Saturday, January 30, 2010

Thank you email from a virtual patient !

I just got this email today.


Dear Dr. Malpani,

I have just spent the better part of my afternoon reading your website. I just wanted to let you know that I have been going though IVF for over 6 months now and this is by far the best website I have seen and I have seen many! It is very informative and it feels like it is very personally speaking to me. Even though I feel knowledgeable by both studying IVF and physically going through it, I have still learned a great deal from your information.

Thank you for having it available. Even though I am very far from India and will not be able to use your services, I appreciate what you are doing for families. Keep up the good work. Thank you.

Friday, January 29, 2010

First, Do No Harm - Proto Magazine - Massachusetts General Hospital

First, Do No Harm - Proto Magazine - Massachusetts General Hospital: "You mean most heart surgery is unnecessary?

A: I judge any treatment by whether it increases patient longevity or improves quality of life. Studies of coronary by–pass surgery show that for 97% of patients—those without a major blockage of the left main coronary artery—there is no meaningful improvement in longevity. Weigh that against the chance of dying on the operating table, and the increased likelihood of post-operative emotional distress and depression. There is no compelling evidence that angioplasties are more effective. The argument that any of these procedures improves quality of life is based more on myth than on substantive evidence.
Q: Then why are so many of these procedures performed?

A: We live in a time of unbridled medicalization. Sometimes that is to our benefit—if you have a fever, headache and a stiff neck, you had better be medicalized or you may succumb to meningitis. The problem is the tendency to medicalize despite science, promulgating the belief that medicine can fix everything. Such claims are promoted by the vested interests in our health-care system, including drug companies, hospitals and doctors themselves. Rather than encouraging critical thinking, peer review displaces it. Cardiologists review each others’ studies as to whether one treatment is better than the other without first asking if either really helps the patient."

It's nice to hear such a refreshingly honest point of view from a physician !

BBC News - Mental health patients get novel prescription

BBC News - Mental health patients get novel prescription: " GPs across Lanarkshire are to refer patients with mental health problems to their local libraries as part of their treatment. Patients will be 'prescribed' self-help books, CDS and DVDs and librarians will be trained to offer advice and support.

The programme is a partnership between NHS Lanarkshire and North and South Lanarkshire Councils.
Research has shown that reading can help people cope with problems such as depression, stress, and bereavement.

All 50 community libraries across Lanarkshire have been given resources to offer to patients referred by their GPs."

This is exactly what HELP has been doing for the last 11 years in Bombay !

Thursday, January 28, 2010

Why doctors are happy with Plus91's EMR

This is an interview with the MD of Divinations Healthcare, a prominent Path Lab Chain in Pune. Plus91 built their website and they also use LabC Plus91's Lab Information System to manage their reporting, accounting and inventory.

Wednesday, January 27, 2010

Coming to India for IVF treatment !

Here's a first person account from a patient - who is now a friend !

My fertility “adventures” have involved 3 trips to Mumbai; in total, I’ve spent right around 2 months in India. In that time I’ve discovered kind caring people, awe inspiring places, and a few tips I wish I had known before getting started. I came to truly love India and Mumbai, and I look forward to traveling there again soon (when my expected twins are old enough to enjoy it!). In the hopes of helping other single women on the fertility journey, here are a few of my thoughts on how to get the most out of your medical tourism in India:

General Travel Tips:

-Pack light. I take only one carry-on backpack. This means I never have to worry about my luggage, can travel on foot, and don’t have to worry about heavy lifting after the embryo transfer. Remember-whatever it is you may not have brought- “they have those there!” You’re not going to the ends of the earth. If you forget something, odds are you’ll be able to purchase the item reasonably on site. I will note that I never travel anywhere without a “Lonely Planet” or “Rough Guide” of the area.

-Dress for success. I’ve found that 2 pairs of travel pants with multiple secured pockets are a godsend. That way, I always know exactly where my passport, cash, and necessities are, and I never have to worry about my bag being taken. I’ve also noticed that modesty in dress comes with high rewards in India. I’ve found lightweight but modest (sleeved) cotton shirt or blouse to be ideal-the fact is, if you dress in a way which shows respect for the culture around you, people are far more likely to engage with you, making your trip much more enjoyable. I’ve come to love my Indian style tops (kurtas) and scarves (dupattas). The scarves are much more than accessories-I put a dab of lavender on mine and found it useful in dealing with the icky smells frequently encountered while travelling. I pack two shirts, knowing that every hotel sends out same day laundry and that I’m sure to buy one or two lovely items I want to take home with me.

