Techie-driven healthcare apps don’t help clinicians or patients. They only help administrators and that’s not enough!
When we discussed the Indian healthcare delivery pyramid earlier, we pointed out that a majority of the population’s health needs are met by private neighbourhood clinics. Physicians in single-speciality and multi-speciality clinics meet hundreds of thousands of patients each week, several of whom are returning patients undergoing a long-term treatment plan. Yet, most of these clinics are not computerised, don’t maintain electronic health records; many of them maintain no record of any kind.
These clinics cannot continue to operate in this manner anymore, due to both regulatory and competitive pressures. The Clinical Establishments (Registration and Regulation) Act 2010 brings all clinics — multi-speciality, single-speciality and neighbourhood clinics in our healthcare delivery pyramid — under one umbrella. This Act, currently adopted only by a handful of states, mandates the “maintenance and provision of EMR or EHR for every patient”. In addition to several other provisions and guidelines for establishing a clinic, the Act also lays down standards and guidelines for the collection and storage of patient records. Moreover, there also exists the Medical Council of India’s (MCI) guidelines for clinical practice that physicians adhere to.
In the near future, patients will demand insurance coverage for outpatient visits. When that happens, to keep track of patients’ health and to prevent fraud, insurance companies will drive digital adoption. If clinics don’t fast catch up, they will be left behind by outpatient clinics attached to hospitals that already have an EMR.
Alongside, patients also have begun demanding a better bang for their buck. A regular employer-mandated health checkup now comes with impressive quality of reports. A paying customer would certainly want the same quality and go where s/he can get it.
Health-tech providers sniff this massive opportunity. They also see that in a country with only 6,00,000 doctors, there are potentially a billion patients. It is for this reason that a B2B practice management software needs a “discover doctor”, “fix appointment” and “rate the doctor” application to survive.
Think about a standard software available today that are made for clinics. Think about its features — automated appointment SMSes, easy cancellation/rescheduling, flexible payment options, billing and collection of feedback — all helping the patient (treated as customer) more than the physician. Almost as an afterthought, hidden among these administrative features is a way to collect and store medical records.
Existing technology offers “practice management” and not “physician assistance”. For most physicians, existing software is a tool that they neither need nor want, because it doesn’t fit into their existing workflow. Instead, it re-organises the workflow by adding steps that didn’t exist without improving steps that do.
Moreover, most providers build and sell only software. This means that clinics end up using modern software on existing desktops and laptops, which are often long since outdated. This makes the software inefficient and causes unnecessary delays. Software providers, though, wash their hands off, blaming the clinicians for not owning the hardware needed to run modern software.
In essence, practice management technology today does little or nothing to help physicians deliver better healthcare. It doesn’t increase the average face time between doctor and patient, in fact reduces it. It doesn’t give better visibility of a patient’s medical history to the doctor; instead, it gives better visibility of a clinic’s profitability to the administrator.
Built by technology delivery folks in the air-conditioned silos of Bangalore’s tech-parks, health-tech today doesn’t understand the ground reality of clinicians who cater to a large part of the country’s population. To make any real impact, technologists should talk less and listen more. We should “re-invent” less and discover more. We should “re-organise” less and integrate more.
