ARAS - Delivering World Class

Healthcare IT Solutions

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SRISHTI Software
progress through creation...

The Healthcare Revolution Roadmap
Healthcare is undergoing a distinct movement along a logical trajectory from its historical focus on Acute Care to Long Term Care. While Acute Care deals with immediate and severe outbreaks of illnesses, Long Term Care focuses on continuous care over a significant span of time, ideally a life time covering both episodes of acute illnesses and exacerbations of chronic illnesses. This shift leads us to Preventive Care, delivered through early detection & treatment, resulting in reduced morbidity load on individual and society. And finally, this logical journey ends at Predictive Care, i.e. not waiting for early signs of illness but predicting and thwarting it before the illness has the chance to take root. We are moving towards a consulting/service based healthcare with focus on lifestyle changes and behavior adaptation to prevent/cut-out the roots of any instance of illness. There are clear challenges within the current health-care ecosystem that must be overcome before realizing the benefits of above mentioned revolutionary changes.
4. Predictive Care 1. Acute Care 3. Preventive Care 2. Chronic Care

Current Challenges
A. Alternative delivery model to multiply reach Low reach/inaccessibility as well as insufficiency (where available) of quality care Presence of specialist doctors is restricted to the metro and major cities Low focus/risk of under-utilization of capacity (beds, doctors, nurses)

Care Beds / Population of 1000
8.00 7.00 6.00 5.00 4.00 3.00 2.00 1.00 0.00 0.00 USA UK France Spain Egypt India Germany 4.00 Delhi 3.00 Alex. 5.00 Cairo Port-said

2.00

India

Egypt
Monofeya

1.00 UP

Kalyubya

B. Integrated Healthcare Information

Fulfillment Specialist Orthopaedist, etc.

Fragmentation of patient data and medical know-how across entities in the ecosystem Lack of one-point complete patient record High Cost/Low Productivity due to bottom-up recreation of
Patient Data

Healthcare Entities

diagnosis/analysis at every instance

C. Alternative transaction models

.

2. Chronic Care

Business models are currently focused on Acute Care across the healthcare ecosystem. Models catering to Chronic, and more advanced providers Preventive Care need to be explored by insurance companies and healthcare service alike.
1. Acute Care 3. Preventive Care

The current payment models, focus mainly on Acute Care

4. Predictive Care

But, at the base, are technologies ready to convert these challenges into opportunities - and make the revolution actually happen?

PARAS - The Healthcare IT Suite from Srishti
Srishti's Healthcare IT solutions support modern healthcare service providers with future proof initiatives, best in class delivery models and emerging technology conformance. To address the need of various hospitals at different stages of their Healthcare Informatics deployment, Paras comes in three different configurations - Paras Lite, Paras and Paras Premium. This ensures that our customers need not change their platform with their growing needs and changing work flows. Basic philosophy behind PARAS is to achieve integration of entire spectrum of healthcare technology enablers and is built using Srishti's powerful tool-kit approach. This two pronged strategy ensures that healthcare services don't hit a technology roadblock as business models change. PARAS is the answer to the need for a one-stop technology solution for healthcare service providers.

Healthcare Management IT Platform v 5.7
Public Portal Patient Portal Clinician Portal eGov Portal

Bedside Monitors

Specialty Formsets

Clinical Protocols

Isabel CDSS

KPIs / QOFs

Disease Registries Bio Terrorism Alerts

DICOM Devices

EHR - CPOE

EHR Centric Modules - Nursing, Consultant, OT

EHR - eMAR

Disease Surveillance

Lab Equipments

RIS, PACS & Image

BB, CBB LISIntegrated EHREB

eMAR Pharmacy

CSSD, eMAR Diet, Therapy

Clinical Analysis

RFID Tags

ADTRF Mgmt

IP - Bed / LIS Mgmt Ward

IP - Billing Mgmt

Plan & Payer Mgmt

Business Analysis

Smart Card

Registration Mgmt

OP - Clinic Mgmt

OP - Billing Mgmt

Help Desk Mgmt

Actuarial Analysis

Ambulances

HR & Duty Mgmt

Finance Mgmt

Procurement & SCM

Support Services Mgmt

Program Effectiveness

PACS Repository

Application DB

ICD 10 / SNOMED-CT

Knowledge Repository

PACS: Picture Archival and Communication System RIS: Radiology Information System SCM: Supply Chain Management Ref / FU: Referral / Follow up ADT: Admission, Discharge, Transfer

BB, CBB: Blood Bank, Cord Blood Bank LIS: Lab Information System IP Mgmt: In-Patient Management CPOE - Computerized Physician Order Entry EHR: Electronic Heath Record

RCM: Revenue Cycle Management CDSS: Clinical Decision Support System OT: Operation Theatre CRM: Customer Relationship Management EB: Eye Bank

eGov: Electronic Governance QOFs: Quality Outcome Frameworks KPIs: Key Performance Indicators eMAR: Electronic Medication Admin Record CSSD: Central Sterilization & Supply Dept.

