Megh Sushrut (MS) :: An ERP Solution for Health Delivery in SaaS Model using Garuda Network as the Computing Cloud

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Registration Name : eINDIA2011/AN/168
Project Category : eHealth::Best Civil Society/ Development Agency Initiative of the Year
Project Name : Megh Sushrut (MS) – An ERP Solution for Health Delivery in SaaS Model using Garuda Network as the Computing Cloud.

Details of Applicant
Name : George Varkey
Address : Anusandhan Bhawan C-56/1, Sector – 62
City : Noida
State : Uttar Pradesh
Country : INDIA
Zip Code : 201307

Details of Project/Implementing Agency
Name of Organisation : Centre for Development of Advanced Computing (C-DAC)
Address : Agriculture College Campus,Near District Industries Centre,Shivajinagar
City : Pune
State : Maharashtra
Country : INDIA
Zip Code : 411005
Name of the head of Organisation : Prof. Rajat Moona
Website :

Brief description of the programme/project/Initiative :
Megh Sushrut is an initiative by C-DAC for providing Hospital Information Management System (HIMS) using the emerging Cloud Computing and Software as a Service (SaaS) paradigm. Under this initiative, C-DAC has set up a comprehensive HIMS in its data centre, which is running on 24 X 7 basis and is making the services available over multiple hospitals using the backbone network of MPLS/VPN cloud. This backbone cloud is set up with more than 99.9% availability to ensure that the services are available in the hospitals almost all the time. The full infrastructure needed in the hospital is also set up by C-DAC (including deployment of manpower). Charging is based on number of transactions. This ensures that extensions of hardware and software infrastructure get matched with the financial outflow from the project.

Why was the project started :
C-DAC has been in the business of HIMS for many years and have completed computerization for many Government hospitals. It was felt that the current model of HIMS implementation is grossly wasteful and inefficient, since each hospital is setting up costly servers and third party software in each of its premises. This necessitated the deployment of professionals at the hospital premises to look after and manage these server systems. The experience from many hospitals was that, after installation and acceptance, the hospital is unable to manage and sustain these systems over the years and get into a very serious problem of maintaining them as an essential service at the hospital. With the emergence of new paradigms of computing (Cloud Computing and Software as a service model), C-DAC felt that the proposed solution is much better suited for hospitals in the country.

Objective :
To provide Hospital Information Management System under SaaS model, in any hospital that can be connected to the C-DAC computing cloud. In this, the client pays for the services on ‘per transaction’ basis. Note that this model is successful in the mobile phone and cable network industries. It provides HIMS solution at the hospitals as a turnkey service; stationery, operating manpower, etc. being part of the service, and recover the cost over a period of time by charging the beneficiaries on ‘per transaction’ basis.

Target group : Small and medium level hospitals and nursing homes in the country.
Geographical reach : No limitation
Date from which the project became operational : 1 September 2011
Is the Project still operational : YES

10 points that make the programme/project innovative?

  1. First Such Initiative : The project is the first initiative in the country to provide HIMS services under SaaS Model
  2. Turnkey Solutions: All functions including provision of stationery, operating manpower, etc. is made as a part of the package. This is to ensure that nothing is left to chance.
  3. Reuse: The costliest part of the system (Servers, Third Party Software, etc.) are used across hospitals. This reduces the total cost.
  4. Automated EMR: Normally the medical records of patients get scattered across the visiting hospitals. With the current system, the medical records get accumulated in the server systems, thereby allowing automatic creation of EMR across the participating hospitals.
  5. Reduced Cost of Ownership: Capital investment in the hospital is reduced to a minimum. This also reduces the manpower expenses and other related costs.
  6. Market driven software development: Since the model adopted is SaaS, in case the service agency does not provide the needed services, users will stop availing the services. This ensures that modification needed by the market will be incorporated on a continuous basis.
  7. Virtual Hospital: The system effectively creates a virtual hospital spanning all the participating hospitals. The patient can avail consultancy in any of these hospitals, since the EMRs are centrally stored, which become available to the relevant doctors.
  8. Sharing: Since the system creates a virtual hospital across all the participating hospitals, it will become possible to share the expertise and experience available across the hospitals. This will be specially useful during the emergencies. For example, if a rare blood is required in a hospital, it will be possible for the system to determine whether this blood is available in some other hospital or not, by the click of a button.
  9. Statistical Analysis: Since the information from all the hospitals amalgamates over the data centre, very realistic statistical analysis can be conducted.
  10. Availability of complete ERP solution even in very small hospitals: The solution available in the data centre is a super set of the solutions required across the hospitals. Thus, even the smallest hospital can be assured that the module required by them will be available and can be made available to them as “As Is Needed” basis.

List the 5 achievements of the programme/project?

