Do you want to learn how to overcome barriers to integrating patient-centric hospital software? What can healthcare learn from other industries? How to ensure integration hassles do not come in the way of providing a great patient experience? How to expedite the integration process? 

This episode covers these and many more important issues related to healthcare integration. Join some of the best minds in the healthcare industry and become better at integration. 

Duration: 52mins
Published Date: 17th Dec 2021

Mr. Kumar KV (Vice President and Group CIO & CISO – Narayana Health)
Mr. Bharat Gera (Strategic Advisor, BestDoc)

Midhun Subramanian (Head of Marketing, BestDoc)

Successful Integration of Patient -Centric Hospital Software with Legacy Systems

Midhun Subramanian: Good afternoon, one and all to this webinar in the series focusing on the patient experience at hospitals, organized by BestDoc. Today, I’m really excited to introduce our main guest,  Kumar KV, the group CIO of Narayana Health, one of the largest and, of course, the most reputed health care brands, not just in India, but across the globe. And this reputation extends to the technology front as well, with NH being early adopters of many new digital initiatives led of course, by  Kumar’s vision and leadership. 

Joining Kumar is, of course, Bharat Gera, who is a strategic advisor at BestDoc and a pioneer in the digital transformation of health care. Bharat has worked with hospitals across India and outside, including most recently with St. John’s National Academy of Sciences, Bangalore, and has designed and implemented multiple projects for digital health care globally. 

Again, just a quick check on the agenda. So for the next 45 minutes or so, we will be looking at all things around integration at the hospital. So we’re looking forward to a very nice conversation across many of these things as mentioned here. And, if you look at the successful integration of patient-centric hospital software, which is the topic for today, that can only happen if you can understand and learn from the challenges and experience. 

And who better to share the thoughts around this than our speakers who have more than 50 years of combined experience in healthcare technology transformation. So,  Kumar, to start with you. Talking about these challenges again, I’m sure you would have a lot of experience to talk about this journey that you were saying. So it’s an ongoing journey but during this journey, you would have seen a lot of things.

So how has it been, and where are we right now in terms of this particular maturity on the technology side of hospitals?

Kumar KV: Sure Midhun. Thank you so much for the opportunity. 

So, let me first give you a quick overview from an integration standpoint, because when you talk about patient-centric integration, it becomes very important. 

In healthcare, the four pillars are speed, access, quality, cost. And one thing that is not mentioned is safety. These five pillars are very important in delivering this. In the last several years, we’ve seen a good amount of progress happening across all these areas, but purely because there is an increasing risk across the entire health system because we are handling people’s lives over here.

And whatever we do from a technology standpoint to bring all these together, especially on the safety, on the experience, on the quality, and everything access, it’s more of an incremental approach and it requires a lot of improvement. And, what assembles all these areas and connects all these areas is the integration. 

You look at integration. When we think about delivering these to the patient because the end consumers are going to use these services. 

We have to think about this from a system integration standpoint or a systems approach and identify what are all the building blocks that are required to power these.

And these are very important to deliver across all the four pillars from a healthcare standpoint. There has been considerable progress that has been made by HL7 and FHIR, DICOM, LOINC standards over the last decade or two. But there is still a lot more work to be done when we say that true interoperability, portability, and standardization of records, as well as systems, happen. 

These are all nice things to say, but these are very hard to achieve for a country like India. For a population like ours and the infrastructure that is there. These are the goals that are there. And, we have to define milestones that show how we can achieve them. But let me end this by giving an example from the aviation industry. 

The healthcare industry can learn from the aviation industry. Because, let’s say an airline wants to build an aircraft, right, it does not start assembling all the parts.

What has happened is a lot of standardization in terms of components, a lot of standardization in terms of software, the integration of, let us say, communication equipment, softwares, engines, oxygen masks, everything has been standardized. 

So all you require is a large integrator who can assemble something like this, somebody like an Airbus or a Boeing or a Bombardier based on the nature of the aircraft to deliver low cost, high quality. 

So when we are able to bring in standardization, when we can bring integration and you’re able to bring all this, then we can think of a pretty large platform where players can easily come and systems will get seamlessly integrated and deliver the required experience. 

Today, the landscape is fraught with lots of issues in terms of, as you mentioned, non-standard data formats, there are multiple data sources. There are not-so-secure integrations, privacy is still in its infancy. 