-Be cautious but not paranoid. Yes, as a single woman travelling alone, it’s easy to become a target for scams, unwanted attention, and potentially unsafe situations. So be careful. But I’ve also found that my outsider, and solo status inspire kindness and caring. I’ve been helped, guided, and saved innumerable hassles because individuals have reached out to help me. When I first arrived in Mumbai I was terrified and overwhelmed by the noise, dirt, and seeming chaos. I spoke to no one since, in theory, anyone could be trying to take advantage of me. What a terrible way to live! Once my senses had begun to adjust to the richness of Mumbai, I was able to make acquaintances and friends, to take folks up on their offers of chai and conversation, and develop a system of friends and support away from home. I’m so grateful! Favourite experiences have been being taken to meet Maharani Satvashiladev (in southern Maharashtra), and celebrating Diwalli with friends in their homes in Mumbai.

-Adopt an open attitude. India rewards those who travel with an open heart and flexible mind. A flexible schedule helps enormously too, but can be challenge when you’ve come for medical treatment. I’ve found my favourite experiences were made possible because I was willing and able to “go with the flow”. For instance, on one trip, I learned I had 5 days between visits to the clinic. I walked out the door of the clinic, found a travel agent, and booked a next day flight to Delhi. From there I trained it to the holy city of Haridwar where I was privileged to stay in a wonderful, restful ashram, took part in the Harki Puri ceremony, and was officially blessed in the river Ganges. Here too, I found instant friends eager to share a cup of chai, and some insight into their city. I even met up (by accident) with the guy who takes Madonna and Brad Pitt on their Indian treks and visited a tribal village with him! And yes, I got lost along the way and had to ask for help from many folks who more than happily took care of me. If you’re going to travel outside of Mumbai, just be aware that everything is more complicated and takes longer than you’re probably used to.

Learn about Giving and Taking (help that is)- I found that I needed help from EVERYONE! From learning how to cross a street, to making travel arrangements, ordering food, buying a phone, and using an ATM, I needed people in a way I never have before. And they stepped up. I was so gratified when I could return the favour in some small ways. For instance, I found that wherever I travelled, folks were curious about me, and my lifestyle, career, family, etc. I met people who wanted to practice their English, some who wanted to learn more about North America, I was able to help friends apply for small business loans through NGOs, and I even taught English reading and writing to a small group of children and young men. (by the 3rd visit we were reading newspapers together. Yeah!) Engaging with people was a great way to get to know others , and I confess that at times I felt more connected to this adopted community than I do to my own. My life is so much richer for having had these opportunities; I’m sure you’ll find your own adventures in Mumbai.

In short- fertility treatment can frustrating, expensive, and isolating; this is especially true for a single woman. Sometimes life feels totally out of control, ruled by hormones, injections, and treatment schedules, interrupted only by serious financial planning sessions, and chocolate and crying binges. It’s important to find joy wherever you can. Although at first you may be nervous and even a little scared about your trip to India, with some careful planning and mindful openness, you may discover some unexpected joys along the journey.

Tuesday, January 26, 2010

The 8 things you need to take to your doctor

Doctors are busy people ,and have a limited amount of time to spend with you. What can you do to make the most of this precious time ? If you forget to ask an important question, there’s no point in kicking yourself afterwards about this !

The trick is simple – you need to do your homework and to prepare before you doctor’s visit.

These are the 8 things you need to take with you to your doctor, to help him maximize his efficiency !

1. A one page summary of your medical record. First, arrange all your medical records ( consultations, hospital discharge summaries, lab reports and so on) in reverse chronological order. Then, after doing this, prepare a one-page summary, which highlights the medically important events in chronological order. This ensures your doctor gets an accurate overview of your medical history in a few seconds, and that nothing is overlooked. It will save you a lot of time – and will save your doctor a lot of frustration. If you well organized, he will not need to extract information from you painfully – you’ll be able to provide him what he needs gracefully !

