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Case study– Obstetrics & Pediatrics

Patient logs into the Patient logs into the website or makes a phone website or makes a phone

call for an appointmentcall for an appointment

I rregular menses

Anita Roy

anita@gmail.com 9899720801

Gynaecology

Dr. D. Prasad

20 OCT 2007

21 OCT 2007

Patient is given reminder Patient is given reminder about the appointment and about the appointment and current status of the queue current status of the queue

on her mobileon her mobile

SMS- 15 min delaySMS- 30 min delaySMS- 1 hr delaySMS- 2 hr delaySMS- 4 hr delaySMS- 1 day delay

Patient gets a unique Patient gets a unique registration number for registration number for

all subsequent visitsall subsequent visits

RBN20071021012 ROY O +VE

17 NOV 1969HOUSEWIFEMRS

ANITAMARRIED

C-56, FIRST FLOOR

ARDEE CITY

NEW DELHI

DELHI

110016

2210221

997202225

ANITA@GM

DILEEP

ROY

HUSBAND

9972022251

Patient meets the relevant Patient meets the relevant doctor, fee is collected based doctor, fee is collected based

on relevant price liston relevant price list

Charges calculated based on Doctor’s SpecialtyDoctor’s SeniorityVisiting doctor’s own OP ratesDate of last visitCross-referral chargesPatient category discountsCorporate/ Insurance rate listsPatient’s income category

Charges calculated based on Doctor’s SpecialtyDoctor’s SeniorityVisiting doctor’s own OP ratesDate of last visitCross-referral chargesPatient category discountsCorporate/ Insurance rate listsPatient’s income category

31 yrs 11 mon 8 d Female OPD

--1

Suspected pregnancy

3 w

Past cycle 10-12 / 24-25 days Para 1 + 0. Last child age 3 yrs. 2 month amm

Mother with asthma

Obstetrical and menstrual History

Past Medical & Surgical History

NA

98

Per abdmonial examination shows a lump arising from the pelvis 8-10 week size. Per vaginal examination shows uterus 14-16 week size mobile

I rregular menses with bulky uterus suggestive pregnancy

80

Anita Roy

Family History

Duration of present complaint

Doctor takes the relevant Doctor takes the relevant history, conducts systemic history, conducts systemic examination and records examination and records

provisional diagnosisprovisional diagnosis

Doctor takes the relevant Doctor takes the relevant history, conducts systemic history, conducts systemic examination and records examination and records

provisional diagnosisprovisional diagnosis

31 yrs 11 mon 8 d Female OPD

--1

Suspected pregnancy

3 w

Past cycle 10-12 / 24-25 days Para 1 + 0. Last child age 3 yrs. 2 month amm

Mother with asthma

Obstetrical and menstrual History

Past Medical & Surgical History

NA

98

Per abdmonial examination shows a lump arising from the pelvis 8-10 week size. Per vaginal examination shows uterus 14-16 week size mobile

I rregular menses with bulky uterus suggestive pregnancy

80

Anita Roy

Family History

Duration of present complaint

My Templates

History & Physical

Obs & Menses

I nfertility

I rregular menses

Hysterectomy

Ovarian cancer

Pregnancy

Rupture uterus

Vaginal discharge

Family

Ellipsis

Asthma

I nfertility

Diabetes

Cardiac

J aundice

Prov. Diagnosis

Fallopian Tube

Vesicular stone

Uterine fibroid

Pregnancy

Systemic Exam

Orders

Follow up

Based on the provisional Based on the provisional diagnosis, additional diagnosis, additional

investigations and medications investigations and medications are ordered using templatesare ordered using templates

