Hosted in the Cloud: HIS

In IT terminology, SmartKure is the front-end of the integrated medical solution provided by iKure TechSoft. It’s a SAAS model Hospital Information System (HIS). One of our objectives is to build Data Warehouses comprising appropriate health information and accessing tools. SmartKure does exactly that. It consists of an online hosted application to be used by both doctors and patients. Patients can search doctors for better treatment of both generic and crucial diseases. On the other hand, doctors can store patient information and also receive feedbacks. SmartKure also provides a guided appointment system through website login, SMS or phone.

SmartKure consists of a Doctors’ Module, a Patients’ Module and Medico Informatics. The various uses of these modules are:

• Doctors’ Module is used to diagnose patients by doctors. They are also aided in their decision making by the “Guided Diagnosis” feature. The “Guided Diagnosis” is achieved with the help of intelligent data-mining of Medico Informatics, which is the data warehouse of the system. Doctors can also take first hand feedback from patients they have treated. In case of poor feedback the doctor would be alerted and he may speak with the patient and fix the situation. The system will stress more to identify the good doctors among the group rather than pinpoint the not so good doctors.
• The Patients’ Module is used by the patients to search for a more suited doctor, to book appointments, and to provide feedback on their own health as well as their satisfaction with the doctor. A step by step guide will be provided for patients who are not aware which doctor they need to go to for their problem. Patients can search based on specialization, location, feedbacks, fees and availability. Thus, one saves time, money and minimizes wrong medication through this process.
• Other than patient feedback the system will also use data from independent bodies through surveys about the quality of doctors. This will be categorized as critic’s recommendations.
• Patients can easily book appointments in advance, in case the doctor has tied up with the system.
• All the doctors who sign up will need to enter details about their profiles, experience, and expertise in an area and up to last 5 major cases handled. This helps patients in having a better idea about the doctors area of expertise.
• For the not so tech savvy patients, our Tele Agents will facilitate the searches and setup appointments. The system has features for phone and SMS reminders as well, thereby making the process convenient and hassle free.
• The web search will be very light weight since we are using web 2.0 technology and W3C framework.

The diagram below shows two different ways in which a patient can use our service. He/she can directly use the website to search for a suitable doctor and book an appointment. Or, the patient can call iKure’s Tele Agent to do the same for him/her. Similarly, doctors are in touch with the Tele agent for appointments and feedbacks and they also use the hosted application.

Now let’s list out some of the major benefits that SmartKure provides.

(a) Give people more information to make an informed decision in a timely manner while choosing a physician. A patient can avoid misguided advices of friends and relatives. He can search and find the best doctor himself without losing privacy. This will also help treat critical diseases such as Cancer, AIDS, brain tumor where the patients need the best physician quickly.

(b) Help doctors better evaluate the care their practices give and learn new ways to keep patients satisfied. Doctors are required to post up to 5 of their recent best handled cases. Other doctors can use these details in their own practice or just refer the patient to a better doctor themselves.

(c) Give the patients the power to help change the practitioner/hospital by creating a strong and large referral system. We intend to develop SmartKure’s referral system into the largest in India.

(d) Currently, there is no system in place, which can help a doctor to get the first hand information on the effect of medications, as there are new medicines reaching the market every day. The feedback mechanism will act as a data warehouse that can contribute in such research and analysis.

We have been talking a lot about rural empowerment, how does information reach the remote and rural areas then? SmartKure has a different mode of action there. The Rural Coordinator in our health kiosks located at remote locations will be our point of contact for this service and not the patients directly. He can work with the hosted application or even call up a Tele Agent to discuss the situation. The Tele Agent will provide him with details of a suitable doctor and can also fix an appointment if required. The Rural Coordinator then coordinates with the doctor for his patients. The process is illustrated in the diagram below.

Thus we see that SmartKure is an easy to use application with lots of health information for all medical entities and for all types of diseases. For a patient, it is a life saver. Our life is in our hands and we need the right information at the right time to preserve it!!

DgImage - Medical Imaging made easy

DGImage is a cost effective and complete solution designed and developed by iKure TechSoft (P) Ltd. for medical image acquisition and management of hospitals. Medical imaging is the process used to create images of the human body or its parts for clinical purposes. Usually these images are provided to patients in the form of films and scans as a hard copy. DGImage is the technology to work with and store a digital format of these images thereby helping hospitals become more environment-friendly by eliminating the use of paper, films, and minimizing the use of scanners and printers.

A multi pronged product from iKure, DGImage has the following components and functionalities:

Ø Acquisition of Medical images from various modalities like CR, DR, CT, PET, MRI, MI and Ultrasound. These digitized medical images along with relevant information are submitted to the DgImage gateway over TCP/IP network protocol for further processing by DGImage’s Image Processing Engine.

Ø Integration points for non-DICOM compliant modalities: DgImage complies with international standards such as DICOM (Digital Imaging and Communications in Medicine). But it works with non-DICOM compliant image sources as well.

