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The Institute for Health Technology Transformation is a US based organisation that brings together private and public sector leaders to foster the effective use of technology across the healthcare industry.

Their report, "Top Ten Things You Need To Know About Engaging Patients' is a compilation of what key health IT experts from across the U.S. think are the most important things to know about engaging patients in the digital age along with four key recommendations for practical action.

Mostly common sense. Doctors just need to ask a simple question - How would you like your lawyer to communicate with you ? Use the same principles to open as many communication channels with your patients, so it's easy for them to connect with you !

Everyone is worried about the escalating costs of providing medical care. Many solutions to this problem have been based on the premise that the reason medical care is a mess today is because health care delivery is not being properly "managed". The siren song is that if we can "manage" healthcare delivery properly, we will be able to provide better medical care to more patients at a lower cost !

Management seems to have become the panacea to all ills - and it's a very tempting idea ! After all, isn't it obvious that managing something can just help to make it more efficient and effective ?

Sadly, in real life, this is not true. In order to manage healthcare, we need managers who have special training and expertise in management; and then inject them into hospitals to manage doctors . All this ends up creating is an additional layer of people between doctors and patients - a layer which has no medical expertise - and which just adds to costs and paperwork !

Interestingly, this is as true in education as it is in medicine. A great book by Philip Howard called Life Without Lawyers has a thought-provoking chapter titled - Bureaucracy Cannot Teach ( from which I've lifted the title of my post).

He writes - " All these reforms have been based on an unspoken assumption: that better organisation is the key to fixing whatever ails schools. The theory is that by imposing more organisational requirements - better teacher credentials, more legal rights, detailed curricula, the pressure of tests - schools will get better. That's the theory. The effect, however, is to remove the freedom needed to succeed at any aspect of teachers' responsibilities - how they teach, how they relate to students, and how they coordinate their goals with administrators."

Applied to healthcare, this would read, He writes - " All these reforms have been based on an unspoken assumption: that better organisation is the key to fixing whatever ails hospitals. The theory is that by imposing more organisational requirements - better doctor credentials, more guidelines, more legal rights for patients, detailed medical curricula, testing for performance - hospitals will get better. That's the theory. The effect, however, is to remove the freedom needed to succeed at any aspect of doctors' responsibilities - how they treat , how they relate to patients , and how they coordinate their goals with administrators."

Bureaucracy often ends up smothering teachers - and doctors as well ! When we try to manage something, we often end up mismanaging it !

Most management principles are simple applied common sense - and rather than try to have more managers, it would make much more sense to teach doctors basic managerial skills, so they can do a better job managing their patients - and themselves !

There's a lot doctors can learn from other professionals - and there's a lot doctors can teach others as well !

An interesting "recent" innovation in economics is the introduction of "controlled trials" to determine the true impact of interventions to help alleviate poverty. Common sense would suggest that giving the poor loans will them help to turn around their lives - but in reality, this is not what usually happens. The road to hell is paved with good intentions, and "aid" can often end up killing initiative ; fueling waste and corruption; and breeding dependence ! Handouts don't always work well - and it's easy to waste a lot of money very quickly ! The only way to find out what works and what does not work is to perform experiments in the field - something which doctors are very good at ! Innovations are a part and parcel of medicine - but which ones are really useful ? And which ones aren't ? Doctors are very good at figuring this out because they've been doing this for so many years - and the staple technique we use to do so is called a controlled clinical trial. Economists are now adding these to their armamentarium to judge how valuable field interventions are , so they have data to analyse impacts, rather than just having to depend upon their intuition !

Interestingly, marketeers do this all the time as well. They need to figure out which ads work; which don't; and which provide the most bang for their buck. In marketing, a randomised trial is called split A/B testing !

Pharma marketing - what doctors need to know : "Pharma marketing can be classified into two different categories:

1. Push marketing: targeting physicians. Urging them to “push” certain drugs to their patients.
2. Pull marketing: targeting patients. Urging them to “pull” or request certain drugs from their physicians.

The most important approach to marketing taken by many pharmaceutical companies has been push-oriented. All those busy pharma reps swirling around hospital hallways are trying to persuade you to prescribe their drugs to your patients.

Nevertheless, the pull-approach has become more and more prevalent these days. Pharma companies are increasingly targeting the patients themselves.

It's true that both doctors and patients are under enormous pressure these days. Patients have very high expectations from their doctors and expect an instant diagnosis; low costs; and efficient treatment. Doctors are finding it hard to meet these unrealistic expectations, with the result that both patients and doctors are getting increasingly unhappy with the status quo.

One of the commonest complaints patients have is that doctors make them wait for ever and ever, for no good reason. It is true that some doctors are very disrespectful of their patient's time; while others just have poor time management skills. It's also true that the reason some doctors are so super-busy is because so many patients flock to them. If you select such a doctor, you should expect to have to wait ! Remember that you always have a choice - if you are not happy about waiting, you should be happy to go to another doctor ( who may be as good, but may not have such a high profile brand name !)

Rather than complaining ( which doesn't really help anyone !), what can you do to help ?

