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The Linux of Healthcare

Amrita Institute of Medical Sciences, Kochi is making waves in the IT sector with its self-made HIS, reports Nancy Singh

Imagine this. Something that you innovated in your own backyard for personal use becomes such a rage that people are now queuing to buy it! That's the story of Amrita Hospital Informatics Suite or AHIS as it is commonly known. Beginning as a project for personal use, Amrita Institute of Medical Sciences (AIMS), Kochi's HIS has moved beyond its home turf. Today, IT giants like HP, HCL and IBM are eager to integrate with it. "Yes, we have found multiple vendors who are keen to partner with us. Hence, we are now planning to aggressively market the solution," agrees Raghu Raman, CEO, Amrita Technologies, Kerala.

HCL has been a forerunner in marketing this solution. Says Milind Deshpande, Associate Vice President, HCL Infosystems, "We were quite happy with its excellent delivery and scalability. Especially, as it is a solution backed by a great team of software engineers. Also, we liked the fact that it was a solution made by Indians to suit Indian healthcare needs." HCL plans to benefits from its pan-Indian presence. "We plan to market it all over India and provide Level One (L-1) assistance," adds Deshpande.

Necessity is the Mother

Way back in 2003, AIMS decided to take things into its own hands when its IT solution provider was unable to meet its expectations and was facing difficulty in handling the ever-increasing patient load. "The product has to scale up in synch with the demand and it is especially important to move at a phenomenal pace like that of AIMS, where our strength has jumped almost 100 per cent. Our solution provider was based on client-server architecture, making it very difficult to support and it was not able to scale to our growing needs. The management decided to do something about it," explains Raman. Thus came into being Amrita Technologies in 2003 with the amalgamation of a few like-minded NRI software engineers who were Mata Amritanandamayi devotees as well. "We were about 9-10 engineers with 10-15 years of experience in the IT world, working with the best international companies, who came together to form this company," recalls Raman.

The first home assignment was not easy. "We were asked to deliver something very fast. The first version was out in a record nine months, and since then we have been working on it continuously, based on the user inputs and market requirements," informs Raman. "We built it from scratch. Today, I can go to a 100 to 2,000-bed hospital with the same product without any re-designing. Scalability is most important in healthcare," he adds. The AHIS manages all the patient details right from registration to discharge.

Amrita Advantage

What makes this one different from other HIS in the market? "It's an integrated and probably the only healthcare solution based on open source technology, making the customer vendor-neutral," says Raman. The system helps in daily patient care management, and also provides the foundation to foster research and development. It is aided by user-friendly reports and an ergonomic user-interface. The main focus is on the integration of clinical applications with the financial and administrative applications. Although the software was originally designed for use at AIMS, it has now become popular in other leading hospitals throughout India, due to its ease of use and integration. Since Amrita Technologies is a not-for-profit organisation, it has a Memorandum of Understanding (MoU) with these hospitals. To name a few, it is run at Sri Gokulam Hospital (Salem), BARC (Mumbai), JJ Hospital (Mumbai), NIMHANS (Bangalore) and Institute of Liver and Biliary Sciences (New Delhi).

The system mainly allows for centralised access to all organisational and patient data through one single web interface for any authorised user. It has many sub-modules, very tightly and seamlessly integrated, that cover the hospital transactions related to the patients.

The Total Cost of Ownership (TCO) of this solution is apparently the lowest, as it uses freely downloadable database as well as operating system. For routine operations, it is very easy to maintain because of the Java certified N-tier architecture with the open source database and operating system. Another factor which helps reduce the cost to the user is the support for thin clients. "As the solution is fully web-enabled, at the client side, nothing else but a web browser is required, which can be very easily run on a thin client. The cost of a typical thin client as compared to the regular desktop is less by anywhere between 20-40 per cent," says Praveen Bist, Vice President (Product Development), Amrita Technologies.