As healthcare providers, we need to do a lot on the privacy front. And when you talk about integration, we are only seeing this only from a single perspective, not looking at the bigger picture, how the platform would scale over a period of time. Those are some of the things that are very important when you talk about integration when you want to deliver services to consumers. Then we need to ensure that these areas are addressed in a structured manner. 

Midhun Subramanian: True. I think that when you talk about these various areas, right. Of course, there are a lot of facets to it, and when ecosystem players come into play that’s very important.

Bharat, in terms of that, in terms of having one, the standardization part of it, which  Kumar was mentioning. And then bringing all these players together. How do you feel that approach has been or should be? 

Bharat Gera: I’m going to take you to the first slide where you showed our mugshots. If you see the mugshots, I’m holding a book there. The book is called Explorers Guild. It talks about the early journeys to the North Pole and trying to cross the continents using the North Pole route. And it used to always end in disasters. Each of those explorers ended up in wrecks. We’ve heard about the famous Titanic, of course, but there were a lot of these explorers who went through tremendous challenges and everything was an obstacle for them.

If you look at the reality of hospital systems today, that’s more like the real situation. The ideal situation is where we have everything standardized, like the airline industry. But the reality of hospital information systems, especially in India, is pretty much full of roadblocks, full of things that will throw you off and get you frost-bitten and everything. 

Terrible experiences. Some of the situations I’ve heard about from my colleagues include because the patient just did not show up in a waiting queue. There were people held up in daycare surgery for more than half an hour. I’ve experienced this, and sometimes they just didn’t get the right attention at the right time. This is terrible. Worklists going wrong seems like, okay, maybe some items didn’t show up in the queue, but, oh no. That means people are sitting there waiting for half an hour for a service and not seeing their name come up. Now, put yourself in the shoes of somebody who’s waiting for the name to come up. And the name doesn’t show up because there was something wrong in the integration that was done between the radiology system and your queue management system.

And patients don’t see the entire blocks behind it, and they only see what they see for their interaction. So we really need to think about it by putting ourselves in the patients’ shoes. We know a lot is going on at the back which the patient doesn’t know about. So of course, a lot of work needs to be done in what I would say are three layers. 

So the first layer, the bottommost layer, which the industry has been working towards for the last 15 to 20 years is the integration of the hospital systems. When you are in the hospital – the lab, the radiology, the blood bank, and all the departments – need to be integrated together. There is this idealistic ERP kind of hospital information system or EMR, which is supposed to be all in one. But invariably you end up in a large hospital, you end up with, like, 60 subsystems. So those all need to be integrated in some way. And there’s been a lot of work done. Like Kumar mentioned using HL7 and various integration platforms that help do it, integration engines that help do it like from Siemens. Now that’s the first layer. That is today should be taken for given. But we know that in India, it cannot be taken for given and it is still an area where we are ten years behind.

The next layer is where we talk about the integration with the patient-facing application. Like I spoke about the queue management application, the payment application, getting to see my records, getting to see my bills. All that is what the patient wants, right? That part is where the mistakes are more easily visible to the patient. And that’s where if you’re not working on those, we get to see the impact of that right away. That’s the next layer of systems that need to be integrated. 

At the highest level is what we are calling the Super Highway, which is the integration of records across the healthcare ecosystem so that if you go to one hospital, you can go to the other lab and you go to this lab and the doctor in the hospital can see your records. Now, this is the ultimate Nirvana of the healthcare system so that everything works together across all the hospitals and clinicians and labs and diagnostics and everything. 

But that’s what the patient wants. And I really applaud the approach taken by ABDM, the Ayushman Bharat Digital Mission as it’s called now, and it was called the National Digital Health Mission earlier, the approach that has been taken is brilliant to pull all the records into a personal health record, which you can give consent to and then authorize your clinician to see it.

But Kumar and I were just speaking about this. That’s the journey of 1000 miles. We are still at the single step. What do we do now? That’s what I am sure a lot of people attending this event want to know, what do we do first?

