as the use of telecommunications to provide medical information and services. It may be as simple as two health professionals discussing a case over the telephone, or as sophisticated as using satellite technology to broadcast a consultation between providers at facilities in two countries, using videoconferencing equipment”.
A broader definition from University of Virginia is “the use of telecommunication technology to deliver healthcare services and health education to sites that are distant to the host site or educator”
The American College of Radiology has however defined the detailed ACR standard for Teleradiology, which includes definition of teleradiology, besides goals, qualifications, qualification of personnel, equipment guidelines, licensing, communication, quality control.
Applications
Clinical applications could be utilized in the following areas effectively, though one could argue that telemedicine could be used for any specialty.
Cardiology
Radiology
Homecare
Pathology
Endoscopy
Nephrology
Ophthalmology
Surgery
Emergency care
Many of these have specific applications and interfaces built around these specialties, which differentiate them from generic telemedicine applications.
Telemedicine worldwide
The history of telemedicine dates back to 1971, when the Alaska Biomedical Demonstration Project linked 26 sites using NASA satellite technologies. The Nebraska Psychiatric Institute is mentioned as the pioneer in some papers citing the use of closed circuit television in 1955 as “telemedicine”. In 1967, Mass Gen linked up to Logan airport using 2 way audiovisual microwave circuit. The developed world has made major strides in utilizing telemedicine for healthcare delivery.
Telemedicine in India: the drivers
The drivers for adoption of telemedicine could vary from country to country based on various factors. Some of the factors that would expedite the telemedicine revolution in India are:
Topography
Think of a patient in Tinsukiya, Assam or Aragonda, Andhra Pradesh who requires a consultation with a specialist at Bangalore or Mumbai. The cost of travel and the travel it self could be a deterrent to the poor patient in these rural settings. Even if a specialist is available at the nearest town, reaching the interiors of such a far flung village would be a challenge. This is where telemedicine could be utilized as an effective medium for healthcare delivery. India with a diverse collection of landscapes with mountains and valleys and high altitudes, telemedicine could well be a boon for the patients.
Travel Time /Cost
There is a shortage of specialist/ super specialist professionals in India, especially in rural areas. It might not be good time management on the part of the specialist to travel all the way to the rural areas without having enough patients to be attended to there. Travel time can be cut down dramatically while the expertise is made available in real time via technology. The specialist’s physical presence becomes necessary only when a surgical procedure is planned. In reality even surgical procedures are being conducted with guidance from the specialist who is at a remote location. For a patient cost of travel is a major worry especially if she has to fly in to a specialist care center in a city.
Pressure to reduce costs
Cost of healthcare and questions on who will bear the burden of care are issues across the world, developed countries included. The incidental expenses related to patient care, i.e. the cost associated with factors other than the actual medial care such as travel, accommodation for relatives, food etc also contribute substantially to the cost of treatment. In a country where health insurance is yet to catch up, cost of acre is borne by patients, in many cases by selling property and livestock. If hospitals can reduce these costs associated with treatment it would go a long way in reducing the burden of care on the patient. Telemedicine seems to the answer.
Availability of healthcare facility/ Transportation
It is no understatement if I say that healthcare delivery in rural India is not adequate. The government has limitations and so does private enterprise. Setting up a full fledged care facility at a remote location might not always be economically or operationally viable. Even if there is a healthcare facility with bare minimum resources, transportation might be a challenge. Various studies have documented the inverse relationship between distance and outcomes particularly in Acute MI and Ventricular Arrhythmias.
Training
Telemedicine is an effective medium to impart knowledge to professionals within a healthcare organization. This becomes relevant in corporate hospitals chains spread across the country wherein they could share and institutionalize best practices across the group. Telemedicine could also be utilized to provide public health education to the remote corners of India.
Telemedicine for Competitive Advantage
Telemedicine is a technology enabled marketing tool as well. It makes it possible for hospitals to address the needs of patients who might not have otherwise used their services. Slowly by steadily telemedicine is being utilized as a tool for competitive advantage, which would over a period of time, lead to a divide in the healthcare industry along the lines of “telemedicine haves and have nots”.
