Got this jpg while browsing through Peepal through Amit’s mail. I found this pretty interesting

I was just working on getting an idea of the benefits an EMR system can bring to the healthcare unit. I came across the following EMR benefits which I may append as I get to learn more

EMR Benefits

Complete data: System-wide EMRs have greatly increased the amount of
patient information by populating the database with outpatient office visits
as well as inpatient hospital stays.

Information accuracy: Electronic data entry eliminates misinformation
from illegible handwriting on patient charts.

Safer treatment: Complete medical records, including at least a problem
list, allergies and medications, leads to safer treatment. Regular use of alerts
makes physicians more aware of safety issues about patient treatment.

Collaboration and consultation: EMRs allow multiple clinicians to organize,
configure and view patient data in multiple ways, which encourages collaboration
and consultation about diagnosis and treatment.

Real time availability: All events on a patient’s record are entered upon
transaction, collected in a single file, kept up-to-date and available immediately.
Previously, clinicians waited for paperwork to arrive or initiated treatment
with an incomplete file.

Speed and length of stay: Use of EMRs, especially in ERs, reduces treatment
time and improves patient outcomes. Quicker, more accurate and
safer medical treatment facilitated by an EMR has been proven to reduce
the length of inpatient stay by 10 percent or more.

Stress reduction: A beneficial side effect of relying on the EMR for patient
care is reduction among clinicians of the incidence of pressure ulcers stage
2 or more from 4.2 percent to 1.5 percent.

Adverse Drug Reaction Events : EMR helps reducing adverse drug events in the inpatient setting as well as ambulatory settings

Evidence Based Recommendations : EMR systems can integrate evidence-based recommendations for preventive services (such as screening exams)
with patient data (such as age, sex, and family history) to identify patients needing specific services.

Templates for Consistency : Condition-specific encounter templates implemented in an EMR system can ensure consistent recording of disease specific clinical results, leading to better clinical decisions and outcomes

Increased Compliance to Preventive Care : Reminders to patients generated by EMR systems have been shown to increase patients’ compliance with preventive
care recommendations when the reminders are merely interjected into traditional outpatient workflows

Electronic Messaging : Electronic messaging offers a low-cost, efficient means of distributing reminders to patients and responding to patients’ inquiries

Remote Monitoring Systems : Remote monitoring systems can transmit patients’ vital signs and other biodata directly from their homes to their providers,allowing nurse case managers to respond quickly to incipient problems

Elapsed time from medication orders to medication dispensing. The Stage 6 benchmarks in this area appear to be 15 to 20 minutes for routine orders, and less than 10 minutes for STATS.

Diagnostic report turn-around. The Stage 6 hospitals are reporting turnaround times in minutes instead of hours.

Medication errors. Stage 6 hospitals are finding more medication errors, but
are also able to show significant reductions in medication errors. In one case a
hospital has prevented 170 wrong patient errors; 1,500 wrong drug errors; 203
wrong dose errors; 2,947 wrong time errors; and 26 wrong route errors out of
158,684 administered doses. Another facility reports that 42 percent of errors
attributed to handwriting have been eliminated, and omitted drugs have been
reduced by 70 percent.

Reduction in agency nurses. Two facilities reported a reduction in the use
of agency nurses, and one facility does not currently use agency nurses. One
facility reports that approximately $2 million of agency nursing costs has been
eliminated at their facility.

Reduction in nursing overtime. Only one facility reports a reduction in nursing
overtime that has resulted in a $300,000 annual savings. Most of the Stage 6
hospitals report they have not seen any reduction in nursing overtime. One of
the facilities reported that since nurses are documenting at the bedside, the time
saved is being used for patient care. One organization reported that nursing
overtime is actually increased. It is apparent from the diversity of results that
regional and competitive environments will continue to produce varied results
on this subject

Length of Stay (LOS). The Stage 6 hospitals sharing metrics in this area had
either reduced their LOS metrics or maintained the same LOS metrics with
increasing census and acuity. HIMSS Analytics is conducting research on the
correlation of EMRAM stages/scores and LOS that is projected to be published
in September 2007. What we are finding to date is a reverse correlation – higher
EMRAM stages/scores have a reverse correlation to LOS (the higher the score
the lower the LOS).

