1. Deepak Agrawal
I/C Computerization & Assoc Prof Neurosurgery,
JPNA Trauma Centre,
All India Institute of Medical Sciences, New Delhi
How cost-effective EMR is
possible in India
JPNATC
Experience

2. Those who
cannot remember
the past are
condemned to
repeat it.

4. • 1980’s
• TCS WON TENDER TO COMPUTERIZE
WHOLE AIIMS
• WORTH SEVERAL CRORES
• INSTALLED ‘STATE OF ART HARDWARE &
SOFTWARE’
• ‘IMPLEMENTATION’ FAILED MISERABLY

5. • Conceived in 1980’s by AIIMS
• Handed to Delhi Government
• Returned to AIIMS in 1992
• Dry run began on 27 November
2006
• Became fully functional on 26
November, 2007 (ED was
opened to general public)

6. • No precedent
• Expectations were very low

7. "The greatest danger
for most is not that our
aim is too high and we
miss it, but that our
aim is too low and we
reach it."

10. • Handwriting issues
• Non-Reproducibility
• Signature
• Address, designation and registration
number of Doctor
• Not tamper proof
• Storage issue

11. • Hand writing not a problem
• Reproducible
• Tamper-proof
• Electronic signature
• Identity of issuing doctor
• Space

17. • Network printers
• Duplex printing
• Heavy duty
• Full maintenance contract with per page price (<40
paisa/page)
• Capable of scanning patient files

18. 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

19. • New tender (Rs 1.3 crores over 5 years)
• All software developed by vendor should be open
source & released compulsorily in source forge for
testing by community
• Web-based front-end
• EWD
• Registration & lab front end should be complete within a month

20. • Hardware
• Servers 50 lakhs
• Storage 25 lakhs
• Desktops & thinclinets: 25 lakhs
• Printers: 10 lakhs
• Networking
• Switches etc: Rs 25 lakhs
• Wireless & wire: Rs 10 lakhs
• Total: 1.45 crores

22. • Cats etc-20 @9000 Rs 1.8 lakhs
• Vista support Rs 2.5 lakhs
• Stationary/printing Rs 0.2 lakh
• Call Centre Rs 1.0 lakh
• Miscl Rs 0.5 lakh
• Total Rs 6.0 lakhs/month

23. • Radiology (CT/MRI)
• Cost of films/year Rs 60 lakhs
• PACS
• Now 90% filmless
• Saving/year Rs 54 lakhs

24. • Incalculable
• Implementation pays for itself in direct &
indirect benefits may times over

26. • "If I have seen
farther than others,
it is because I was
standing on the
shoulder of giants."