The players:
The two major players in the Telemedicine space in India are Apollo Hospitals and Asia Heart Foundation. Between the two, several remote villages have realized the benefits of technology enabled care. The organizations are now in a position to share the expertise available in in-house with neighboring countries too. The missionary zeal with which these hospitals operate will ensure that distance will not be a deterrent to patient care. The public sector too is taking steps in this direction. According to Dr. Alok Roy, Asia Heart Foundation, several lives were saved by telemedicine intervention in far flung villages, which might not have been otherwise possible.
Issues:
Beneath the glossy reports of telemedicine successes, there are many stories of hard work, dedication which happen behind the scenes to make this all happen. Making Telemedicine work is not as sweet as the reports. Some of the issues involved are outlined below:
Connectivity
Connectivity for Telemedicine is a major concern as many of the remotes villages do not have basic telephony. Thus an exclusive satellite from ISRO to service healthcare needs is revolutionary and will change the dynamics of telemedicine in India very soon. Satellites provide almost 100 percent uptime, making it the best medium for countries such as India with diversity in terrain. The bandwidth available with various connectivity options are provided below.
POTS – 20 kbps
ISDN – 128 Kbps
T1 - 1.54 Mbps
Cable modem – 1- 27 Mbps
T3 – 44 Mbps
ATM - 155 Mbps
Small Foot print Satellite Dish – 400 kbps
Low orbiting Satellite
Asynchronous: – 6 mbps
Synchronous: 14 kbps – 2 Mbps
Wireless Terrestrial: 1- 26 Mbps
Standards
As Telemedicine becomes ubiquitous, a challenge to be addressed is adherence to standards. A few years down the line, when corporate mergers and acquisitions become commonplace in the healthcare sector integrating to leverage investments made be a major roadblock to integrating services. Integrating disparate systems could be expensive in the long term, unless standards are followed from day one. HL7 and DICOM are two standards that are critical for the success of Telemedicine in India.
Security & Privacy
Security and Privacy are no serious concern in India at the moment as consumerism in healthcare is yet to take the proportions in the developed world. However this is set to change soon. As patients become more aware, thanks to the Net, these concerns will have to be addressed. European and US standards for Privacy and Security are being incorporated by vendors in those countries.
IHE
Integrating the Healthcare Enterprise initiative is a US initiative by leading trade organizations in the US. The role of IHE is the integration of healthcare information, promotion of existing standards ( eg HL7, DICOM, CORBA, XML) and implementation profiles for transactions used to communicate images and patient data within Hospital Information systems Radiology Information systems ( RIS) and Picture Archiving and communication systems ( PACS). These initiatives will make the move towards a Telemedicine enabled Electronic Health Record.
Legal & regulatory
Who is liable is a Tele medicine assisted remote surgery ends in a disaster due to loss of connectivity? The surgeon? The Satellite provider? The software/hardware provider? What is the legal status of a telemedicine based diagnosis in a medico legal framework? Many of thee questions have not been raised in India as we are still in the honey moon phase of Telemedicine, when all news is good news.
Management Issues
Strange as it may sound the major areas of concern in Telemedicine implementation is not technology perse, but the organization’s preparedness to handle the management and human resources issues related to the same. Telemedicine is a labor intensive process which involves co ordination with sending and receiving stations and the staff technical, clinical and support staff at the centers. Management buy in is slow in most organizations. Training the doctors, nurses and technicians on a continuous basis is critical, more so as employees turn over is increasing in the healthcare setting. The success definitely depends on the management’s commitment to a long-term strategy to achieve competitive advantage utilizing telemedicine.
Saturday, April 28, 2007
Healthcare IT Outsourcing to India
Outsourcing of IT services to India started to gain momentum during the Y2K crisis and has come a long way since then. Today, more than 300 of the Fortune 500 companies outsource some part of their technology and business processes to India. The healthcare industry, however, has been slow to adopt this trend.
According to a Gartner study, 60% of healthcare organizations will outsource more than half of their IT operations by 2007. Coupled with an increase in outsourcing of business processes, this creates a large opportunity for offshore providers tapping the healthcare market. In the healthcare industry, payers and product vendors have been early adopters of outsourcing to India, with most of the large players already leveraging the availability of a technical talent pool. Providers have been relatively slow in utilizing services of offshore service companies.