Pregnancy is confirmed after Pregnancy is confirmed after the USG – radiology reports the USG – radiology reports and images are available to and images are available to

doctor at her computerdoctor at her computer

Anita Roy

31 yrs 11 mon 8 d Female Room #6 Bed #3

Full term pregnancy1

Irregular menses with pain in lower abdomen since 21/04/2007

Bulky uterus since 21/04/2007

Chest X Ray received at 22/10/2007 10:05 AM

Pharma Order: Autrin at 21/10/2007 6:10 PM

Radiology order: ECG order at 21/10/2007 6:10 PM Appears at emergency with full term on 22/10/2007 11:30 PM

Excessive menstrual bleeding since 18/10/2007

GENERAL EVALUATION:

Fetal Cardiac Activity: Normal at 141 BPM.Fetal Lie: LongitudinalFetal Presentation: CephalicPlacenta: Anterior, Grade II.Uterus: NormalCervix: ClosedAdnexa: Not seen.Amniotic Fluid: NormalBIOMETRY:BPD: 6.4cm consistent with 38 weeks, 2 daysHC: 33.1cm consistent with 37 weeks, 5 daysAC: 37.0cm consistent with 40 weeks, 6 daysFL: 7.7cm consistent with 39 weeks, 3 daysCI (BPD/OFD): (70-86) 83FL/BPD: (71-87) 82FL/HC: (20.6-23.4) 23.3FL/AC (20-24) 21HC/AC: (0.87-1.06) 0.89

I mages

Anita Roy

41 yrs 11 mon 8 d Female Room #6 Bed #3

Irregular menses with pain in lower ...1Pregnancy 1st trimester. Routine investigations

Routine investigations are Routine investigations are ordered using templates and ordered using templates and results are compiled centrallyresults are compiled centrally

The hospital reminds the patient The hospital reminds the patient of the next appointments – and of the next appointments – and

gives education material for gives education material for each trimester- using pre-each trimester- using pre-

defined templatesdefined templates

Anita Roy

31 yrs 11 mon 8 d Female Room #6 Bed #3

Full term pregnancy1

Irregular menses with pain in lower abdomen since 21/04/2007

Bulky uterus since 21/04/2007

Chest X Ray received at 22/10/2007 10:05 AM

Pharma Order: Autrin at 21/10/2007 6:10 PM

Radiology order: ECG order at 21/10/2007 6:10 PM Appears at emergency with full term on 22/10/2007 11:30 PM

Excessive menstrual bleeding since 18/10/2007

Patient Education

Asthma during pregnancySince asthma is a very common disease affecting millions of people, it is not strange that lots of mothers-to-be would be suffering from asthma as well. Asthma often worsen during pregnancy, especially in conditions that are already severe. There are others who improve during pregnancy, especially if their disease was mild before they became pregnant. Another third experience no change. Cases where asthma or asthma attacks become worse, they mostly occur during 24 to 36 weeks of pregnancy. Only about 1 in 10 women with asthma have symptoms during delivery.Medication - to take or not to takeContinuing to take asthma medications during pregnancy is a must. One can do worse damage by not taking them.Today there are many excellent medications for treating asthma and allergies. Although no medication can be proven entirely safe for use during pregnancy, the patient and the doctor can work together to develop a treatment plan that carefully balances medication use and symptom control, and assures that the potential benefits of the medication outweigh the potential risks of the medication and of uncontrolled asthma.Can one take allergy shots during pregnancy?Allergy shots do not have an adverse effect on pregnancy, so they can be continued. As always, your allergist will monitor your dose to lessen the risk of an allergic reaction to the shots. These reactions are rare; however, such a reaction could be harmful to the fetus. Allergy shot treatments should not be started for the first time during pregnancy

Asthma

Medicine

Allergy

Dietary

Exercise

Patient appears at Patient appears at emergency without any emergency without any

records – triage records – triage conducted at the ERconducted at the ER

Severe pain

60

40

99.1 125

10080

Full term pregnancy Under hospital supervision

31 yrs 11 mon 8 d Female Emergency

Full term pregnancy-4Anita Roy

Attending doctor views Attending doctor views patient history allergies, patient history allergies,

radiology reports, radiology reports, medications, past lab results medications, past lab results

and other specific instructionsand other specific instructions

The admitting doctor The admitting doctor consults with the attending consults with the attending

gynecologist on phonegynecologist on phone

Doctor advises admission, Doctor advises admission, patient appears for patient appears for

estimation and finds out the estimation and finds out the deposit amountdeposit amount