Ø Dicomizes the medical images: In case the images received at the image processing engine are non-DICOM compliant, they are submitted to Dicomizer engine of DGImage, which standardizes the image as per DICOM standards.

Ø Compress and Encrypt the Medical images: The image processing engine uses industry standard algorithms for lossless compression and image encryption before storing them in the DGImage database. This helps hospitals in maintaining both - a high security standard and reduced storage space.

Ø Index and archive the Medical images: Hospitals need a long-term solution for medical image archiving that optimizes on volume, storage capacity and on-demand access. In order to achieve these targets we use the DGImage database with appropriate indexing, which facilitates faster retrieval of images in real time.

Ø Physical Data Backup of medical images: DgImage supports image backup on CDs and other backup media for up to 2 years. After a backup is taken, the images can be deleted from the database to free memory for new patients.

Ø Facilitate external system to query the data from DgImage database: Only authorized personnel are given access to the system.

Ø Integration points with internal and external Information Systems: In general, hospitals have various workflows catering to different healthcare processes. To support these workflows, multiple Information Systems are in place. For an efficient functioning, all these workflows need to work in harmony. DGImage helps to integrate all image related workflow by providing query and retrieval protocols to obtain images from the database in real time.

Ø View and analyze Images using DgImage viewer: DGImage Image Viewer, another component of the DGImage package, supports viewing and analysis of both DICOM and non-DICOM images. The Images can be exported to the most common picture or movie file formats. Dicomizer wizard is integrated with DGImage Image Viewer.

Ø Pre built integration to Smartkure and Medico-Informatics: DGImage has a pre-built integration in place with iKure’s other products - Smartkure and Medico-Informatics. This provides the hospitals with a complete solution integrating all workflows around patient management under a single platform.

Looking at the features of our product one can easily grasp its multi pronged benefits. The image above explains the structure and connectivity of DGImag. The image processing engine is the core component of DGImage. It receives images from the gateway server, processes the image and stores it on the database. It also enables the integration of DGImage with web server, authorization server, external systems, printers, archives, backup media etc. Hence, this product aids all entities of the medical system – Hospitals, Doctors and Patients. Some of its implicit benefits are:

ü Helps patients: The amount of data obtained in a single scan is very extensive. Most of this data is usually discarded when making films. However this data can be saved as digital format and that can save patients time and money, while reducing their exposure to radiation. As their scans are stored on a central storage system, patients need not worry about protecting the films.

ü Helps doctors: The doctors can modify the images (size, contrast, color, resolution, etc) using Image Viewer for better examination. They can also cross-refer the reports over the network to other doctors in real time.

ü Helps Hospitals: DGImage helps hospitals build a centralized Image Information and Management System to fetch, handle, store, analyze and transfer-over-the-network. It also enables hospitals to carry out image handling in a secured way prohibiting any unauthorized access to the hospital's Medical images.

ü Medical tourism and Diagnosis of remote patients: DGImage complies with international standards such as DICOM thus enabling hospitals to exchange more and more information with hospitals across the globe.

ü Adhering to a uniform standard for Medical Image Handling: DICOM is almost universally accepted among both manufacturers of medical imaging equipment, health care institutions and their IT departments. It has emerged as the common protocol for medical image communication world wide.

Medical imaging also finds its use in scientific and industrial applications. It has become a major tool in clinical trials since it enables rapid diagnosis with visualization and quantitative assessment. DGImage can be helpful in streamlining processes in an industry and making it much easier to store, retrieve and analyze data.

Health for remotest of areas – the iKure way

India is a country with a wide variety in almost every field – ranging from food, clothing, language, religion, festivals, to a great divide in academic and socio-economic backgrounds. More than two-thirds of India resides in villages and remote areas cut off from basic medical facilities. Caste divide adds to the existing woes of health services. About 65% of Indian women still deliver at home. There is a growing concern about health inequalities between different social groups. An idea of rural – urban disparity can be obtained from the statistics below:

Statistical Data (per 1000)	Rural	Urban
Hospital Beds	0.2	3.0
Doctors	0.6	3.4
Public Expenditures	Rs. 80,000	Rs. 560,000
Out of Pocket	Rs. 750,000	Rs. 1,150,000
Births Attended	33.5%	73.3%
Full Immunization	37%	61%

