Technology for Emergency Care Management & Healthcare Delivery-Varun Bahl ,Vaibhav Srivastava

8/3/2019 Technology for Emergency Care Management & Healthcare Delivery-Varun Bahl ,Vaibhav Srivastava

http://slidepdf.com/reader/full/technology-for-emergency-care-management-healthcare-delivery-varun-bahl-vaibhav 1/12

Title: Technology for Emergency Care Management & Healthcare

Delivery

Authors

Varun Bahl works as a Business Consultant in the Healthcare payer IT field with more than 8

years of experience. His areas of interest include Health Reforms, Medical IT Process

Optimization and Health Innovations. Varun has expertise in many healthcare businesses

including Health Insurance, Third Party Administration, Pharmacy Management and New health

technologies and innovations.

Varun can be reached at [email protected]

Vaibhav Srivastava works as a Business Analyst in the Healthcare domain consulting field with

more than 3 years of experience. His areas of interest include Health Reforms, Healthcare

Process Optimization, Innovations, Thought Leadership and Healthcare Strategic Consulting.

This paper was submitted for eINDIA 2011 conference Page 1

mailto:[email protected]




Vaibhav can be reached at [email protected]

Table of Contents

1. Introduction

a. Statistics on Emergency Services in India

2. Current State of Emergency Care Management in India

3. Transformation Strategy

4. Leveraging Technology for Integrated Emergency Care Management

5. Cloud based Integrated Emergency Care Management

a. Interactions with Stakeholders

b. Revenue Model – How to make ERC’s viable

6. Summary







1. Introduction

Emergency Services are restricted in India- to sum up the current state of emergency services and its delivery;there is a famous quote by an Ex – Dir AIIMS, “If you feel there is an emergency, better arrange for your own

transport than to wait for an Ambulance”. Most of the population is completely unaware of emergency

procedures and appropriate contacts. Emergency delivery systems are also constrained, due to lack of system

integration, leading to poor delivery of care.

Statistics on India Emergency Care- Drivers of Change:

With more than l Lakh Road Traffic Accidents related deaths, 98.5% Ambulances used for transporting dead

bodies, 90% of A m b u I a n c e s devoid of Oxygen of any Equipment, 95% Ambulances having untrained

personnel, most ED doctors having no formal training in EM, misuse of Govt. Ambulances and 30% mortality

due to delay in care, India portrays a worse image than what existed in USA of 1960s (Source:

http://www.iiems.org)




2.Current State of Emergency Care Management in India

Emergency Care is one of the most critical aspects of care delivery. Quality of care and timeliness of appropriate

care are equally important for effectively treating emergency situations. Cases related to trauma and heart

diseases are common and need specialized care.

Typically, most of the “emergency care” in the hospitals in India is provided in areas known as Casualty or

Accident rooms. Formal education and specialty training in emergency care are neither available nor mandatory

for personnel involved in emergency care. These Causality/Accident room physicians lack any specific training

in emergency medicine. In many hospitals, physicians staffing the emergency rooms lack the resources and

knowledge to manage the wide variety of emergencies. They therefore function as ‘postal carriers’ who ‘deliver’

victims to the respective specialties. The most junior and inexperienced staff frequently treat the most seriously

injured patients. Needless to say, the state of emergency medical services in India remains in bad shape.

3. Transformation Strategy

A detailed gap analysis is required to identify the loop holes that exist in the way emergency services are

delivered currently. The major challenges that need to be addressed are as follows:

o No single point of contact for Emergency Management

o Lack of Standard Treatment Guidelines

o Lack of Traffic Management for Emergency Services Delivery Vehicles

o IT Equipped Medical Vans are very rare in India

o POEC – Point of Episode Care is highly constrained




IT Integration supported by real time data communication systems can achieve the dream of providing optimum

quality emergency care in the least possible time. Integration of various stakeholders through advanced

technological devices can lead to increase coordination of care.

Indian healthcare system needs to recognize IT as a strategy for survival. IT can not only reduce manual

intervention but also enable required decision support at the point of care. A rule based platform can enable care

givers in adhering to standard treatment protocols.

Thirty per cent of emergency patients in India die before they reach a hospital. Over 80% of accident victims donot achieve access medical care within one hour of the incident. Efficient real time communication systems can

offer invaluable capabilities of reducing this time gap, so the treatment starts as soon as the request is raised.

There is a need to establish an Emergency Response Center, a dedicated centralized hub equipped with state of

the art Call Center Facility, which will act as a nodal point for any emergency issues, on the lines of Emergency

response center in Gujarat. It will allow the person to call a single number for his entire healthcare emergency

needs rather than remember hospital emergency numbers.