The provisional diagnosis The provisional diagnosis and the estimate are sent to and the estimate are sent to

the cashless insurance the cashless insurance company with the necessary company with the necessary

pre-authorization form pre-authorization form

Patient is allocated a room Patient is allocated a room based on the patient choice based on the patient choice

and availabilityand availabilityMRN2345566Asha Goyal , F/21Uterine FibroidDr. B.Prasad

MRN2345566Asha Goyal , F/21Uterine FibroidDr. B.Prasad

OT is scheduled for the OT is scheduled for the patient based on the patient based on the

availability of the visiting availability of the visiting surgeonssurgeons

Anita Roy

41 yrs 11 mon 8 d Female Room #6 Bed #3

Irregular menses with pain in lower ...1

Nurses place the ward charges Nurses place the ward charges directly to the patient account directly to the patient account

at the point of care – rather at the point of care – rather than making paper chargesthan making paper charges

All orders for the patient are All orders for the patient are consolidated for quick review consolidated for quick review – thus minimizing follow up – thus minimizing follow up

needsneeds

The relevant lab results are The relevant lab results are consolidated in clinically consolidated in clinically

useful forms for the doctoruseful forms for the doctor

Order Flag

Pre-op checklists given to Pre-op checklists given to nurse using templates – nurse using templates –

patient is monitored through patient is monitored through flowsheet and chartsflowsheet and charts

ITEMSSystolic BP

Diastolic BP

Primary surgeon : Dr. D. SinhaProc surgeon : Dr. R. GuptaMonitoring staff : ShyamalaMonitoring start :10/11/2007 11:00 am

120

100

80

60

40

Anita Roy

41 yrs 11 mon 8 d Female Room #6 Bed #3

Irregular menses with pain in lower ...1

OT notes during the OT notes during the surgery prepared using surgery prepared using

templatestemplates

After the surgery, the After the surgery, the patient is monitored and patient is monitored and

medication record medication record preparedprepared

Anita Roy

41 yrs 11 mon 8 d Female Room #6 Bed #3

Irregular menses with pain in lower ...1

The patient account balance The patient account balance is periodically reviewed and is periodically reviewed and

additional deposits are additional deposits are requested, if neededrequested, if needed

Direct material are tracked Direct material are tracked to the patient consumptionto the patient consumption

Consumption is tracked to Consumption is tracked to the departments, based on the departments, based on budgetary guidelines; while budgetary guidelines; while the inventory is tracked at the inventory is tracked at the stores and sub-storesthe stores and sub-stores

Discharge summary is Discharge summary is automatically prepared automatically prepared and specific follow up and specific follow up instructions are given instructions are given

using templatesusing templates

ANITA ROY

HOUSEWIFEFEMALE17 NOV 1979

Emergency arrival with labor pain

Routine investigations to establish surgical fitness – USG, CBC, routine urine, blood sugar, serum, SGPT

Full term pregnancy requiring Cesarean section

Cesarean section was conducted. Infant and mother recuperated sufficiently. The postoperative period was uneventful. Some bleeding seen, mostly in the anterior uterine wall.

Discharge bill is immediately Discharge bill is immediately consolidated based on all the consolidated based on all the

charges made through the charges made through the patient staypatient stay

Baby is automatically Baby is automatically registered in the hospital registered in the hospital

for subsequent visitsfor subsequent visits

Pediatrician assigned, Pediatrician assigned, history and vitals history and vitals

maintained as medical maintained as medical recordrecord

1

0 yr 0 mon 2 d

Nil Nil

-

Nil

-

Born of LSCS. Uneventful birth.