Some of the organizations active in offshore outsourcing are:
Cigna
Aetna
Several Blue Cross organizations
United Healthcare Group
Kaiser Permanente
Henry Ford Health System
McKesson
Cerner
Siemens
Misys
Isoft
There are 15 to 20 large and midsize vendors in India that provide IT services to the healthcare market in North America and Europe. About 8,000 professionals are involved in the healthcare informatics segment, primarily serving the needs of these markets. The services provided are mainly centered on application maintenance, system integration, application development, product re-engineering/maintenance, HIPAA consulting, and e-business initiatives. Recently, multinational players such as Accenture, EDS, CGEY, FCG, Keane, and IBM have established a presence in India and are hiring professionals, leading to an increase in wages that still average $8,000 per year for entry-level software engineers.
The segment growing faster than IT services is business process outsourcing (BPO), which includes insurance claims processing, adjudication, receivables management, medical transcription, and billing and coding services. Clinical process outsourcing such as radiology reporting is beginning to take off as well.
The healthcare industry's slow pace of offshore adoption is due in part to the fact that many IT service providers lack the necessary healthcare domain expertise. However, Indian companies are addressing this weakness by hiring professionals with healthcare domain knowledge. Moreover, vendors are investing in building knowledge of healthcare informatics standards such as HL7.
The HL7 affiliate in India has been active for the past five years and will generate more than two hundred HL7-certified professionals by the end of this year. Similarly, professionals in India are being trained in other standards and languages, such as Digital Imaging and Communications in Medicine (DICOM).
Contrary to popular belief, the major players in the offshore IT and BPO markets in India adhere to HIPAA-compliant security policies and procedures, which are audited by HIPAA consulting organizations, thereby ensuring privacy of medical records. In fact, the Indian government is considering a proposal to implement data protection laws in India, and HIPAA privacy and security regulations may be adopted with minor changes.
Strange as it may sound, one of the major concerns of IT services vendors in India is whether there will be enough qualified professionals to meet the outsourcing demand boom in the coming years. Several Indian vendors have already set up shop in China to mitigate this risk.
According to a Gartner study, 60% of healthcare organizations will outsource more than half of their IT operations by 2007. Coupled with an increase in outsourcing of business processes, this creates a large opportunity for offshore providers tapping the healthcare market. In the healthcare industry, payers and product vendors have been early adopters of outsourcing to India, with most of the large players already leveraging the availability of a technical talent pool. Providers have been relatively slow in utilizing services of offshore service companies.
Some of the organizations active in offshore outsourcing are:
Cigna
Aetna
Several Blue Cross organizations
United Healthcare Group
Kaiser Permanente
Henry Ford Health System
McKesson
Cerner
Siemens
Misys
Isoft
There are 15 to 20 large and midsize vendors in India that provide IT services to the healthcare market in North America and Europe. About 8,000 professionals are involved in the healthcare informatics segment, primarily serving the needs of these markets. The services provided are mainly centered on application maintenance, system integration, application development, product re-engineering/maintenance, HIPAA consulting, and e-business initiatives. Recently, multinational players such as Accenture, EDS, CGEY, FCG, Keane, and IBM have established a presence in India and are hiring professionals, leading to an increase in wages that still average $8,000 per year for entry-level software engineers.
The segment growing faster than IT services is business process outsourcing (BPO), which includes insurance claims processing, adjudication, receivables management, medical transcription, and billing and coding services. Clinical process outsourcing such as radiology reporting is beginning to take off as well.
The healthcare industry's slow pace of offshore adoption is due in part to the fact that many IT service providers lack the necessary healthcare domain expertise. However, Indian companies are addressing this weakness by hiring professionals with healthcare domain knowledge. Moreover, vendors are investing in building knowledge of healthcare informatics standards such as HL7.
The HL7 affiliate in India has been active for the past five years and will generate more than two hundred HL7-certified professionals by the end of this year. Similarly, professionals in India are being trained in other standards and languages, such as Digital Imaging and Communications in Medicine (DICOM).
