[Eric R] Week 3

It’s time for my next post! This past week has been inspiring for me. Overall, I was very productive; I managed to make new friends, see some sights, and have many well-developed conversations with very smart people.

I ended my time in Pune with a round of laundry. Although Malik offered to take care of it himself in the communal washing machine behind the guesthouse, he also (politely) suggested I take my laundry to “My Dhobi,” a business that does your washing for you. I elected for that option, and had a lovely conversation with the manager who has traveled extensively in the southwest US, and has a niece in Auburn Hills, MI.

I had my first experience with the long-distance trains – I managed the four-hour trip from Pune to Mumbai (Dadar Station) by myself. I almost missed it; I literally hopped aboard the first car I saw, and we started chugging along (note to self: remember to print your ticket beforehand!). Luckily, I jumped onto the right one! At Dadar, I took a taxi to my hotel in Khar West, about a 10min ride. The taxi driver promised me a good deal, and tried to charge ₨2000 when his meter said ₨57. He pulled out a fare conversion card “given to him by the government,” that although looked plausible, I knew was a forgery based on the prices. I was astounded when a local started to back him up, and so I called Ketaki to make sure I wasn’t just being ignorant. In fact, the charge was ₨57. Fellow SiSA students… be careful!

I visited two hospitals this week, but had multiple interviews at each, over four days. At the first, Tata Memorial Hospital in Parel, I met with five physicians. Each chose to focus on slightly different aspects of EMR systems. I’m finding that a good first question to ask is, “What do you define as an EMR system,” followed by, “What is the difference between that, and an HIS system?” A high percentage of all hospitals here have a hospital information system (HIS) that might include modules such as “Admissions, Discharge, and Transfers,” “Bed Occupancy,” “Billing,” or “Patient Registration.” Many of the physicians, when asked if they use an EMR system, they say yes, but really are referring to their hospital’s HIS system. The key difference, in my opinion, is that an EMR system needs to provide support for clinicians when making important decisions regarding patient care. Such provisions could include patient allergy alerts, diagnosis information, prior medical histories, lab results, and all medical images. Of these features, none of the hospitals I’ve visited so far have implemented all of them. Most have implemented a module for viewing images (MRIs, CTs, etc.) and some have implemented a module for viewing lab results. But of course, the modules are all separate, and have unique login information for each.

The second hospital I visited was Fortis, Mulund, where I interviewed another five physicians, four of which were during their outpatient clinic periods. This provided a unique opportunity for me to understand the different settings in which an EMR system could be used. The number one challenge these physicians emphasized was patient volumes. There are simply too many patients to be seen each day to spend time wrestling with their computers while they’re at it. And frankly, I don’t blame them. If there is one thing I’ve seen most during my time here, it’s people. I’ve ridden the trains a few times in the last couple days, but always during off-hours. The trains and platforms have been crowded, but I’ve managed to always make it on and off the trains alright. Today on my trip to Fortis (about a 1.5hr journey), I left Khar at 9a, just as peak travel times were beginning. It was madness. I felt like a sheep being herded through a tunnel squished against a million other sheep. The transfer at Dadar was equally as crazy; there were easily 5,000 people on the station platforms at any given time. I loved having the opportunity to fit as a local, and even had some people ask me, "agle station kya hai?" (what is the next station?) To which I was able to proudly offer, "Bandra," "Khar Road," and "Nahur."

I’ve been told there is not a lack of doctors here, and I’m inclined to believe that after hearing so many of them graduate and continue into hospital administration, business, and pharmacy. From what doctors have told me, what India lacks is healthcare facilities. There simply aren’t enough hospitals to take care of every person with the same level of attention as in the US. When time is of the essence, and an “expensive” hospital consult is ₨500 ($9), doctors simply don’t care to put the effort into learning a new system and dealing with the training period required for an EMR system to stick. Not to mention the grossly inadequate amount of infrastructure – imagine having to run from the patient’s bedside to the single nursing station in the ward to check a patient’s chart one more time. Then there’s the slow Internet connection, the forgotten passwords, and my favorite, the software runtime errors.

At some point during all of my interviews, the physician says something along the lines of, “You know, all we need is a visionary – someone to come in and push for EMRs. Someone just needs to take our paper away!” If you’re reading this and feeling inspired, let me know, and I will put you in touch with the right people!


-ericr