Kumar KV: Correct, I think Bharat you talked about the integration we see there are two layers. There is a horizontal integration that you spoke about, right? The EMR, billing, the outpatient, and various other areas getting integrated to a mobile app, to a display unit that is more of horizontal integration. Vertical integration is what we connect to ABDM- Ayushman Bharat Digital Mission and the other ecosystems, opening up the entire ecosystem from an interoperability standpoint. I think from a healthcare provider standpoint, we have to or if we say this as an entire journey, and if we look at this from a patient perspective, get into their shoes and see things. 

From registration to billing or sample collection or whatever we do to improve the overall experience. It is very important to understand what we have understood is, we walk through this entire area and see how a patient will basically go. We try to do heat maps and understand how they go in search of services. Are they going in search of services? Are they being directed correctly? And understanding what sort of data requirements are actually there from an integration standpoint. 

So when you are talking about it, let us say it can be as simple as integration with a queue management system right? So what data needs to be populated and displayed, right? You don’t have to display their phone number, their Aadhar number, and everything, but it might be their name, maybe the last four digits of their MRN, and that or you can even send it as an SMS. When we think about integration, we say that, oh, I have projected that, not many people even lookup the screen. But if you are able to send this on WhatsApp and if you are able to integrate that, that will basically improve your overall adoption of this also. 

So people will be able to see that they will get notified. Because gone are the days where you want to have large HD display units and you want to, what do you say, show up all the information over there. It can even be through as simple as WhatsApp and telling them you are actually you are in queue next, your turn is going to come. That itself would push the needle from a patient experience standpoint. So if you’re able to look at this from a horizontal integration standpoint, identify the pieces where the patient is actually going across the ambulatory area, or let us say, across the entire ambulatory process or the inpatient or daycare for that matter or even it can be as simple as going to the cafeteria. So saying that you can see various places where you can notify the patient, where you can ensure that data is cleanly routed and data which is really required for them to see. I think if you’re able to figure out this piece first and to a large extent, we have standardized this piece, integrated this piece, and still working on it. Because as we all know, this is a journey. This does not stop. There is no destination. I get into each station. I see how I’m doing. Sometimes I get beaten up. Sometimes I’m really praised for what is done. But then we pick up the lessons that is actually there and take the next path. And basically do the course correction. 

Constant recalibration is actually required because as patients or I would say, consumer behavior is changing, digital is becoming more of an everyday talk. So, we have to constantly recalibrate and see how to deliver a better experience that can only happen through a clean integration. And if we have to think through this from a patient standpoint, and if we think from a tech standpoint, it’s really not going to work. 

Bharat Gera: Very true. And taking that journey analogy, right. I think the whole approach of design thinking, which starts with the customer journey map. It’s surprising that so few healthcare providers actually do that effectively. I’m sure NH does. But there’s a lot of – at BestDoc we’ve done this often whenever we build a product, what we’ve always done is, hey, what’s going on in the customer’s mind when they’re going through each step of that journey like you just spoke about, they go into the cafeteria or they’re waiting for their lab results. So you need to have empathy. You need to know what is their state of mind? Are they worried at this point in time? What can we give them to address that worry? We can tell them. Okay. This is going to take half an hour or more. If a critical result comes in, we need to probably give them some kind of immediate response in terms of somebody coming there and helping them out. These things need to be modeled by empathy and using techniques of design thinking is my stand.

I think it works very well in BestDoc of what I’ve seen to design effective products. So one of the things that I’ve seen – when we do these journey maps and we do these design thinking exercises, I’ve always thought of it in a very simple way. I request the audience to think also in that way. What you do when you really want good service at the hospital, you call somebody, you know, at the hospital. Almost everybody does that right? They say, I know this guy vaguely,  I know this person, I will call this person, this person will help me out because he’s my friend and maybe he’ll help me jump the queue. Maybe he’ll help me get the right doctor. Maybe she will be comforting to me when I go to the hospital or whatever. 

I think the ultimate goal of technology is to be your friend in the hospital. You don’t have to call anybody else. Just call this friend. Right. And I’m hoping BestDoc gets there and becomes the friend of all the patients in the hospital.

Kumar KV: Very well said, Bharat. I think one example is like you said when I want to get let us say my parent or relative to the hospital, then I always put in a word. I think the best patient-centric experience is when we can say confidently if you have achieved that state of Nirvana is when we are able to send our mother or our loved ones to the hospital without even putting a word. And they’re going and getting everything done for them. And they’re coming back and telling that – fantastic experience.