Contrary to popular belief, the major players in the offshore IT and BPO markets in India adhere to HIPAA-compliant security policies and procedures, which are audited by HIPAA consulting organizations, thereby ensuring privacy of medical records. In fact, the Indian government is considering a proposal to implement data protection laws in India, and HIPAA privacy and security regulations may be adopted with minor changes.
Strange as it may sound, one of the major concerns of IT services vendors in India is whether there will be enough qualified professionals to meet the outsourcing demand boom in the coming years. Several Indian vendors have already set up shop in China to mitigate this risk.
Healthcare IT Outsourcing – Avoiding the booby traps
The fact that outsourcing, especially off-shoring can provide cost effective solution in a tight economy, has been long realized by CXOs of the early adopters of off-shoring in the financial services industry. Off shoring has started to gain traction with several health plans and product vendors taking the lead; providers are following as well. Though India has been the recognized leader in offshore outsourcing the relative strength from a healthcare perspective has to be evaluated thoroughly before making a buy decision. This article looks at some of the critical questions one should ask while evaluating an offshore healthcare vendor relationship.
1. How long has the vendor been in business?
There are several IT service organizations that have recently sprung up seeing the requirement in the healthcare market. Maintenance and support is necessary for the healthcare organization from a long-term perspective. It is therefore imperative that healthcare organizations choose vendors that have been in business for at least ten years and have the resources to stay afloat in a volatile IT market.
2. Can the vendor provide end-to-end solutions?
The vendor should be able to provide a reasonable range of services in the healthcare spectrum so that the healthcare organization does not have to spend time locating vendors for each separate requirement.
3. Does the vendor understand the healthcare business?
It is essential that the vendor understand the nuances of the healthcare industry. The knowledge accumulated over a period within the organization definitely helps in understanding the client’s requirements better.
4. What is the vendor’s policy on privacy, security and business continuity?
Most mature vendors understand implication of HIPAA and are compliant with the requirements, which may not be the case with lesser-known entities. However it makes sense to be safe than sorry and include a privacy clause in your contract.
5. Is the organization associated with trade bodies in the healthcare space?
Association with the concerned healthcare bodies ensures that the consultant is current on the developments in the healthcare space. (I have met with organizations that believe that HL7 is named after the seven founding fathers of the organization, if there were eight, HL7 would have been named HL8!!)
6. What is the size of the company in market capitalization and employee strength?
Since the days of dotcoms going bust, it makes sense to associate with accompany that has the staying power. Size DOES matter. Go with companies that are at least $200 million in revenue.
7. Does the vendor have the right mix of professionals?
Healthcare IT is an enterprise wide issue, which has regulatory, management, legal, technology and human resources components. A cross-functional team with the right mix of domain, business and technology is essential to address the various concerns raised by the healthcare organization.
8. Does the consultant have reference able clients?
Reference checking is a good practice in vendor evaluation, and will never be a bad idea. Watch out for vendors who have been only involved in staff augmentation.
9. Does the vendor have a structured onsite offshore relationship model?
When the project is on fire, you would want a vendor representative right way in your office to drive the mitigation plan. You would not want this to be just a voice some where in Bangalore or Shanghai. Insist on a having an onsite account manager who would report to you whenever required.
10. Does the organization have a quality certification?
Adherence to Quality processes and Quality Certification ensures that the vendor will provide a minimum necessary quality assurance and control. Look for organizations with SEI -CMM Level 5 certification.
11. How is the vendor organization geared to coping with uncertainty?
The organization should be mature enough to have risk mitigation plans for adverse events such as key professionals leaving the company, or other business concerns that could occur.
12. Does the pricing model provide value for money?
Finally price does matter too. Do not go for a vendor that is priced exorbitantly high or pathetically low.
1. How long has the vendor been in business?
There are several IT service organizations that have recently sprung up seeing the requirement in the healthcare market. Maintenance and support is necessary for the healthcare organization from a long-term perspective. It is therefore imperative that healthcare organizations choose vendors that have been in business for at least ten years and have the resources to stay afloat in a volatile IT market.
