An EMR (Electronic Medical Record) is software that you as a Doctor would use to prescribe medications, order investigations, schedule follow-ups, write medical certificates and more.

However, an EMR is not to be confused with only prescription writing software. It does help with prescription writing, but that is only a subset of what it can do. The software helps record all information about a patient’s visit, such as patient history, allergies, immunisation, recalls, care plans and more.

A PMS (Practice Management Software) on the other hand, lets you manage the non-medical aspects of your clinic i.e. such as appointment scheduling, SMS reminders, billing, receipts, reporting and more.

Back in the 90s and as late as the mid-2000s, in developed markets such as Australia, EMR and PMS would be sold as two different software systems that needed to be integrated with each other. The idea being, that a Clinic could well do, by buying only the EMR or only the PMS, without needing both. So a clinic may buy an EMR to digitize the writing of consultation notes and still use a paper-based system for appointment scheduling, billing and other administrative aspects of their clinic. Or, vice versa with the clinic buying a PMS and avoiding an EMR, stick to writing prescriptions by hand.

Back then, in Australia, 2 products ruled the roost. Medical Director, was the largest selling EMR, and PracSoft was the market leader in PMS. Together they owned 85% + of the market share in Australia. The interesting bit, is both Medical Director and PracSoft were owned by the same company, Health Communication Network. This led to a situation where competing companies could enter on lower budgets to build only an EMR and compete with Medical Director, or build a product to handle the admin end of things and compete only with Pracsoft on the MS front. This encouraged software systems with a very limited feature set to hit the market and created awareness and acceptability amongst Clinicians towards complexity and costs of integration. Having 2 different systems to manage the Clinic was the norm. It cost twice as more, and updates to any of the 2 systems would cause heartburn, but the tone had been set and it was followed ever since.

Fortunately for India, not much was happening on the technology front for Clinics, during this phase. The only name that rings a bell back then was Prescription Pad – a Delhi based imitative, that was commendable in what it was trying to achieve. However, Prescription Pad was way behind the curve of what had become technically possible.

So by the time the likes of Easy Clinic, Doctor Sahaab, Plus 91 Technologies, and TurboDoc (later went on to be called Practo), came knocking in the Indian market, there was no precedent to fall back on and hence all the companies tried to build a complete product inclusive of EMR + PMS. It would save the Indian Clinicians from the complexities and costs that Integrated Systems had created in Australia.

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 step-son, 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, the Doctor 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 Doctors 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 the 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 only held a minuscule component of the patient’s encounter with you, thereby making your followups either be done on half the information, or you still had to fall back on your tried and tested approach before you went on to use computers. The prescription printout was cosmetic, but something was better than nothing. This led to a new problem.

While the Australian market created niche software products with limited feature sets, they produced extremely high-quality results. They had no choice, by working towards niche products with limited feature sets, 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 Doctors 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, and the bar had been set low.

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 with the SMS reminders feature being touted as a complete Clinic Management System. Since they all did the same thing, the only area left to compete, 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 models came up in India. Sign up for free, for life. While those companies would eventually falter, and such plans would eventually reveal to the riders – that your data can be used by us for resale, before the bell would ring, the collateral damage would be companies trying to offer a thorough EMR + PMS = the real Clinic Management Systems. They were hamstrung in cutting prices further, and became awfully expensive relatively, leading to poor sales, which lead to zero incentive towards RnD and product development.

It became quite similar to the story of generics v. brands. The Indian market got characterized by generic products where price became the primary differentiating factor.

This went on fine till now. But as the market matures, Clinics grow, family-owned practices move up to try to set up corporate brands, and the needs are changing. Those who are looking to expand into Clinic Chains, do so by virtue of satellite offices and franchises and each case brings the need to manage operations without being physically present at each point of service. They need standardization of medical care, centralization of inventory for pharmacies, consistent billing policies, sharing of patient health records across multiple clinics, and pan-India rollout of promotions and wellness programs. For a market that did not cultivate a comprehensive Clinic Management System, this seems like too giant a jump across the abyss. So growing Clinics have been left with very limited options.

Those who could afford the cost and had the willingness to direct resources at a non-core area outside of their realm of expertise, have set up in-house IT teams producing home-bred white elephants – software systems that they need to sustain and live with for years to come. Such systems however are below commercial grade products available in the market, have a single customer, the Clinic Chain itself and tend to progressively inch by inch lose their competitiveness to nimble targeted solutions that need to fight for their survival in a wider market. Those who could not afford to build in-house teams had no other choice but to piggyback on generic ERP’s with custom added forms (simple new web pages added on the large ERP software) that lack any medical intelligence, acting as a substitute to an EMR. A few swam against the tide and ended up setting up dedicated new IT companies to deal with the issue.

Let us however talk about the majority, Clinics that are yet to expand into Clinic Chains, but who want to and hope to scale. How do they differentiate themselves from the rest of the pack? They cannot hope to do so anymore by sending out SMS Reminders, or by giving out a printed prescription. The low-hanging fruits have been plucked.

Rather than EMR + PMS, you need a platform now, that has a much wider surface area – that can execute complex scheduling for not just Doctors, but also Therapists, Consult Rooms, Portable Equipment, and systems that can have highly specialized EMRs that understand your Clinic is not the same as the rest of the others on the street, and its individuality in treatment and care is what sets it apart and which needs to be accommodated and handled by the software, a system that is no longer an island but a platform that can manage in-house pharmacies, handle sample collection for lab tests, incoming and outgoing phone calls, support your branding activities by capturing leads from web site inquiries, weekend camps, that can identify the potential segment to whom you can cross your wellness programs. You need a medical ERP.

Do not confuse this to be the younger brother of the HIS/HMS (Hospital Information/Management System). Just because you need a higher seating in your car with ABS and 6 airbags along with rear vents for passenger comfort, does not equate to you buying a truck or a modified version of it. Similarly, neither is the answer to this problem, buying a cut-down version of the HMS. I have seen a lot of systems built for the hospital being sold as a Clinic Chain niche product. Do remember garbage in, garbage out. If the system you take up, is so complicated and difficult to use that you do not end up using it, your implementation of the system will fail, and so will all initiatives attached to it. If you are still in doubt, ask yourself when was it that you last saw a Doctor in a Hospital using an EMR to record his IPD rounds.

If you hope to grow, think beyond a product with a set of features. Think about your workflow, end to end, ie EMR + PMS + Leads Management + Call Management + Pharmacy (if required) + Lab (if you do it in-house or if you collect samples) + Radiology + Analytics + Mobile Apps + Patient Portal + your Clinic Website. You need an ERP built for Clinics.

 

 

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