The healthcare industry is on the brink of a major transformation driven by the demand from consumers for more patient-centered care, a desire by healthcare professionals to provide improved quality and efficiency of care, and the need of payers to stem the rising costs of healthcare delivery. Improving the healthcare system on all fronts requires increased information sharing through connected healthcare technologies that provide access to important patient information across various healthcare facilities and providers. Over the last few years, the cost and complexity of setting up IT systems have decreased, with the availability of remote support, software-as-a-service (SaaS), and cloud computing, giving a momentous boost to the healthcare IT industry.
With the digital revolution being a priority now, hospital management have been fostering the technological advancements to streamline the processes and keep pace with the evolving market. These advancements have impacted every aspect of medicine – from surgery to diagnostics, and research to record keeping, replacing the traditional files and paperwork with digitized systems. There is a growing emphasis on simplifying hospital management by automation of the workflow and providing the users access to information as adoption of electronic health records (EHR), radiology information systems (RIS), cloud computing, and picture archiving and communication systems (PACS). Hospitals, healthcare groups, and medical practices have adapted to newer management structures and systems to curb spiraling costs. A number of large hospitals and healthcare providers have already shifted to a more integrated and comprehensive approach to excel in the clinical, operational, and financial spheres of the organization, while the smaller chains are finding ways to achieve collaborations for cost-effective access to resources.
The confluence of healthcare and technology in the form of digital health is the key pillar with which the healthcare management can be made more efficient. While significant inroads have been made in the use of digital health and healthcare IT initiatives globally, these applications are still at a nascent stage in India. The initiatives taken by the government aimed at addressing the healthcare gap in the country are slowly but surely revolutionizing the public health scenario. Coupled with the large number of startups that are driving the penetration of technology in the healthcare sector, this joint public-private focus on digital healthcare is paving the way to the future.
Indian Market Dynamics
Digital technology adoption is already gaining prominence in India's healthcare industry, with efforts from both the public and private sectors. The government has launched several initiatives such as Digital India and Aadhaar in some cases with support from the private sector. The Digital India initiatives have given a further boost to digitization that will help in the adoption of EHR and health information systems in the sector to enable seamless interoperability of data that will facilitate patient safety and lead to better patient outcomes.
The Digital India initiative represents a landmark in ushering the first digital revolution in government healthcare at AIIMS, Delhi. The successful implementation of the AIIMS e-Hospital project and the AIIMS OPD transformation project, transformed AIIMS into India's first fully digital public hospital. Integration of radiology services with PACS is yet another milestone in the digitization of AIIMS. In the phase I of year 2017, the equipment in cardio-neurosciences center, trauma center, center for dental education and research, center for ophthalmic sciences have been integrated with PACS.
At present in India, adoption of the EHR system is slow, because EHR or EMR is not mandated in India. In 2013, Ministry of Health and Family Welfare (MoHFW) notified EHR standards for India. Some organizations are at the forefront of the curve. For decades, they have adopted electronic records while rest are still in the planning phase. Historically, on basis of the survey, taking up of EHR has been considerably lesser in India as compared to other developed nations. To enhance the acceptance and to influence its returns, the governmenthas budgeted 128,640 crore for HIT.
The major barriers in the adoption of EHR include interoperability standards issues; lack of funds; shortage of suitable governance health policies. Despite great concern by the governmenton adoption of EHR, impetus is still to be recognized.
In a recent move, a scheme to set up an Integrated Health Information Platform (IHIP) to create the EHRs of citizens and to be made available nationwide online for medical history, with the help of Health Information Exchange(s), has been approved and is being implemented. MoHFW has notified EHR Standards Version 2016 for India in December 2016 (whilst the earlier version of EHR Standards was notified in September 2013) with the intent to bring standardization and homogeneity, inter-operability in capture, storage, transmission, use etc. of healthcare information across various health IT systems. State/UTs have been advised and are already working on computerization and implementation of hospital information system (for creation electronic records) in their hospitals/health facility with support under National Health Mission. With the advent of the envisaged system of EHRs of citizens in an interoperable manner pan-nation, online availability and accessibility would be ensured facilitating continuity of care, better affordability, better health outcome, and a better decision support system. This is expected to help in reducing expenditure on avoidable repetitive and similar diagnostic tests.
As per Healthcare Information and Management Systems Society (HIMSS) Asia-Pacific, there are eight stages/levels of acceptance of EHR varying from level 0 to level 7. At stage 0 there is small or nil acceptance while at stage 7 there is complete implementation or acceptance. With reference to the HIMSS analysis adoption model of EHR, by the end of 2016, only 2.6 percent of hospitals crossed level-6.
On September 4, 2014 Max Hospital and on December 8, 2014 Apollo Hospital achieved stage-6 from HIMMS (Asia Pacific). Additionally, exchange of data information among hospitals was complex because of lack of interoperability standards among hospitals, which creates major hurdles among the co-ordination of patient care. These barriers, along with deficiency of regulatory momentum, are the major barriers for industry in adoption of electronic health records widely.
