Charak suite of Healthcare IT products: An

overview

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 Asclepius Consulting is a Healthcare IT venture global and Indian
doctors, software personnel and management consultants
Team
Aravind Hiremath Satyajeet Prasad Vishal Ranjan

• BE (CS) -Karnataka • IIT Kharagpur • IIT Delhi

• GE Healthcare • IIM Lucknow • IIM Calcutta
• GE Healthcare • A.T. Kearney

• Over fifteen years of experience in
design & development of global
healthcare software products
• Focused on Diagnostic equipments &
CIS with expertise in Healthcare
Standards (DICOM, IHE & HL7)
• Over eight years of experience across
the globe in implementing high end
software solutions
• Expertise in six sigma, HL7, IHE and
Healthcare IT solution delivery in Asia,
US, Australia and Europe
• Over five years of management
consulting experience with MNCs in
setting up businesses and devising
growth strategies
• Expertise in BPR, process
improvement and business planning

Dr. A. K. Keshri Pratyusha Pallavi Dr. Rolika Keshri Dr. Suneel Majagi Sachin Prasad
MS, Civil Surgeon, Bihar GE Healthcare/ SP Jain MS, Obs/ Gyn, PMCH MS, KLE hospital IITD/ IIMB, Boston
HL7, DICOM Expert Consulting Group

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Asclepius Consulting is a vertically integrated Healthcare IT company
with end-to-end IT solutions for Indian hospitals
Offerings

• New business set up • World class healthcare IT

• Business process re- systems built for Indian
engineering clinical workflows
• Customer relationship • Focus on clinical
management information systems (CIS)
• Organization structure • Includes HIS, LIS and IIS
• Business planning solutions
• Growth strategy • Robust solutions built on six
• Investment banking sigma methodology

• Hand-holding the • Synergizes with Charak to

client organization support specific IT needs
during transition • India focus & domain
• Training programs expertise to deliver
and workshops complete solutions
• Change management • Six sigma software design
• Annual maintenance and development
support and regular methodology to ensure
upgrades world class software

3
 Hospitals in India are adopting IT in a massive way– driven by
changing business conditions

Why are Indian hospitals adopting IT? Increasingly aware patients

Increasing legal pressures

Increasing competition

Increasing time pressure on

doctors
Healthcare
Increasing
Accreditation
Increasingly
Get more fromtime
insurance
legalpressure
needs
aware
same pressures
competition needs
from
patients
set on
of doctors
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clinical
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attechnology
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resources
4
 Hospitals have been able to achieve multiple benefits from adopting
IT
ILLUSTRATIVE
Potential benefits from IT

• 85% faster admission, transfer &

“…frees up the doctor’s time from discharge
..implements scientific
paper
“..ensuresworkbetter
“.. reduces andtheadministrative
planning
missingand • 40% faster diagnosis time
management
“…increased
“..better
“..leads
“..reduces
material
to better practices
coordination
missed/
tracking
control like
incorrect
of
lead
leading
theto
activities,
higher
documentationimproves
resource
“…reduced forthe quality
utilization
medical insurance of
for key
errors • 30% reduction in medication
budgeting,
reduction
to
charge
organization customer
betterslips
in
planning
wastage,
across
through relationship
andmultiple
pilferage
robust
lower
patient
communication
revenue
leading tocare
lowerand
sources significantly
leadinge.g.toOT,
litigation better
costs” dispensing error
management,
service points medical
andunpredictability
inventory
processes”
in the ”audits,
in books”
hospital” • 20% faster inventory re-stocking
improves
surgeons, hospital
collection”bottom-line”
devices etc.”
SOPs” • 20% reduction in Average Length of
Stay
• 80% reduction in billing errors
• 40% growth in patient volumes
• 33% growth in profit margins

Source: Typical impacts measured by IT implementation in a Pediatric hospital

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Globally, IT in hospitals, undergo a transition from administrative to
clinical processes
ILLUSTRATIVE
Clinical
Features for Hospital IT
Remote
patient care
EMR Drug data
Clinical

bank Clinical Patient

EMR – Alerts
protocols monitoring
EMR – Charting Clinical decision Lab Information
EMR – Vitals support system (LIS)
EMR – Discharge EMR – Orders Emergency
Orders
summary handling
EMR –
EMR – Clinical rules
Investigations
Diagnosis Radiology Information
Admin Stores EMR – Medication System (RIS)
EMR -Flowsheets
Pharmacy