2. Make sure your records are complete. Carry all your original X-rays . If your surgery has been recorded on a CD, please carry a copy of this CD, so you can leave it with him. If your records have become voluminous, you might want to scan them in and save them on a CD or flash drive.

3. Rehearse what you want to say. Carry a note pad with a list of your questions , so you don’t forget any in the stress of the consultation.

4. Carry all your medicines in a brown bag. This is very helpful when you are taking many medicines. Many of these may be unnecessary – while others may interact harmfully with each other. A brownbag review of your medicines will allow your doctor to check what medicines are essential – and which ones you can stop.

5. Money ; and your insurance details. You need to pay for your medical care, and the better organized you are, the easier it is for you to ensure that your treatment costs are reimbursed quickly. Insurance companies are very big on paperwork, which is why you need to be prepared for handling this efficiently.

6. Take a relative or friend with you. The stress of a consultation can cause you to forget important details; or get confused when the doctor bombards you with instructions and floods you with jargon. A friend can act as a patient advocate, who can help to provide clarity; and help both the doctor and you by acting as a valuable intermediary!

7. If you’ve spent a lot of time on the internet researching your problem, carry a summary of your printouts , so the doctor can help you make sense of conflicting information which may cause you needless anxiety

8. A novel or ipod or laptop to read or listen to while you are waiting patiently in the reception area can help you reduce your anxiety levels and keep your calm when the doctor is running late

If you are well organized, it’s easier for the doctor to look after you well.

Monday, January 25, 2010

A customised website for doctors in 24 hours !

I interviewed Aditya Patkar of Plus91 to figure out how they can provide personalised websites for doctors within 24 hours.

Why have you decided to create websites for doctor?

Plus91 believes in Information Therapy and a website is a very powerful way of facilitating this. A website gives an avenue for patients to search for doctors, view their services and also see their location and contact information. For a doctor , a website is vital to reach out to his patients and to educate them about their medical problems and treatment options. It saves the doctor time and money , because the doctor can provide information to the patient , without having to do so face to face. Websites for Doctors is an initiative to help promote information therapy to the masses by promoting a website for every doctor in India within the next 2 years.

How can you manage to create a customized website for a doctor according to their specialty in just 24 hours?

The key to specialization is expertise, experience, preparation and effort. Just like a doctor who specializes in Orthopedics spends 3 years after his MBBS to learn how to treat bone disorders, we have spent a lot of time mastering the technology for making doctor’s websites work well. This is our core competence and because we are a focused factory and do only this, we are very good at it. In fact , if the doctor selects a template and send in information he wants us to upload, we can setup his website within 12 hours flat !

What’s your magic sauce?

The fact that we have addressed a very specific niche, for which we have developed unique processes , make us very innovative. A strong technical knowledge of how to create a state of the art medical website ; and extensive research into what an outstanding doctor’s website should look like in terms of content and graphics have helped us in achieving this goal.

How much do you charge?

We have 3 tiers, depending upon the doctor’s requirement. We charges Rs. 4,995/-, Rs. 9995/- and Rs. 24,995/-, for each of these tiers, each of which provides varying degrees of customization, services, pages and widgets for the doctor and patient.
Each doctor has a specific agenda for wanting a website. The tiers were created so that a doctor has a choice in how much time and money he wants to put into his own website. Providing high quality websites at low cost is a logical extension of the “ Right to Information “ for patients across India. The aim is to plug the gaps in doctor-patient communication which are present today.

How can you afford to do this so inexpensively when other companies charge so much more for a similar website?

I think the answer can be found in the processes we follow and the fanatical research we do to help us reduce costs and provide quality service. Using the right servers, the right technology, the right templates, and close follow up – all these help in providing a cost effective service which delights our doctors. In fact, as we scale up, we expect to become even better !

Are you doing this for Indian doctors only ?

No, of course not ! We are happy to create websites for doctors from all over the world ! The process is exactly the same - and when you convert this to dollars, the websites we offer are a steal for US physicians - this works out to only US $ 500 for our top-end website, with its own content management system !

What are your technical skills which allow you to do so?