1. Reframe your expectations. Understand that the doctor is human; he is doing his best; he does have other patients to see; and that complications can occur. Give him the benefit of the doubt and be charitable. Rather than get angry, you should admire how hard he works ! And while waiting, rather than losing your temper, you can use your waiting time productively
( perhaps by reading more about your medical treatment options !)

2. Make more effective use of your doctor's precious time. Try to do your homework before you see the doctor, so he does not have to waste time explaining the basics to you. If you can learn about this online, prior to your visit, you can improve the quality of the questions you ask your doctor - and thus, the quality of his answers as well !

Rather than be a complainer and a blamer, try being a fixer - remember that both you and your doctor are on the same side - yours !

Our website is the global face of our clinic. I take it very seriously, because we treat patients from all over the world and our website is the first point of contact for all our patients. It’s crucial to our success and our webmaster plays a key role in our business !

I need a webmaster who understands the importance of a website in our business – someone who does not see himself as just a web designer, but rather as a business partner who can help us to grow.

Here’s my wish list for a perfect web designer/ webmaster.

• His competence and efficiency is taken for granted – but I am a premium client, and want to be treated as one. I am willing to pay the additional premium, and I want someone who understands the importance of keeping me happy !
• I want someone who will extend my horizons – someone who will push me to explore new digital technologies and will keep me on my toes. I’d like someone who comes up with new ideas – and encourages me to explore them.
• I want someone who understands that I am a professional and that I am investing my hard earned money in my website – someone who will do their best to maximize my ROI.
• I want someone who makes me happy to work with him – someone who is willing to listen to my suggestions as to what he can do to improve the quality of services he provides to me.
• I expect him to grow and keep up with the new technologies – so that as he grows , so will our website ! I want someone who is willing to partner with other web companies, who have complementary skill sets, so he can provide a more exciting range of services.
• I want someone who is willing to put in the effort to be a “one-stop shop” for me, so I do not have to talk to many service providers about my digital presence
• I need quick replies and a fast turnaround time. If my website is down , this is an emergency – and I need a quick response and a fast fix ! I want someone who will monitor my website uptime – and will fix problems if they arise by talking to my web hosting company.
• I want someone who will take a proactive role in helping me to reach out to more patients ! He will teach me about Web 2.0; social media; facebook ads and google adwords, so I can explore these additional avenues.
• I want someone who has a ticketing system to log in complaints – and provide me a with a timeline in which they will be fixed !
• I want someone who is customer centric. As a doctor, I am in the service business and am intensely focused on what I can do to help my patients. I want someone who treats me exactly the way I treat my patients – with respect ; and the assurance that I will get the full attention of a consummate professional, who will give me value for money !

Society takes great pride in depicting business barons as being role models of success. They are revered as "wealth creators" and admired in a capitalistic society.

However, in reality, many of these businessmen are just traders . They do not actually create anything - they just accumulate money. While it's great to be rich, all they have done is merely transfer assets from others into their pocket, without creating anything new.

The real creators are the creative artists, who actually produce something out of nothing. However, while it's true that a work of music is a piece of art, this is a luxury which only affluential societies can afford to indulge in !

The true creators are the farmers ! Unfortunately, most of us have never been to a farm, so it's hard to remember what a miracle growing food really is. Farmers tap the energy of the sun and the microbes in the soil to create food for all of us - truly, something out of nothing.

Especially when they use Natueco farming principles, the food they create comes purely from solar energy, without depleting or damaging the soil !

You can watch a video at http://www.youtube.com/watch?v=DPAmswBSTmI !

The Indian healthcare system has become sick. Doctors are illness experts – and not healthcare experts. Healthcare needs to learn from the revolution which has occurred in microfinancing. When given money and the freedom to use it as they see fit , even very poor people have come up with remarkably innovative ideas which could never have been planned, designed or anticipated by the traditional experts - bankers!

Information Therapy - the right information at the right time for the right person - can be powerful medicine ! Ideally, every clinic , hospital, pharmacy and diagnostic center should have a patient education resource center, where people can find information on their health problem .

This new model is called Participatory Medicine - and HELP is proud to be an Innovator Organisation in the Society for Participatory Medicine !

HELP is India's largest patient education resource center. We want to establish patient education resource centers all over India, to promote Information Therapy. We are now looking to recruit doctors to spearhead this initiative. You will need to create India-specific relevant information for patients; build closer relationships with physicians, pharma and health insurance companies; and help to set up patient education centers at hospitals and train patient information officers.

This is an exciting and unique opportunity with helps to Put Patients First !

Please send your resume to : helplibrary@gmail.com

Why do Indian doctors continue practising in exactly the same way their seniors did 40 years ago ?

A major lacuna is the poor quality of medical records which most doctors keep. The medical record is the heart of clinical care - and yet it's extremely poorly maintained in Indian clinics today. The majority of doctors do not even bother to store and keep their patient's medical records - they just write down their opinion on their letterhead and hand it over to the patient. Usually, this is just a laundry list of tests the patients needs to do and a hand written illegible scrawled prescription - without even a mention made of the clinical findings or what the diagnostic impression is ! While it's good that the patient owns his own records, what happens if the patient forgets to get his records for the next visit ? This creates a lot of frustration for the doctor, who berates the patient for his carelessness - but the damage is done ! Wouldn't it make much more sense to keep a copy - and give one to the patient if he wants it ? Is this a lot of hard work ? Not anymore ! In the old days, one would have to make carbon paper copies or provide xeroxes, but using electronic medical records, this is now very easy to do !