Salient Features Salient Features
Fully compatible with NABH & JCI criteria
Conforms to HL7, HIPAA & ITIH standards

Best in class image recording & communication platform Clinical Pathways conforming to global standards Integrated with ISABEL CDSS, world’s best clinical decision support system

Capable of integrating with standard CMVs like ICD 9, ICD 10, CPT 4, SNOMED CT etc. Internationalization support Fully functional EHR integrated with relevant modules & localization with multilingual

Modular approach to deployment & implementation Capable of generating clinical performance indicators

Hospital Management Information System (HMIS)
KPI Reports CPOE Module
Lab Investigation Order Handling Radiology Request Management ADT Order Handling Procedure & OT Request Nursing Order Handling

Isabel CDSS Integrated EHR Module
Demographics Allergies & ADRs History Details Episode & Problem Details Review of Systems Physical Examination Clinical Notes Drawings & Image Management Protocol Management Specialty Specific Formsets Standing Orders Disease Registries

Clinical Pathways eMAR
Physician Ordering Drug Interaction Validation Pharmacist Dispersing Nursing Compliance Nursing Station Charting

RIS Module
Radiology Workstations Image Storage Management Image Manipulation Analysis & Reporting

LIS Module
Lab Admin Lab Store Haematology Biochemistry Microbiology Cytology Histopathology Immunology

Pharmacy Module
Pharmacy Store Management Pharmacy Request Management Pharmacy Cash Management

Support Services Module
Operation Theater Management Central Sterilization [CSSD] Blood Bank Management Cord Blood & Stem Cell Management Diet & Kitchen Management House Keeping & Laundry Vehicle Management Building Maintenance Library Management Eye Bank Management

ERP Module
Human Resource Management Employee Database Leave Management Payroll Management Duty Roster & Personnel Performance Management Material Management Stores Management Equipment Management Inventory Management Asset Management Vendor Management Purchase Management Finance Management Accounts Payable /Receivable Statements of Accounts General Ledger Cash Flow Analysis Profit & Loss Statement Trial Balance / Balance Sheet

PAS & CRM Module
Registration Patient Registration Token Management Telephonic Registration Web Registration Ward Management Bed wise patient details Vacant bed status Bed utilization report Bed / ward nurse roster In-patient Management· Admission Management Discharge Management Transfer Management HL7 CDA Documents Appointment & Scheduling Clinician Appointment Lab Scheduling Radiology Scheduling OT Scheduling Billing General Billing Advance Payment Package Billing Lab Billing Investigation Billing Corporate Billing Insurance Billing Final Settlement

PARAS Lite
PARAS Lite, an out-of-box product has been created by retaining the essential PARAS modules & is targeted at Small & Medium hospitals, and IT starters among big hospitals.

PARAS
PARAS is an end to end customizable solution for a hospital providing Complete Clinical & Administrative Integration across the enterprise including highly sophisticated integrated EHR.

PARAS Premium
The PARAS Premium is a framework based solution and is targeted at hospital-chains with number of beds numbering in thousands. This high-end solution handles, at a centralized location, the heavy-duty data management and complex information access needs of all branch hospitals. Moreover provides Complete Clinical Informatics Framework conforming to International Standards.

Tele Medicare Solution
Tele Medicare is a rapidly developing aspect of clinical care where Medical & Health information is transferred via Telephone, Internet or other Networks to facilitate Consulting, Assessment or for Performing Procedures. Srishti’s Tele Medicare Solution, anchored at both ends to an integrated EHR & HMIS, provides Unfragmented and Complete Clinical & Administrative data to all stakeholders at point of care.
Thus, PARAS products address all the segments of the market. This facilitates the customer to grow on the same platform without changing the solution as and when their business & IT needs grow.

Integrated Electronic Health Record System (EHR)
At the heart of Srishti's PARAS is an Integrated Electronic Health Record – EHR, a complete, updated and accurate one point patient clinical database across entities in the healthcare universe.

Summary EHR

Home

Health Info Location Specialist

EPR

Social Workers

EPR

EHR
GP Nursing
EPR

Aged Care Path Lab

EPR

Large Hospital

Local Hospital Imaging Lab

RIS & PACS
PARAS’s RIS can work as a stand alone module or with a PACS server - own or institution’s existing server.