Billing Insurance

Discharge Inventory
Administrative

management
Admission

Registration

Time
A scalable and modular solution is needed which can support the hospital all
through its growth and future needs
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The product – Charak - is an end-to-end IT solution for the entire hospital
with sufficient depth to meet the needs of an involved user
ILLUSTRATIVE
 Covers end-to-end treatment cycle

Clinical
• From pre-admission to diagnosis, orders,
treatment, monitoring and discharge
 Integrates with multiple hardware
• Mobile phones, digital pens, voice recorders,
Ancillary systems

Infrastructure
bed side devices
modules  Is accessible remotely
Administration

• Available on internet, with thin client solution

 Built on six sigma quality and international
standards
• Compliant to HL7, DICOM, IHE guidelines
 Provides process control
MTOSS • Through protocols, pathways and clinical
decision support
 Supports research
Specialty • For clinical procedure evaluation, evidence
modules
Value added based medication etc.
modules  Is specific to specialties
• E.g. different work flows for gynecology vs.
Core cardiology
modules
 Meets the documentation needs for accreditation
and cashless insurance process

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Charak has some of the most business relevant & less commonly
available features ILLUSTRATIVE

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Together with the consulting services, Charak meets a large part of
the documentation needs required for NABH accreditation

Process
Accreditation needs from NABH Charak Consulting
Access, Assessment & Continuity of care
(AAC) ◑ ●
Patient Rights & Education (PRE)
● ●
Care of Patient
◕ ◑
Management of Medication (MOM)
● ◑
Hospital Infection Control (HIC)
◔ ◑
Continuous Quality Improvement (CQI)
◑ ◕
Responsibility of Management (ROM)
◑ ◔
Facility of Management and Safety
◑ ◕
Human Resource Management (HRM)
◑ ●
Information Management System (IMS)
● ●

● High support
○ Low support

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Asclepius adopts robust business process re-engineering (BPR)
frameworks to improve upon existing processes while minimizing changes

To-be process mapping

How do you make

How is the doctor pricing decisions –
recommending what is your cost to
discounts serve?
accounted for?

How do you calculate

the stock of all
Can you give a single paracetamol
purchase order for the medicines put
deliveries for the entire together?
year?

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The administrative IT solution (HIS) covers the entire administrative
needs of the hospitals

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The elements of electronic medical record (EMR) comprise all
relevant information from the clinical processes

 Past and present history

 Problems and complaints

• Patients go where the hospitals
 Physical examination
‘know them’ – for preventive check
 Systemic examination up, emergency, surgery as well as
standard cure
EMR number  Diagnosis
RIMS072201223 • EMR generates a single
 Investigation reports consolidated record for all relevant
Aditya Goyal
07 NOV 2005
patient information – valuable
 Radiology images
B +ve during the stay
 Flowsheets & device data
• The EMR should be readily
 Surgery notes available – through internet, mobile
phones, across hospital facilities
 Progress notes

 Medications

 Discharge summary

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All the relevant activities – for the doctor, the patient, the admin staff-
can be accessed through a central switchboard

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All notes from doctors, nurses, labs etc. can continued to be
captured on paper – and seamless integrated with Charak

The digital pens allow minimal change in clinical practices – at OPD, during wards rounds,
discharge, follow ups etc.

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 The critical data available remotely on mobile phones and hand-held
The critical data is available remotely on mobile phones and hand-held
devices
devices

View list of patients with critical details

Get alerts on patients in wards/ ICU

View key patient data (BP, ECG)

Give medicines and lab orders

Advise treatment remotely

Know appointments, schedule-for-day

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Charak can extract data from any digital medical device - bed side
devices, digital X- rays, CT scans -and integrate it with patient record

• The Charak team has extensive experience in

interoperability of clinical software – across
devices, CIS systems, Labs and Radiology
systems

• Charak conforms to HL7 standards, hence shall

seamlessly integrate with all new hospital software
appearing in future

• Charak is built on DICOM standards to ensure

easy transfer of digital radiology images

• Charak has specific solutions for image viewing

and interfacing with standard PACS solutions

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All the patient data is available on simple clicks