2. Can the vendor provide end-to-end solutions?
The vendor should be able to provide a reasonable range of services in the healthcare spectrum so that the healthcare organization does not have to spend time locating vendors for each separate requirement.
3. Does the vendor understand the healthcare business?
It is essential that the vendor understand the nuances of the healthcare industry. The knowledge accumulated over a period within the organization definitely helps in understanding the client’s requirements better.
4. What is the vendor’s policy on privacy, security and business continuity?
Most mature vendors understand implication of HIPAA and are compliant with the requirements, which may not be the case with lesser-known entities. However it makes sense to be safe than sorry and include a privacy clause in your contract.
5. Is the organization associated with trade bodies in the healthcare space?
Association with the concerned healthcare bodies ensures that the consultant is current on the developments in the healthcare space. (I have met with organizations that believe that HL7 is named after the seven founding fathers of the organization, if there were eight, HL7 would have been named HL8!!)
6. What is the size of the company in market capitalization and employee strength?
Since the days of dotcoms going bust, it makes sense to associate with accompany that has the staying power. Size DOES matter. Go with companies that are at least $200 million in revenue.
7. Does the vendor have the right mix of professionals?
Healthcare IT is an enterprise wide issue, which has regulatory, management, legal, technology and human resources components. A cross-functional team with the right mix of domain, business and technology is essential to address the various concerns raised by the healthcare organization.
8. Does the consultant have reference able clients?
Reference checking is a good practice in vendor evaluation, and will never be a bad idea. Watch out for vendors who have been only involved in staff augmentation.
9. Does the vendor have a structured onsite offshore relationship model?
When the project is on fire, you would want a vendor representative right way in your office to drive the mitigation plan. You would not want this to be just a voice some where in Bangalore or Shanghai. Insist on a having an onsite account manager who would report to you whenever required.
10. Does the organization have a quality certification?
Adherence to Quality processes and Quality Certification ensures that the vendor will provide a minimum necessary quality assurance and control. Look for organizations with SEI -CMM Level 5 certification.
11. How is the vendor organization geared to coping with uncertainty?
The organization should be mature enough to have risk mitigation plans for adverse events such as key professionals leaving the company, or other business concerns that could occur.
12. Does the pricing model provide value for money?
Finally price does matter too. Do not go for a vendor that is priced exorbitantly high or pathetically low.
Clinical Process Outsourcing
Business process outsourcing (BPO) is the use of external service providers to manage a business function or unit within an enterprise. Business process Outsourcing has been in the limelight for quite some time. The healthcare industry being labor intensive can benefit from the emerging trends among healthcare organizations (HCOs) to outsource business processes. The BPO space in healthcare is a highly fragmented market, with analysts currently engaged in defining and sizing the various niche segments involved. Clinical process outsourcing is one such segment, which involves the outsourcing of clinical processes offshore, to take care of some of the clinical work currently handled by physicians, nurses and paramedics.
Drivers
Some of the drivers for BPO in the US healthcare space are:
Shortage of nurses and Paramedical Professionals
According to a recent journal of American Medical Association Study, 20,000 patients die every year in US due to shortage of qualified nurses. HCOs are tying all routes to attract trained nurses to hospitals in US. Coupled with this is the shortage of paramedical professionals in this sector.
Greying Population
As per the 1999 census the US has 74 billion Americans 50 years and older, and by 2030, one in five Americans will be 65 years or older. This has implication for healthcare industry from both a care delivery and employment perspectives.
H1B visas
The socio political compulsions have forced the US government to reduce the H1B visas, which allow professionals from other countries to work in US. As employers would have to live with less HIB workers one option would be to look at alternatives such as outsourcing.
Though these scenarios provide opportunities for Indian companies, the challenges are many.
Challenges
Socio political landscape
On the political front the noise is being heard both from Europe and US to limit the loss of jobs to Asian countries, which they claim would affect the US /European economies adversely. There were some trade unions in UK, which negotiated with a major retailer to limit the outsourced call center facility in India to only 200 seats. A New Jersey senator recently presented a bill questioning some of the BPO initiatives of US government agencies.
