[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

[Eric R.] Initial Post

So, apparently my previous post is lost. I apologize! It was mostly about packing, and my running around to prepare for departure. I also gave a quick introduction to my project, and what I'll be working on while here. I will be sure to write about my project in the future.

This has certainly been an adventure, so far! I landed in Mumbai at 11.15p last night, and made it through customs and immigration very quickly. I was supposed to be looking for my driver, Santosh, who had a placard with my name on it. I exited the airport into a square surrounded by people, all holding placards! I had been warned of the smell – that I’d want to walk back inside and fly home. I can officially say, it’s not worth all the hype. Mumbai smells…humid, and a touch musty. But not bad.

I ended up using my phone briefly to call Santosh, and found him standing shyly in the corner with my placard: “Ayrik Reylan.” I suppose that’s close enough. I went with him to his car, and began the drive to Pune. Let me tell you, easier said than done. At first, there was only one tiny road. It wound through the slums of Mumbai, and had potholes and construction everywhere. Bikes and auto-rickshaws were weaving in and out of traffic, and sometimes the cars would come into the wrong lane to avoid a particularly large pothole (don’t forget they drive on the left, with the steering wheel on the right!). After leaving the island that Mumbai is on, we began to travel up into the mountains. Despite being about 1am, traffic was gridlocked. Going up into the mountains was slow going; cars were in the minority, and large trucks carrying carefully-balanced loads blocked most of the road. Driving on the shoulders was commonplace. My favorite sign I saw: “over-speeding causes accidents. Slow down.” Not speeding, just over-speeding. I heard (and sang along to) a medley from Kal Ho Naa Ho on the drive, and a few others I recognized from the films I’ve seen.

I rolled into Pune at 3.40a, and was greeted by Malik, who has become my guide for the time being. He showed me my room, and I was pleasantly surprised when he turned on the A.C. before leaving me for the night. I am fortunate enough to enjoy sleeping on a firm mattress; I think my bed is more like a cushion on a piece of plywood!

I slept very well, but briefly. I woke up at 8.30a when Malik walked in and asked if I’d like some tea. I said yes, of course, and came downstairs for some tea and crackers. He likes the word “going,” and uses it synonymously with “coming.” It made for some interesting conversation this morning, and we ended up walking a couple blocks around the guesthouse due to a misunderstanding (on my part, clearly!).

Malik asked me this morning if I was married; after clarifying to ensure I understood him, I quickly told him no! He laughed a bit, and said at 25/26/27 he will get married (he’s 20, I think). I told him I was only 21, and he told me I should start looking! We talked a little about our families, and bonded a bit. I hope we become friends!

Mr. Kumar, my contact at OHUM, is in Delhi today, and will be returning Saturday. However, I visited the OHUM office for an orientation this afternoon. There are two other interns starting with me; they are Masters in Health Administration (MHA) students (Ketaki and Yogindra). Yogindra is a doctor already, but is interested in managing a hospital. Apparently, about half of all Indian medical students do not practice medicine after graduation, but continue on to receive their MHA's, MBA's, etc. The three of us met with a number of employees at OHUM, and learned about their mission statement and their main piece of software, VistA. My task for the rest of the afternoon: read the 144-page user's manual to have more background information when I go to meet with doctors starting next week...wooo!!!!

-eric