  1. Fastest Implementation: The first implementation of the project has started in May, 2011. It became operational in August, 2011. Considering that the system was set up by a government agency in a government hospital, this is probably the fastest implementation in this area.
  2. Satisfied Customer: The hospital is quite satisfied with the product. The “word of mouth” publicity has been so good that many hospitals in Delhi have been approaching the Directorate of Health Services of Govt. of NCT of Delhi, to permit them to use this model for their hospital as well.
  3. Acceptance of OPD Modules by Doctors: The computerization of the OPD Module in the hospital is a major challenge in any of the HIMS implementation in India and abroad. In this package, we have created an innovative module and this has been well appreciated by the doctors.
  4. Operationalization of Computerized Pharmacy Module within record Time: The Computerization of the Pharmacy Module was a major challenge. With the innovative solution proposed, we are able to move from the manual system to computerization operation within a few days.
  5. Usage of Drug Warehouse Module by other Agencies: The version of the Medical Warehousing System has been accepted by the Government of Rajasthan, for implementation of the similar model and presently, 135 warehouses in Rajasthan are using this facility.

List the 5 key challenges faced while implementing the programme/project/iniative:

  1. Reluctance from Government to accept new Schemes: Acceptance of Scheme by at least one Government Hospital so that the system may be shown to be working there. Since this was a new concept, acceptance by the Government was a major issue. The proposal was submitted to the Government of NCT of Delhi in November, 2009 and more than 10 high level meetings were conducted before it was finally approved by the Cabinet in April, 2011.
  2. Service Provider for Backbone Connectivity: Getting a proper service provider for MPLS VPN connectivity. Since the application critically depends upon availability and quality of backbone network, getting a proper service provider was a major issue. This was done by partially going for 2 service providers – with one fiber based lease line connectivity and another RF based last mile connectivity. This ensures that at least one of this is operational all the time and both of them are working most of the time.
  3. Initial Teething Troubles: Any implementation of this nature will have a number of teething troubles. Ensuring that this does not happen, was a major challenge. The complete team was motivated with a special training to ensure that all the problems are solved within a period of few hours. This strategy proved to be quite helpful.
  4. Buy-in from Hospital: Acceptance of Business Process Reengineering by hospital authority. Introduction of any computerization activities ultimately relates to a number of business process reengineering. Making a hospital staff acceptable to these changes was a major challenge. This was overcome by conducting User Acceptance Trials and direct interactions with the hospital staff at all levels to ensure that they accept the system.
  5. Operational Staff: The operational staff and faced with different problems at different times, many of which are not envisaged in the Operating Manuals and other documentations. Ensuring that they are still able to continue the operational without disrupting the critical activities of the hospital, was a major challenge. This was overcome by intermixing the developers along with the operational staff for some period of time so that quick solutions are found at the place of operation itself and they are implemented by the developers in the system without wasting any time.

List the 5 points how can the programme serve as a model that can be replicated or adapted by others?

  1. SaaS is a new paradigm in the software industry. The current system can be replicated by others in the HIMS field for the benefits indicated in section “Innovativeness of the Programme”.
  2. The programme need not be limited to hospital segment alone. With proper modification, the same scheme can be utilized for other e-Governance applications like distribution of Birth and Death Certificates, etc.
  3. The proposed model replaces the requirement of high-end computers and the location of operations by that of high quality bandwidth. This reduces the requirement of manpower, electrical power, computing power, etc. for the total solution. Thus, it can be duplicated in all situations where similar services distributed across geographical areas are required and can be provided by a cloud computing platform.
  4. One of the major highlights of the programme is the involvement of local experts as teaming partners of C-DAC. These are private agencies which take care of operationalising the system at the Registration Counters, Emergency Desks, etc. and provide training to the hospital staff. They also take care of first level maintenance. This model ensures that first level services are available at the location itself, thereby reducing the time to attend to the problem originating at the location and also ensuring proper acceptability of the operators, since they are from the same locality. It also reduces the cost of implementation. This model can be replicated in all cases where handholding and training partners are required for providing the e-Governance services, over an extensive period.
  5. The programme can be replicated across the country and also abroad. Since there are over 11000 hospitals, 22000 PHCs and 145000 sub-centres in the government sector in the country, most of which are not computerized. There is a huge potential for the HIMS implementation in government sector, in the country. The current model is probably the best for replicating for these areas. This is now possible due to availability of bandwidth in most parts of the country.

List 5 points to elaborate on the scalability of the programme/project/initiative:

  1. The programme is inherently scalable. The system servers are hosted on the cloud and in case of higher through-put requirement, more servers can be added to the cluster with load balancing, to ensure that the required load is available at the server stations.
  2. It is also possible to create a Grid wherein all computing stations are placed on multiple locations, interconnecting with high speed lines. This ensures adequate power and redundancy for the data.
  3. HIMS applications are generally common across the world. It consists of diagnostic services (like OPD, IPD, Blood Bank, etc.), Support Services (like Diet Kitchen, Vehicle Management, Mortuary, Bio-Medical Waste Management, etc.), and Backup Services (like Personnel Information Management System, Accounting, Budgeting, etc.). All these services form part of the Megh Sushrut. Individualized Modules needed by specific hospitals can be developed and made integral part of the system and this can be made available to other hospitals, which may need them. Thus, the system has the potential to become highly scalable.
  4. It is also possible to integrate alternate forms of medical practices like Ayurveda, Siddha, Unani, etc. into the current scheme of Megh Sushrut. This will have the additional advantage of comparing the progress of patients going to different streams of treatment by looking at the data accumulated in the central database. Thus, the system is not necessarily tuned to one single stream of medical practices.
  5. Availability of bandwidth can ensure that the system may be used in countries other than India as well. South Asian countries, African countries can be direct beneficiaries of this scheme.

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