Management Challenges
In a clinical process outsourcing to India the major challenge would be the current outlook and management of hospitals in India. Hospitals by themselves, barring a few are mostly inward focused and not quite proactive in gearing up for this emerging opportunity. Whether many hospitals in India want to diversify into this space is to be watched. The focus on BPO by HCOs in India would require considerable re orientation of work culture, including shift timings, reallocation of priorities etc.
Availability of resources
Though India has abundance of skill sets in the healthcare domain, there is a relative shortage of specialist skill sets. Moreover the need for relevant training to align existing resources to the US requirements calls for investment too. In some areas, for instance remote radiology report generation, it needs to be seen if India has the required critical mass of specialists to handle volumes that US healthcare would outsource to India.
Process /Technology Maturity
Managing the delivery process itself calls for technology intensive and human resources intensive practices, coupled with process maturity in handling similar work. Most HCOs in India have not evolved to global standards on this aspect. Hospitals may however align with BPO/IT companies to leverage the expertise by for such expertise. Managing the disparate organizational cultures is to be addressed in that case.
Quality
Quality is critical in any service-based industry. Adoption of world-class quality processes has been a key differentiator for the Indian IT industry. A culture of quality calls for financial investment and long-term commitment from the healthcare community. In fact the medical transcription Industry in India is a classic case where large-scale quality deterioration led to the near death experience faced by the sector.
Though analysts proclaim billion dollar markets, whether India Inc has the delivery bandwidth to address this is to be assessed.
Drivers
Some of the drivers for BPO in the US healthcare space are:
Shortage of nurses and Paramedical Professionals
According to a recent journal of American Medical Association Study, 20,000 patients die every year in US due to shortage of qualified nurses. HCOs are tying all routes to attract trained nurses to hospitals in US. Coupled with this is the shortage of paramedical professionals in this sector.
Greying Population
As per the 1999 census the US has 74 billion Americans 50 years and older, and by 2030, one in five Americans will be 65 years or older. This has implication for healthcare industry from both a care delivery and employment perspectives.
H1B visas
The socio political compulsions have forced the US government to reduce the H1B visas, which allow professionals from other countries to work in US. As employers would have to live with less HIB workers one option would be to look at alternatives such as outsourcing.
Though these scenarios provide opportunities for Indian companies, the challenges are many.
Challenges
Socio political landscape
On the political front the noise is being heard both from Europe and US to limit the loss of jobs to Asian countries, which they claim would affect the US /European economies adversely. There were some trade unions in UK, which negotiated with a major retailer to limit the outsourced call center facility in India to only 200 seats. A New Jersey senator recently presented a bill questioning some of the BPO initiatives of US government agencies.
Management Challenges
In a clinical process outsourcing to India the major challenge would be the current outlook and management of hospitals in India. Hospitals by themselves, barring a few are mostly inward focused and not quite proactive in gearing up for this emerging opportunity. Whether many hospitals in India want to diversify into this space is to be watched. The focus on BPO by HCOs in India would require considerable re orientation of work culture, including shift timings, reallocation of priorities etc.
Availability of resources
Though India has abundance of skill sets in the healthcare domain, there is a relative shortage of specialist skill sets. Moreover the need for relevant training to align existing resources to the US requirements calls for investment too. In some areas, for instance remote radiology report generation, it needs to be seen if India has the required critical mass of specialists to handle volumes that US healthcare would outsource to India.
Process /Technology Maturity
Managing the delivery process itself calls for technology intensive and human resources intensive practices, coupled with process maturity in handling similar work. Most HCOs in India have not evolved to global standards on this aspect. Hospitals may however align with BPO/IT companies to leverage the expertise by for such expertise. Managing the disparate organizational cultures is to be addressed in that case.
Quality
Quality is critical in any service-based industry. Adoption of world-class quality processes has been a key differentiator for the Indian IT industry. A culture of quality calls for financial investment and long-term commitment from the healthcare community. In fact the medical transcription Industry in India is a classic case where large-scale quality deterioration led to the near death experience faced by the sector.
Though analysts proclaim billion dollar markets, whether India Inc has the delivery bandwidth to address this is to be assessed.
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