Billing. This question was asked relative to the HIPAA Claims Attachment
regulations that will be effective within the next 24 to 36 months. Currently one
Stage 6 hospital reports a reduction in the time it takes to post both inpatient and
outpatient bills. Another hospital reports improvements in charge capture.

Claims Denials. Coding denials at one facility dropped from 9.2 to 2.2 percent
and overall denials dropped from 23 to 10 percent

Competitive market advantages. There were many responses given by Stage 6
hospitals in this area. Most of the responses were centered around patient safety
and clinician support to facilitate better patient care with aggressive marketing
of their EMR advantages to win patients via radio, TV, and Web/portal
marketing programs.

Hospital is an institution for health care providing patient treatment by specialised staff and equipment, and often but not always providing for longer-term patient stays. In terms of size hospitals can be compared to enterprises having various departments working cohesively to provide healthcare benefits to the patients. Hospitals have various departments based on the treating speacialities that the hospital provides. However apart from the treating speciality there are departments within the hospital which are pretty much common to all hospitals. Let us take a look at these departments within a hospital.

We can divide the departments within the hospitals in two major categories

• Administrative
• Clinical

Administrative

• Enterprise Management
• Resource Accounts
• Resource Manager
• Schedular

Patient Management

• Registration Manager
• OPD Admissions
• IPD Admissions
• Billing
• Managerial Accounting

Material Management

• Inventory
• Procurement
• Supplier Management

Care Management

• Diagnostics
• Therapy
• Clinical Notes
• Nursing
• Operation Theatre
• DICOM - PACS

Support Services

• Pharmacy
• Blood Bank
• HR Management
• Health Promotion
• Kitchen & Laundry

Communication

• Internal Communication
• Payer Communication
• Supplier Communication

ReportIT

• Standard Reports
• Custom Reports
• Report Designer

Accounting and Costing

• Financial Accounting
• Advance Accounting
• Costing Analysis

Data Analytics

• Business Intelligence.

Clinical

• Laboratory.
• Radiology.
• PACS.
• Telemedicine.
• Critical Care.
• Paediatric Care.
• CSSD Management
• Clinical Support and Personal Health Record
• Dental Care
• Perioperative Care
• Nursing Care

Wikipedia’s definition of Hospital Information Systems

“A hospital information system (HIS), variously also called clinical information system (CIS) is a comprehensive, integrated information system designed to manage the administrative, financial and clinical aspects of a hospital. This encompasses paper-based information processing as well as data processing machines.”

A beg to differ.

There are essentially two major activity segments in which a typical hospital is divided

-Hospital Administration
-Clinical Care Management

Hospial Administration typically includes administrative, financial, day-to-day activities, patients in-bound and out-bound traffic, scheduling, billing and all the other activities.

Clinical Care Management typically includes everything to do with patient’s clinical activities to Interacting with other entities involved in Patient care. This includes Patient encounters, patients medical history records, patient surgeries, medical prescription, pharmacy Integration, Laboratory Integration, Medical equipment interfacing and much more.

Hence clubbing Clinical care management and hospital administration in my opinion is not a good idea.

Hospital administration activities are more of the surrounding activities which revolves more importantly around the financial aspects of the hospital, whereas Clinical management deals with Patient care and safety.

Majority of the Information technology today hits the first section within the hospitals and provide really intutive and easy to use hospital management/information systems. This solutions will have ability to register patients, schedule patients, print bills, manage hospital finances, manage inventories, manage laundries, resource planning and other business functions.

Clinical Information Systems also called “CIS” is an Information technology solution which will be use to increase efficiency in the neglected area of Clinical Management systems. CIS should provide ways and means to improve Quality of clinical care. There is one more general synonym for CIS widespread in the market and this is known as “EMR”. And I must admit this is much closer to CIS than HIS, although not exactly the same. EMR stands for Electronic Medical Record. This is the patient’s medical record which is stored electonically. The entire patient’s medical history is captured electronically in the medical record. However EMR is one part and rather an important part of Clinical Information System. However CIS is much more than just EMR. CIS is targetted to integrate all the clinical activities inside a healthcare unit so that there is seamless interaction between all the eligible clinical systems to attain total patient safety. So along with EMR, one would also have an integrated laboratory, integration pharmacy, integrated nursing,integrated equipments. CIS systems also provide decision support tools to make clinicians better medical decisions based on gathered historical data. They also have clinical alerts capabilities which will allow required timely updates.