In addition, government organizations including Centre for Development of Advanced Computing (C-DAC) and Electronics Corporation of India Limited (ECIL) have been developing versatile hospital management information systems (HMIS) that have been implemented at large hospitals. These systems are modeled on the unique combination of a patient centric and medical staff centric paradigm, thus providing benefits to both recipients and providers.
The adoption of HIS will surely boost the competence of healthcare systems but on the other side several parameters like lack of standards, cost, guidance, security, and confidentiality, could remain a concern. For well-built healthcare and wider range of benefits of HIS, the government support to provide incentives acts like a booster to promote the market of HIS adoption. The adoption challenges today industry is facing are complex and a solution to these challenges is not so quick and simple. National policies are required for stability regularity of these problems. More innovative approaches like web-based and cloud-based solutions can be used.
Global Market Dynamics
The rapidly growing geriatric population is creating a high demand for healthcare information systems as these systems play an important role in meeting the healthcare requirements of this expanding population. The mounting need for integrated healthcare systems is stoking the growth of the market. In addition, healthcare IT companies are continuously pouring funds into the development of new and advanced healthcare IT solutions. The advent of these solutions is, thus, providing a fillip to the healthcare information systems market.
On the flip side, the dearth of skilled physicians is inhibiting the growth of the market. This is further exacerbated by the hefty sums required to train personnel for operating these systems. Furthermore, the high expenses of maintenance and services are keeping the market from realizing its utmost potential. Owing to these factors, the global healthcare information systems market is projected to reach a valuation of USD 448 billion by 2024 from USD 211.39 billion in 2016, progressing at a CAGR of 10.1 percent from 2017 to 2024.
There is a paradigm shift from the traditional approach of paper-based manual operations to paperless IT-based solutions in hospital management. The growing number of government initiatives across the globe is accelerating the deployment of such technology. The IT companies and healthcare organizations are collaborating at a greater level to develop high-utility services and products to improve overall hospital administration. For instance, IBM and Cleveland Clinic have announced their 5-year agreement to expand Cleveland Clinic's health IT technologies. Another example is partnership between Hospira and Latric Systems to work toward developing a two-way communication between EMRs and Hospira's smart infusion pumps.
On the basis of component, software will continue to account for the lion's share in the global HIS market. The development of mobile applications that facilitate easy exchange of healthcare information between patients and physicians is bolstering the growth of the segment. The hardware segment is estimated to post a noteworthy CAGR during 2017–2023. Rapid advancements in hardware are providing a significant boost to the growth of the segment.
Based on end users, hospitals will continue to dominate the market until 2024, expanding at a CAGR of 11.1 percent from 2017 to 2024. The demand for HIS will remain high in the segment owing to the pressing need to store a massive amount of data and make it easily accessible to physicians.
With the strides made in the implementation of HMIS at all levels, developing a user-friendly interface with coherent data utilization systems is still a challenge to the systematic operation of hospital information systems. Interoperability, high cost of installation, and availability of skilled workers are some of the factors hampering the growth of hospital information systems. EHR, apart from being advantageous in storing information face the challenges of collecting, storing, and protecting the data.
As new technology continues to transform the healthcare industry, it is more important than ever for healthcare professionals to be aware that private health information is at risk of being exposed. Data security and retrievability are the two segments to work upon to ensure efficient data flow and reduced scope of error. With more devices in the data storage network using wireless technologies, issues related to privacy and cyber security could arise. The healthcare organizations are challenged to anticipate the full spectrum of intentional and unintentional threats that might expose potential vulnerabilities in their networked medical devices. The developing IT industry holds a promising future for the hospitals in delivering care in a high-quality, safe and secure, patient-centered, and cost-efficient manner.
Hospitals are information-intensive organizations and successful implementation of hospital information systems will promote a well-organized management of the administrative and medical information. With unparalleled flexibility and scalability, these systems have great potential in reducing healthcare cost and in improving health outcomes.
The advancements in the IT sector, such as the introduction of cloud computing and PACS have provided an opportunity to the hospital and healthcare providers to boost operational efficiencies and improve patient centricity. Initiatives to promote EHR and electronic data sharing will enable healthcare providers to improve the clinical outcomes through care collaboration and evidence-based practice, while reducing administrative paperwork and streamlining workflow. With an increase in the competition faced by the hospitals, it has become imperative for the managements to step ahead with appropriate measures to boost their efficiency with the incorporation of these information systems at all levels.
To survive in the markets flooded with surplus competitive partners, the hospital administrates follow a patient-centered approach by incorporating robust information technologies and taking utmost privacy and security measures. The implementation of alluring information technologies will accelerate the rate of growth in the healthcare sector and reduce the burden on administrators while increasing the level of quality and satisfaction for patients.
There is certainly no greater time for the healthcare industry than today, and with the healthcare and IT industry coming together, the possibilities of healthcare are immense. Technology is already advancing the way in which healthcare is provided, from transitions of care to delivery systems, it is all about getting the right information into the right hands to best serve the needs of patients.
India has the potential for digital growth, given its current technology penetration, advancing economy, growing population, and accelerating healthcare industry. The rise of digital technology is pushing India to achieve Health for All, putting the country at the forefront for foreign investment. With these opportunities, India is emerging as the global leader in digital health.