Clinical care protocols are very similar in the US and in India. This is hardly surprising - after all, patients are the same the world over , and most will need the same kind of treatment. However, while most Indian doctors will provide exactly the same standard of medical care a doctor in the US does, why is there such a big difference in the way they keep medical records ?

In the US, every medical encounter is carefully documented ! Perhaps this was originally done for protecting against lawsuits for medical negligence; but today, the US government is making it compulsory for all US doctors to use EMRs - not just to improve the quality of care, but also to reduce costs ! Why don't Indian doctors use exactly the same approach to documenting their clinical care ? Are they too busy to do so ? too lazy ? or do they feel it's not important enough ?

Why do most doctors in India not bother to document their clinical encounters well ? Why is medical record keeping still shoddy and badly done in most practises ?

If Indian doctors understand the clinical importance of keeping good quality medical records, then why are they so reluctant to use EMRs ( electronic medical records ) ? In the past, it was true that PCs were very expensive; and that few doctors would afford them. Also, many older doctors were not very computer -literate; and the software programs which were available for medical record keeping were very doctor-unfriendly ! A combination of computer-unfriendly doctors and doctor-unfriendly software meant that most doctors were quite disillusioned with EMRs and were not willing to use them.

The good news is that things have changed dramatically ! Technology has improved; computers have improved; and Indian medical software companies such as Plus91 ( in which I am an angel investor) are realising the importance of mapping the doctor's clinical processes and respecting his work-flow so they are now making EMRs which are doctor-friendly and which enhance his productivity !

So why aren't Indian doctors rushing out to buy these , given the fact that they are inexpensive and can help them to improve the care they provide to their patients ?

Partly, this is because of the unhappy experiences doctors have had with Indian medical software in the past. It was the computer-savvy early adopters who were the first to lump on the IT bandwagon 10 years ago, to try to use computers to improve clinical care. Unfortunately, they burnt their fingers, which is why they are reluctant to try again.

As a consequence, most doctors do not know any one else who is using EMRs; and because they have little exposure to practise management skills during their training, they still do not understand the value an EMR can provide to their life.

Another major problem is that Indian doctors are not willing to pay for this. This is because they have been completely spoilt by the pharma companies . Because they are so used to getting everything free from pharmas, they are not willing to pay for anything at all ! This means EMR companies find it hard to sell their products - but if they do not generate revenue, how will they be able to produce good software ?

Please remember that your patients form the heart of your practise - and your patient's medical records are worth their weight in gold. If you keep them carefully; update them religiously; and share them with him, you can show your patient that you have all his medical details on your fingertips. This will help to inspire confidence in your clinical skills . Patients will rave about how well-organised you are - and this word of mouth marketing will help you get more patients, as it differentiates you from other doctors.

Also, by keeping your patient's records, you are creating a lot of patient loyalty and "stickiness" . If your patient is confident you know all about him because you have all his medical details, he is going to be very reluctant to switch doctors - after all, who wants all the hassle of explaining his medical history all over again to a new doctor ?

However , if you do not keep your patient's records; and the patient has to start explaining everything which has happened to him every time he sees you, be is likely to lose confidence in you very quickly ! ( That doctor does not even remember my name - forget about my medical problems !)

Hospitals in India have started documenting medical care electronically; and boutique medical clinics and chains have also started doing so. This is very heartening progress - and doctors who do not start doing so soon are going to find they will start losing their patients to computer-savvy doctors ! You need to move with the times - or you will get left behind !

I got an email from a patient whose fallopian tubes were blocked at the fimbrial end. I explained to her that her best option would be IVF.

She was very concerned about how expensive IVF was; and wanted to explore alternative options. She sent me a link to this website - Blocked Fallopian Tube Kit (USA & Canada)
http://biotanicalhealth.com/products/blocked-fallopian-tube-kit-usa-canada and asked me my opinion as to whether this would be useful.

Visiting this site made my blood boil - and also taught me a lot about how people will prey on an infertile patient's desperation and ignorance and take them for a ride. It's also a great example of clever marketing ! The manufacturer has cleverly packaged a few herbs, tampons, books and DVDs ( costing about US $ 50) - and is selling them as a Kit ( for over US $ 500 ) to help women with blocked tubes get pregnant ! It's a great selling job because the site has testimonials and long-winded explanations as to why this kit works ( all of which are just hot air ) If this actually worked, I'd be happy to close my IVF clinic and send all my patients to this person ! The reality is that this is all marketing hype, which is being used to exploit infertile couples.

The only way couples can protect themselves from such quacks is by arming themselves with Information Therapy !

Indian doctors have an excellent reputation for their clinical skills and patients all over the world look upto them . Because of their exposure to a large number of patients during their training in medical college, they have a lot of clinical experience; excellent diagnostic acumen; and are technically proficient. They are quite conscientious and are willing to work long hours for the sake of their patients.

