Eliminating queues in hospital clinicsAn m-health initiative by JPN Apex trauma Centre, AIIMS

Dr Deepak AgrawalAssist Professor, Neurosurgery & In-charge Computerization,JPN Apex Trauma centre,AIIMS, New Delhi

BACKGROUND Bedridden and wheelchair bound patients (head &

spinal injuries) have to travel long distances for follow up visits.

This increases the socio-economic load on the families.

Scarcity of specialist doctors in rural areas

Local doctors unable to attend to simple queries of these patients

BACKGROUND

Mobile penetration in India exceeds 50% The subscriber base in wireless segment increased to 563.73 million in February (TRAI- march 2010)

Almost every family has access to mobile

Pilot study at JPNATC shows that all patients could give a mobile number at the time of registration

INTRODUCTION

Although Call-centres are common in commercial industries like telecom, the concept has been alien to hospitals.

Hospitals usually have reception desks which manage general enquiries and appointments.

INTRODUCTION

An integrated call-centre on the other hand manages extensive backend administrative chores and services besides providing a host of patient related activities on a common platform.

JPN Apex Trauma Centre has a mature EMR system making it ideal for case study

Why was the project started Long queues in OPD’s (clinics) especially

in governmental hospitals Patients stand in line from 6AM Encourages corruption & malpractice

Doctor's may be unavailable pts usually come from far distances & it is a major

socio-economic burden to come for follow up visits.

In case the doctor is on leave/ busy, patients have to come another day

AIMS & OBJECTIVES

To streamline the process of hospital visits and minimize wait times for patients by using m-health initiatives.

A secondary objective was to improve transparency and accountability in the OPD’s

Target group: General public and patients visiting hospitals

Geographical reach: All over India (As patients come from various

states from all over the country to AIIMS)

Initiative

1. Mobile number is captured in the EMR and verified by the Call-centre

during the first visit/ admission

2. Call-centre give

appointment using voice

&SMS

3. On day -1, sends list of all appointments

that files can be taken out

5. Pt waits with token

number which is displayed outside each

room

4. On Day ‘0’, final list is

prepared and put on each doctors table

6. Call centre phones in

evening and gives next

appointment based on

doctors orders

How is the project innovative? It is for the first time that initiative has been

taken by a government hospital to make OPD visits more ‘patient friendly’

It is for the first time that mobile phone is being used as primary mode for registration for appointments and for delivery (by sms) of token number and approximate wait times in the setting of a government hospital.

ACHIVEMENTS

Following this initiative, patients no longer have to queue for appointments with doctors/ stand in line for registration

The wait time to be seen by the doctor has drastically been cut down to less than 2 hour for the majority of the patients

In case the doctor is unavailable or there is change in schedule, an intimation by SMS is sent to the patients and appointments rescheduled

ACHIVEMENTS

The token number sent as SMS remains the queue number which is displayed on electronic display boards in real time outside each doctor’s chamber.

The OPD area is dramatically less crowded leading to better ambience and staff response.

For the first time statistics on the number of patients waiting to be seen by a clinician/ specialty will be available to the government so that necessary policy changes can be made.

TECHNICAL OVERVIEW

Hardware HP proliant rack mounted servers

Software PHP,AJAX, Javasript, Perl for connection

Platform Linux OS

USP

Independent of make of mobile phone!! SMS & voice call based

Hosted on Internet

Technical requirements Broadband (As call centre is Outsourced)

Public IP’s (do)

Database access for retrieving EMR data

SMS gateway

Call Centre hardware & software

TIMELINE

Developing and integrating application with patient database: Jan2010

2. Pilot implementation: April 2010

3. Full implementation: May 2010

Content & Services

Content Token number Appointment time Approximate wait times

Services Reminder service Appointment booking Universal 24 X 7 call centre support (human

middleware)

INTERACTIVITY

fully functional call centre with all applications integrated and real time availability.

Even illiterate people can interact, get appointments, discuss their problems and have their questions sent (by email) to concerned doctors without any technological barrier

UNIQUENESS

It is for the first time that initiative has been taken by a government hospital to make OPD visits more ‘patient friendly’

It is for the first time that mobile phone is being used as primary mode for registration for appointments and for delivery (by sms) of token number and approximate wait times in the setting of a government hospital.

It is for the first time that such an initiative is being done completely free of cost to the patients.

Sustainability & Scalability

The total expenditure is presently around Rs 1 lakh/ month (including a nine seater call centre)

The width and breadth of the initiative is immense. One tele-centre can cover multiple hospitals, or at state level and even at national level

Vision for mobile technology in India Our vision is to have mobiles as enabling

devices for the empowerment of society so that appropriate information is available without end-user technological barriers to the masses.

For this, a back end call centre which collates all data, integrates with mobile application and acts as an ‘human middleware’ to the masses is essential.

THANK YOU