A solid understanding of website design ; along with trained professionals in web 2.0 and software development ; and in house medical expertise are the skills which are vital to making this initiative a success.

What has the response of doctors been?

The response has been overwhelming ! Most doctors have an email address – and lots of them now want their own website !

What are the problems you have encountered ?

Doctors are very busy, and display a lot of inertia. They understand the importance of having a website, but are quite laidback and slow about providing the information we need to customize their website. This often means that getting the personal details we need from them for personalizing their own website can take quite some prodding and pushing ! We have simplified the process so much, so that all the doctor has to do is to fill in a simple one page form. This means his website can go live, without disrupting his busy schedule!

Interestingly, another problem is that doctors find it hard to believe that we can provide such a high quality product for such a low cost. Many of them think there must be a catch somewhere ! What they fail to realise is that our business model is based on creating a large number of specialised websites very quickly, so we make our profits in our volumes !

Do you think doctors are smart enough to be able to manage their own website after you publish this for them?

Yes, doctors are capable of handling their own site, but the big concern here again is the time they wish to spend on it. The younger generation is savvy enough to use social networking portals and blogs , and I predict these doctors will be happy to run their own websites, so they can information in real time and keep their website content fresh and alive.

What does a doctor have to do if he wants you to create a website for him?

Contact us on or via email([email protected]) / telephone(020-32340204, 09821142465). We then email him templates according to his specialty; along with a one page form. For the basic site, all he needs to do is select his domain name, the template, fill in the form, and send it back to us along with his payment. Once we have these 3 items , we can publish his site. As you can imagine, the more expensive sites need more information and time taken to complete these depends upon the doctor and how quickly he provides us with the information he wants us to upload to his website. With our process, we have created sites for doctors without even having to meet them ! All our interaction was done through email or via the phone !

When you say his own domain name, what does this mean ?

I think this is the key special ingredient of our offering. With our services, the doctor can select his website's name, so he can custom design his website address ( also known as the domain name or url). Thus, if your name is Dr Deshmukh, and you are a pediatrician in Bombay, you can select a website name such as or ! This gives you your own identity - and your personalised email address as well, so that it now becomes [email protected] rather than [email protected] !

Do you offer websites for other companies?

We specialize in providing sites for doctors, medical entities and healthcare companies only. We are not a general web site designing company and do not create non-healthcare sites.

What do you think the future holds for doctor’s websites?

The future looks promising as more and more doctors today are aware of the effect the web and mobiles are having on their practice . A website is an extension of their clinic into the digital domain. We are seeing a steady increase in orders, and are waiting for the tipping point where every doctor doesn’t just want one , but needs one to start his practice !

Can I see a demo of your work ?

Sure ! Check out !

Sunday, January 24, 2010

Customised websites for medical specialists in just 2 days !

Plus91 creates personalised websites for doctors in 48 hours ! I am going to interview Aditya Patkar,their Marketing Director, to find out how they manage to do so in my next post.

My doctor refused to give me a copy of my IVF treatment !

Patients often come to me for a second opinion when their first IVF cycle fails and it breaks my heart when I see how poorly informed they are . Most are completely clueless about even basic facts of their treatment , such as how many eggs were retrieved and what the quality of their embryos was ! When I ask them for a printed treatment summary, a very common answer is - The clinic keeps all the files and does not give us any medical details. Some say that even when they specifically requested the doctor for a copy, the doctor refused to provide one , because it is against the clinic policy to do so ! I think this is ridiculous ! Patients have a legal right to all their medical records - the doctor has no choice in this matter. He is legally obliged to give you a copy of your treatment summary - period. If you find your doctor is being difficult, make a request in writing , with a copy to the hospital administrator. If even this produces no results, ask your lawyer to write a letter on your behalf.

Ignorance is not bliss - and you cannot afford to remain unaware of what is happening during your IVF treatment !

If your IVF clinic does not routinely provide you with a written summary of your treatment cycle and photos of your embryos, then this is a red flag ! And if they refuse to provide you with these, even after you request them to , this is a major black mark against them - and is a strong sign that you should look for another clinic . After all, why should a good clinic hide anything ?

Saturday, January 23, 2010

I never got a chance to talk to the consultant !