One the one hand we have a rural-urban disparity in medical care, and on the other, there is an increase in chronic conditions that need regular patient monitoring. Also, with hospitalization costs skyrocketing, patients are finding it difficult to be admitted in hospitals for a longer period of time. These factors are challenging the health system to find a new approach to health management.
A feasible solution is to remotely monitor patients and admit them only during emergency conditions. Our country needs a reliable and cost-effective remote health care monitoring solution. New technologies have come up that can scan and convert medical reports to digital format. This can be stored on central servers, to be accessed and shared by doctors. Worldwide it has been proved that Remote Monitoring, Telemedicine and Wireless Technologies if combined together, can improve health care delivery manifold.
Our company iKure TechSoft, strives to bring health services and insurance to the neglected section of our society, through an entrepreneurial “kiosk” model. We have tied up with SSE (Society of Social Entrepreneurs, IIT Kharagpur), who in turn is partners with GVL (Global Venture Lab), Finland. Selected entrepreneurs are trained under the TEDP (Technology based Entrepreneurship Development Program) course at IIT Kharagpur. They are given rigorous training in personality development, business calculations and risk management. Kiosks, thus setup by these budding entrepreneurs are the nodal point of telemedicine and remote patient monitoring.
Every ‘health kiosk’ has a Rural Medical Practitioner (RMP) who has been trained by specialists using advanced technology. The RMP helps patients take readings for BP, Blood Sugar, Body Temperature, Electrocardiogram (ECG), Weight, Height, Pulse, etc. These readings are wirelessly logged into the system, as they are all in digital format. Based on the patient’s test results, the RMP can prescribe medicines. His analysis and prescription is also entered into the system. In case of a complicated or confusing case, the patient may need special medical advice. For this he/she is referred by the RMP to a hospital attached (contracted) to the kiosk. Hence, these special health centers called ‘health kiosks’ guide patients in getting better access to doctors without venturing very far from their home.
When a patient is referred to a specialist, his medical history is sent wirelessly to the hospital. This provides the doctor with instant access to the patient’s medical reports and also to the line of treatment followed by the RMPs at the health kiosks. Patients from rural areas usually don’t remember details of their medical history and are not aware of medication they have taken. So, having test results and prescriptions transmitted to the hospital or to specialist, helps reduce consultation time with the new doctor. On the other hand, if the case is not that serious, the RMP can also consult a specialist via phone after transmitting his patient’s details. This further saves the patient travel time, cost and energy.
The new age technology that has made the whole idea work, is a handheld device called WHIMS (Wireless Health Incident Monitoring System) which is currently under the patent process. This is the core device that collects digital data from various health monitoring devices and sends them to the main system. WHIMS provides lot many benefits:

1. As this device enables the patients to be in touch with the health experts around the clock, it brings an emotional security and support to them.
2. The adaptable technology of the device helps it to work with multiple measuring devices, thereby covering all the major chronic diseases that can be remotely monitored.
3. Device has a broad spectrum, from urban to rural areas, from educated to illiterate.
4. It is simple and easy to use.
5. It has a facility to send an auto alert to doctors when the readings are way beyond the acceptable range.

IKure has already setup a functional kiosk at a remote area in Madhyamgram, North 24 parganas, West Bengal. The kiosk has facilities for measuring vital statistics, BP, blood glucose, pulse, etc. and to transmit data to some hospitals in Kolkata. A few other projects are in the setting up phase in Durgapur area of West Bengal.

Along with setting up kiosks, Ikure also aims to bring specialists from other areas such as Vellore, Chennai and Mumbai for complicated and unique cases. The patient’s data will be shared by these specialists & the patients can have a remote consultation with these doctors. In case there is a surgical requirement the specialist can intimate the patient on details of cost, hospitalization tenure etc., so that the patient can travel with all the details in hand. Besides helping the patients the data accumulated at the central monitoring server can also be utilized by various research firms and health agencies for study of new medicines, their effectiveness and for general medical research.

Thus we see that the contributions of Remote Monitoring and Wireless Technologies to health care delivery are 3 fold. Access, especially to under privileged, and to provide better Quality at reduced Cost.

Teleradiology - Ikure initiative

TeleRadiology: Tele Radiology is a branch of Tele Medicine that deals with transmission of digitized radiographic images for interpretation by a specialist. It is one of the fastest-growing areas in health care worldwide. It is one of the most widely deployed uses of telemedicine and also tops the list of outsourced telemedicine services. TeleRadiology helps bring cheaper, faster and high quality radiological services to patients, irrespective of his location. It even helps doctors discuss critical and unique cases across the globe, thereby bringing much needed hope to patients and their families.

iKure proposes to bring forth an affordable and efficient mechanism for teleradiology image management of hospitals in India through its product called DgImage. DgImage complies with international standards such as DICOM (Digital Imaging and Communications in Medicine), thus enabling hospitals to easily interpret each others scans. The digital images are small enough and are easily stored in databases. DgImage coupled with SmartKure (another product from iKure), allows not only doctors but even patients to access their radiology reports from anywhere and at anytime.

Teleradiology helps improve patient care, as it provides access to sub specialists even in remote and underserved areas. The radiographical images taken in rural areas can be sent to hospitals and specialists in the city using WHIMS (a health monitoring product from iKure). Patients do not have to travel far and wide, thereby cutting overall cost of treatment. In a country like India, where the majority still lives in villages, health care is always a challenge. iKure aims to provide them with cheaper and quality healthcare in a self sustaining model.

Some years ago, a study by radiology experts in the US predicted that up to 20% of image interpretation business would soon be provided via teleradiology. Today’s fact is that teleradiology makes up nearly 50% of all telemedicine applications.