However, most doctors in India still do not use technology intelligently. The majority do not bother to store and keep their patient's medical records ; or if they do, it's done in an extremely disorganised fashion. Most prescriptions are hand written illegible scrawls - and most doctors still manage their clinics very poorly . The doctor is often rushing from clinic to clinic , while his patients are made to wait for ever and ever. Phone calls are poorly handled, because doctors do not realise the importance of running their practise as a small business.

The major problem is that while doctors in India are taught to be good clinicians during their training, they are never taught how to run their practise. They have poor practise management skills, and are so focussed on the clinical care they provide , that they lose sight of the overall big picture as regards the services they provide to their patients.

Remember that when a patient comes to your clinic, the amount of time he spends with you is only a few minutes. Most of it is spent waiting; filling up forms; paying money; or talking to your staff. While many doctors feel that all these activities are administrative paraphernalia which are below their dignity, the fact remains that all these do contribute significantly to the experience your patient has in your clinic ! However, if you do not spend time and energy in training your clinic staff; or if you treat your front office staff badly, they are likely to treat your patients badly as well - causing a lot of unhappiness and grief for everyone !

Unfortunately, because doctors ignore and neglect these aspects of their practise, they do a bad job with delivering services to their patients. Many do not learn to use assistants efficiently to leverage their time; while others would rather do everything themselves, because they have never learnt to delegate well.

Even worse, though that have a lot of clinical experience and expertise, they do not share this efficiently, because they do not publish medical papers or articles. The only reason US doctors are more prolific in their writing skills is because they use the time and expertise of secretaries and editors to hone their publishing skills. India has so much untapped non-clinical talent which doctors can easily use to provide better services to their patients - and a higher profile for themselves !

Sadly, most doctors are not entrepreneurial enough and have poor practise management skills because they do not learn how to handle staff; and to delegate non-core non-clinical activities to others. Unless Indian doctors learn to maximise their productivity and efficiency using technology and other people's time, they will never be able to grow to their maximum potential !

The good news is that there are now many clever young entrepreneurs ( who are not doctors) , who are entering the Indian market. They realise that the way doctors provide medical care leaves a lot to be desired - and have come up with clever new solutions to address patients' pain points. They understand that healthcare is a service business - and while the doctor has an important role to play, there are lots of ancillary services which need to be provided around the doctor, both to improve his productivity; and to make the patient experience more pleasant.

As these businesses grow and flourish, hopefully all doctors will realise the importance of paying attention to how critically important it is to focus on the complete patient experience in their clinic - not just on the clinical care they provide ! The good news is that it's easy to fix these problems - we just need to pay attention to them !

We treat patients from all over the world and many of them want to do a phone consultation with me before coming to our clinic for an IVF treatment.

I can understand why they want to do so - after all, going half way across the world to get treated by a doctor you've never seen or met is a major leap of faith - and talking to the doctor can help to reduce some of this anxiety !

While it's true that the human touch is very important in providing good medical care, the truth is that it's not humanly possible for me to do so. This is true for many reasons.

For one, because of time zone differences, it's quite difficult to find a time slot which suits both the patient and me. We often end up playing phone tag - causing even more frustration ! Also, phone connections in certain countries ( such as Africa) are not of good quality, so that it's hard to hear each other. Also, sometimes patients forget some of their questions ( not all of them are well organised enough to prepare a list of their questions) , which means they often need to call twice or thrice ! Also, sometimes they do not understand what I am saying , because I may use a medical term they are not familiar with and it can be hard to explain everything in detail on a phone call . Another problem is that the husband calls me ; and after I finish answering his queries , his wife calls in another 5 minutes for additional clarifications, because he could not explain to her what I told him ! And when I am busy seeing patients in the clinic , it's hard for me to spend time on the phone . This means that my phone conversations are often short , which gives patients the wrong idea that I am curt or rude !

However, my major argument against a phone consultation is that it is not a very efficient means of communication ! There is no documentation , and too much scope for confusion and errors. This is why I prefer email, where everything is written down. I can answer as many questions as the patient has - and the patient can share this information with friends or family members who are doctors or nurses , to make sure I am providing sensible advise. They can also cc their spouse, to make sure everyone is on the same page. Because we can store and refer later on to this email conversation trail, there is no scope for ambiguity; and no confusion about medications or their dosages .

It's also much easier for me to answer more complex questions in case more clarity is needed, because the patient can ask for more details in his reply, in case he does not understand something I have said. Moreover, the advise I can provide by email is far more sophisticated and reliable as compared to a phone call, because I can think carefully before sending the email ! Email also allows the patient to send me all their medical records, so I have all the medical details I need to provide intelligent answers , customised to the patient's medical history !

A major benefit with email is that I can provide links to the relevant pages on our website, so they can get even more detailed information about their specific problem. While some patients email is much more impersonal than a phone call, I believe email is much more efficient, when used intelligently !