Bharat Gera: I will give an award to the hospital that takes out that VIP tag from the list of patients. All hospitals have this VIP tag. Every patient is a VIP. That is how it has to be.

Kumar KV: Absolutely. I think that is well said. I think that, that is the end goal of today’s hospital, to map, invest in design thinking, invest in tools like companies like BestDoc or other startups that are actually there. Understand how this entire journey plays out. And say not everybody will be able to cater to their entire patient experience but identify good players through pilots or through your MVPs. Take those routes, integrate and do multiple dry runs and see if this experience really works, and do these course corrections.

So if they are able to do this and watch the data that is actually coming out of it in terms of your analytics and everything. If they’re able to do that, I’m very sure that we will be able to provide a very optimal patient-centric experience in each of our healthcare providers’ institutes. 

Bharat Gera: I have to ask his to Midhun and I’ve been asked this by people in banking who work on banking systems and retail systems, and Midhun has been in marketing automation for this. 

What is so damn difficult in this domain that you are not able to achieve what we are able to do in all other fields. What is so complex here that you’re not able to do? Why is it so difficult to do it with healthcare? They just can’t understand it. Midhun, can you talk about how others do it so well? We all want to be inspired by it.

Midhun Subramanian : No. If you look at the past months that I’ve been looking at healthcare, one thing I’ve seen is that in the other industries, there is a lot of maturity in terms of standardization. I think not just maybe nationally over the overall ecosystem in terms of the vendors as well. That has been over the many years that has now become a point of parity. As a customer or even as a vendor one of the first things you’ll ask is how strong are your APIs? How well is your documentation available? How is it integrated into this solution? So I think that awareness is there, I think, across all the actors across stakeholders in this particular purchase.

Bharat Gera: So, Kumar, Do you agree with that? Is the level of maturity of technology used in health care that is the culprit or is it something else? Sometimes I hear the complex workflows that exist in healthcare are not very amenable to classic BPM. Because we’re looking at multiple processes working together. So it’s not classic BPM. It’s not as easy as retail or banking is in that sense. 

Kumar KV: So in retail or banking, they have standardized the entire process because here across different providers, we have tried to customize it so deeply that there is no standardization, so lack of standardization in the entire process.

Bharat Gera: But can there be standardization in workflows? We know very well in clinical workflows there can be so many variations. 

Kumar KV: Correct. But it all depends, at least in certain areas you can bring in some amount of standardization and see how again, we have to invest time and to plan out to really understand what are all the ways in which things can actually be standardized. Of course, there will be variations that we have to take into account and see and design those experiences accordingly.

Bharat Gera: Just following NABH or the clinical protocols that are laid out in quality systems, putting that energy and investment in that, help the hospitals design workflows that work. And then going back to the other question, Kumar, I want to know specifically, is the technology maturity of the healthcare sector very low, and is that the culprit as well?

Kumar KV: No. I think I feel that the entire ecosystem is very fragmented. We have a multitude of health information systems that are there. And after COVID, numerous others have actually come in. And anybody – or many of these, I wouldn’t say there are certain very good people also, so I don’t want to generalize any statement. But when they build software, it is very important to adhere to a specific standard, ensure that there are standardized integration interfaces or APIs that are actually provided for all of this. 

Many a time, even data models, when you talk about clinical data models like FHIR data model, many people talk about it, but actually, they might not have implemented that too. So that’s where the technology falls flat, because you say that the software might be very good from the outside but inside the components that are actually put in, how these components are actually joined together, the back end that is actually supporting these components, they might not have adhered to the standard. So there has to be a way in which these softwares can actually be graded so that when healthcare providers procure this, they know that they stand for these. There is a checklist that is actually there where they can actually tick off and say that, yes, we know for sure that these adheres to the standard, and it will help me to build that the standardization or integration that I really want. 

Bharat Gera: So like the Meaningful Use act in the US and now what India is doing with the ABDM Sandbox you have to meet. In fact, what I find is that the efforts by the government are remarkable in terms of what they’re doing in terms of an API-based platform.

In fact, what I tell the hospital, you know what they’ve done a great job as an architecture. You mimic that architecture and build it in-house. You will achieve the same thing within the hospital and what is being planned for the superhighway. 