An unhappy patient who had failed an IVF cycle at another clinic was ventilating her pent up anger. Her major grievance was that she never got a chance to talk to the senior doctor and that all the clinical care was provided by her juniors, most of whom were inexperienced.

It seems to have become the norm that as a doctor gets busier and more senior , he starts employing assistants whose job seems to be to improve his productivity, so that he can treat even more patients. The senior surgeon then does only the operations, while his juniors do the consultations and the counselling. Most senior surgeons take pride in having fully booked operating rooms and month long waiting lists. To my mind, this seems to be poor time management.

I think this is an unhealthy trend . While it's important to improve the "star surgeon's" productivity and throughput, this should not be at the expense of the quality of care provided to the patient. Taking a patient history and doing a consultation is the heart of clinical medicine - and "outsourcing" this to an assistant is poor clinical practise.

Busy surgeons will always be very busy - but doing so at the expense of not having time to talk to patients is a recipe for disaster in my opinion ! It's not possible for him to establish a rapport , and such super busy clinics become assembly line " patient processing units" . Not only is this bad for the patient, it's equally bad for the star doctor, who then no longer gets a chance to get his batteries recharged by connecting with and empathising with his patients.

However, it's not fair to blame the surgeon. After all, he is being perfectly rational and doing what makes a lot of economic sense - maximising his revenue. Part of the blame has to be shared by patients who are willing to put up with this kind of neglect and inattention !

New HELP website !

HELP, the world's largest free patient education library, now has a brand new re-designed website at

HELP has had a website for over 10 years now - and was one of India's first health portals. With this new overhaul, we are keeping up with the times !

Dr Malpani, what makes you better than other IVF clinics ?

One of my patients challenged me with this provocative question recently - Dr Malpani, what makes you better than other IVF clinics ? Why should I come to you ? All IVF clinics claim to be the best and have high success rates - what makes you so special ?

This is a thought provoking question, which I am sure many of my patients must be wondering about as well. ( Fortunately, most are too polite to ask me to my face. ) I had to think through a reasoned reply, which would allow the patient to judge the competence of a clinic - and what makes us better.

It boils down to two groups of factors - intangible and tangible.

1. The intangible factors include things like: bedside manner; clinical skills ; ambiance; our reputation; trust and transparency.
2. The tangible factors include things like : our equipment and facilities; and the quality of the embryos we create in our lab.

Now it's hard to judge intangible factors. All doctors feel they have the best bedside manner in the world - and I am no exception ( though I am sure some of my patients may disagree, especially when I am tired or upset). Part of the reason we are experts at what we do is because of our practise setting. We are a boutique clinic which is a focussed factory. We provide a high quality service with lots of hand holding and pampering, because we treat only infertile couples who need IVF. This allows to develop a lot of experience and expertise very quickly. We take pride in our transparency; spend a lot of time in educating our patients; and are very good at communicating with them.

Our facilities are state of the art, as we use the best equipment available globally. But this must be true of lots of other IVF clinics as well - and how is the poor patient to understand which incubator is better ; or why one embryo transfer catheter is better than another ?

This brings me to the crux of the issue. Not only are we very good - we take pride in our skills and are happy to display them publicly ! This is why we routinely take photographs of our patients' embryos and provide these to them. This allows us to show our expertise to our patients - after all, the fact that we have made embryos means we are experts at IVF - and this kind of tangible evidence provides patients with peace of mind that they have received good quality medical care !

Friday, January 22, 2010

How many embryos should I transfer ? More is not always better !

All infertile patients want to maximise their chances of success in their IVF cycle. If one embryo has a 20% chance of becoming a baby, and if transferring 2 embryos will double that chance, then why not transfer 2 routinely ? And using the same logic, why not transfer 4, to increase the odds of success ?

This seems very logical, but more is not always better ! If an embryo is going to become a baby, then even one is enough ! And if it's not, then even six are not going to work. Most doctors believe that beyond three, we've reached the point of diminishing returns.

Also, transferring more embryos just ends up increasing the risk of having a multiple pregnancy. While most infertile couples will treat a twin pregnancy as a bonus, anything more can be a major medical problem, because of the risks of prematurity.