Remote DICOM Modality

Teleradiology Workstation

PACS Server

DICOM Modality

Radiology Workstation Radiology Workstation

eMAR
Over & above a standard eMAR module (diagram 1). Paras has a robust drug interaction alert generation (diagram 2).

Interaction Level
Pharmacist:
Dispenses medication

Alert Type

Level 5
Staff Nurse:
Is notified that ordered medication is available for administration

Physician:
Writes order for medication. The application in the background checks for possible interaction using the “Drug Interaction Alert” functionality

Fatal
Level 4

Electronic Medication Administrative Record
Data:
Is added to patient’s electronic medical record

Level 3
Staff Nurse:
Verifies and cross checks against medication order(s)

Level 2

Mild

Staff Nurse:
Completes medication administration and electronic documentation

Level 1
eMAR diagram 1 eMAR diagram 2

Isabel: The Award-Winning Diagnosis Reminder System
Isabel is a validated, web-based diagnosis decision support and knowledge mobilizing system with accuracy of more than 91% designed to help reduce and manage diagnosis error at the point of care.

Isabel addresses the causative factors that have a significant impact on the level and quality of patient care.

Diagnosis error – a compelling patient-safety issue Medical diagnoses that are wrong, missed, or delayed make up a large fraction of all medical errors and cause substantial suffering and injury. A 3-year project by the Cook Country Rush Developmental Center for Research in Patient Safety, funded by the Agency for Healthcare Research and Quality (AHRQ) and published in 2005, found that 10 – 30% of errors are errors in diagnosis and the diagnosis errors far outnumber medication errors as a cause of claims lodged. A review of 53 autopsy studies found an average rate of 24% missed diagnoses.

A 2006 Medical Liability Insurance study found that errors in diagnosis were the leading allegations of closed claims. In Family Medicine, Internal Medicine, Pediatrics and Radiology more than 50% of lawsuits alleged a failure to diagnose.
Source : ProMutual Group study reported in the American Medical Association Newsletter, March 2006.

Failure to consider reasonable alternatives – single most common cause of misdiagnosis A 2005 Veterans Administration study funded by the National Patient Safety Foundation analyzed cases of diagnostic error involving internists and found that cognitive factors contributed to diagnostic error in 74% of cases. Premature closure, i.e., the failure to continue considering reasonable alternatives after an initial diagnosis was reached; was the single most common cause. Isabel addresses the very issue of premature closure and has been proven in clinical studies to minimize diagnosis error by reminding physicians to consider important diagnoses. Constructing a complete differential diagnosis – reinforcing basic medical training Professor Arthur Elstein, PhD at the Department of Medical Education and the School of Public Health at the University of illinois at Chicago, and expert on diagnostic reasoning in clinical medicine, spent a lifetime's work on answering questions such as: How do physicians make decisions? How can we help them make better ones? Elstein has suggested the value of compiling a complete differential diagnosis to combat the tendency to premature closure, the most common cognitive factor identified to contribute to diagnosis error. Medical students and residents are trained to construct a complete differential diagnosis for each patient.

Diagnosis Reminder System
Isabel, either as a standalone system or interfaced with PARAS EHR system gives dynamic clinical decision support, enabling clinicians to: Quickly obtain a list of likely diagnoses including bioterrorism diagnoses and causative drugs for a given set of clinical features Learn more on investigations and treatment for each diagnosis, either through a cursory quick-read, a more detailed read, or clinical information on bioterrorism from the CDC, USA Access the clinical lessons learned and errors that have been reported in relation to the diagnosis being considered View diagnosis specific annotated images or helpful list of investigations that can be performed to confirm or rule out a diagnosis Stay up to date with recent advances clinically sorted into diagnosis categories - and avoid time consuming office research using online and library resources

Testimonials...
"Isabel suggested the correct diagnosis in 98% cases. Decision-support systems can help doctors avoid falling victim to "premature closure" - the tendency to focus on one diagnosis that seems to explain all of the symptoms, then stop considering other possibilities."
Mark Graber MD, Chief of Medical Service at the VA, Northport, NY, quoted in the Wall Street Journal. Nov 2006

“There had been software products over the years ... but Isabel was the most sophisticated product I had ever seen,"
Leslie G. Selbovitz, MD, Senior VP for Medical Affairs & CMO, Partners Newton-Wellesley Hospital, interviewed Oct 2007

"Isabel is a great tool for difficult to diagnose cases!"
Mary Lynn Allen, MD, VA - Gainesville, FL

"I am impressed with the concept and its execution. This is an innovative product that I think may soon be proved to have significant clinical utility, particularly if integrated into EMRs so that the system can operate in the background and be selected when needed, with minimal effort from the clinician. In a world of exploding biomedical knowledge, and limited human cognition, the arguments in favor of Isabel and other decision support systems are compelling. I will watch for the peer-reviewed results of further study with great interest. Institutional and individual buyers should definitely give it a look."
Gary Kantor, MD. Case Western Reserve University February 2006