You don’t need the superhighway today, you need your local road. Use the same method of building the road– the blocks, the tar, the way of building the road– you will build the roads fast and efficiently. Is that a valid thing to build internal platforms?

Kumar KV: No, rather than looking, see not every provider might have the DNA to build their own platforms or build something. I think if you are able to have an architecture mindset if you are able to identify the various processes that are there across the entire healthcare chain, we can identify real good partners and identify their products and services and see how to integrate this. So when we talk about whether we should build something or whether we can plug it into a platform, I think the way in which things are actually going, some things which will help you to move the rollout products faster, improve your time to market, and everything is plugging into a platform.

So you can build a virtual platform from where you can actually plug in multiple products. As long as we have a very clear view of what data that is there actually pumping in, what data you are pumping in, what data you are pumping out, and ensure that you always build a very strong integration layer. If you have that layer and if you are able to identify products, you can seamlessly plug in and you’ll be able to realize the experience.

Bharat Gera: So here’s a nice question from Dr. Ankit. It’s a classic problem. An exception case. He says that when you have a PACS image, which is a radiology image for a trauma patient, you don’t have an ID generated for them. Let’s suppose a patient needs to be sent directly to the X-ray room. How do you get that image done? It’s a workflow issue, right? John Doe processes, as we call them.

Kumar KV: Correct. I think you can always create a temporary ID. You might still, there are cases where you treat them in the trauma or the emergency, and then immediately send them back. But creating an MRN or a medical record number can do it. There are ways to assign a temporary ID. Using that temporary ID you can always create a service order for an X-ray and basically send them out. It’s a classic, as Bharat said, workflow issue. If you’re able to get a temporary ID for all these patients and later convert that temporary ID, it’s almost very equivalent to converting a lead to an MRN number. 

This is patients coming into the trauma center. Maybe you can assign a temporary ID, Later, convert them into an MRN number, but you can still place an order and get the job done.

Bharat Gera: I noticed that at NH, the quality team works very closely with you, and that is an ideal scenario where the process and the quality team works closely with the technology team. Another hospital that I’m advising also does this very effectively., And one of the approaches that I believe you also take and I’ve seen others take as well is that you kind of see what is going wrong, you get feedback from the patients and then you use it to deliver a patient-centric experience. So, hear your patients, get each observation on what is happening wrong, and then you fix it, and that’s a great way to solve problems.

Do you want to talk a little bit about how you do that? I know you do a lot of that at NH.

Kumar KV: What we have actually done is we have created a service excellence team because purely focus on improving patient-centric services. iIt can be starting from parking like once they come into the lobby and parking their car, till getting their medicines from the pharmacy. Creating a service excellence team where the quality team is also part of it because they have a very clear view of what are all the various indicators that they need to measure from a feedback standpoint, be it, outpatient or inpatient. We have created this cross-functional team where technology is one of the players in this cross-functional team and identify the entire experience of what are all the various touch points involved the moment the patient enters or they even make a call or they enter the premises, the entire experience is actually mapped.

We have identified what are some of the quality indicators. Let us say when we come to registration, what are the things that we have to look out for like It can be as simple as putting a registration kiosk so that they can pretty much do self-service. And they are automatically routed nearest to the appropriate doctor’s office. And from there we are trying to see whether we can send SMS messages or when the doctor places an order by a CPOE, the pharmacy can actually get an order or they will get the medication in the app itself so that they will be able to then show it to the pharmacy and collect their medicines too.

There are other ways in which we are trying to do and when we complete all the services, we also send feedback to close the loop to see how we have actually performed. And in some cases from an IP standpoint, we ensure that feedback is actually made mandatory because we will know exactly what is the level of our services and gives a good indicator of how we are doing across all these areas. 

Apart from that, we also use a checklist management utility to take a question, let us say, if it’s going to be air conditioning, there are multiple areas that are actually mapped. And we basically check the air quality because that forms a key part of the entire patient experience journey. So a lot of things have to come into action to basically deliver this experience.

