TECHNOLOGY AT NH

Narayana Hrudayalaya, wants to create a robust IT platform to control the finance

department and quality of services.

They are perhaps one of the few hospitals in the world where a balance sheet is created
on a daily basis.

A sophisticated ERP system on a cloud solution houses all the financial details about all
the group hospitals.

But its 2010 visionto go from 5,000 beds to 30,000 beds in five years, making it Indias
first private hospital group to operate at such a scalewas a challenge on a whole new
level. They realized that to support a massive operation like that they would need IT
infrastructure that was extremely scalable and robust.

Setting up and maintaining that IT infrastructure was not what Narayana Hrudayalaya
specialized in; fixing HS (human systems) is a different ball game from fixing IS
(information systems).

There were issues of building up and owning systems, being able to find skilled IT
resources and retaining them. Moreover, if they built datacenters, either centralized or
disparate, they would need to be backed up with a hot, real-time DR site. The upfront cost
implications were huge, let alone the manageability issues. A conventional datacenter set
up, whether at a centralized location or at every hospital, would have been a time
consuming, tedious affair.

Rx Cloud
They needed a solution that freed the hospital from the burden of building and running a
datacenter; a solution that was scalable, agile, and allowed them to focus on the business of
healthcare.
The cloud, it seemed, was just what the doctor prescribed.

In 2010, however, the idea was extremely forward-looking, especially for a healthcare
player. On the plus side, they were fortunate they entered the market at a time when most
cloud solution providers were developing the idea and were eager to partner and
experiment. They chose to go with a private-hosted model with HCLs blu Enterprise
Clouds Infrastructure as a Service (IaaS) solution. Right away they faced with the
challenges CIOs face with the cloud, even today. The first was integrating Narayana
Hrudayalayas hospital information system (HIS) with the cloud.

It would have been difficult to migrate the entire system to the cloud if the applications were
built on a .Net framework. But fortunately, they had ensured that from day one, their outsourced
partner built Web-based applications.
Security is another issue that keeps CIOs away from the cloud.

NH reflected the outlook of a growing number of IT leaders: Leave it to the experts. The
biggest organizations, with the best of security systems, have lost the battle to cyber
criminals. With NHs modest IT team, they could spend their entire waking life just
trying to keep systems secure, explaining why they believed they made a right choice by
trusting their partners.
Another large challenge was connectivity. With the complete HIS on the cloud and 1,500
concurrent users logging into their systems at any given point of time, they could not
afford connectivity going down. So when they started a six-month proof-of-concept at the
hospitals center in Jamshedpur, a small township in the state of Jharkhand, they made
sure the hospitals Achilles heel was protected. They asked their service provider to
provide not one but two major lines, the second from an independent service provider
from a different geographical area. The n+1 arrangement ensured that even if one line
was disturbed because of a fiber cut, the other could take over. The chance of both of
them going down at the same time is a very remote possibility.
Narayana Hrudayalaya saves between Rs 20-25 crore in capex costs by moving to the
cloud. If they built their own infrastructure, including an active DR site, it would have
cost them between Rs 1-1.5 crore per facility.
The cloud also allowed NH to raise the standards of healthcare that Narayana
Hrudayalaya promises.
With a central database, patients referred from one branch of the hospital chain to
another dont have to carry files or register all over again. And doctors can get a look at a
referred patients history even before that patient steps into a doctors cabin.

They used the power of IT to reduce the cost of operations. Their IT initiatives give
them a profit and loss account on a daily basis. Every day at 12 noon, their senior

doctors/administrators get an SMS on their mobile with the previous days revenue,
expenses, and profit/loss margin.
As doctors, they know exactly what is happening with their organization. For them,
looking at the P&L account at the end of the month is like reading a post-mortem report.
They cant really do anything about whatever losses they have. But looking at the account
on a daily basis is a diagnostic tool; you can take remedial measures. Produce the data in
front of doctors. One can tell them exactly how many days the patient stayed there before
the operation, how many days in the ICU, how many days post-op, and what the cost of
material used for the operation was. All this information cannot be generated without the
help of IT. Narayana Hrudayalaya has invested heavily in IT, and they are now reaping
the benefits.
They have various hospitals spread across the country. Mr. Devi Shetty havent even
visited some of these after the inauguration. But he has a clue of their day-to-day
proceedings.
They have a complaint management system (CMS) that keeps track of all the problems a
particular hospital faces in a day. They dont discourage complaints. So, it helps him in
calling out the bluff of the COO of a particular hospital if he says things are fine, while in
reality, he know that there were 184 complaints registered that day. When they started the
CMS, they registered 200-300 complaints a day, but now, it is down to about 60 to 80
complaints. This is the power of information.

SANA PLATFORM

Narayana Hrudayalaya & Harvard/MIT Join Hands to launch m-Health Project. NH has
already screened about 400 high-risk cancer patients and detected numerous lesions using
the SANA platform. Narayana Hrudayalaya (NH) and SANA (a research group at
Harvard/MIT) have collaborated on a mobile healthcare project to enable screening and
early detection of chronic diseases in India.
NEED:
India is experiencing a double burden of disease with persistent infectious disease
coupled with increasing incidence of chronic disease like cancer and cardiovascular
diseases.
Unfortunately, due to lack of specialists care in rural areas, most chronic diseases are
diagnosed at an advanced stage, when treatment is complicated and expensive. This is
precisely the problem in cancer too.
Most patients at hospitals show up with stage-4 tumors that cost lakhs to treat and
survival is 30 per cent. If detected early, the survival rates go up to 90 per cent and cost
15-30 thousand rupees to treat.

 Using mobile technology and the collaboration of their partner institutions, they can
enable early disease detection and thus create a win-win situation for patients, hospitals
and even insurance and wireless companies.

Technology used
The technology is open source and ideally suited for developing countries like India not
just for cost-reasons but it is equivalent and perhaps better than existing proprietary
solutions.
With the proliferation of mobile networks, smart phones, and open source software, NH
can overcome three fundamental issues in telemedicine power, cost and connectivity.

Example of a workflow using SANA

Using the power of open source, Sana benefits from the work of software engineers
worldwide at institutions like MIT, Harvard, Yale, University of Philippines, Monterrey
Tech in Mexico and IIT Delhi. The collaborative nature of open source allows Sana team
members to focus on building the best mHealth solutions instead of wasting time reinventing the wheel.
Process : The pilot targets the detection of oral cancer and involves two other large
hospitals in Karnataka serving about 20 lakh people KLE Dental Hospital in Bengaluru,
and Navodaya Medical College in Raichur. These institutions trains general physicians,
nurses and medical students to screen for high-risk individuals using automated
questionnaires encoded on the phone and high quality lesion pictures using the phones
camera. They diagnose the condition either by using the phones decision support
algorithms, or by uploading the data to NHs EMR system for specialist feedback. They
can then recommend treatment and counsel the patient through interactive videos on the
phone, or if required refer to specialist.