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Cloud Computing in Indian Healthcare - A Game Changer

U.K. Ananthapadmanabhan

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Dichotomy in Indian Healthcare 40% children malnourished / inadequate Public health

infrastructure / Acute shortage of medical professionals

Public sector provisioning 20% while private sector is 80%

Overall, good improvement in life expectancy/MMR/IMR/eradication of polio

Corporate hospitals and medical colleges established / Reforms initiated – NEET

Huge Private equity / Venture capital / Foreign / NRI investment in Healthcare

Hitech procedures done at a fraction of US costs – Emergence of medical tourism

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Technology Penetration India leapfrogging in Information Technology and Telecom. India is a IT

power house of the world

Enormous support, encouragement and investment by state and central governments under “Digital India“ initiative

Healthcare – a slow adopter of technology, unlike Banking, Manufacturing and Retail

Healthcare organizations are slowly changing focus from automation of back office systems/reimbursement methods/regulatory compliance and accreditation requirements

Major drivers of Healthcare IT - establishment of large hospitals in private sector, insurance penetration, accreditation requirements and emerging disruptive technologies like cloud computing, Robotics, Machine leaning, Big data and BOTs

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What is Cloud Computing?

Discussion

Hardware, software applications, Network, storage resources are sold and consumed as a service or utility like electricity / air travel

Shared pool of configurable computing resources

Real time, available on demand, rapidly deployable, minimum management effort or service provider interaction

Any time, any device, any place access

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Key Characteristics of Cloud Service

Measured Service

• Pricing for no. of cores, RAM, Storage, Disaster recovery systems, Band width

• Annual Maintenance contracts, MC

• Escalation Matrix

Rapid Elasticity & Homogeneity

• Provisioning by day / time for increasing patient loads in existing / new hospitals

• Version upgrades

• Master data and work flow standardization

Multi-tenancy & Resource

Pooling

• Multiple hospitals / clinics

• Operating systems / HIS / SAP / email services / 3rd party software tools

Ubiquitous Network Access

• Remote / any device / any location (hospital / clinic / home) access

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Cloud - Service & Deployment Models

Cloud Service Models Deployment Models

Infrastructure as a Service

For processing, storage, networks, and other computing infrastructure resources

Platformas a Service

To deploy applications developed using specified programming languages or frameworks and tools onto the cloud infrastructure

Softwareas a Service

Private Cloud

Public Cloud

Hybrid CloudTo access applications from varied end-user devices (generally through a web browser)

Operated solely for one organization only or for an individual person

Open to the general public or large industrial groups and are owned and are usually managed by a cloud service provider

Combining two or more clouds (private or public) that remain unique entities but are bound together with data and application portability.

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Why Cloud in Healthcare?

Cost Effectiveness

Elasticity

Rapid Scalability

Anytime-Anywhere Access

Move from CPEX to OPEX for new hospitals (Pay as you go)

Long term reduced cost of owernership for existing hospitals

Less IT manpower costs

Computing resources can be configured for varying transaction load patterns peak times in a day / week or Holidays

Ensures optimum untilisation of resouces

Establising servers / networks / airconditioning / power conditioning equipment may take one or two months

Provisioning hardware /software / tools will just take few hours

Clinicians access any data from any place at any time for any patient – improving quality / efficiency and patient experience

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Benefits of Cloud Computing

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Key Risks & Challenges

Data security, Integrity, Privacy and Compliance

Latency Risks

Lose contorl over patient data and privacy

May not be certified or compliant for industry standards / regulations -NABH / HIPPA

User request to server response

Time – Ping time

Computational and Network

Bandwidth constrains from network vendors – Fibre optic lines?

Few Hospital Information

Systems in the Cloud

Most HIS not cloud ready

Hospital Management and IT staff still hesitant to embrace cloud

Description

Identify vendors with region specific certifications / compliances

Ensure data security / privacy guarantees

Choosing the right / trusted vendor

Proximity of hospital to data centers locaton

Indian and foreign vendor gearing

Cloud version / localization and customization of software CST / TCS

Mitigation

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Cloud Market in Global Healthcare

By Region

North America Europe Asia Rest of the World

Pricing Model

Pay as you go Spot Pricing

End-users

Healthcare Providers Healthcare Payers

Deployment Model

Private Cloud Public Cloud Hybrid Cloud Community Cloud

Software

Clinical Information Systems Non-clinical Information Systems

Component

Hardware Software Services

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Cloud Deployment in Healthcare

