The Indian market simply by virtue of coming late to the party had skipped through the perils, cost, and complexity of integration, and benefited with full-bodied unified products that were far more cost-effective and simple.
However, India faced its own set of challenges, as EMR remained largely the stepson, with companies gravitating towards appointment booking, SMS reminders, and prescription writing. Very few Clinicians would ask for more; it was akin to having a baby without the 9-month labour. Patients receiving SMS reminders for their appointments were left visibly impressed, putting the Clinic in good light, and the Physician could continue writing prescriptions by hand. The only thing that had changed here was the skillset of the receptionist who was now making appointments on a computer rather than the register. Some Physicians went a step further and even started recording their prescriptions on software, which produced smart printouts, way better than the (bit difficult to read) handwritten notes.
This was a good start in the right direction. However, more complex products that offered the complete suite were left to adapt and move their marketing budgets from marketing to re-educating and creating awareness – that prescription writing in isolation without a context of the Patient’s past medical history, allergies, active problems, family history, was a mirage in the making. By putting an effort into recording information in software, you were digitizing patient data, but because the software was so basic and limited, it became a data entry tool, that gave nothing back in return. The early adopters in the medical community got burnt, over and over again. They were putting in a herculean effort towards the adoption of poorly designed, sub-standard products to record every component of a patient’s encounter, only to get nothing of value back when it came to medical summaries and follow-ups. This led to the onset of a new problem.
While the Australian market created niche software products with limited feature sets, they produced extremely high-quality end results. Australia being a mature market, the vendors had no choice. The vendors were producing niche products with limited feature sets, so they had to ensure they were able to fill the niche and fill it well, else in such a small market, a company would not survive (34 companies were competing for 20,000 Physicians back in 2006). In India, quite the opposite happened. There were only a handful of companies (in 2008 there were <10, focused on primary healthcare software products), targeting a Clinician base of over 8.5 lacs, the bar for quality had been way below acceptable standards. The lack of legislation would only go on to make matters worse.
With the entry barriers set so low in terms of what the product needed to achieve, soon enough every Tom, Dick, and Harry had an appointment booking software with SMS reminders and these were sold off to the unsuspecting Practitioner as complete Clinic Management Systems. Since they all did the same thing, the only area left to compete on was prices, and therefore came the period where each company was willing to go lower than the other. It was not long before the completely free-for-life pricing models came up in India.