41/F D Sinha

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All patient data and investigation reports can be readily reviewed by
the doctor through clinically relevant screens

18
The software generates relevant MIS for the hospital to check
aggregate hospital performance

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The software supports extensive research capability for the doctors
to evaluate care protocols and analyze evidence based medication

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 The software can been leveraged to a drill-down dashboard framework
to “report by exception”
Level I dashboard
(CEO & Board) ILLUSTRATIVE
• Effective Surgical Revenue (ESR)
• Effective Bed Revenue (EBR)
• Effective Diagnostic Revenue (EDR)
• Operating costs Level II
(Mid Management)
• No. of case sheets
generated Operating costs
• No. of research • Average revenue/ patient • Consumable costs
papers published • Market share • Salary costs Level III
• No. of technology • % of repeat patient • Rental costs (Process)
initiatives underway • Patient satisfaction index1 • Pharmacy costs
• Marketing costs Consumable costs
• General Admin • Direct material
• Attrition rate
• ROCE costs • Overhead material
• No. of employee
• Operating Margin • A- Category
training days • PAT growth material purchase
• No. of full time
• Cost of Capital
doctors • Avg. direct consm
• Employee per patient
satisfaction index1 • No. of partner patients
• No. of referrals from spoke to hub
• Operating margin at partner sites
• No. of technology transfer initiatives underway

Effective Surgical Revenue (ESR) = No. of surgical procedure X Avg. revenue per surgery
Effective Bed Revenue (EBR) = Avg. Length of Stay X Avg. Bed Occupancy X Avg. Bed Rate X Available Beds
Effective Diagnostic Revenue (EDR) = No. of diagnostic procedures X Avg. revenue per diagnosis

(1) Satisfaction index measured through periodic neutral surveys conducted by external agencies 21
 Charak can create significant improvements across the hospital

Patients Doctors Hospital

Well Long
defined appointments Extensive paper work Sub-optimal
Hospital wideresource
resource
waiting time Computer
(OT notes, generated reports
(At OPD,and scheduling
surgery, wards, discharge)
discharge summary, utilization
optimization
orders) (OR, wards, doctor’s time, labs)
Delayed
Quick emergency
response at the Repetitiveactivities
Automated activitieswith Limited
High resources
resource utilization
response
Golden Hour
(Patient instructions, pharmacy, billing
status report only (Doctor’s time, beds, OPD hours)
(Missing data, triage, ambulance) estimations)

Multiple investigations Multiple coordination

Centralized planning and Poor hospitalcomputer
Extensive evaluation
Standardized
(Similar care
tests conducted plan
due to missing (OR planning, duty allocation, (No easy metrics to measure hospital
old records) scheduling
appointments) generated
performance)MIS

Multipleclinical
Consolidated visits data Multiple
Alerts follow ups
and Exception based Transaction
Wastages based material
and pilferage
(Visits for consultations, labs, reports, (Check patient conditions, order
available
follow remotely
ups) status,Reporting
room occupancy)
(OR material, tracking
stores items, pharmacy)

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 No. 8, 1st Floor, 15th Cross,
100 Ft Ring Road, J.P. Nagar, 6th Phase,
Bangalore – 560078
Tel: +91 80 4165 0200
+91 98800 46849
www.asclepiusconsulting.com

This proposal is exclusively intended for the personnel at Frontier Lifeline, Chennai. Distribution, quotations and duplications — even in
the form of extracts — for third parties is only permitted upon prior written consent of Asclepius Consulting.

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• Additional slides

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The software comprise over 100 modules – majority available as standalone
solutions – working seamlessly with existing IT solutions

Existing IT system

Charak modules
ADMINISTRATIVE INFRASTRUCTURE
CLINICAL MODULES ANCILLARY MODULES
MODULES MODULES
Admission, Discharge Orders and Medication Clinical Decision
Interoperability
Transfer (ADT) Record Support
Scheduling Documentation & Notes Clinical Protocols Hardware Options
Charting and Management
Material Management Privacy and Security
Flowsheets Information Systems
Event-based Billing Alerts/ Reminders Device Integration System Monitoring

LIS/ RIS Research

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The software aims to minimizes the total cost of ownership by taking
care of all the relevant costs accruing to the hospital

