The document outlines Rajendra Pratap Gupta's keynote address on the future of healthcare IT in India over the next 5 years. It discusses how the government plans to increase healthcare spending and implement universal healthcare coverage, creating a need for greater accountability that can be addressed through increased IT usage. This will include issuing national health entitlement cards, developing hospital information systems, and using IT to support public health decision making, service providers, and remote healthcare delivery through telemedicine. The government aims to be the initiator of large-scale changes in digitizing India's healthcare sector.

1. 14TH
MARCH
2013
THE
PARK
HOTEL,
NEW
DELHI,
INDIA
A
thought
leadership
event
where
you
can
contribute
your
ideas
for
the
future
of
healthcare
IT
in
India

2. Rajendra
Pratap
Gupta
Chairman
Board
of
Directors
Opening
Keynote
address
Healthcare
IT
in
India
-­‐
The
Next
5
Years
©Rajendra
Pratap
Gupta
.
Email
:
office.rajendra@gmail.com

3.
‘Delivering
healthcare
without
using
InformaBon
Technology
is
like
driving
a
car
without
a
dashboard
&
a
steering.
Neither
you
can
make
out
what’s
happening,
nor
you
can
manoeuver
the
vehicle
to
avoid
mishaps’
Rajendra
Pratap
Gupta
15/03/13
3
©Rajendra
Pratap
Gupta
.
Email
:
office.rajendra@gmail.com

4. Who
will
drive
the
Change
?
Government
PAC
/
CAG
Insurance
Drivers
Changing
HCIT
Demographics
of
Providers
Change
InternaEonal
PaEents
Developments
Professional
Developments
&
Challenges
15/03/13
4
©Rajendra
Pratap
Gupta
.
Email
:
office.rajendra@gmail.com

5. Government
:
IniBator
of
the
‘Mega’
change
• The
spending
on
healthcare
as
%
of
GDP
to
increase
every
year
• Increased
spending
will
lead
to
increased
scruBny
• Increased
scruBny
will
call
for
increased
accountability
• For
accountability
in
healthcare
,
use
of
IT
is
the
starBng
point
15/03/13
5
©Rajendra
Pratap
Gupta
.
Email
:
office.rajendra@gmail.com

6. Government
:
IniBator
of
the
‘Mega’
change
• 2012
was
a
historical
year
–
UHC
&
decision
to
increase
our
GDP
spending
on
Healthcare
• Increase
the
Health
spending
to
3.0
%
by
2022
• Five
fold
increase
in
per
capita
spending-­‐
from
Rs.650-­‐700
in
2011
to
Rs.
3400-­‐3500
in
2021-­‐22
• Private
OOP
spending
will
decline
from
Rs.1800-­‐1850
to
Rs.1700-­‐1750
by
2021-­‐22,
i.e
decrease
from
67
%
to
33
%
15/03/13
6
©Rajendra
Pratap
Gupta
.
Email
:
office.rajendra@gmail.com

7. Government
:
IniEator
of
the
‘Mega’
change
• Ensuring
effecBve
and
affordable
access
to
medicines
,
vaccines
and
appropriate
technologies
is
criBcal
for
promoBng
health
security*
• Every
ciBzen
will
be
issued
an
IT
enabled
NaBonal
Health
EnBtlement
card
(
NHEC
)
that
will
ensure
cashless
transacBons
,
allow
for
mobility
across
the
country
and
contain
personal
health
informaBon
.
Such
a
card
will
also
help
the
state
to
track
paderns
of
disease
burdens
across
the
country*
* High Level Expert Group Report on Universal Coverage for India
15/03/13
7
©Rajendra
Pratap
Gupta
.
Email
:
office.rajendra@gmail.com

8.
Government
:
IniEator
of
the
‘Mega’
change
• InformaBon
Technology
can
be
used
in
at
least
four
different
ways
to
improve
healthcare
and
systems:*
• Support
public
health
decision
making
for
beder
management
of
health
programmes
and
health
systems
at
all
levels*
• Support
to
service
providers
for
beder
quality
of
care
and
follow
up*
• Provision
of
quality
services
in
remote
locaBons
through
telemedicine*
* 12th Five Year plan document .ihttp://dmai.org.in/12th-Plan-up-to-page-46.pdf
15/03/13
8
©Rajendra
Pratap
Gupta
.
Email
:
office.rajendra@gmail.com

9. Government
:
IniEator
of
the
‘Mega’
change
• SupporBng
educaBon
,
and
conBnued
learning
in
medicine
and
health*
• A
composite
Hospital
InformaBon
System
(HIS)
,
when
fully
operaBonal
,
would
incorporate
the
following:*
• Universal
registraBon
of
births
,
deaths
and
cause
of
death*
• NutriBonal
Surveillance
,
parBcularly
among
women
in
the
reproducBve
age
group
and
children
under
6
years
of
age*
* 12th Five Year plan document .ihttp://dmai.org.in/12th-Plan-up-to-page-46.pdf
15/03/13
9
©Rajendra
Pratap
Gupta
.
Email
:
office.rajendra@gmail.com

