Tuesday, October 13, 2009

Why don't Indian doctors use medical software in their practises ?

Technology infiltrated medicine a long time ago . Doctors are quite savvy and are happy to use advanced technology to improve patient care. Today, all the imaging specialties use computer hardware and imaging processing software routinely . So why don't doctors use EMRs and practise management software routinely to take care of their patients ? Isn't it sad that while hotels use specialised software programs routinely to provide hospitality to their customers, most hospitals are still stuck in the pen and paper stage - forget about individual clinics and doctors. In fact, most doctors use their PC just for word processing and sending email - which means that this powerful electronic brain sitting on their desktop is very poorly utilised.

This is is a hangover from the old days when computer programmers expected doctors to change their habits, so they could use the complicated programs they wrote. These program were never designed to be simple to use; and were very inflexible. Traditionally, this was a result of the way they were built. Some hotshot doctor would hire a programmer who would design a database in Visual Basic for his clinic, so the doctor could start capturing data electronically. While this worked well for the doctor because the program was customised to suit his workflow, when the programmer tried to get other doctors to use the same program, he encountered considerable resistance, because each doctor has his own working style and is very reluctant to change it. While it was possible to change the user interface or to adapt this, this required the programmer to sit down with the doctor and to make the changes - a time consuming and expensive exercise, which is why medical practise management programs never became popular.

This is what Aditya Patkar, Marketing Director of Plus91, has to say about why medical software never caught on in India so far.

The earlier generation of medical practise management software programs suffered from the following defects.

1. Unfriendly and complicated user interfaces: Programming languages were hard to master , and doctors had to hire programmers to write the programs for them. Because doctors are not workflow experts, the software was often designed badly and was unnecessarily complicated. The programs dictated rigid work flows and telling doctors what to do has never worked well !
2. Large learning curves: Doctors are busy people and don't really have time to learn how to use a program - especially if it is complicated or not designed to match the doctor's work flow
3. Complex system requirements: The software worked well only on high end PCs . These were expensive and doctors were not willing to make this investment.
4. Very narrow capability: The software was so specialised and did such specific tasks , that it required two separate programs to manage the clinic ! For example, one program did appointment scheduling only and the doctor needed to buy another program for billing or for writing prescriptions !
5. The programs were expensive. Because the market was limited ( not many doctors owned a PC), it was not possible to sell many copies of the program. However, the development costs needed to be recovered, which is why the programs were very expensive and not cost effective.
6. Uneducated staff. The administrative modules of the software had to be used by the clinic staff. Often, they were not clever enough to use the software properly - and without training, most of them preferred to abandon it and go back to using paper and ink. They would then bad-mouth the program to the doctor, claiming it was user-unfriendly.
7. Lack of portability; The programs ran only on desktop PCs and LANs, which meant that when doctors needed to travel from clinic to clinic, they could not carry their programs with them on their laptops.
8. Poor customer support. Doctors were never willing to invest in high end products, as a result of which the companies were often forced to skimp and cut corners. They were unable to hand-hold the doctor or his staff, and could never provide adequate training or after sales support, beause of wafer-thin profit margins. As a result, many software companies were forced to shut down , leaving the poor doctor high and dry - and with an unhappy opinion of the software industry as a whole!
9. Poor profitability because of poor sales .It was always hard for the software companies to scale up and become profitable because providing sales and support was expensive and involved travelling and troubleshooting in the doctor's clinic. Today , thanks to the internet, it's now possible to provide demos, videos and help online. This saves the dctor's time and also allows the company to provide effective customer support inexpensively , efficiently and effectively !
10. Bad word of mouth. Because so many doctors burnt their fingers buying programs which never worked well, many of them simply gave up on the practise management packages, as a result of which all innovation and progress was stifled for many years.

Today , a new generation of doctors which has cut its milk teeth on computers is finally waking up to the fact that well-designed software can be used intelligently to help them manage their practise better. Programming languages have improved, and the software is designed to adapt to the working style of the doctors , using clearer process mapping. Because computers have become cheap and broad band internet easily available, software companies can now sell ther products in large numbers, so that it's possible to provide these programs inexpensively, making them a cost effective investment for the doctor. This confluence of factors means that the market for practise management programs and EMR for doctors is ready to explode in India !


  1. Hello Doctor,
    Interesting comments, my question to you is: Its been couple of years since you have written on this subject. Does your opinion still stand today?

    The reason I am asking you is because I am CEO of a Software company and we are looking towards working closely with Doctors. You can read more about us on our blog. Just google for Fafadia Tech.

  2. Times are changing - but slowly. This is partly because a lot of medical software is not created with the doctor's work flow in mind. It looks great on a paper - and the demo is attractive - but in real life, a lot of these implementations fall flat because it's hard for a doctor to change their habits - and it's hard for software engineers to get into a doctor's mind.

    The software needs to become much more doctor friendly. This means it has to be customisable - every doctor wants to do things his own way !

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  3. Doctor i dont agree with ur comment. Time has come, when indian software for doctors are also user friendly and compitable, you can see it on truworthhouse.com

  4. Anonymous6:34 PM

    I think I really agree with Atul !

  5. This is a million dollar question. I am venturing in to creating software for Doctors (my wife is an established Dr., herself) - to help Doctors manage their Clinic, Patients and its operations well, including quite a robust appointment management system. TO be delivered on PC/Tablet and Smartphone App. While, some comments has been quite encouraging from her fraternity, there is plenty left to be desired. There is a mental block and rightfully so. I am not faulting any one. It takes time and the advent of Smartphones must give us enough room to make things happen in this area. Quite discouragingly, the Numero Uno (supposedly) also has created quite a number of concerns (rightfully so, if I may add) in the minds of the Doctors. It may take moving mountains to make a foray in to this domain, but who every said life is a bed of roses! We have to take this journey, ethically, in the right direction.


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