This is why I request patients who want to talk to me to send me their medical details by filling in the free second opinion form instead, so I can guide them properly. Some get upset with me because I refuse to talk to them on the phone - while others understand that I am doing so in

I know lots of doctors, but most of them are not very good at handling money. The fact that they got into medical college means they are bright and must have been in the top of their class, but most of them have very little business sense. Why is this so ?

Even though every clinic is a small business, most doctors have no exposure or training in business management . While they are very hard working and intelligent, they are often not good at managing other people or building teams.

Sadly, most of them are not willing to learn . One of the occupational hazards of being a doctor is that because they did so well academically, many of them they think they know it all , and cannot be taught anything. How sadly mistaken they are ! If you do not know what you do not know, how will you ever learn new stuff ?

Most doctors do not have role models they can emulate. Doctors are often intensely political and competitive. They are secretive and not willing to share what they have learnt with their colleagues - which means that most doctors have to make their own mistakes in order to get ahead.

Most doctors are in solo practise, which means they are stuck thinking small most of their lives. In their first decade of practise, they are so busy trying to attract patients, they they often lose sight of the big picture. By the time they become more mature, they are already ready to retire !

Sadly, giving cuts has become the norm today and most doctors are so used to taking shortcuts in order to build their practise, that they lose sight of basic customer service principles. This means that rather than spend time and energy keeping their patients happy, they waste a lot of it networking with colleagues who refer patients to them . Because these colleagues think the same way they do, there is very little attention paid to growing the business ethically.

Some senior doctors take a perverse pride in the fact that they are not interested in earning money ! They consider medicine to be a service profession and feel that earning money is below their dignity . They will often look down ( or pretend to do so ) upon doctors who are richer than they are.

Most doctors do not use technology cleverly. While they are often aware of the latest gadget and gizmo in their own specialty, they are often not smart enough to use technology for managing their clinic , growing their practise or marketing themselves.

Many are woefully financially naive. When they first start practise, they are so used to working for free that they do not think about paying themselves at all ! When they start their clinic, they treat the clinic's income as their personal income. However, this is actually the income of their business - they should only be paying themselves a salary as a CEO. The clinic should be profitable enough to pay them a salary and should be able to run without their presence ! Most doctors are so busy working in their practise , that they fail to work on their practise !

Doctors do not learn to leverage their strengths; and because they are so busy competing with each other , they do not learn to cooperate and grow the pie for their profession. They fritter away the goodwill they have earned from their patients on personal gratification. Sadly, the leaders of the profession are intensely political , and because they are so focussed on looking only after their personal selfish interests, they do little for the profession as a whole. By the time they are senior and are capable of looking at the big picture, they are thinking about retiring !

Most doctors are good at what they do, which is taking care of their patients . While this is good for their personal wellbeing, it's not good for the profession, which lacks leaders who can provide wise counsel for their colleagues and peers.

This is a guest post from Aditya Patkar, Marketing Director, Plus91.

I met a doctor socially the other day, and we had a very interesting conversation about his practice. He has published a website with the help of Plus91 Technology’s Website For Doctor's initiative , and we were discussing the merits of a doctor using the Internet for reaching out to patients.

His first worry was: doesn't this amount to advertising? Because a website is personal digital real estate, he felt this was fine, but was very uncomfortable about using social media to reach out, because he felt this was unethical. I agree that flagrantly advertising and singing praises about yourself may be unethical, but not informing people about your services is also downright unethical ! Imagine a poor patient with a brain tumour who is forced to travel miles in order to talk to a good neurologist , just because the neurologist in his neighborhood doesn't bother to let anyone know about what he does!
Doctors in India are in short supply – don’t they have a responsibility and duty to let people know about their expertise, so that it can be used more efficiently ?

We then started talking about how his website has made a difference to his practice.

a. He now could interact with his patient via the site

b. He could easily give directions to his clinics and his timings by directing people to the site , which had all the information patients needed, including a google map. This saved his patients a lot of time and energy – and his staff did not have to keep on repeating the same directions to all his new patients !

c. The website did convey that he is a serious up-to-date professional, and his patients appreciates this.

Did it get him new patients? The ability of a website to do this depends directly on the web traffic coming to the site, and because his site was fairly new, the numbers were still small, so it was hard to say if this has had a significant impact. If he promotes his website effectively, it is common sense that it is bound to help him attract new patients ! It’s always hard to judge the return on investment ( ROI) on a website , since it takes time for a website to grow ! It needs to be nurtured carefully – and doctors who do this will find this a very cost effective option ! Even one new patient can help him to recover the cost of a year’s hosting ! However, he is reluctant to spend the money to promote his website ( using a search engine optimisation – SEO - firm) , so it’s possible that his website may not help him to grow his practice, making this a self-fulfilling prophecy !

His skepticism arose from the fact that in his experience, when patients search for a doctor, they usually ask a friend or a family member for a recommendation or a referral. Patients may do research online to find out more about the doctor, but not many patients in India today use the internet as a tool to find a doctor. , However , as time goes by, this is likely to change quickly, because many people change cities when they switch jobs; and few have a family physician they can trust. It’s becoming increasingly common for urban Indian patients to use the internet to select a medical specialist to help them get the best medical care.

