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Title: Technology

for Emergency Care Management & Healthcare Delivery

Authors Varun Bahl works as a Business Consultant in the Healthcare payer IT field with more than 8 years of experience. His areas of interest include Health Reforms, Medical IT Process Optimization and Health Innovations. Varun has expertise in many healthcare businesses including Health Insurance, Third Party Administration, Pharmacy Management and New health technologies and innovations. Varun can be reached at bahlvarun@gmail.com

Vaibhav Srivastava works as a Business Analyst in the Healthcare domain consulting field with more than 3 years of experience. His areas of interest include Health Reforms, Healthcare Process Optimization, Innovations, Thought Leadership and Healthcare Strategic Consulting.
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Vaibhav can be reached at vaibhav.srivstava@gmail.com

Table of Contents

1. Introduction
a. Statistics on Emergency Services in India

2. Current State of Emergency Care Management in India 3. Transformation Strategy 4. Leveraging Technology for Integrated Emergency Care Management 5. Cloud based Integrated Emergency Care Management
a. b. Interactions with Stakeholders Revenue Model How to make ERCs viable

6. Summary

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1. Introduction

Emergency Services are restricted in India- to sum up the current state of emergency services and its delivery; there is a famous quote by an Ex Dir AIIMS, If you feel there is an emergency, better arrange for your own transport than to wait for an Ambulance. Most of the population is completely unaware of emergency procedures and appropriate contacts. Emergency delivery systems are also constrained, due to lack of system integration, leading to poor delivery of care.

Statistics on India Emergency Care- Drivers of Change: With more than l Lakh Road Traffic Accidents related deaths, 98.5% Ambulances used for transporting dead bodies, 90% of A m b u I a n c e s devoid of Oxygen of any Equipment, 95% Ambulances having untrained personnel, most ED doctors having no formal training in EM, misuse of Govt. Ambulances and 30% mortality due to delay in care, India portrays a worse image than what existed in USA of 1960s (Source: http://www.iiems.org)

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2. Current State of Emergency Care Management in India

Emergency Care is one of the most critical aspects of care delivery. Quality of care and timeliness of appropriate care are equally important for effectively treating emergency situations. Cases related to trauma and heart diseases are common and need specialized care.

Typically, most of the emergency care in the hospitals in India is provided in areas known as Casualty or Accident rooms. Formal education and specialty training in emergency care are neither available nor mandatory for personnel involved in emergency care. These Causality/Accident room physicians lack any specific training in emergency medicine. In many hospitals, physicians staffing the emergency rooms lack the resources and knowledge to manage the wide variety of emergencies. They therefore function as postal carriers who deliver victims to the respective specialties. The most junior and inexperienced staff frequently treat the most seriously injured patients. Needless to say, the state of emergency medical services in India remains in bad shape.

3. Transformation Strategy
A detailed gap analysis is required to identify the loop holes that exist in the way emergency services are delivered currently. The major challenges that need to be addressed are as follows: o o No single point of contact for Emergency Management Lack of Standard Treatment Guidelines Lack of Traffic Management for Emergency Services Delivery Vehicles IT Equipped Medical Vans are very rare in India POEC Point of Episode Care is highly constrained

o
o o

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IT Integration supported by real time data communication systems can achieve the dream of providing optimum quality emergency care in the least possible time. Integration of various stakeholders through advanced technological devices can lead to increase coordination of care.

Indian healthcare system needs to recognize IT as a strategy for survival. IT can not only reduce manual intervention but also enable required decision support at the point of care. A rule based platform can enable care givers in adhering to standard treatment protocols.

Thirty per cent of emergency patients in India die before they reach a hospital. Over 80% of accident victims do not achieve access medical care within one hour of the incident. Efficient real time communication systems can offer invaluable capabilities of reducing this time gap, so the treatment starts as soon as the request is raised.

There is a need to establish an Emergency Response Center, a dedicated centralized hub equipped with state of the art Call Center Facility, which will act as a nodal point for any emergency issues, on the lines of Emergency response center in Gujarat. It will allow the person to call a single number for his entire healthcare emergency needs rather than remember hospital emergency numbers. Emergency Response center will be equipped with the latest technology to a. b. Support the patient until the emergency service arrives To co-ordinate emergency care from the nearest healthcare center (Private/Public)

4. Leveraging Technology for Integrated Emergency Care Management

Patients medical history, in case of an emergency, is most one of the important input for effective treatment in a crisis situation, thus ensuring availability of adequate medical information to the care givers can make a big difference.