Hospital Information

SystemsNetwork Vendors Disaster Recovery

Systems

Data Centers

Provision VMs / storage

Location of data centers

Long term contract (5years)

Better pricing; Falling Cloud services pricing

SLA contracts

Escalation Matrix

Monitor Resource consumption

Primary & Secondary MPLS connectivity

Fiber optic Vs RF connectivity

SLA - 99.9% up time

Take advantage of falling prices

Patient Management

Op/IP Billing; CPOE

Radiology/Laboratory services

EMR/PACs and ERP- SAP

Third party software – Asset management, canteen billing

Claims Management

Hot / Cold DR

Remote location

Expensive

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Sl No Name of vendor Healthcare Organization

1 CtrlS Data center, Hyderabad

Apollo Hospitals, Rainbow Hospitals, Call Health

2 Ricoh India data center

Fortis Hospital, Delhi /Artimis, Gurgaon / Emanuel Hospital

3 Microsoft Azure L V Prasad Eye Institute, Hyderabad / Partners Health, United States / Apollo Hospitals / Fortis Hospitals

4 Amazon Cloud services

Cleveland Clinic, Ohio, United States

Cloud service providers & Healthcare customers

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Case Study: “Rainbow Digital” – Cloud HIS for Rainbow Hospitals (1/2)

Context

Legacy Systems

Key Initiatives

Rainbow Children’s hospital is one of India’s largest, foremost and most progressive super-specialty pediatric hospital networks - 800-bed, private, equity-funded group has positioned itself nationally as a center of excellence.

Why Cloud?

Growth necessitated a complete digital transformation and meeting commitments to ongoing improvements to patient safety, quality of care and efficiencies as more hospitals came online.

Decision to comprehensively overhaul all hospital IT systems and replace the old legacy system with a new state-of- the-art integrated solution.

# of Total Beds Daily in-patients Daily out-patients

1200600

1200

Newly procured Arcus hospital information system including electronic medical records

SAP and Adrelin (Polaris) ERP systems for materials, HR, and finance management

Integrated and hosted on the cloud at the well-established Tier4 cloud service provider, CltrS limited, Hyderabad. CltrS has data centers in Hyderabad, Mumbai and Delhi.

Cloud-hosting has enabled Rainbow to scale up or down its infrastructure requirements based on fluctuating and evolving demand with minimal investment.

Rainbow ran with two large computer servers - one supporting four hospitals in Hyderabad (the Hyderabad cluster) and another - a stand-alone server at Vijayawada hospital.

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Sl No

Name of Hospital /Clinic location No of Beds Type of Project

Date of Go live

1 Raiinbow ,Vikrampuri, Hyderabad 75 Existing 25/1/15

2 Rainbow ,Kondapur, Hyderabad 70 Existing 22/2/15

3 Rainbow Kukautpalli Hyderabad 100 7/3/15

4 Rainbow Madhapur clinic Hyderabad NA Existing 17/3/15

Rainbow ,Banjara Hills Hyderabad 175 Existing 19/3/15

Rainbow children’s hospitals with cloud enabled Arcus HIS

Clinicians visiting multiple hospitals - now able to access HIS and order for tests, procedures, view reports and write notes from remote locations

Group purchasing and centralized store management for all hospital units with SAP hosted on the cloud – helped reduce inventory & material purchase costs

Real-time dash board reports on number patient visits, inpatient and outpatient billing, pending laboratory reports, manpower/ material cost greatly improved

Turnaround times in laboratory, radiology, OT & OPD areas down by 40 to 50 percent Configuring 3rd party software, lab equipment, tariff across all the version upgrades of

application software, operating systems and tools became very simple as they could be done centrally on the cloud eliminating the need to perform in each hospital server

Ensuring security, integrity, and privacy of patient data practically shifted to Cloud service provider. Hospital IT department - no longer required to ensure these in each of the hospital units and less dependent on their IT personnel

Legacy software in hospitals replaced by new Telstra Arcus HIS one after another over a period of one year with a time gap of one month.

Key Outcomes

Improvement in documentation accuracy

Increase in patient satisfaction rates

Reduction in theatre waiting Time

Reduction in laboratory test results turnaround times

Improvement in radiology turnaround times

60%

50%

60%

50%

50%

Productivity Impact

Case Study: “Rainbow Digital” – Cloud HIS for Rainbow Hospitals (2/2)

With Cloud - existing hospital servers became redundant and no infrastructure maintenance required in any hospital

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Thank you!

Questions?