Social media has a very important role to play, because it is the digital version of “word of mouth” marketing. Let’s take a doctor who specializes in arthroscopic knee surgery. If all his colleagues on twitter, facebook and orkut feeds know about this, they can create a lot of buzz for him. Anytime someone asks these people about knee surgery , they will be sure to say, “Hey , why don't you go in for mini incision surgery and avoid the big scar ? I know a guy who does this and his website is …..”. Here your website becomes a tool which allows others to refer their friends to you easily. If you have videos on your website displaying your surgical skills, as well as patient testimonials, this allows you to build your prospective patient’s confidence in your expertise, and helps to enhance your credibility !

Today's Times of India is full of reports about how doctors in private practise in Mumbai are no longer going to honour cashless policies from patients who have been insured by public sector insurance companies.

This is a battle ( doctors and hospitals versus insurance companies) which was simmering for a long time, and has now come to a head. Let's look at this dispassionately.

It's the doctor's duty to provide medical care to his patients. However, paying for this medical care is the patient's responsibility. Typically, this was a "fee for service" model . The doctor provided the services, and the patient paid for them. If the patient could not afford to do so , the doctor would reduce his fees - and even offer free services for poor patients who were deserving of financial assistance.

However, as medical costs increased, and patients found it difficult to afford these, health insurance companies stepped into this picture. The job of the insurance companies was simple - it was designed to protect the patient from the financial pain of paying for his medical care when he fell ill. This worked because the company would pool risks from the entire community. They would collect premiums from lots of people; and use this to pay the medical bills of the unfortunate few who fell ill.

The traditional model was one of indemnity. The doctor provided the services and the patient paid for them . The patient would then submit the medical bills to the insurance company, who would then reimburse these bills. The doctor did not have to deal with the insurance company because his only task was professional - to provide medical care to his patient. This was simple and beneficial for all parties concerned - so far, so good.

However, as time went by, two changes crept in which corrupted this system.

1. Doctors and hospitals started getting greedy. They would inflate the bills they would provide to patients who had insurance coverage and then share the spoils with their patients. Many doctors and patients were happy to indulge in this practise. They felt that they were milking a large faceless, heartless insurance company, so no one was getting hurt ( the moral hazard fallacy) , while they were profiting handsomely ! In fact, some patients felt entitled to getting reimbursement from the insurance company every year ; and would plot with doctors to submit fake medical bills even when they were not ill, just so that they could get this money from the insurance company. Their justification was - " We are paying a premium every year , so why shouldn't we get some money ? And anyway, the insurance company can afford this ! How will a few thousand hurt them ? "

In all fairness, the insurance companies also took a stand which encouraged this padding on the part of hospitals and doctors. They would take an inordinately long time to reimburse legitimate hospital bills; and would find many flimsy reasons to delay the payments due - and even to refuse payment altogether. They did this because they wanted to make money on the "float" - and the longer they delayed the payments they owed to hospitals, the more the money they could make. When hospitals found out that it was taking insurance companies 3 - 6 months to pay them their rightful dues, they started padding the submitted bills even more, to try to recover some of their rightful dues. Sadly, as more and more doctors and hospitals started indulging in this malpractise, insurance companies found they could no longer afford to overlook these losses, which were proving to be a drain on their profits ! They start scrutinising these claims and did their best to plug these loopholes. However, this was a difficult task; and was made even more difficult by the fact that health insurance was provided only by Public Sector companies owned by the Govt of India. They were allowed to collect artificially low premiums from their clients, because health was seen to be a social good, and the government was reluctant to charge realistic market-prices for these policies. All the players did their best to reduce their losses , but since they were forced to do so within the artificial constraints set by the government, everyone was unhappy.

2. As the health policies continued to lose money , insurance company executives started to think of new ways of reducing their losses. They realised that doctors were padding their claims and submitting inflated bills for insured patients. They decided to negotiate fees directly with hospitals and doctors; and since they had a lot of clout, they turned the screws on doctors by forcing them to accept capped fees for each procedure - fees which the insurance company set; and which the doctor was forced to accept. Since doctors did not have any unity and they did not want to lose their patients, many quietly agreed to toe the insurance company line. While the initial fees which were set were reasonable ( the company would ask for a 10% discount on the typical market fee for a procedure), the insurance companies started to act as bullies and continued to progressively lower the fee, year after year, until doctors could not afford to treat their patients at the abysmally low rates which the insurance companies were offering.

This was the flash point, which has triggered off the crisis which exists today !
The tragedy is that everyone is hurting today.

Originally, medical insurance was supposed to be a win-win situation. Doctors were happy, as their workload increased. Patients who would not have been able to afford to pay them their fees originally could now afford to have surgery done in private hospitals, because they had insurance coverage, and the insurance companies had deep pockets.

Patients were happy, because they could afford to get good quality care in private hospitals, without paying a bomb.

Insurance companies were happy, because they could collect the premiums and make money on the float.

However, because of some rotten apples, the entire health insurance business has now become confrontational !

Doctors are unhappy because insurance companies refuse to pay them their full professional fees. They are willing to pay only a pittance, and doctors find that they cannot survive on such low fees.