Emergency Response center will be equipped with the latest technology to

a. Support the patient until the emergency service arrives

b. To co-ordinate emergency care from the nearest healthcare center (Private/Public)

4.Leveraging Technology for Integrated Emergency Care Management

Patient’s medical history, in case of an emergency, is most one of the important input for effective treatment in

a crisis situation, thus ensuring availability of adequate medical information to the care givers can make a big

difference.




Electronic Medical Records is the way forward in this direction, a Standardized way of representing the medicalinformation in an electronic format that is available to healthcare professional at the click of a button can assist

in an effective care delivery mechanism.

As soon as the information reaches the contact person, emergency management team can look at the critical

information, such as allergies, ailment history, prior diagnosis, tests, report and treatments to decide on the line

of treatment needed for a particular emergency scenario. Hence the process can be initiated even before the

patient’s actual condition is analyzed.

As technologies evolve, they create avenues for path breaking changes in society, some of the technologies that

can help in better Emergency Care Management are

a. Telemedicine

Telemedicine are like virtual clinics where patient is at one end of the terminal while the doctor is at

the other end of the terminal, the consultation happens through a telepresence / Video conference that

also has basic devices attached to provide doctors information on patient current state, these include

BP Monitor, Glucometer, ECG monitor, Thermometer, Stethoscope etc.

Telemedicine has a huge scope in providing medical consultations almost on a 24X7X7 basis to

everyone subject to them having access to basic IT infrastructure

b. Online Traffic Updates

Although relatively new concept in India, where traffic management does not generate interest for

Technology companies, inputs from traffic management tool can help Emergency teams to plan the

evacuation of patient in better fashion

c. Integrated update system

Other updates include weather updates, area population updates, cultural festival updates, event

updates such as rallies, exhibitions and games etc. can help the Emergency response team to plan their

deployment of resource to address maximum population




d. Integrated Call Center

Integrated call center with capability to route the calls to multiple customer service representativesfrom a single number. Ability to handle and support level of variation in call flows with minimal

infrastructure can help in maintaining connectivity with the patient/patient’s know in and during the

emergency until the help arrives

e. Cloud – Right way to manage Emergency Infrastructure

Concept of cloud is based on renting infrastructure rather than setting it up. Cloud infrastructure can be

very helpful in managing the cost of infrastructure, since it is known fact that call volumes grow during

a certain period of during the year, such as weather changes, festivals, winter etc. Thus allow

Emergency Response Center to maintain its services at optimal levels.

5. Cloud based Integrated Emergency Care Management System

Cloud based Integrated Emergency Care Management System intends to fill the gaps that currently exist in the

way emergency care services are delivered in India. This extensive solution can resolve multiple issues that

currently exist across the spectrum of stakeholders involved in emergency care.




The above diagram depicts how the information would flow in an emergency care scenario across various stake

holders using a cloud based service. The various stakeholders that can leverage IT for effective care management

in an emergency using the Cloud based Integrated Emergency Care Management System are defined below in

detail.

• Emergency Response Center

Emergency Response Center will be a dedicated center to handle Emergency needs to a state wherein the

calls to a single number will be routed to the nearest free center associate. These associates will be trained




on handling of medical emergencies and will take the basic details of the emergency, put it into the systems

and look for immediate responses in the system.

ERC System will reside on Cloud to ensure scalability of infrastructure at different times and also in cases

of Catastrophes like Terrorist attacks, Earthquakes, Flooding, and Major Accidents etc., Cloud would also

provide seamless connectivity to other stakeholders such as Hospitals, ambulances etc. as only services and

real-time data can be deployed on the cloud.

ERC system on receiving the details such as person, his age, unique iD if any, place of episode and type of

emergency, allergies or adverse interaction, current medications will show up the following important

information’s to the stakeholders for an episode through ERC Cloud Interface

a. Check if the patient has an EMR for unique ID shared, if yes, check if the current episode is

related to existing conditions and if patient can be stabilized with the current resources at the point of

episode. Display probable approach based on historical data

b. Check the symptoms and what diagnosis it corresponds to, give the initial lines of action, from

which the Emergency Response Center professional can decide which may be appropriate, also

guidelines for address the emergency until the Ambulance reaches the point of episode

c. Establish contact with the nearest center having Ambulance available, through state of the art

GPS, with all the ambulances associated to the medical center. Guide them to the route that can be taken

to reach the point of episode in the shortest possible time

d. Checks for the timings, events, festivals, happenings in the area and assess the rush in roads,

suggest alternate routes to reach in shortest possible time

e. Information will relayed sent parallely to the ambulance and the closest hospital that will be

equipped with connectivity to the Emergency Response Center and will be able to access the updates on

the situation including the condition, symptoms and primary first aid being provided. Thus allowing the

paramedical staff and hospital to prepare for the emergency

• Ambulances/Paramedics

Hospitals and paramedics enlisted with the ERC will be certified by the ERC team for GPS and readiness,

Paramedics will get an update if it’s not already tagged as occupied. Paramedics can then connect to ERC

system and check the place and kind of episode, on the way paramedics can decide on the line of action and




start preparing for medical instruments/medications that will be needed to stabilize patient enough to be

taken to the hospital.

