Tell us about the dynamics of the model on which KMES operates?
The primary cost of KMES was developing the platform, this was done with the grant money from Rockefeller Foundation. For operations, KMES is sustained by itself, as it is not about any new services but enhancement of the existing emergency services. The other operational costs are the emergency inquiry centre that will be manned 24X7 and occasional system updates.
We are taking the following three routes to tackle these costs:
- Enabling interactive voice response (IVR) and SMS, thus eliminating/minimising the need of human resources for responding to a phone call
- Working with the government to see if they can adopt the emergency centre within their existing emergency response centre
- We will provide consultancy for implementing the system in any city of India and in any other developing countries. We have heard that such a central system does not exist even in few of the developed countries. We will be able to provide consultancy to implement such a software platform in all the cities that are interested in putting such a system in place. We will not only bring software expertise, but will also provide the best practices of implementing such a centralised, real-time medical emergency system in a metropolis like Kolkata w We also have plans for few other related healthcare projects which will help to sustain KMES easily
What are the challenges that you came across while setting up KMES and during operations?
At the very onset of the project, we identified the following complexities in implementing a medical emergency system in Kolkata, where emergency care is provided by multitude of service providers with varying capabilities:
- Each hospital has different workflow and it is very difficult to standardise bed management
- The service providers are very heterogeneous when it comes to data and information management
- All hospital information management systems are proprietary, closed and isolated. Several of them do not have any internal IT staff to integrate the internal systems
- Though several standards exist for interoperability of clinical data (HL7, CCR etc), none exist for medical emergency services
- No hospitals want to share their patient data due to privacy and financial reasons
- Several of them did not want any automated interface between their internal system and KMES due to fear of theft of patient list
- And finally, several of the hospitals manage the beds using paper tickets (known as bed-tickets) and do not have any electronic system in place
How did you tackle these issues?
We tackled these issues by following few pragmatic approaches such as:
- Multiple options to integrate, instead of dictating a specific standard to everyone. KMES provides customisable solutions for each hospital/blood bank to integrate its own data source
- If permitted, real time integration with internal electronic systems
- Easy, one-click update for hospitals that do not have any electronic bed management system or not willing to opt for automated integration.
- Minimalistic intrusion into the existing internal system.
- The KMES platform only captures supply chain information (CCU, BSU) without any patient record.
- Efficient and optimum implementation framework using Opensource technologies so that the wheel is not recreated. Importance is given to implementation rather than on technology.
What are your future plans and expansions?
We would like to extend KMES to other parts of West Bengal where the healthcare provider is government hospitals. As such it is very important that the West Bengal public health system integrates with KMES. In fact, we consider this to be in the current scope of the project and we would like to collaborate with government hospitals, starting with tertiary hospitals, as soon as possible.
To make it fully useful and effective for the people of Kolkata, the second phase of KMES will be the ‘reach’ phase by integrating, strengthening and improving the current existing infrastructure.
Also, the byproducts of the KMES project will be: the Free and OpenSource Software (FOSS) platform, and the best practices for implementing an emergency medical system in densely populated urban areas. The software platform will be published under OpenSource licensing, and any organisation will be able to use the software free of charge and change it as they see fit. With minimal changes it is likely that the system can be implemented in other cities in India as well as across South-East Asia, Africa, and Latin America. KMES can help other civic bodies and governments to implement this system in their respective cities based on the best practices learned during the pilot implementation. We are already in discussions with an NGO in Cairo, Egypt.
Where do you envisage KMES in the next five years?
In the next five years, we expect KMES to be an end-to-end solution like a 911/112-type emergency system. We also expect KMES to take the concept of community help to create a crowd sourced activism/response.
We hope that our project will bring the following significant changes in this unequal system:
- With a centralised system where all hospital data is exposed to the general public without any restriction, the perception of divided healthcare system will change
- Every citizen with this information will feel empowered to help a fellow citizen, whatever their respective social status
- Every citizen will feel comfortable going to a hospital based on proximity and availability, the most important criteria during a medical emergency.