To conclude, Clinical Information Sytems are much more than Hospital Information systems or Electronic Medical Records. Clinical Information Systems are built to enchance the overall Clinical Information Workflow rather than just capturing the Patient’s data electronically or increasing hospital administration efficiences.

Health care, or healthcare, refers to the treatment and management of illness, and the preservation of health through services offered by the medical, pharmaceutical, dental, clinical laboratory sciences (in vitro diagnostics), nursing, and allied health professions. Health care embraces all the goods and services designed to promote health, including “preventive, curative and palliative interventions, whether directed to individuals or to populations”.

Healthcare in India is the responsibility of constituent Indian states.The National Health Policy was endorsed by the Parliament of India in 1983 and updated in 2002.

Indian Healthcare Issues

Malnutrition

• Half of children in India are underweight, one of the highest rates in the world and nearly double the rate of Sub-Saharan Africa.
• India contributes to about 5.6 million child deaths every year, more than half the world’s total.

Women and Children

• India contributes to about 5.6 million child deaths every year, more than half the world’s total
• The maternal mortality in India is the second highest in the world.Only 42% of births in the country are supervised by health professionals
• According to UNDP Human Development Report (1997), 88% of pregnant women (age 15-49) were found to be suffering from anemia.

Water and Sanitation

• In 2002 by the World Health Organisation that around 700,000 Indians die each year from diarrhoea.
• As of 2003, it was estimated that only 30% of India’s wastewater was being treated, with the remainder flowing into rivers or groundwater.

Healthcare Infrastructure

• India spends relatively little on healthcare, which accounts for 4.8 per cent of India’s GDP. Of this, 3.6 per cent is contributed by the private sector and only the balance 1.2 per cent by the Government
• Further, a recent WHO report indicates that India spends just 17 per cent of its public expenditure on health while the corresponding percentages for Pakistan, Bangladesh, China and Brazil are 20, 28, 38 and 54, respectively
• As per analysis the current (2006) bed per thousand population ratio for India stands at 1.03 as against an average 4.3 of comparable countries like China, Korea and Thailand (2002 data).
• Out of the total about 896,500 beds will be added by the private sector with a total investment of 69.7 Billion US$ (Rs 222,000 Crores) over the next six years
• However, the gains are commensurate in this capital intensive industry, since the revenues generated by private hospitals in the year 2012 will be to the tune of US$ 35.9 Billion (Rs. 161,440 Crores) growing at a CAGR of 15%.
• Shortfall of over 450,000 doctors in the year 2012 is foreseen.
• India would require investments of up to $20 billion over the next 5 years
• A middle-level manager with a family of four, spends between US $ 170 and US $ 255 a year on healthcare – compared to just US $ 43 in the late –1980s

References :

• http://www.ibef.org/artdisplay.aspx?cat_id=391&art_id=5204
• http://www.thehindubusinessline.com/2008/08/22/stories/2008082250140800.htm
• http://www.ficci.com/media-room/speeches-presentations/2007/jan07/ExecutiveSummaryReport.pdf
• http://en.wikipedia.org/wiki/Healthcare_in_India#Issues

I got this idea while I was on my way to office today and thought to write it down before it wipes of my RAM.

India has a significant contributions to IT services. However when it comes to Software product Development we need to still prove our mettle.I am sure a lot of discussion must have already gone into this topic and is still happening. Here are my thoughts on the same.

Everybody knows that there is a significant difference in the way an IT services company is executed and a product development organization. However what is happening is since majority of the Indian IT professionals have a services mindset, they unconsiously tend to bend towards executing a product development company also on lines of a services company.

One needs to understand that the gestation period of a product is always much more than an services. The time it takes to build a steady product is significantly higher than developing a piece of customized software for a client.  Hence it is essential to plan the gestation journey to start with meticulosly. This is the first hurdle that one needs to pass.

Another important aspect to understand is that the product always goes to various iterative cycles over the time to improve. As against customized software which will not vary much unless doing further enhancements whenever required. Product instead
will get refined increasing its footprint, defining more features and so on. Apart from engineering, marketing and sales of a product is totally different than what happens in a services domain. India in my opinion needs to significantly improve in this area if they need to build successful products. I am sure Indian talent is capable of developing world class products (For that matter many of the world class products are engineered in India, although they are for global companies). The need is to understand the other areas which are required for a product company which are totally different than the services organization.