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Electronic Medical Records is the way forward in this direction, a Standardized way of representing the medical information in an electronic format that is available to healthcare professional at the click of a button can assist in an effective care delivery mechanism.

As soon as the information reaches the contact person, emergency management team can look at the critical information, such as allergies, ailment history, prior diagnosis, tests, report and treatments to decide on the line of treatment needed for a particular emergency scenario. Hence the process can be initiated even before the patients actual condition is analyzed.

As technologies evolve, they create avenues for path breaking changes in society, some of the technologies that can help in better Emergency Care Management are a. Telemedicine

Telemedicine are like virtual clinics where patient is at one end of the terminal while the doctor is at the other end of the terminal, the consultation happens through a telepresence / Video conference that also has basic devices attached to provide doctors information on patient current state, these include BP Monitor, Glucometer, ECG monitor, Thermometer, Stethoscope etc. Telemedicine has a huge scope in providing medical consultations almost on a 24X7X7 basis to everyone subject to them having access to basic IT infrastructure b. Online Traffic Updates

Although relatively new concept in India, where traffic management does not generate interest for Technology companies, inputs from traffic management tool can help Emergency teams to plan the evacuation of patient in better fashion c. Integrated update system

Other updates include weather updates, area population updates, cultural festival updates, event updates such as rallies, exhibitions and games etc. can help the Emergency response team to plan their deployment of resource to address maximum population

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d.

Integrated Call Center

Integrated call center with capability to route the calls to multiple customer service representatives from a single number. Ability to handle and support level of variation in call flows with minimal infrastructure can help in maintaining connectivity with the patient/patients know in and during the emergency until the help arrives e. Cloud Right way to manage Emergency Infrastructure

Concept of cloud is based on renting infrastructure rather than setting it up. Cloud infrastructure can be very helpful in managing the cost of infrastructure, since it is known fact that call volumes grow during a certain period of during the year, such as weather changes, festivals, winter etc. Thus allow Emergency Response Center to maintain its services at optimal levels.

5. Cloud based Integrated Emergency Care Management System

Cloud based Integrated Emergency Care Management System intends to fill the gaps that currently exist in the way emergency care services are delivered in India. This extensive solution can resolve multiple issues that currently exist across the spectrum of stakeholders involved in emergency care.

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The above diagram depicts how the information would flow in an emergency care scenario across various stake holders using a cloud based service. The various stakeholders that can leverage IT for effective care management in an emergency using the Cloud based Integrated Emergency Care Management System are defined below in detail.

Emergency Response Center


Emergency Response Center will be a dedicated center to handle Emergency needs to a state wherein the calls to a single number will be routed to the nearest free center associate. These associates will be trained

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on handling of medical emergencies and will take the basic details of the emergency, put it into the systems and look for immediate responses in the system. ERC System will reside on Cloud to ensure scalability of infrastructure at different times and also in cases of Catastrophes like Terrorist attacks, Earthquakes, Flooding, and Major Accidents etc., Cloud would also provide seamless connectivity to other stakeholders such as Hospitals, ambulances etc. as only services and real-time data can be deployed on the cloud. ERC system on receiving the details such as person, his age, unique iD if any, place of episode and type of emergency, allergies or adverse interaction, current medications will show up the following important informations to the stakeholders for an episode through ERC Cloud Interface

a.

Check if the patient has an EMR for unique ID shared, if yes, check if the current episode is

related to existing conditions and if patient can be stabilized with the current resources at the point of episode. Display probable approach based on historical data b. Check the symptoms and what diagnosis it corresponds to, give the initial lines of action, from

which the Emergency Response Center professional can decide which may be appropriate, also guidelines for address the emergency until the Ambulance reaches the point of episode

c.

Establish contact with the nearest center having Ambulance available, through state of the art

GPS, with all the ambulances associated to the medical center. Guide them to the route that can be taken to reach the point of episode in the shortest possible time

d.

Checks for the timings, events, festivals, happenings in the area and assess the rush in roads,

suggest alternate routes to reach in shortest possible time

e.