"Several features I feel are innovative and useful for my practice as a pediatric infectious diseases consultant. The Diagnosis Reminder System is useful to check my differential diagnosis list against. The regional preferences search option is one I like a lot, because of the importance of travel history and geographic exposure patterns to many of my consults. For teaching and communicating with trainees and families, the Lessons Learnt and What's New options give me ready access to potentially interesting PubMed articles. I find Isabel unique and uniquely helpful"
Jeff Mckinney, M.D. Ph.D. Assistant Professor In Pediatrics andMolecular Microbiology, Washington University School of Medicine, St. Louis, Missouri Dec 2005

"Implementing PARAS has immensely enhanced the customer experience that we offer to our patients. Using PARAS, the relevant details of the patients of Narayana Nethralaya are recorded and preserved in computer systems and one can retrieve the same by just entering their name or registration numbers into the computer systems during their future visits to the hospital. Thus resulting in effective utilization of the time and immediate treatment to the patients by having their Electronic Medical Record available at finger tips to our doctors and other concerned staffs."
Dr Bhujang Shetty, Director, Narayana Nethralaya, Bangalore.

“Srishti Software has worked with us to improve every area of our hospital, from helping us to improve our production flow and order entry processes, to reporting functions. All of this has helped us to provide excellent patient care."
Dr. Manjunath, Medical Director, Sri Jayadeva Institute of Cardiology, Bangalore.

“Srishti's Healthcare Suite 'Paras' has helped us achieve full automation and better patient care. All administrative & support processes like Registration, Billing, Store, Pharmacy, Labs; are now online. Optimal utilization of resources have reduced costs. Availability of pertinent information at point of care has improved clinical outcomes. Logical scheduling has reduced waiting times - leading to greater patient satisfaction.
Dr. Jeetendra Kumar, Director, Mahavir Cancer Sansthan

Our Delighted Customers Include...
Zydus Hospitals & Healthcare Research Pvt. Ltd., Ahmedabad- Multilocation Centre for Sight, New Delhi- Multilocation Rajiv Gandhi Cancer Institute & Research Center, New Delhi SUT Hospitals, Thiruvananthapuram- Multilocation KG Hospital, Coimbatore Narayana Nethralaya, Bangalore- Multilocation TATA Chemicals Hospital- Multilocation Sri Jayadeva Institute of Cardio Vascular Sciences & Research- Multilocation Mahavir Cancer Sansthan, Patna Prashant Memorial Charitable Hospital, Muzaffarpur

Isabel Clientele

Awards & Recognition
Isabel has been extensively featured in Fox News (Dec 2006), Wall Street Journal (May 2005 & Nov 2006), CBS (May 2006), New York Times (Feb 2006), Forbes (Aug 2005) and CNN (Oct 2004). Isabel has had editorials and reviews in key medical journals, including The Lancet, the British Medical Journal, Journal of Intensive Care and Archives of Disease in Childhood. Peer reviewed articles and results of clinical studies have been published in Archives of Disease in Childhood, Journal of the American Medical Informatics Association, Medinfo 2004, Journal of Intensive Care Medicine, Health Management. Technology and BMC Medical Informatics and Decision Making. Winner of the 2005 Frost & Sullivan Healthcare Information Technology Product Innovation of the Year Award Stay up to date with recent advances clinically sorted into diagnosis categories – and avoid time consuming office research using online and library resources. Recognized as one of the "outstanding and innovative developments within the IT sector" at the 2002 British Computer Society IT Professional Awards.

A few accolades...
“For demonstrating excellence and growth in the IT channel business.” Channel World, Fast Track 100 Awards, Honouree 2008 "Consistently among the top 100 IT innovators in India” "Among the FIVE most promising Indian IT companies to look out for” “One of the most innovative IT companies in India”
R

NASSCOM Survey, 2007 Information Week, 2005 NASSCOM, Feb 2005

SRISHTI Software
progress through creation...

INDIA
Srishti Software
L-174, 6th Sector, HSR Layout Bangalore - 560 102 Karnataka, India Ph: +91 80 4110 9060/ 61/ 62/ 63 Fax: +91 80 4110 9064 E-mail: kumud@srishtisoft.com

UK
IntelliApp Solutions
Suite 5-6, 46 Dorset Street London W1U 7NB United Kingdom Ph: +44 750 246 0465 Fax: +44 207 224 3838 E-mail: kdeepak@srishtisoft.com

www.srishtisoft.com
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