Bharat Gera: Fantastic. Now, when consumerisation happens in any industry, when the consumer is king, that is when the quality improves and that’s when you see excellence. So from what I’ve seen Midhun, the problem sometimes is that, unlike a restaurant. I went to this restaurant. It’s a very nice place in Hyderabad, which has very nice cocktails. And there’s this app, where I can order anything I want, and it comes to my table and I can pay for it. I don’t have to call the waiter at all. I could go through the entire dining experience without calling any waiter, without paying any bill or calling for the bill or anything. You remember at all the restaurants, you’re trying to get that guy. I don’t have to face any of it, everything just lands up at my table and I’m doing a call through the app. I’ve not even downloaded an app. I’m just using a QR code, scanning it, and doing that, which is what BestDoc is planning to do in the hospital and the kiosks that Kumar also spoke about. 

Now the consumerisation there is a little bit of challenge in the hospital industry because, unlike that restaurant where I can order three cocktails and get away with it – when my wife is not watching – I can’t do that to get three shots of insulin. It’s not going to work like that, right? There is a control mechanism for doing things. It can’t be totally consumerised. So if you say okay, no, you can get whatever you want, eat whatever medicines you want, eat whatever, get whatever injections done for you, that’s not going to work. It has to be a controlled system in healthcare. That is where the comparison with consumerisation becomes a little bit of a challenge. But the biggest challenge Kumar I’ve faced is the legacy systems. And I’m sure a lot of people here in the audience have faced that.

I’ve seen across the Indian health care system that the hospital information systems are legacy. They are 15 to 20 years old, which makes them very inflexible, written in client-server technologies. There’s a huge technology debt. I want you to walk us all through how NH overcame that technology debt to be in a position that today BestDoc comes and you say, hey, click, plug and play, put your kiosks on. That’s how you work now we know that we’re working with you. 

So, how did you reach that point from a legacy system scenario?

Kumar KV: Yeah, see from us, this goes back if I can rewind this to 2015. We strongly believe that technology will be the force multiplier to deliver health care or enable healthcare to reach the last mile. And if you have to deliver health care at scale, it is very important that we harness the power of technology. So, as many organizations, do talk about digital transformation, but we said that if you are going to digital transformation, it is not one of the exercises, it is not about looking at one part of the health information system. It is not about just standing up on a patient portal and saying that we are completely digitally transformed.

Bharat Gera: Now, the latest is an app. Everybody says we put an app and all the problems are solved. 

Kumar KV: There is an app for it right? So we said that there will be two phases of digital transformation. Phase 1 itself was for 5 years and that 5-year phase was from 2016 to March 2020 itself had 3 different stages. The first is building the foundational platform for the future which means that we have to start cleaning up the house, laying new wires, getting all the foundational blocks. Because you are talking about video traffic, you are talking about a ton of integration traffic, you are talking about of messages. Today we handle around 15 million transactions, we have 12,000 sessions in our hospitals. Unprecedented scalability we have actually built in the entire system. And it was not built in a day. sso foundational platform for the future and we say phase two was transforming business operation. We looked at the entire landscape, we looked at the hospital information system, we looked at our ERP system. 

But let me talk more about the health information. We never looked at HIS as a health information system, but we looked at it as a health information platform and said that let us build up this platform using open source components, using components used for eCommerce. And like Bharat said used design-thinking approach about how this flow needs to be orchestrated

The UX/UI – looking at when you see a screen, what is in the line of sight, how you can actually do things just with the keyboard by not even touching the mouse. How we save microseconds and even seconds in each of the screens, which when aggregated can give improved efficiency across the entire stakeholders. So we designed such a system, we invested in a hospital information platform in 2 and half years. We rolled out the entire thing flat our in 10 months in our tertiary care centers, clinics, and our heart centers. All this was actually possible because we thought through the entire thing, lot of experiences was involved in this. There was a great team with me to plan this out completely and constant iterations, continuous delivery, continuous integration. We were able to release certain modules independently, transition to it, we were able to understand user behavior then we started rolling out the entire thing. 

As we speak, we have completed stage one and today it’s all about changing the entire outpatient experience. And we are working with partners like BestDoc to improve our feedback management, we are working to improve the complaint management system, we are working to improve registration systems. The next  3 years of digital transformation is going to be focused on improving outpatient, inpatient, and day care experience. When we talk about patients – now it’s all about horizontally we are doing Changing experience for doctors – we have already changed the way in which doctors communicate, we rolled out a WhatsApp for doctors which gave them unprecedented flexibility and it’s all about chatting. 

