Sales Pitch V0.7

Charak suite of Healthcare IT products: An overview

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Asclepius has a healthcare IT product FOR India- Charak Augmented with consulting, software service and implementation offering Asclepius’ Offerings Management Consulting • • • • • Offered complementarily with Charak to ensure completeness, while enriching Charak modules Critical to ensure ‘one-stop-solution’ for customer and for Charak to evolve

New business planning Business process re-design De-bottlenecking Clinical workflow improvement Investment banking

Charak suite of Healthcare IT products

• Focus on clinical information systems (CIS) Made to Order Software• Includes HIS, LIS and IIS Solution (MTOSS) • International quality solutions built for Indian clinical workflows • Synergizes with Charak to • Robust solutions built on six support specific IT needs sigma methodology • Six sigma software design and development methodology to ensure world class software

Offered as diagnostic studies/ strategy workshop to build team credibility Gives insights into customer requirements Vital Charak sales strategy to build partnership

Offered as an end-to-end solution developing interfaces etc. to ensure successful usage Key offering needed to gain customer acceptance and higher satisfaction

Implementation and life cycle management • Process design, BPR • Multi-product, multi-generation interfacing and integration • Training programs, workshops, change management • Software support and upgrade services

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Asclepius Consulting has worked with some of the leading Indian healthcare providers over multiple engagements Select client list A 1700 bed multi-specialty hospital at Belgaum, Karnataka, KLES hospital has engaged Asclepius over multiple engagements like material management, investment banking and cardiology EMR software

CSI is a 120 years old, 220 bed multi-specialty hospital. It is leveraging Asclepius’s services across the HIS/ CIS/ RIS/ LIS workflow, while leveraging extensively on its Process Consulting services

Church of South India Hospital, Bangalore

B2F is a chain of clinics specializing in sports medicine and musculo-skeletal conditions. Asclepius has been involved with the founding team right from the business planning level till project roll out and associated IT initiatives. Asclepius holds a Board of Advisor seat in the company HCG group is a chain of 15 hospitals focused only in Cancer care, supported with state of art oncology equipments. Asclepius is supporting the group in implementing several growth strategies, streamlining multiple IT solutions and setting up a multi-site HIS/ CIS solution MVA is a leading 100 bed pediatrics and maternity care hospital in Patna.

Mahavir The hospital has engaged Asclepius over a multi-generation software Vaatsalya,Patna solution to meet the growing HIS/ CIS/ RIS/ LIS needs of the hospital

Our business model thrives on acquiring multiple engagements from our existing clients by consistently exceeding expectations and building long term relationships 3

Hospitals in India are adopting IT in a massive way– driven by changing business conditions Why are Indian hospitals adopting IT?

“A robust IT system supporting the clinical workflow.. is the need of hour.. the next wave of modernity.. the new Healthcare Increasing time insurance legal pressure pressures needs on doctorsrule of Accreditation competition needs from Government Increasingly aware patients Get more from same set of resources ••Liability Cashless Good doctors ofinsurance clinical arebring always negligence laystate-of-art down pressed is very alltechnology for stringent on time Larger Stringent hospitals process and documentation needs

•Most I cangame.. spendhospitals money –are buthospitals don’t have time will good running at close to the the documentation hospital across care process to from provide NABH betterneeds facilities 100% utilization ••Increasing of reports patientsand across I can’t carrynumber all those files ••multiple •Attempts Major Documentation losses facilities in collections is only protection due to difference Technology Increasingly is patients leveraged shall to decide build strong hospital toadopt improve revenue fromfrom same set either & succeed or •of I can’t wait for appointments and long in litigation authorization and approval processes quality based and on enhance accreditation quality ratings of care resources (Higher revenue/ ft.)in •Spend unnecessary inefficientsq. time queues ••Specific Most Negligence corporate cases and customers are repetitive typical insist activities adjudged on More Huge and resources higher required paying patients for meeting are procrastinate & perish” •documentation focus to reduce ALOS, increase supporting cashless against insurance attracted accreditation those needs at hospitals forefront of technology •unfavorably My familyto need personalized care efficiency and optimize utilization

Dr. S.K. Bhattacharya, ICMR, Govt. of India

Increasingly aware patients Increasing legal pressures

Increasing competition Increasing time pressure on doctors Accreditation needs from Government Healthcare insurance needs Get more from same set of resources 4