Information will relayed sent parallely to the ambulance and the closest hospital that will be

equipped with connectivity to the Emergency Response Center and will be able to access the updates on the situation including the condition, symptoms and primary first aid being provided. Thus allowing the paramedical staff and hospital to prepare for the emergency

Ambulances/Paramedics
Hospitals and paramedics enlisted with the ERC will be certified by the ERC team for GPS and readiness, Paramedics will get an update if its not already tagged as occupied. Paramedics can then connect to ERC system and check the place and kind of episode, on the way paramedics can decide on the line of action and

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start preparing for medical instruments/medications that will be needed to stabilize patient enough to be taken to the hospital. On the way the paramedics will be put on the call going on with the ERC team, till the time he reaches the location and treats the patient, the paramedic will close the ERC request once the patient is acquired by the paramedic. Paramedic will then analyze the situation and decide on transportation of patient or in case he needs to stabilize or call for further discussion. He can connect to the state of the art Telemedicine over the laptop or treatment kit to further analyze the situation and bring it under control. Once the transportation starts, the Vitals for the patient will be flashed over to the nearest hospital whom the ERC has already assigned the case. They will be able to monitor the vitals and see the treatment being provided by the paramedic in real time. Live feed about the patient can also be provided if the ambulance is equipped with this facility.

Hospitals/ Emergency Care Centers


Hospitals will get a notification once the patient is put on the Ambulance for transportation, the details about the episode will be flashed on the emergency screens. This will detail out the statistics and data collected by the ERC team. Ambulance Medical monitoring information will also be flashed in the hospitals to see how the vitals are doing and if the patient is losing or stabilizing, this will help in final tracking the progress of the patient till the time he/she reaches the hospital under emergency care. In parallel the hospitals will be allowed access into the Electronic Medical Records of the patient (if its identified that he has a medical record/history). This will allow the hospitals to have full details of the patient and will be able to analyze diagnosis and start preparing on the plan of action way before the patient reaches the hospital. Time saved during the emergency episode will allow the patient to get on time, precise and quality care thus increasing the chances of survival of the patient.

Revenue Model How to make ERCs viable

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Although the Ambulance and hospitals can charge for the medical services and supplies provided by them, the question still looms around how the ERC will be funded. ERC would need to have state of the art technology and resources trained for extreme conditions, these are high cost investment and they would need to be made on sustained bases as the technologies evolve. Thus there needs to be multipronged approach to revenue generation. Some of the Channels that can be tapped into for funding of these initiatives include a. i. Government Funding at two levels Technology Upgrades One time funding would be required for upgrades that might happen on need basis, this can be requested in the form of grants to the state, central government, with stress on healthcare in the 12th 5 year plan, there will be scope to get funding for this infrastructure even at the central level ii. Operations States can be requested to allocate the funding from the earning through taxes and grants or a medical tax can be included in the current tax structure of the states to allow them to fund this initiatives iii. Policy Changes Making policy changes to make the grants to ERC tax free would encourage people to donate. Other policy arguments can be discussed where in tax free imports and rebates to companys part of ERC can go a long way in reducing cost this indirectly supporting the project b. Funding by people

i.

People can also fund the project; this can be done by charging commodities with cess on the service provided on the lines of Education cess.

ii.

Charging for ERC usage as part of the bill from paramedics then transfer of the amount to the ERC centers account.

c.

Funding by corporate

i.

Corporates can be tapped into specialty healthcare through the following

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1. Healthcare providers (Ambulance/Hospitals) will be asked to pay subscription fees. This


should be mandatory for all hospitals operating in the area of where ERC is deployed 2. Healthcare providers can use the ERC data base as this will be rich source of information and can be deciding factor in their business 3. Trends and utilization and usage can be shared with corporates as this can be viable and critical tools in the hands of marketing and research companies 4. Even information such as latest happenings can allow companies to plan their target and events around such happenings, these can be shared free along with the subscriptions 5. ERC can act as provider of ambulances and paramedics for major functions, fairs and events 6. Insurance Companies can provide for funding as itll reduce the criticality of the episodes, thus saving on medical expenses being incurred if the case is admitted to the hospital 7. Pharmacy companies can use data to track the consumption of drugs and its fallout on the cases reported through ERC

6. Summary
Emergency care services need a highly efficient and well interconnected system that can act as a single point of contact. The cloud based integrated management solution aims at considerably improving the scenario of emergency care in India. Its an IT cloud based solution; hence is scalable, highly integrated and can act as a key differentiator if used correctly by the care giver. The concept of Emergency Care Centers needs to evolve in India and it has to be well networked with all the medical centers of the city to offer maximum advantage. This solution has the capability to work on self-sustaining basis once the initial financial requirements are met. The advantages of the solution are numerous, but what it would definitely assist in; would be saving precious lives and improving the existing standards of emergency care delivery in India.

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