10.
Government
:
IniEator
of
the
‘Mega’
change
• Disease
Surveillance
based
on
reporBng
by
service
providers
and
clinical
laboratories
(
public
and
private
)
to
detect
and
act
on
disease
outbreaks
and
epidemics*
• Out-­‐paBent
and
in-­‐paBent
informaBon
through
Electronic
Medical
records
(EMR
)
to
reduce
response
Bme
in
emergencies
and
improve
general
hospital
administraBon*
• Data
on
Human
Resource
within
the
public
and
private
health
system*
• Financial
management
in
the
public
health
system
to
streamline
resource
allocaBon
and
transfers,
and
accounBng
and
payment
faciliBes
,
providers
and
beneficiaries
.
UlBmately
,
it
would
enable
Bmely
compilaBon
of
the
NaBonal
Health
Accounts
on
an
annual
basis*
*12th Five Year plan document .ihttp://dmai.org.in/12th-Plan-up-to-page-46.pdf
15/03/13
10
©Rajendra
Pratap
Gupta
.
Email
:
office.rajendra@gmail.com
*

11. Government
:
IniEator
of
the
‘Mega’
change
• A
naBonal
repository
of
teaching
modules
,
case
records
for
different
medical
condiBons
in
textual
and
audio-­‐visual
formats
for
use
by
teaching
faculty
,
students
and
pracBBoners
for
ConBnuing
Medical
EducaBon
(CME
)*
• Telemedicine
and
consultaBon
support
to
doctors
at
primary
and
secondary
faciliBes
from
specialists
at
terBary
centres
*
• NaBonwide
registries
of
clinical
establishments
,
manufacturing
units
,
drug
–
tesBng
laboratories
,
licensed
drugs
and
approved
clinical
trials
to
support
regulatory
funcBons
of
the
government
*
• Access
of
public
to
their
own
health
informaBon
and
medical
records
,
while
preserving
confidenBality
of
data*
• Programme
monitoring
support
for
NaBonal
Health
Programmes
to
help
idenBfy
programme
gaps*
* 12th Five Year plan document .ihttp://dmai.org.in/12th-Plan-up-to-page-46.pdf
15/03/13
11
©Rajendra
Pratap
Gupta
.
Email
:
office.rajendra@gmail.com

12. Government
:
IniEator
of
the
‘Mega’
change
• To
achieve
these
goals
,
computers
with
internet
connecBvity
would
be
ensured
in
every
Primary
Health
Centre
(PHC
)
and
all
higher
level
health
faciliBes
in
this
plan
period*
• All
District
hospitals
would
be
lined
by
tele-­‐medicine
channels
to
leading
terBary
care
centres
,
and
all
intra-­‐district
hospitals
would
be
linked
to
the
district
hospital
and
opBonally
to
higher
centres*
• The
role
of
the
MOHFW
would
be
to
lay
IT
systems
standards
,
and
define
indicators
which
would
be
openly
shared
.
This
will
be
funded
by
NaBonal
Health
Mission*
• Health
surveys
would
be
annually
conducted
to
generate
district
level
health
informaBon
on
health
status
,
which
will
also
serve
to
verify
the
accuracy
of
rouBne
health
informaBon
system*
* 12th Five Year plan document .ihttp://dmai.org.in/12th-Plan-up-to-page-46.pdf
15/03/13
12
©Rajendra
Pratap
Gupta
.
Email
:
office.rajendra@gmail.com

13. Government
:
IniEator
of
the
‘Mega’
change
• NOFN
–
NaBonal
OpBc
Fibre
Network
–
3
pilot
projects
in
Telemedicine
(
Ajmer,
Tripura
&
Vizag
)
• NaBonal
Medical
College
Network
(NMCN)
• NaBonal
Rural
Telemedicine
Network
• NaBonal
Health
Portal
• State
Wide
Area
Network
–
SWAN
–
2
MBPS
connecBvity
up
to
block
level
• NaBonal
knowledge
network
(NKN
)
-­‐
under
DieTY
–
100
MBPS
connecBvity
to
EducaBonal
and
research
insBtutes
15/03/13
13
©Rajendra
Pratap
Gupta
.
Email
:
office.rajendra@gmail.com