On the way the paramedics will be put on the call going on with the ERC team, till the time he reaches the

location and treats the patient, the paramedic will close the ERC request once the patient is acquired by the

paramedic.

Paramedic will then analyze the situation and decide on transportation of patient or in case he needs to

stabilize or call for further discussion. He can connect to the state of the art Telemedicine over the laptop or

treatment kit to further analyze the situation and bring it under control.

Once the transportation starts, the Vitals for the patient will be flashed over to the nearest hospital whom the

ERC has already assigned the case. They will be able to monitor the vitals and see the treatment being

provided by the paramedic in real time. Live feed about the patient can also be provided if the ambulance is

equipped with this facility.

• Hospitals/ Emergency Care Centers

Hospitals will get a notification once the patient is put on the Ambulance for transportation, the details about

the episode will be flashed on the emergency screens. This will detail out the statistics and data collected by

the ERC team.

Ambulance Medical monitoring information will also be flashed in the hospitals to see how the vitals are

doing and if the patient is losing or stabilizing, this will help in final tracking the progress of the patient till

the time he/she reaches the hospital under emergency care.

In parallel the hospitals will be allowed access into the Electronic Medical Records of the patient (if it’s

identified that he has a medical record/history). This will allow the hospitals to have full details of the

patient and will be able to analyze diagnosis and start preparing on the plan of action way before the patient

reaches the hospital.

Time saved during the emergency episode will allow the patient to get on time, precise and quality care thus

increasing the chances of survival of the patient.

Revenue Model – How to make ERC’s viable




Although the Ambulance and hospitals can charge for the medical services and supplies provided by them,

the question still looms around how the ERC will be funded. ERC would need to have state of the art

technology and resources trained for extreme conditions, these are high cost investment and they would need

to be made on sustained bases as the technologies evolve. Thus there needs to be multipronged approach to

revenue generation. Some of the Channels that can be tapped into for funding of these initiatives include

a. Government Funding at two levels

i. Technology Upgrades

One time funding would be required for upgrades that might happen on need basis, this can

be requested in the form of grants to the state, central government, with stress on healthcare

in the 12th 5 year plan, there will be scope to get funding for this infrastructure even at the

central level

ii. Operations

States can be requested to allocate the funding from the earning through taxes and grants or

a medical tax can be included in the current tax structure of the states to allow them to fund

this initiatives

iii. Policy Changes

Making policy changes to make the grants to ERC tax free would encourage people to

donate. Other policy arguments can be discussed where in tax free imports and rebates to

company’s part of ERC can go a long way in reducing cost this indirectly supporting the

project

b. Funding by people

i. People can also fund the project; this can be done by charging commodities with cess on the

service provided on the lines of Education cess.

ii. Charging for ERC usage as part of the bill from paramedics then transfer of the amount to the

ERC centers account.

c. Funding by corporate

i. Corporate’s can be tapped into specialty healthcare through the following




1. Healthcare providers (Ambulance/Hospitals) will be asked to pay subscription fees. This

should be mandatory for all hospitals operating in the area of where ERC is deployed

2. Healthcare providers can use the ERC data base as this will be rich source of information

and can be deciding factor in their business

3. Trends and utilization and usage can be shared with corporate’s as this can be viable and

critical tools in the hands of marketing and research companies

4. Even information such as latest happenings can allow companies to plan their target and

events around such happenings, these can be shared free along with the subscriptions

5. ERC can act as provider of ambulances and paramedics for major functions, fairs andevents

6. Insurance Companies can provide for funding as it’ll reduce the criticality of the

episodes, thus saving on medical expenses being incurred if the case is admitted to the

hospital

7. Pharmacy companies can use data to track the consumption of drugs and its fallout on the

cases reported through ERC

6. Summary

Emergency care services need a highly efficient and well interconnected system that can act as a single

point of contact. The cloud based integrated management solution aims at considerably improving the

scenario of emergency care in India. It’s an IT cloud based solution; hence is scalable, highly integrated

and can act as a key differentiator if used correctly by the care giver. The concept of Emergency Care

Centers needs to evolve in India and it has to be well networked with all the medical centers of the city to

offer maximum advantage. This solution has the capability to work on self-sustaining basis once the initial

financial requirements are met. The advantages of the solution are numerous, but what it would definitely

assist in; would be saving precious lives and improving the existing standards of emergency care delivery

in India.


Documents

Technology for Emergency Care Management & Healthcare Delivery-Varun Bahl ,Vaibhav Srivastava