Globally, IT in hospitals, undergo a transition from administrative to clinical processes ILLUSTRATIVE

Clinical

Features for Hospital IT Clinical

EMR EMR – Alerts

Remote patient care Drug data Patient Clinical bank monitoring protocols

EMR – Charting EMR – Vitals EMR – Orders

EMR – Discharge summary EMR – EMR – Investigations Diagnosis EMR – Medication Admin Stores EMR -Flowsheets Pharmacy

Administrative

Billing Discharge Admission

Lab Information system (LIS) Emergency Orders handling Clinical rules Radiology Information System (RIS)

Clinical decision support

Insurance Inventory management

Registration Time

After successful automation of administrative processes, Indian hospitals are increasingly adopting clinical processes 5

While the benefits of automating administrative activities have been established, IT enabling the clinical processes yields higher benefits ILLUSTRATIVE

Potential benefits from IT

Demonstrated benefits of hospital IT 85% faster admission, transfer & discharge

Typical benefits from CIS

40% faster diagnosis time 30% reduction in medication dispensing error 20% faster inventory re-stocking 20% reduction in Average Length of Stay

Typical benefits from HIS

80% reduction in billing errors 40% growth in patient volumes 33% growth in profit margins

If you cant measure it, you cant manage it ! Source:

Typical impacts measured by IT implementation in a North American Pediatric hospital

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A strong IT system is increasingly demanded by the hospitals to build robust processes and achieve efficiencies “Every patient should get the same excellent care across the entire hospital” KLES, Belgaum

“I could manage the show when the hospital was small, now I need to delegate with… repeatable and replicable processes” Franchisee hospital, Apollo Group

“..if only, my MBBS doctor could be reliable enough to take some roles of the senior doctors” Cardiac specialist, Patiala

“..I have to stay up till midnight to manage the show here..(its) inefficient and unreliable” Raj Hospital, Ranchi “..only large branded hospitals can afford accreditation”

• Processes are vital to standardize care and achieve efficiencies • Large hospitals have been able to leverage IT to build these processes • While mid sized hospitals have reaped benefits through HIS implementation, CIS solutions can achieve higher efficiencies by automating clinical processes

Ruban Memorial, Patna

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The product – Charak - is an end-to-end IT solution for the entire hospital with sufficient depth to meet the needs of an involved user Clinical

ILLUSTRATIVE

Infrastructure modules

Ancillary systems

Administration

MTOSS

Specialty modules Value added modules Core modules

 Covers end-to-end treatment cycle • From pre-admission to diagnosis, orders, treatment, monitoring and discharge  Integrates with multiple hardware • Mobile phones, digital pens, voice recorders, bed side devices  Is accessible remotely • Available on internet, with thin client solution  Built on six sigma quality and international standards • Compliant to HL7, DICOM, IHE guidelines  Provides process control • Through protocols, pathways and clinical decision support  Supports research • For clinical procedure evaluation, evidence based medication etc.  Is specific to specialties • E.g. different work flows for gynecology vs. cardiology  Meets the documentation needs for accreditation and cashless insurance process

The software comprise over 100 modules – majority available as standalone solutions – working seamlessly with existing IT solutions Existing IT system

Charak modules ADMINISTRATIVE MODULES

CLINICAL MODULES

ANCILLARY MODULES

INFRASTRUCTURE MODULES

Admission, Discharge Transfer (ADT)

Orders and Medication Record

Clinical Decision Support

Interoperability

Scheduling

Documentation & Notes

Clinical Protocols

Hardware Options

Material Management

Charting and Flowsheets

Management Information Systems

Privacy and Security

Event-based Billing

Alerts/ Reminders

Device Integration

System Monitoring

LIS/ RIS

Research 9

The administrative IT solution (HIS) covers the entire administrative needs of the hospitals

Go to Patient

Register patient

OPD Billing

IPD Billing

Event log book

Material Tracking

Admit patient

Day Procedures

Investigation Billing

Discharge patient

Package Estimation

Hospital Services

Pharmacy stock review

Transfer patient

Cashless Insurance

Pharmacy billing

Administrator

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Event based patient care system ILLUSTRATIVE Examination Procedures

Monitoring

Lab

Radiology

Others

Discharge

Emergency OPD Day care IPD

• Deluxe room admit time – 28/9/07 9:00 am • History – Cardiac patient, asthmatic • Physical - BP-130/85 28/9/07 9:10 am • Provisional diagnosis – Stone in Gall bladder

