Narayana Hrudayalaya finds a way to deliver better healthcare services and expand by hosting its hospital management system on the cloud.
During the second week of July, 2003, a two-year-old Pakistani girl with a damaged heart crossed both the Wagah border and the Thar Desert to get to Narayana Hrudayalaya. The hospital was her only hope for survival.
Noor Fatima's heart-rending story caught the attention of two nations that had just gone to war four years earlier. News updates on her condition were watched anxiously in both India and Pakistan, who set aside their differences for a while as the child fought for her life.
At the heart of that national drama, was a Narayana Hrudayalaya program whose singular focus is to help poor children with heart conditions. The program forms a crucial part of the hospital chain's single-line vision statement: Affordable quality healthcare for the masses worldwide.
An aim like that costs money, a lot of it. But Narayana Hrudayalaya is used to battling costs. The chain, which created a world record by performing about 15,000 surgeries on patients from 25 countries, has a higher profit margin (7.7 percent after taxes) than most private American hospitals (6.9 percent).
It's ability to keep costs low was put to test when, in 2010, Narayana Hrudayalaya decided to expand from a 5,000-bed operation to 30,000 beds in five years. To support that growth Srikanth Raman, CIO at Narayana Hrudayalaya, would have to find a way to create IT infrastructure, literally from thin air--or carry the burden of taking money away from children, like Noor Fatima, who really needed it.
Etiology
The hospital, which opened in 2000, has made great strides in turning its vision of easily available, world-class healthcare into a reality. "From our primary centers in Bangalore and Calcutta, we expanded to 15 centers and the number of smaller hospitals that we are associated with now is close to 25," says Raman.
But its 2010 vision--to go from 5,000 beds to 30,000 beds in five years, making it India's first private hospital group to operate at such a scale--was a challenge on a whole new level. "We realized that to support a massive operation like that we would need IT infrastructure that was extremely scalable and robust," Raman recalls.
Setting up and maintaining that IT infrastructure was not what Narayana Hrudayalaya specialized in; fixing HS (human systems) is a different ball game from fixing IS (information systems). "There were issues of building up and owning systems, being able to find skilled IT resources and retaining them," says Raman. Moreover, if they built datacenters, either centralized or disparate, they would need to be backed up with a hot, real-time DR site.
"The upfront cost implications were huge, let alone the manageability issues. A conventional datacenter set up, whether at a centralized location or at every hospital, would be a time consuming, tedious affair," says Raman.
Rx Cloud
Raman needed a solution that freed the hospital from the burden of building and running a datacenter; a solution that was scalable, agile, and allowed him and his team to focus on the business of healthcare.
The cloud, it seemed, was just what the doctor prescribed.
In 2010, however, the idea was extremely forward-looking, especially for a healthcare player.
On the plus side, Raman says, they were fortunate they entered the market at a time when most cloud solution providers were developing the idea and were eager to partner and experiment. Raman says he chose to go with a private-hosted model with HCL's blu Enterprise Cloud's Infrastructure as a Service (IaaS) solution.
Right away he was faced with the challenges CIOs face with the cloud, even today. The first was integrating Narayana Hrudayalaya's hospital information system (HIS) with the cloud.
"It would have been difficult to migrate the entire system to the cloud if the applications were build on a .Net framework," he says. But fortunately, Raman had ensured that from day one, his outsourced partner built Web-based applications.
Security is another issue that keeps CIOs away from the cloud. Raman's attitude reflects the outlook of a growing number of IT leaders: Leave it to the experts.
"The biggest organizations, with the best of security systems, have lost the battle to cyber criminals. With my modest IT team, we could spend our entire waking life just trying to keep systems secure," says Raman, explaining why he believes he made a right choice by trusting his partners.
Another large challenge was connectivity. "With the complete HIS on the cloud and 1,500 concurrent users logging into our systems at any given point of time, we could not afford connectivity going down," says Raman.
So when Raman started a six-month proof-of-concept at the hospital's center in Jamshedpur, a small township in the state of Jharkhand, he made sure the hospital's Achilles heel was protected. He asked his service provider to provide not one but two major lines, the second from an independent service provider from a different geographical area. "The n+1 arrangement ensured that even if one line was disturbed because of a fiber cut, the other could take over. The chance of both of them going down at the same time is a very remote possibility," says Raman.
Good Medicine
In 2010 and throughout 2011, while IT leaders were busy debating the challenges and benefits of the cloud, Raman was already knee deep in it. Today, Narayana Hrudayalaya is reaping the harvest of an early sow.
Raman has helped Narayana Hrudayalaya save between Rs 20-25 crore in capex costs by moving to the cloud. "If we built our own infrastructure, including an active DR site, it would have cost us between Rs 1-1.5 crore per facility," says Raman.
The cloud also allowed Raman to raise the standards of healthcare that Narayana Hrudayalaya promises. With a central database, patients referred from one branch of the hospital chain to another don't have to carry files or register all over again. And doctors can get a look at a referred patient's history even before that patient steps into a doctor's cabin.
For patients like Noor Fatima that can mean the difference between life and death.