Maternal grandmother with a history of asthma

18

6.2

Nil

Nil

Education material on Education material on baby care given using baby care given using

templatestemplates

Baby Nutrition TipLearn what healthy nutritional needs your new baby or infant has. The below tips will help you decide what feeding schedules and baby food is age appropriate for you child. When Can Baby Drink Water?Nighttime Feeding WeaningHow Often Should You Breast Feed Baby?What Mom Should Eat While Breast FeedingStoring Homemade Baby FoodBaby Clothing Tip These baby clothing and apparel tips will help you pick the right clothing styles that are safe, comfortable, and seasonally appropriate for your baby. Read how you can make the most of your baby clothing budget and not over buy certain items. Baby Behavior Tip

Learn all about your babies cries? Is she hungry, sick, or just need attention? Find more information and tips about why your baby fusses, smiles and acts the way she.

Patient Education

Reminders for immunization Reminders for immunization and birthday wishes given and birthday wishes given

for entire 5 yearsfor entire 5 years

Immunization due RBN071020013

The patient logs in the The patient logs in the hospital website to download hospital website to download

discharge summary, lab discharge summary, lab reports, bills and seek reports, bills and seek

appointmentsappointments

Welcome Ms. Anita Roy

The documentation generated –for The documentation generated –for clinical as well administrative clinical as well administrative

workflow – closely meets the HL7 workflow – closely meets the HL7 and NABH guidelinesand NABH guidelines

Extensive graphical Extensive graphical reports and excel–like reports and excel–like queries are generated queries are generated

based on the billing databased on the billing data

The reporting tool is The reporting tool is leveraged to carry out leveraged to carry out

patient research based on patient research based on clinical conditions clinical conditions

Asclepius Consulting Asclepius Consulting collaborates with the collaborates with the hospital to generate hospital to generate

specific dashboards to specific dashboards to Report-by-ExceptionReport-by-Exception

Operations

Customers

Investors

Partners

Employees

Innovation

DASHBOARD METRICS

• Effective Surgical Revenue (ESR)• Effective Bed Revenue (EBR)• Effective Diagnostic Revenue (EDR)• Operating costs

• ROCE• Operating Margin• PAT growth• Cost of Capital

• No. of partner patients• No. of referrals from partners• Operating margin at partner sites• No. of technology transfer

initiatives underway

• Attrition rate• No. of training days• No. of full time doctors• Employee satisfaction

index1

• No. of case sheets generated

• No. of research published• No. of technology

initiatives underway

• Average revenue/ patient• Market share• % of repeat patient • Patient satisfaction index

Operating costs• Consumable costs• Salary costs• Rental costs• Pharmacy costs• Marketing costs• General Admin costs

Operating costs• Consumable costs• Salary costs• Rental costs• Pharmacy costs• Marketing costs• General Admin costs

Consumable costs• Direct material• Overhead material• A- Category material purchase• Avg. direct consm per patient

Consumable costs• Direct material• Overhead material• A- Category material purchase• Avg. direct consm per patient

Average revenue/ patientMarket share% of repeat patient Patient satisfaction index

Attrition rateNo. of training daysNo. of full time doctorsEmployee satisfaction index1

ROCEOperating MarginPAT growthCost of Capital

Effective Surgical Revenue (ESR)Effective Bed Revenue (EBR)Effective Diagnostic Revenue (EDR)Operating costs

Operating costsConsumable costsSalary costsRental costsPharmacy costsMarketing costsGeneral Admin costs

Operating costsConsumable costsSalary costsRental costsPharmacy costsMarketing costsGeneral Admin costs

No. of partner patientsNo. of referrals from partnersOperating margin at partner sitesNo. of technology transfer initiatives underway

No. of case sheets generatedNo. of research publishedNo. of technology initiatives underway

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J.P. Nagar, 6th Phase,Bangalore – 560078

Tel: +91 80 4165 0200 +91 99720 22250

www.asclepiusconsulting.com