Here, I would wish to move towards Indian Manufacturing or India pharma. If you observe over the years, once India started opening up, Indian manufacturers have indeed shown the world that they can create world class products can necessarily also execute world class organizations.Manufacturing or pharma were tradionally into product making and not services. Hence they have mastered the art of product making.

Firstly, they focus on the very minute details of engineering before building things. The concept of a very detailed design is quite clearly visible in manufacturing while it is lacking to an extent in software product.

The plan for profitability is again laid out considering all the factors in quite details. The risk taking appetite is much more and the margins are calculated very carefully. One of the advantage that IT comapnies had over the years was the margins due to export. Most of the IT services companies worked for clients outside India and hence they are used to deduce huge margins owning to currency difference. This IMO,does not allow them to take significant risks. They always want to break-even as early as they engineer a product.

I think the Indian software product development, needs to follow Indian manufacturing in terms of risk apetite, planning and finer level execution to be globally successful in terms of product development and needs to change the services mentality.

I attended Innovations 2008 (5-6th Jan 2008). An event organized by IIT Bombay Alumni association’s Pune chapter.The day started with Anand Deshpande talking about his ideas why product start-ups are not that successful in India and why are we not able to produce world class products.

The important points that he pointed out were we are weak in identifying product market space, product marketing and managing distribution channels.

He also referred to some good examples from the book Blue Ocean Strategy by W Chan Kim

This was followed by the talk from the keynote speaker for the event, Dr. R.A.Mashelkar. I was pleasantly surprised to know the contribution of Dr. Mashelkar in the field of innovation and there can be a separate blog just on that
He talked about some very interesting aspects of innovation and suggested that in Indian context innovation needs to happen at three different levels which is poor, middle class and rich. And there needs to be different strategies and different vision for each category of innovation to reach the correct segment.

One thing that really touched me was when he said this. ” I am sure India will definitely be an economic and technical superpower, what we also need to make sure is that we are super power in ethics and moral and guide the world with us. We need to think of the poor across the world and not just India and that will make true Indian super power”.

This followed by a session of show casing innovations. Interesting session where we saw innovations from various categories ranging from chemical, mechanical, bio-medicine, IT etc.

Well organized and discipline sessions was a pleasure to watch particularly in India.

I also got a glimpse of IIT way of starting and ending a function. The function began with singing a National Anthem (everybody actually sung it and no playback) and ending with something called Pasaydaan , which was unique and I would wish any Indian function should follow.

Barcamps are indeed a wonderful way to connect,share,communicate and socialize. The following post might be a little controversial,however believe me the intension’s are really very positive.

Having attended certain barcamps, I had a few observations. I am not sure if other friends of mine also had similar observations.

• The initial few hours are barcamps are very popular and full of energy. The enthusiasm levels starts dipping after the lunch hours and by around the end of the camp, the last few sessions attract very little crowd.
• Barcamps are getting popular, however my personal view is that the popularity somehow seems to be restricted to a set of audiences and not reaching the entire mass. Again there are pros and cons to this point as well. However one of the significant con to this is that the diversity in topics and speakers might be effected after some times.
• Barcamps being totally democratic, there is no control over anything, be it quality of speakers, quality of presentations and anything else for that matter. Democracy is always welcomed. However this might have an impact in such a way that if there are lets say 3-4 presentations in a row which are targeted to a totally different set of audience then the one present, the interest in the rest of the presentations might have an impact even though they might really be genuine.

I again want to reinforce that the intention of this article/blog is to get the best of ideas for making things better and it does not in any form negating the idea of barcamps or its present form.

It would be great if people can open up their minds and throw up comments for making barcamps even more effective and more and more impressive form of communication.

This is part-I in this series and I would wish to add more to this after the initial comments that I receive for this article.

-H

Belgium generally requires you to have a work permit or evidence that your employer has applied for one on your behalf before you can apply for a residence permit or long-stay visa.

There are three types of work permit in Belgium:

A C permit is valid for only one year, allowing the holder to work for multiple employers. This is usually issued to migrant agricultural or domestic workers. C permits generally aren’t renewable.

