How did you prepare your hospital to manage the outbreak of Covid-19?
Covid-19 has hit hard most of the hospitals worldwide in several ways. From shortage of drugs to materials and consumables, from disruption in supply chain to manpower – frontline workers as well as support staff getting infected. Revenue stream is completely choked as patients did not turn up in OPDs and also avoided coming for admissions.
We could foresee most of these problems at the initial stage and purchased the drugs and consumables sufficient for six weeks of consumption instead of usual three weeks (reduced consumption further helped ensure availability). We planned staggering the duties in such a way that less people are available for longer periods. Strong awareness campaigns and persistently advising the download of ‘Aarogya Setu’ app helped employees and patients getting necessary and sufficient information. We also provided laptops and VPN connections to clinical and non-clinical senior staff to work from wherever they are, to limit physical presence to absolutely necessary levels.
We promptly rolled out the patient app ‘RGCI Care’ to enable telemedicine. Using this app, our patients can book appointments (telemedicine or in-person both), new patients can even register through this app. They can make payment for online consultation, consult the doctor at pre-arranged time through the app using videoconferencing and automatically receive the prescription after the consult. The app offers easy access of lab reports, radiology reports, previous prescriptions, bills, etc.
Telemedicine will be essential in the epidemic of new epidemics, please describe your work/journey with telemedicine?
Subscribing and rolling out apps is a small and easiest part of the whole scheme of things. There are several options available in the market.
Subscribing an application was easy but integration with our Hospital Information System- HIS would have proven to be a nightmare. We rather worked with our HIS partner to enhance their app to fit into our environment.
Building the security layer was the next important challenge as we were about to expose our servers to the users sitting outside our firewall. We had to deploy the application on a cloud and build a secured replication layer to provide for a guarded connection with our live database. After completing this layer, we thoroughly tested the application and its integrations with payment gateway and videoconferencing solutions.
Training the doctors, operations staff and patients was the next big challenge. The IT department had to shoulder the responsibility of running telemedicine for one month directly with doctors and patients, and gradually hand-over the process to operations. This has been an incredible learning opportunity for the IT department. We refined our user manuals and training documentation a couple of times in this course after realising the real difficulties faced by doctors and patients.
Were there any challenges faced by your hospital in handling Covid-19 cases? What were some of the key lessons learnt?
We are a specialised Cancer Care facility and were naturally not prepared to cater to Covid-19 patients. We all understand the difference between the facilities dealing with communicable diseases vs. the facilities dealing with non-communicable diseases. Cancer is a non-communicable disease and Covid-19 is a highly contagious communicable disease. Given the situation, every hospital had to reserve 20 per cent beds for Covid patients. We followed a standard protocol of creating a flu corner, performing temperature screening at the entry, hand sanitisation and all other necessary precautions were put in place. Based on our experience on dealing with microbes in the laboratory, we quickly created a diagnostic facility to test Covid-19. An NGO called Ripples of Change Foundation (ROCF) donated a sample collection kiosk which proved to be helpful in safely collecting the samples.
We restricted the crowd in the OPD area by limiting the number of attendants to only one with each patient. We limited the number of OPD slots and allowed the patients to go to OPD only after taking clearance from the flu corner. We also encouraged people to consult our doctors using our telemedicine facility unless it was absolutely essential to meet the doctors in person. We initially experienced a surge of infection rate amongst our frontline staff including doctors and nurses (in spite of regular precautions). We have almost stopped in-person meetings and use virtual meeting platforms to discuss the matters.
How has the use of digital health helped in dealing with the Covid-19 situation in the context of your institution?
The telemedicine app helped reduce unnecessary in-person visits of the patients. Our patients are generally immune-compromised. Covid-19 type infection could be dangerous for them. Virtual Tumor Board, e-meetings through video conferencing, etc. all are significant contributors from digital health.
How do you think digital health at Rajiv Gandhi Cancer Institute & Research Centre will look like post Covid-19?
This pandemic has pushed far more number of transformation initiatives that any of the super most capable CIO or most visionary CEO could have driven. A CIO’s role was gaining importance based on the process transformations driven by them in their organisations. Now, this has accelerated the pace. In order to survive as a CIO in a hospital, one has to lead digital transformation from the front. Hereafter, it will be just binary – either excel or perish.
Coming to visualising digital health, we will see rapid transformation in the way we receive our patients, waiting rooms at the hospitals; transform the way we navigate our patients from OPD to billing counters or to sample collection area. Digital will transform the process of collecting the samples or put patients under radiology examination, patient’s report and take appointment for next visit or admission.
There will be a boost in robotic process automation in all patient touch-points, diagnostics, supply chain (pneumatic chutes, robotic arms, etc.). Machine Learning will be used in electronic health records and CDSS, predictive and prescriptive analytics will take center-stage.