• ICU entry time – 29/9/07 4:00 pm • Payment –Rs. 1400 (due) • ICU exit time – In ICU • Oxygen start time – 29/9/07 4:10 pm • Oxygen end time – 29/9/07 4:50 pm • Dr. S. Kumar entry– 29/9/07 4:20 pm • Dr. S. Kumar exit– 29/9/07 4:25 pm

• X-ray – 28/9/07 9:00 am • Payment – Rs. 110 • Report – Awaited • Alert sent to radiologist – 9:45 am • Ultra-sound - 29/9/07 7:00 pm • Payment – Rs. 350 • Report – Received 30/9/07 8:00 am

Such an event based patient care system can integrate the clinical and administrative events throughout the patient care process

The elements of electronic medical record (EMR) comprise all relevant information from the clinical processes  Past and present history  Problems and complaints  Physical examination  Systemic examination

EMR number RIMS072201223

 Diagnosis  Investigation reports

Aditya Goyal 07 NOV 2005 B +ve

 Radiology images  Flowsheets & device data  Surgery notes

• Patients go where the hospitals ‘know them’ – for preventive check up, emergency, surgery as well as standard cure • EMR generates a single consolidated record for all relevant patient information – valuable during the stay • The EMR should be readily available – through internet, mobile phones, across hospital facilities

 Progress notes  Medications  Discharge summary 12

All the relevant activities – for the doctor, the patient, the admin staffcan be accessed through a central switchboard

Go to Patient

Patient summary

History & Physical

Alerts

Billing & Material status

Medication administration record

Events record

Doctors

Diagnosis notes

Device data and images

Lab reports

Surgery notes

Research notes

Care plan & Protocols

Charting

Discharge summary

Doctor Notes

Flowsheets

Follow up advices

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All notes from doctors, nurses, labs etc. can continued to be captured on paper – and seamless integrated with Charak

The digital pens allow minimal change in clinical practices – at OPD, during wards rounds, discharge, follow ups etc. 14

The critical data available remotely on mobile phones and hand-held The critical data is available remotely on mobile phones and hand-held devices devices

View list of patients with critical details Get alerts on patients in wards/ ICU View key patient data (BP, ECG) Give medicines and lab orders Advise treatment remotely Know appointments, schedule-for-day

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Charak can extract data from any digital medical device - bed side devices, digital X- rays, CT scans -and integrate it with patient record

• The Charak team has extensive experience in interoperability of clinical software – across devices, CIS systems, Labs and Radiology systems • Charak conforms to HL7 standards, hence shall seamlessly integrate with all new hospital software appearing in future • Charak is built on DICOM standards to ensure easy transfer of digital radiology images • Charak has specific solutions for image viewing and interfacing with standard PACS solutions

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Asclepius adopts robust business process re-engineering frameworks to improve upon existing processes while minimizing changes To-be process mapping

How is the doctor recommending discounts accounted for?

How do you handle multiple deliveries against a single Purchase Order?

Do you charge for dressing services or for cotton & gauze?

What is the stock of all paracetamol put together?

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Together with the consulting services, the software can meet several documentation needs required for NABH accreditation Accreditation needs from NABH Access, Assessment & Continuity of care (AAC) Patient Rights & Education (PRE) Care of Patient Management of Medication (MOM) Hospital Infection Control (HIC) Continuous Quality Improvement (CQI) Responsibility of Management (ROM) Facility of Management and Safety Human Resource Management (HRM) Information Management System (IMS)

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High support

Support from Charak

◑ ● ◕ ● ◔ ◑ ◑ ◑ ◑ ●

Support from Process Consulting

● ● ◑ ◑ ◑ ◕ ◔ ◕ ● ●

○

Low support 18

The software generates relevant MIS for the hospital to check aggregate hospital performance

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The proposed aims to minimizes the total cost of ownership by taking care of all the relevant costs accruing to the hospital Very competitive license costs Lowest customization cost Professional process consulting Thin client solution implies minimum hardware requirements Easy integration with multiple devices Seamless interfaces with existing systems Integration with DICOM devices Expertise in integrating HL7 devices Free upgrades with AMCs Negligible run time license costs Minimal costs for additional user licenses High quality lead to low debugging costs Local service network for AMC Remote performance monitoring Easy integration with future HL7 solutions Easily scalable to additional facilities and expansions