Very competitive license costs Illustrative

Lowest customization cost
Professional process consulting
Thin client solution implies minimum
hardware requirements
Easy integration with multiple devices
Seamless interfaces with existing systems
Integration with DICOM devices
Expertise in integrating HL7 devices
Free upgrades with AMCs
Negligible run time license costs
Minimal costs for additional user licenses
High quality lead to low debugging costs
Local service network for AMC
Remote performance monitoring
Easy integration with future HL7 solutions
Easily scalable to additional facilities and
expansions

Significantly lower total cost of ownership

(TCO)
RECOMMENDED MODULE IMPLEMENTATION PLAN
Core Admin Enhanced Admin
Admin AD 1, AD2, AD3, AD4, AD5 AD6, AD7, AD8, AD9

Core EMR CPOE & Drug Databank Protocols & CDS

Clinical
CL1, CL2, CL3, CL4, CL7, CL8 CL5, CL6, CL9, CL10, CL11 CL12, CL13, CL14

Printing and Reporting LIS, RIS and PACS solution

Ancillary
AC1, AC2, AC3 AC4, AC5, AC6

Core Infra Multiple Hardware

Infra
IF1, IF2, IF3 IF4, IF5, IF6

CLINICAL MODULES ANCILLARY MODULES

ADMINISTRATIVE MODULES
CL1 Documentation AC1 Whiteboard
AD1 Patient Admit, Discharge, Transfer CL2 Notes AC2 Inquiry and MIS
CL3 Charting and Flowsheets AC3 Printing
AD2 Patient Registration & Identification
CL4 Medication admission record AC4 LIS
AD3 Scheduling and Appointments CL5 CPOE/Order Entry AC5 RIS/PACS
CL6 Alerts AC6 Rules Engine
AD4 Room management
CL7 Event manager
AD5 Event based Billing CL8 Patient discharge & education INFRASTRUCTURE MODULES
CL9 Workflow and checklists IF1 Security and Privacy
AD6 Pharmacy management
CL10 Clinical configuration IF2 User Organization
AD7 Hospital services management CL11 Drug databank IF3 Remote service-RM&D
CL12 Clinical Protocols IF4 Interfaces
AD8 Material management
CL13 Clinical Decision Support (CDS) IF5 Hardware options
AD9 Cashless insurance management CL14 Clinical collaboration IF6 Notification engines 27
The prices of these solution are contingent to specific needs of the
hospital
Core Admin Enhanced Admin
Admin AD 1, AD2, AD3, AD4, AD5 AD6, AD7, AD8, AD9

Core EMR CPOE & Drug Databank Protocols & CDS

Clinical
CL1, CL2, CL3, CL4, CL7, CL8 CL5, CL6, CL9, CL10, CL11 CL12, CL13, CL14

Printing and Reporting LIS, RIS and PACS

Ancillary Dashboard reporting solution
AC1, AC2, AC3 AC4, AC5, AC6
Core Infra Multiple Hardware
Infra
IF1, IF2, IF3 R1 IF4, IF5, IF6 R3 R4
R2

• Release #1: Core • Release #2: • Release #3: • Release #4: LIS/ RIS
administrative Documentation and CPOE, Alerts and solution together with
processes with charting EMR solution workflow together rules engine, clinical
requisite ancillary and with additional with hardware protocols and clinical
infrastructure modules administrative processes options and decision support
notification engines

Cost for 100 Rs. 2-5 Rs. 10-15 Rs. 22- 25 Rs. 32- 40
bed hospital lakhs lakhs lakhs lakhs

Specific pricing arrangements can be developed to make the overall cost affordable
to the hospital
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Asclepius offers world class IT solutions – with high quality and
international features – at a very affordable total cost of ownership

• Six sigma quality leading to

• Built by Indian doctors negligible bugs
• Extensive depth in features • HL7 and DICOM compliant
• Extracts data from devices • Conforms to IHE and NABH
• Extensive configurability guidelines

• Integrated ecosystem • User- centric design

• Shows radiology images • Extensive domain expertise

• Allows remote data access • Team of doctors, process

consultant, GE Healthcare

• Very affordable prices • Low customization costs

• Cheap hardware required • In depth process analysis

• Zero run time license costs • Collaborative implementation

• Remote performance monitoring • Provide hand-holding, drive change management

• Free upgrades with AMCs1

Free uprades or first 30 customers only1 29