A B permit is valid for one employer and runs for one year, after which it can be renewed (by the same employer, usually for the same job or job classification). If you change employers, your new employer must apply for a new B permit. You may find that you have to return to your home country and re-apply for a residence visa before you can start your new job! Once you’ve renewed a B permit four or more times, i.e. have lived and worked in Belgium for five years on the same permit, you can receive an unlimited A permit.

An A permit allows you to work for any employer in Belgium for an unlimited period of time. These permits are issued only to the following categories of applicant: the spouse of an A permit holder, the non-EU spouse of a Belgian national, the non-EU spouse of an EU national legally resident in Belgium, and any foreigner with five years’ uninterrupted (legal) residency in Belgium.

The B permit is the standard form of work permit for most foreigners. Applying for a B permit is the responsibility of the employer wishing to hire a non-EU foreigner. You must give your potential employer a certificate of health and three passport-size photos, which he then submits along with a copy of the proposed employment contract to the Ministry of Labour. Before issuing the work permit, the Ministry of Labour must determine that there’s no Belgian or other EU national who can fill the position and they may send the employer candidates for the job from their lists of Belgians drawing unemployment benefit. (In the case of managerial positions, the permit is usually granted with little or no question.) It can take up to 12 weeks for a B permit to be granted.

Self-employed professionals from outside the EU must apply for a professional card (carte professionale/beroepskaart) in order to work in Belgium. A professional card can be issued for a period of five years. You’ll need a passport, medical certificate and a police certificate (certificat de bonne vie et moeurs/bewijs van goed gedrag en zeden) in addition to proof of your qualifications in your profession. Be sure to check with a Belgian embassy or consulate in your home country, as some professions require specific proof that you’re already established in your field. For example, to qualify for a professional card as a journalist, you must produce press credentials and be eligible for a Belgian national press card; to qualify as a freelance writer, you’ll need to submit copies of published works and evidence of your income from freelancing over the past few years.

Pasted from <https://www.xing.com/app/forum?op=showarticles&id=5945367&articleid=5945367>

I was looking into the details of rss today. Until now I know that RSS is used for sharing your blogs and a lot of other things. However not all was aligned and I was not getting an end to end idea of what exactly this is and how it works. So here it is from what I learnt today.
RSS is a xml reprensentation of your data in a typical format. There is no specified standard that RSS follows however RSS 1.0 version used W3C RCD standard.

So lets say you have a plain web page or any kind of document. If you manually convert that document or web page into an XML document with specified syntax, you have the RSS ready. Also there are RSSCreators which are available in the market which will help you generate RSS out of your non-rss content. If you dont want any RSSCreator it is also possible to create our own RSS manually as well. RSS Validators are also available which will validate the generated RSS feed.

Once you have a rss feed, anybody can take this feed and see the contents. Oh what a big deal. They can very well see the contents of my web page as well. Rite :-). However the good part of RSS is that, somebody who is interested in your content, can subscribe to your rss feed. We shall discuss methods of subscription later in this article.
Once somebody subscribes the rss feed, whenever you update the content for this feed, the subscriber will see the updated content automatically and they need not re-visit your site every one hour to check whether there is any update. So this is more of a push technology in that respect where the data will come to you instead of you going to data.

The automatic update of RSS feeds is thanks to RSS aggregators. RSS aggregators are programs which will watch out for the feeds that you subscribed and send you the updated content for those feed.

Coming back to subscriptions, so if you see any RSS content, it will have this icon <icon here> which says, subscribe to this feed. If you click on that it will ask you to choose on your favourite RSS readers where it can subscribe you. Also there is an e-mail subscription option which will send an e-mail everytime any content is updated on that rss feed.

RSS Discovery is finding out feed from the content. Let’s say your web page has n RSS feeds. Using RSS Discovery, you can get the exact xml corresponding to rss which you could subscribe to. Most of the online aggregators these days have the RSS discovery mechanism in built so that if you provide them the URL, it will fetch the appropriate RSS and you can select the RSS to subscribe.
I found an interesting article about RSS Discovery concepts here.

While browsing through RSS contents, I also came across a term OPML again related to RSS. OPML stands for Outline processor markup language ( I dont know where this markup language business is to extend :-)). OPML file lists all the RSS feeds into one. This helps in importing/exporting rss feeds acrosss aggregators. Also it is used by aggregators themselves to exchange feeds. Online OPML managers are also available to manage your OPML files.