14. Insurance
–
The
Big
Bully
• Under
UHC
,
majority
of
the
populaBon
is
likely
to
be
‘covered’
on
the
lines
of
RSBY
• Insurance
companies
/
Payers,
will
‘mandate’
for
pracBBoners
and
providers
to
have
IT
systems
to
get
instant
approvals
–
cashless
treatment
,
follow
treatment
guidelines
and
protocols
and
demonstrate
outcomes
–
ACOs..
• Those
who
do
not
deploy
the
IT
system
might
be
leo
out
of
empanelment
• Aoer
the
Government
,
Insurance
will
be
the
biggest
‘change
agent’
for
HCIT
15/03/13
14
©Rajendra
Pratap
Gupta
.
Email
:
office.rajendra@gmail.com

15. HICT
Providers
–
Beacon
light
• Thanks
to
HCIT
providers,
we
have
‘technical
maturity’
for
HCIT
• HCIT
providers
will
need
to
invest
in
awareness,
educaBon,
research
&
evidence
of
improved
clinical
outcomes
using
HCIT
• Work
with
industry
bodies
and
Governments
to
showcase
success
stories
• Industry
must
set
the
interoperability
guidelines
,
as
there
is
a
likelihood
of
mulBple
soluBons
being
deployed
for
1.21
Billion
people
15/03/13
15
©Rajendra
Pratap
Gupta
.
Email
:
office.rajendra@gmail.com

16. InternaEonal
Developments
• Healthcare
in
India
is
driven
by
modern
medicine
/
Intl.
technology
• India
is
a
‘follower’
market
when
it
comes
to
‘adopBon’
• Be
it
standards
,
regulaBons
or
best
pracBces,
it
always
look
at
the
west
• InternaBonal
studies
&
reports
do
influence
healthcare
pracBces
in
India
15/03/13
16
©Rajendra
Pratap
Gupta
.
Email
:
office.rajendra@gmail.com

17. Professional
Developments
&
Challenges
• Medical
educaBon
,research
&
pracBce
is
undergoing
a
change
• ConBnuing
professional
development
is
a
necessity
• Medical
pracBce
is
becoming
more
demanding
w.r.t.
Bme
&
travel
.
• Compliance
to
complex
regulatory
changes
• Increase
of
medico-­‐legal
costs
would
complicate
the
maders
further
• If
the
clinicians
need
to
keep
pace
with
the
fast
track
professional
changes
(&
challenges)
,
AdopBon
of
IT
is
imperaBve
15/03/13
17
©Rajendra
Pratap
Gupta
.
Email
:
office.rajendra@gmail.com

18. PaEent
:
‘impaEent
for
change’
• PaBent
has
a
lot
more
informaBon
about
‘medical
issues’
• PaBent
Groups
will
be
around
in
the
next
3
years
–
PaBent
Safety
• PaBents
expecBng
an
automated
environment
like
other
sectors
• Processing
ePrescripBon
through
electronic
ordering
system
can
halve
the
likelihood
of
a
drug
error
,
and
avert
more
than
17
million
such
incidents
in
US
hospitals
in
one
year
alone
(
AMIA
,
March
,
2012
.
Courtesy
,
The
Economic
Times
dated
25th
February,
2013)
15/03/13
18
©Rajendra
Pratap
Gupta
.
Email
:
office.rajendra@gmail.com

19. Changing
Demographics
• By
2026,
the
geriatric
populaBon
will
increase
from
96
million
(
2011
)
to
168
million
• Moving
towards
nuclear
families
• NCDs
are
on
the
rise
.
India
set
to
lose
USD
237
billion
by
2015
because
of
pre-­‐mature
deaths
due
to
chronic
diseases
• ‘Baby
boomers
of
today’
will
become
‘PaBent
Boomers’
15/03/13
19
©Rajendra
Pratap
Gupta
.
Email
:
office.rajendra@gmail.com

20. CAG
&
PAC*
• In
India
,
the
recent
trends
point
to
‘acBvism’
at
CAG*
&
PAC*
• ‘The
commidee
are
perturbed
to
note
the
abysmal
low
per
capita
public
expenditure
on
the
health
care
in
India…
at
such
a
paltry
rate
of
public
expenditure
on
healthcare,
the
commidee
fears
that
the
goal
of
universal
health
care
to
all
the
ciBzens
as
envisaged
in
the
Mission
may
remain
a
pious
plaBtude
and
a
distant
dream’**
• ‘While
the
actual
allocaBon
in
the
Eleventh
Plan
was
lower
than
the
original
plan
allocaBon
,
the
actual
expenditure
has
sBll
been
lower
i.e.
the
system
has
not
even
been
able
to
uBlize
the
curtailed
outlay’**
• ‘Given
the
glaring
deficiencies
,
loopholes
,
infirmiBes
and
want
for
effecBve
monitoring
mechanism,
the
NRHM
warrants
a
thorough
restructuring
so
as
to
remedy
the
shortcomings
and
difficulBes
in
its
effecBve
implementaBon
so
that
the
laudable
goals
of
providing
accessible
,
affordable,
effecBve
and
reliable
healthcare
to
the
rural
people
especially
the
poor
are
adained’**
15/03/13
20
©Rajendra
Pratap
Gupta
.
Email
:
office.rajendra@gmail.com
**Public
Accounts
Commi@ee
report
no
1939
*
CAG
–
Comptroller
&
Auditor
General
.
PAC
–
Public
Accounts
Commi@ee
,
Parliament