Today, the ambit of the software suite covers diverse areas of the hospital operations including back office, front office, Clinical Information Systems, PACS, telemedicine and pharmacy. "Some of our partners, like HP and Oracle, have done stress test on our software and have found it to be truly scalable and of enterprise grade," beams Raman.

The technical experts also felt that often many HIS packages have been developed more as an IT project with very little domain contribution. "We have been highly fortunate to work hand-in-hand with the end users (clinicians of AIMS) and be able to provide a very user-friendly solution based on their true requirements. This, we believe, will help in getting a feeling that IT can work in a hospital environment and get more productive with imaginative management," opines Bist.

AIMS was looking out for cost reduction, safety, quality and transparency in a system and the HIS has scored in all avenues. Dr Prem Nair, Medical Director, AIMS, Kochi, says, "When we thought of IT, we thought it would be expensive. But we were proved wrong and saved Rs 30-32 lakh in one year after going paperless.

The biggest challenge was the mindset of people who are reluctant to change. "It's true that doctors and clinicians are not interested in technology. They don't care whether it is open-sourced or not. Hence, we adopted a mode of training wherein instead of IT-engineers, it was doctors who trained them, to make them comfortable and for a better understanding between the two. The support staff had to be trained both in areas pertaining to the basics of their profession and becoming IT-savvy," says Raman.

With the use of PACS, the Hospital saved almost a crore. In fact, it saved up to Rs 20 lakh in hardware alone. AIMS also observed immediate savings in pharmacy, managing to save up to Rs 40 lakh per year. The pharmacy also witnessed zero leakages and heightened the transparency in the system. Today, AIMS has one of the most highly-networked set-ups. It supports around 1,200 computers plus over 200 additional devices like printers, scanners and other peripherals.

The internal and external communication through e-mails saved on paper. In the first six months itself, AIMS saw a 51 per cent decrease in transcription costs, a savings of almost Rs 3,40,000. Transcriptionists reduced from 12 in 2006 to five in 2007.

A 51 per cent to 80 per cent reduction in chart pulls was noticed. The cost of chart folders, dividers, and filing cabinets at Rs 150 per record amounted to a saving of Rs 23,25,000 in six months. Says Dr Sanjeev Singh, Senior Medical Administrator, AIMS, "We are the only Hospital with an in-house HIS system. No licensing fee makes the entire system cost-effective and upgradations are done in-house." Also, departmental integrations played an extremely important role. Resulting from accurate billing and documentation, AIMS saw an increase to Rs 2 crore in a year in collections from third party payers.

The Hospital achieved a significant improvement in revenues in the first year, and expects to realise an additional Rs 5 crore in the second.

Commercial Prospects

In 2005, that is within two years of its inception, AHIS went commercial. As the management saw the growing interest from guests visiting AIMS, and the plight of IT application in healthcare institutions, it started commercial application.

Since then, its kitty is filled with many impressive projects. Apart from around 10 other institutes running this software currently, Amrita Technologies takes pride in being chosen for one of the biggest healthcare initiatives in India by the Government of Maharashtra. Under this project, it plans to integrate all the medical colleges and teaching hospitals under Medical Education and Drugs Department (MEDD). Says Raman, "The project at Maharashtra is as big, if not bigger, than the NHS initiative in the UK."

Apart from this, the product is very unique as it will provide standards-based data capture, enabling many prospective hospitals to look positively towards medical tourism. Adds Raman, "The initiative is also unique because not many IT companies in India even today look at 'product development'. They are very happy implementing services-based projects and solutions. This patient-centric software initiative is expected to reverse this trend in India."

Bright Future

The AHIS has more than delivered on its promises. Capitalising on the open-source platform, based on the patent-pending Healthcare Management Operating System (HMOS) technological framework, AHIS has proven to be very cost effective, meeting the demands of all the functional needs of a hospital. AHIS has significantly helped the AIMS management and its thousands of users—emerging as the most sought after HIS in India.

nancy.singh@expressindia.com