Insurance companies are unhappy because they continue to make losses on their health policies. If they go on bleeding , how will they be able to continue to provide health insurance policies ? Where will the money to pay the doctor come from ?

Patients are unhappy because they find themselves trapped between doctors and insurance companies. Insurance companies are happy to collect the premiums on the policies - but when it's time to pay the medical bills, they create an endless series of barriers and hurdles ! And when the doctor refuses to honour the cashless policy the insurance company has provided, patients feel angry and cheated.

So what's the solution ? Right now there's a lot of blustering and posturing going on. Doctors are trying to get organised, which is good. However , the AAMC ( Association of Medical Consultants in Mumbai) is threatening to penalise those of its members who continue to accept cashless policies. This is a completely toothless threat ! The AAMC is a private organisation for doctors, which some doctors choose to join. All the AAMC can do it cancel the doctor's membership - not an action which is likely to worry most doctors !

Consumer activists are also predictably threatening to go to court in order to protect patients. This is also an equally pointless threat. Doctors are free citizens and no one can compel a doctor in private practise to treat a patient if he does not want to ! Just like no lawyer can be forced to take on anyone as a client, no doctor can be forced t treat a patient if he does not want to ( except in an emergency, as a humanitarian gesture, so save the patient's life)

So what's next ? I think things are going to get a lot worse before they get better. The present antiquated model is broken, and we will have to come up with innovative new solutions. The good news is that these models do exist ! The US healthcare industry is also a mess right now, but there are many clever initiatives which have been piloted by some smart people there , and we can learn from these.

These models include:

• primary care doctors offering cost effective concierge care on a purely fee for service model ;
• allowing insurance companies to charge differential premiums for different policies, based on what the market will bear;
• using Information Technology to promote transparency and efficiency;
• limiting health insurance only to catastrophic illness insurance; and
• introducing consumer driven health care plans, such as Health Savings Accounts.

This crisis is actually an major opportunity - and entrepreneurs who craft win-win solutions will do very well !

This is a guest post from Mr Aditya Patkar, Marketing Director, Plus91

A few Sundays ago , I was privileged to be invited by Dr. Nikhil Datar, a pre-eminent gynecologist and medico-legal expert to witness his premier talk on Patient Safety. It was hosted by IMA Dombivali and over 40 doctors turned up to hear Dr. Datar’s talk. Dr. Datar had recently returned from UK where he attended a program organized by WHO on Patient Safety. I was there because Plus91 Technologies believes in making patient centric software solutions which don’t just automate the clinic or hospital , but also improve quality and service.

The doctors quickly realized that they need to reflect and close loopholes in their own practice, so that they could ensure patient safety. Sometimes we are so focused on the trees, that we lose sight of the forest ! The Q and A session was very interactive , and all doctors left the seminar with a lot of food for thought.
As a software company involved in producing intelligent Healthcare software solutions , patient safety becomes a vital cog in what we are doing .

1. Plus91 creates solutions which ensure and promote safety
2. The unique patient safety features we offer allow us to explain to doctors why are products are better than the others in the market
3. Using Plus91 products helps doctors to get patients more involved in their own medical care - allowing patients to feel safer and better informed.

So what does patient safety entail? It covers a lot of ground , right from something as basic as washing your hands before doing a physical examination ; to something as complicated as giving instructions to your assistants during bypass surgery. They key learning was the need for everyone to be aware of the fact that medical care is a highly complex enterprise and that things can go wrong ; and we need to improve communications and processes to prevent minor errors from becoming major issues.

Simple techniques like reading the names of the medicine aloud; using color coding on various instruments, and storing patient records in a neat and systematic manner can help provide better quality care to the patient. Being aware of the possibility of errors can help you prevent them very effectively, as you take corrective action. Of all the cases which result in a complication, in only about 1% is this a result of negligence. Most are a result of preventable errors – and the majority are not individual failures , but system failures.

A lot of good work is now being done in India in this field by numerous players. The ones which Plus91 Technologies is directly involved with include Dr. Nikhil Datar, PIET (Patient Information and Education Trust), PEAS (Patient Education and Awareness Series), HELP (Healthcare Education Library for People) and Dr. Malpani who is organizing a conference in October in Mumbai called Putting Patients First. As technology pervades healthcare, I can already envision many places where Plus91 can actively help improve patient safety standards. The possibilities are exciting , not only in their scope and challenge, but because this is one place where we can actually claim that we saved a human life – and working towards this goal inspires us with enthusiasm and energy !

This is a guest post from Mr Aditya Patkar, Marketing Director, Plus91.

Patient Safety is a vital aspect of healthcare. Medical errors can lead to deaths and medical tragedies which are preventable , leading to heartburn and losses for all doctors and patients . In any industry, software is used to improve efficiency and accuracy. I am going to highlight some basic examples as to how medical software ( electronic medical records, EMR and practice management software, PMS) can be used to improve patient safety.