21. Where
all
will
the
Changes
happen?
Rural
Health
EducaEonal
Hospitals
InsEtuEons
Home
based
care
EMR
Changes
will
happen
Imaging
/
Radiology
Telemedicine
POC
-­‐
D
NCD
MCH
15/03/13
21
©Rajendra
Pratap
Gupta
.
Email
:
office.rajendra@gmail.com

22. The
Next
five
years
…..
• ConnecBvity
will
not
be
an
issue
• Web
portal
on
Health
would
be
live
and
running
• Roll
out
of
UHC
–
NHEC
(
NaBonal
Health
EnBtlement
Card
)
• Government
Hospitals
being
connected
via
NMCN
Since
the
IT
deployments
are
taking
off
,
the
growth
will
be
fairly
high
over
the
next
15
years,
as
the
starMng
base
is
at
‘ground
zero’
15/03/13
22
©Rajendra
Pratap
Gupta
.
Email
:
office.rajendra@gmail.com

23. The
Next
five
years
…..
• All
states
will
have
State
wide
Telemedicine
Networks
• Insurance
will
mandate
clinicians
to
use
IT
for
instant
approvals
,
adherance
to
treatment
protocols
and
payment
• mHealth
would
have
covered
the
enBre
naBon
• Chronic
disease
management
will
start
using
apps….
Most
importantly
,
doctors
&
paMents
will
be
at
the
forefront
of
driving
this
change
15/03/13
23
©Rajendra
Pratap
Gupta
.
Email
:
office.rajendra@gmail.com

24. Challenges…..
• AdministraBve
automaBon
Vs
Clinical
automaBon
• HCIT
Projects
not
documented
for
clinical
outcomes
• Return
on
Investment
(ROI
)
Vs
Value
on
Investment
(VOI)
• Leading
standalone
clinicians
and
small
nursing
homes
do
not
wish
to
disclose
the
‘actual
earnings’
• Industry
not
on
the
same
page
–
InfighBng
derailing
most
of
the
Government
projects
–
A
serious
cause
of
concern
!
15/03/13
24
©Rajendra
Pratap
Gupta
.
Email
:
office.rajendra@gmail.com

25.
‘Government
IT
plans
in
the
public
sector
will
need
significant
investment.
The
private
sector
needs
to
take
the
lead
in
innovaBon
,
incubaBon
,research
of
IT
products
&
projects
and
training
of
clinicians
for
IT
adopBon’
Rajendra
Pratap
Gupta
15/03/13
25
©Rajendra
Pratap
Gupta
.
Email
:
office.rajendra@gmail.com

26.
USA
is
moving
to
‘meaningful
use’
of
IT,
and
India
is
just
about
to
start
‘using’
IT.
So
,
while
USA
has
become
a
pioneer
as
a
user
of
IT,
India
is
just
a
provider
of
IT
services.
But
in
the
next
five
years,
India
will
move
ahead
of
USA
in
the
adopBon
curve
of
HCIT’
Rajendra
Pratap
Gupta
15/03/13
26
©Rajendra
Pratap
Gupta
.
Email
:
office.rajendra@gmail.com

27. Disclosures
&
Acknowledgements
• Views
presented
are
personal
• Presenter
is
associated
with
healthcare
organizaBons
across
USA,
Europe
,
U.K.
Middle-­‐East
&
India
.
• The
figures
and
studies
are
indicaBve
&
for
representaBonal
purpose
only
• Utmost
care
has
been
taken
to
quote
the
data.
Any
inadvertent
error
is
regreded
•
• The
presentaBon
has
used
many
resources
and
acknowledges
the
contributors
with
appreciaBon
and
thanks
.
Some
of
the
trade
names
/
marks
used
may
belong
to
third
parBes
,
and
have
been
quoted
just
for
the
sake
of
informaBon
for
the
audience
with
or
without
the
consent
of
the
respecBve
trademark
owners
.
• Please
do
not
copy
or
reproduce
in
whole
or
part
thereof,
the
contents
of
this
presentaBon
without
the
wriden
permission
from
the
presenter
.
• Website
for
downloading
www.rajendra.groupsite.com
27
©
Rajendra
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