You can place service orders, you can place medicine orders. You can do radiology, lab reports, everything got delivered. And today this platform or the app that I’m talking about has around 2,000 doctors in that. And they send several million messages a day. I’m talking about serious, million messages a day where we are in the business of saving lives. 

Midhun Subramanian: So, this one question I had was in terms of adoption, right? So when I speak to some of the folks and all they say that, you know, it, it, for me, the challenge is actually getting that adoption or I would say more to do with change management, right? So you are in a particular way of working and then you kind of, you have a lot of tools that we can utilize, but then how do you get people to actually use it as a habitual, and then have it as active, power users. Right? How, how do we tackle that? I see a lot of these things being asked by many of the hospitals from IT or operations, head teams size. 

Kumar KV: How are we able to roll out the entire health information platform in 10 months?  Because we were able to design the UX UI, we gave a lot of importance to designing the screens. We sat with those stakeholders, understood what their current challenges are, understood what they would actually want, And that empathy we were able to empathize with them what they actually see. We sat with people in warehouses, blood banks, and doctors. So we were able to understand the pulse of it. 

Bharat Gera: Kumar you are forgetting one thing. You had a deep commitment from the leadership, you are forgetting Dr. Devi Shetty? 

Kumar KV: No no, absolutely not. I think, without their support and guidance, I would say the entire senior management of or the senior leadership of NH had, I would say,  210% support, but if I can put a number to it or I would say it’s infinite support even till the day, till this minute, the second. It starts from the Chairman and flows completely across all the functionates. 

Today we are committed to this and it’s not been a bed of roses, it’s not as if we have not had challenges. We have had our own share of challenges, we have gone through that, but each challenge – we have recalibrated, we have taken note of what was wrong, or what mistakes that we have actually committed and then worked to correct that. So like always our Chairman says you are allowed to make mistakes but don’t repeat the same mistake. That has always been the advice of our Chairman. So until you allow people to make mistakes, they will not improve as a person. And if we are, if you are doing, if, if me as a person I’m doing this well, and my team is doing this well, it is definitely because of a great leadership who has supported us at every, I would say every step in our work life, I would say.

 Bharat Gera: Yeah, absolutely. Wherever I’ve seen it succeed. It is always – the change management has to be backed by the top leadership.  Dr. Devi Shetty is so proud of,  whatever Kumar and team do. Whenever he meets, he just shows it off. He wants you to come and see how it is working. He’s so excited about it. And he passes that excitement onto other leadership people in the organization. Kumar has tremendous backing from Viren,  in the organization, and a lot of other leaders who are fully backing what he’s doing. 

Similarly, wherever else I’ve seen this happen. The change begins with the leadership commitment I would say number one. There are a few change agents and, there are these,  younger doctors are more motivated to make these things happen. If you look at it, we call it evidence-based versus eminence-based medicine.

So, the younger doctors are more followers of evidence-based, the guys who are eminent, they are generally, they bank on their eminence and they don’t bank so much on the evidence. So they don’t put in that much effort to create data.  There’s also the difference between  a process-driven hospital. One of my colleagues in the current assignment told me very nicely that we are not a process-driven hospital. We are the old style of the hospital, which is like the – you know, people have figured out how to do things really well. They don’t need a process. So whereas the fresher, more Greenfield, recent units are more, more process-driven. So there’s a change in culture, which happens across the ecosystem. And there’s a change, which happens due to certain individuals’ commitment.

And I think one big change factor that is coming our way to conclude this discussion from my side again, I repeat the change that is coming like a tsunami. The ABDM is a tsunami for change. It is going to revolutionize healthcare in India.

I’d love to hear Kumar’s closing remarks on what’s gonna happen. What do you see, next two years, five years, 10 years? People say it’s too far away. I don’t know. Is it really that far away?

Kumar KV: No, I think there has been a tremendous, see, look what COVID has actually done. In two years there’s been a tremendous intake of digital technologies by many healthcare providers. I can’t wait to see what is going to happen in the next three years, because it’s going to be very, very exciting as, as you told ABDM digital mission, there is a huge change. And if you’re able to achieve that as a country, from an interoperability standpoint,  that is going to give us true portability of records. And as consumers focus more from a digital standpoint, we can see many of the providers basically shift to digital-based systems or digital-based  experiences or enabling digital-based experiences to the patients and delivering true delight. 