1. Prescriptions and Medications: The commonest errors occur when doctors write prescriptions on paper and the patient or the chemist misreads the prescription. This is a common occurrence and a printed prescription generated from software with prepopulated Drug Data is the safest bet against such a mishap. Other errors which can be prevented include: mistakes made by doctors in writing the dosage or strength( which intelligent software can automatically prevent) ; and the inadvertent prescription of a combination of drugs which can cause harmful drug interactions. These features are already present in the Plus91 clinic package , Clinkare. This ensures standardized prescriptions, reducing the possibility of error and confusion !
Another neat feature is sending reminders to the patient to take their medication at the correct time via SMS. This ensures high patient compliance , because missed dosages could lead to major problems in treatment. This feature is available in ClinION , the hospital management solution from Plus91 Technologies.

2. Patient History: If doctors are in a hurry, and if a patient comes without his old case papers , the doctor may end up prescribing the wrong treatment ! Not having easy access to the past medical records is a major pain point for all doctors ! EMRs allow storage and instant retrieval of the patient’s medical records, allowing doctors to make better medical decisions , thus ensuring patient safety. This feature ensures that the doctor no longer needs to rely on his error-prone human memory ! Intelligent EMRs also have built-in Clinical Decision Support systems , to help the doctor practice evidence-based medicine.


3. Patient Data Entry: As we know, GIGO holds true – garbage in, garbage out ! Accurate entry of patient data in the system can be ensured by various validation measures and checks in the software. A simple example is the use of validated fields , which accept only values within a pre-defined range. Thus, if the value for hemoglobin is entered as 100, this will be automatically rejected !

4. Check for Informed Consent: A patient must know what procedure they are undergoing – what the risks are; and the important dos and don’ts, to help ensure a good outcome . A software program can ensure that the consent forms are filled in using a reminder / validation system , to ensure that all the patients queries have been answered. It’s also possible to use a video/presentation format , with a consent thumbprint or electronic signature taken at the end. This is helpful for risk management, because it documents that informed consent was obtained. It also ensures that the patient follows all the key preoperative instructions ( such as coming on an empty stomach before surgery . )

5. Check lists: A checklist ( as described in Dr. Gawande’s new book “The Checklist Manifesto”) is the doctor’s most trusted friend. Clinic software programs come with check lists which need to be marked as complete before the next set of tasks ( on the next screen) can be accessed. This ensures that all important steps are carried out in order.


6. Alerts and reminders. SMS or Email alerts can be automatically sent by the software, when there is a problem. For example, if a key lab value falls out of a particular range , the doctor can be automatically alerted, so he can take the needed corrective action !

This is a guest post from Mr Parag Vora, CEO of Infoseek in which I am an angel investor.

In the past, most doctors used to feel that marketing was below their dignity. Medicine was considered to be a noble profession, while marketing was seen to be a sleazy way of soliciting for patients. In today’s competitive market however, , a doctor can no longer continue to retain these outdated beliefs. Every doctor needs to wake up and realise that marketing has become a necessity for survival. Look around you - the corporate hospitals have already started eating into your market share and now take away a large chunk of patients who used to come to you in the past ! Is it because they are better than you? More experienced ? Or that they provide better patient care ? I don't think so ! In fact, the care in many of these hospitals is impersonal – and very expensive ! Why do patients go there ? The answer lies in the simple fact that they are able to 'MARKET'; 'BRAND' and 'POSITION' themselves much better than you can !

Marketing is not the same as advertising ! It basically means you use techniques which influence your patient's choice in selecting his doctor, by demonstrating the true value of your expertise and services. Marketing is something doctors has always done. It’s just that in the past, it was basically simple “word of mouth marketing. In today’s age, you need to adopt the marketing methods being followed by other industries.

To understand how marketing can help your medical practice, you first need to understand how a patient chooses a doctor. The quality of medical care and the expertise of the doctor is a major factor , but the truth is that it is extremely difficult for a patient to assess this , because he simply does not have the technical sophistication to be able to differentiate between a good doctor and a bad doctor ! Hence , patients look at proxy measures , such asreferences from family and friends; the doctor’s “reputation”; whom the local chemist recommends; and often by doing a google search !

In my opinion, a kick-start to your marketing efforts should be focused on your current patient population. Provide them with excellent care and service and they will be the best marketeers for your practice. If you treat them well and provide them cost effective medical care, they are certainly going to recommend you to their family and friends.

Your image is another very important marketing tool for you – and your clinic’s ambience plays a key role ! This could be a plus– or could be a black mark against you ! For instance - acramped waiting room with paint peeling off the walls ; a dirty consulting and examining room; ill-behaved support staff; and no information about the services that you offer. Do you think this will inspire confidence in your patient while he is waiting to see you ? Whenever I check-in to a hotel room, the first thing I see is how well maintained the washroom is. It tells me a lot about the hotel and its service , and builds up their image. Isn’t the first impression often the last?

You must have some marketing “collaterals” ( marketing also uses jargon, just like doctors do !) The list of such collaterals should include :
1. Brochure(about your practice and services)
2. A professional website
3. A patient resource center within your clinic with patient education books and DVD’s.
4. A short AV film about your clinic; your expertise; infrastructure; with patient testimonials.

Marketing yourself does not have to cost a lot of time and money . Marketing is simply letting your patients know that you are genuinely willing and able to take care of them !