Significantly lower total cost of ownership (TCO)

Illustrative

Asclepius offers world class IT solutions – with high quality and international features – at a very affordable total cost of ownership • Built by Indian doctors

• Six sigma quality leading to negligible bugs

• Extensive depth in features

• HL7 and DICOM compliant

• Extracts data from devices • Extensive configurability

• Conforms to IHE and NABH guidelines

• Integrated ecosystem

• User- centric design

• Shows radiology images

• Extensive domain expertise

• Allows remote data access

• Team of doctors, process consultant, GE Healthcare

• Very affordable prices

• Low customization costs

• Cheap hardware required

• In depth process analysis

• Zero run time license costs

• Collaborative implementation

• Remote performance monitoring

• Provide hand-holding, drive change management • Free upgrades with AMCs1

Free uprades or first 30 customers only1

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Charak can create significant improvements across your hospital

Patients

Well Long defined appointments waiting time (At OPD,and surgery, wards, discharge) scheduling Delayed emergency Quick response at the response Golden Hour

BETT ER QUA ITY O oldL records) F C Multiple visits A Consolidated data Rclinical Elabs, reports, (Visits for consultations, (Missing data, triage, ambulance)

Multiple investigations Standardized care plan (Similar tests conducted due to missing

available follow remotely ups)

Doctors

E M I T E RE Forders)

Extensive paper work Computer reports (OT notes, generated discharge summary,

E R MO

Hospital

Sub-optimal Hospital wideresource resource utilization optimization (OR, wards, doctor’s time, labs)

E U N E V RE R E H IG H T. F . Multiple coordination Poor hospital evaluation Q S Centralized planning and Extensive computer ERmetrics to measure hospital Peasy (OR planning, duty allocation, (No

Repetitiveactivities activitieswith Automated (Patient instructions, pharmacy, billing status report only estimations)

Limited resources High resource utilization

(Doctor’s time, beds, OPD hours)

scheduling appointments)

generated MIS performance)

Multiple follow ups Alerts and Exception based (Check patient conditions, order status,Reporting room occupancy)

Transaction material Wastages based and pilferage (OR material, tracking stores items, pharmacy) 22

No. 8, 1st Floor, 15th Cross, 100 Ft Ring Road, J.P. Nagar, 6th Phase, Bangalore – 560078 Tel: +91 80 4165 0200 +91 99720 22250 www.asclepiusconsulting.com All rights reserved. These pages are to be used for selected audience only. Distribution, quotations and duplications — even in the form of extracts — for third parties is only permitted upon prior written consent of Asclepius Consulting.

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Additional slide on competition

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While the HIS market has highest competitive intensity, the CIS market has fewer players owing to high investment in building market knowledge Competitive landscape

IS fo In cu di se an d pl mi ay der siz s ed

• E.g. Santosh Services, Patna • Primarily billing solution built at Rs. 50-75,000 per hospital • Consistently poor on quality and scalability – despite built in close collaboration with the hospital • Easy replacement market, provided hospital’s readiness • Compete on Features Quality and Scalability

ex ‘n d ze ’ ni ors ga d or en un v

td

H

l al Sm

• E.g. 21st Century, Karishma, Shobha • Largely stable HIS solution developed over multiple installations in India and Middle East • Install-base primarily in 500 bed plus hospitals together with Middle East markets • Investments in EMR products largely through service route leading to limited functional expertise • Compete on product relevance and quality, scalability in clinical space, internet based delivery

r oo

m f ro ts s uc er od ay pr pl al al ic n in tio cl a p rn ee inte

‘I n du so str ftw y n ar eu e tr se al r v ’ In ic di es a n

D • E.g. IBA, Perot, Siemens • Strong proven clinical product from international market. Frequently, sell software packaged with healthcare devices • Typically over-designed clinical solutions built as ‘strip-down’ version of US market product • Price points unviable for mid-sized hospitals • Compete on close feature match, lower costs and better reach

• E.g. Wipro, IBM, Intersystems • Leverage strong admin solution built over multiple services delivery. Significant depth in clinical products. Supported with strong on-ground sales force and market reach • Not a priority sector for these players. Most solutions build on the product from US markets only • Compete on better market understanding and industry relevant features

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