So I think in three years, we can definitely see a lot of hospital systems upgraded, a lot of hospitals basically engaging with their patients, enabling them, and communicating with them and enable them to focus from illness to wellness rather than just focus from an illness standpoint. I think that’s what the past year taught us.

Bharat Gera: You guys have already crossed milestone three on the ABDM, and you’re ready, right? 

Kumar KV: We have done the milestone.  We are working on milestone two and three now, we are on that path to do that., We have also completed our Cayman Island’s rollout. So we were pretty busy in that, but I think milestones two and three are in our sight and we will, we should get that done pretty quickly.

Bharat Gera: So what I see happening is that I heard from Kiran Anandampillai – we are gonna launch these PHR apps within next month. And once we do that, you’re gonna have patients lining up at your doorstep saying put your prescription in the writing, Send it to me on my PHR app. People are going to demand like they did with UPI payments.

And that I think hospitals better be ready for that kind of a patient-centric experience. And I think it’ll be a challenge, but it’s the right way to do it. And I think the best leaders would be  best positioned, you know, like we said, you have to have all your underlying systems integrated to be able to do that. And I think the best ones to do that would be organizations like Kumar’s NH and BestDoc hopefully will play a role. I’ve been pushing that we do something in that direction. So I think we’ve overshot the time, Midhun. So do you wanna take some questions from the audience? 

Midhun Subramanian: So I just got a couple of questions. One thing they were asking was,  what are the recommended best practices that one can leverage for minimizing the time taken to integrate. So, Kumar, you want to go with that? I think you have a lot of learning in that.

Kumar KV: One is to understand what you want to integrate first. So when you want to integrate two different systems, understand what data, whether you want to do it unidirectional or bidirectional, do your data mapping, what are all the different sources of data,  and how do you need to present this data? Not everything needs to be presented, so you might get the entire data, but you need to only show certain aspects of it and always look at certain standards because standards provide you with guardrails of how to basically do this. So look at standards. So when you take an integration, say which standards that I need to adhere to, what standards are actually there like HL7, FHIR, DICOM. So if you’re able to adhere to certain standards, then you’ll be able to do a very, very successful integration.

Bharat Gera: My single piece of advice is don’t do patchwork. I mean, I don’t know so many best practices, but I’ve seen a lot of people use what I call worst practices. They’ll just patch it together somehow and make it work and one day or the other that’ll break. You’ve given some table view. The worst case is people take master data from one central or single source of truth, which is supposed to be the single source of truth. They go and put it in the other third-party system. When the master changes , there areno change on there. It all breaks. I think, I mean, people need to realise patchwork doesn’t work. I can tell you what’s the worst practice. Kumar will tell you a lot about the best practices. 

Kumar KV: Yeah. I think best practices – not everything needs to be best practices, but it should be more recommended practices for that organisation.

 Midhun Subramanian: Yeah, of course, I think every hospital – they are in different stages of the journey. So how you actually move from one stage to another and different challenges will come into play, right? You know, level 1, 2, 3, 4, 5 – so that maturity as we go through. And, that’s where I think where Indian healthcare system is also in, right. We have a lot of different players at various stages, but I think as we said in the next couple of years, or more will be, I think the time of flux, right? There’ll be a lot of changes happening through accelerated change, I would say. And, just to conclude I think this particular session I hope has given some light in terms of how we can go about, going, and riding that change effectively and,  bringing transformation across our hospital side. 

Bharat Gera: The best evidence is that you should be able to plug and play.  BestDoc should be able to knock at your door, and say, you are gonna put the kiosks there, you should say, okay, next one hour it is live or next week it is live at the best, it should be within a week, take anything. It’s a monitoring device for patient care in the wards. You should be able to say, hey, you know what? I will make it live in a week. You could just put your patient on it next week. 

Midhun Subramanian: I think that is already possible. I think with the vision as you said, the team that’s involved – that methodology in terms of going through the process of selection and implementation, these timelines are definitely doable. In other industries, it happens in days.

Bharat Gera: Absolutely, it’s a clear maturity level, and the entire industry needs to move up to this maturity level. And all of us are making efforts to do that, to make that happen. 

Thank you Kumar for sharing so much about what you are doing as a leader in the industry.

Kumar KV: Always there to support Bharat

 Midhun Subramanian: Thank you so much  Kumar and Bharat. Thanks again.

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