However, decision making in real life can be much harder . Patients get emotionally attached to their embryos - after all, they have invested a lot of time, money and energy in creating them; and they think of them as being potential babies. To tell patients patients to " discard " their spare embryos can be emotional torture - and many feel that they are abandoning their babies , which is why they'd rather the embryos were transferred back into their uterus. This can also be a major cause of regret when the embryos do not implant. Many patients then fantasise that maybe if they had transferred the extra embryos, that these might perhaps have "stuck"; and they regret their decision to discard these even more acutely.

Counselling can help patients to understand that the trick is to transfer the right number of embryos - not too few - and not too many !

How to make sure you are taking treatment at a good IVF clinic !

One of the manor decisions infertile patients need to make is - How do I select a good IVF clinic ? Most clinics seem to be the same on paper, and their websites are very similar. Most have happy patients - and most IVF specialists talk the same talk - they all quotes high success rates and claim to be the best ! How is a poor patient meant to separate the wheat from the chaff and reassure himself that the IVF clinic he is going to is technically competent ? After all, while it's easy for patients to judge a doctor's bedside manner, it's hard for them to make a call about his clinical and technical competence.

After all, just because the IVF cycle fails this does not mean that the doctor was bad or the clinic was incompetent . After all, IVF has a limited success rate, and only about 20% of embryos implant to become a baby. A failed IVF may just mean that the embryos did not implant for unexplained biological reasons - and is not automatically a reason to change your IVF clinic !

One very important tangible end point which all patients can use to judge the clinical competence of their own IVF clinic is to insist that the clinic provide them with photographic documentation of their embryos. All good clinics do this routinely, for many reasons. It helps to document good quality of care - after all , the fact that the clinic made embryos means that they are expert at superovulation, egg retrieval and fertilisation - and good clinics are proud to display their expertise ! Making embryos in vitro depends upon factors which are partly in the clinic's control - while the outcome of the embryo transfer, unfortunately, is not . This documentation also signifies that they have confidence in their clinical skills and have nothing to hide. This transparency is very patient-empowering ! Equally importantly, these photographs are very helpful in case you need to get a second opinion, or to move to another IVF clinic.

If your IVF clinic does not routinely provide you with a written summary of your treatment cycle and photos of your embryos, then this is a red flag ! And if they refuse to provide you with these, even after you request them to , this is a major black mark against them - and is a strong sign that you should look for another clinic . After all, why should a good clinic hide anything ?

Wednesday, January 20, 2010

Male Infertility - More Confusion !

Feature: The Power and Potential of Personal Health Records - RWJF

Feature: The Power and Potential of Personal Health Records - RWJF: "What are Personal Health Records (PHRs)? How are they related to Electronic Medical Records (EMRs) and Electronic Health Records (EHRs)? What is the role for PHRs in the landscape of health information technology (HIT)? What are Observations of Daily Living (ODLs), and how will this new kind of health information lead to healthier decisions and better health outcomes? What do all these acronyms mean for patients, doctors, and caregivers?

The purpose of this Web feature is to provide a new and enriched context for the body of work on personal health records funded by the Pioneer Portfolio and the Robert Wood Johnson Foundation. After five years of funding PHR-related work, the Pioneer Portfolio has acquired a substantial corpus of reports, podcasts, e-primers, and blog posts concerning personal heath records. The Pioneer Portfolio has worked with several organizations in this space, and each product highlighted in this collection represents the hard work and creativity of various grantees over the span of five years. When considered as a whole, however, this collection presents a more powerful and compelling portrait of personal health records than any one free-standing report possibly could."

Monday, January 18, 2010

A doctor friendly EMR - online video demo

Clinkare is a browser based EMR designed for Indian doctors and clinics. This is from Plus91, a startup I have invested in.

Friday, January 15, 2010

Patience Pays - Free Solitaire Game for Infertile Couples

Infertility teaches you to be patient ! Here's a solitaire game you can play to help you become a better patient, while you are being patient ! You can download this free solitaire card game at

Feedback is welcome !

How we treat patients from the USA cost effectively !

Many infertile couples want to come to us from the USA for their IVF treatment because we are so much more cost effective than US clinics. Most will come to India directly on Day 1 of their cycle, and we can do the entire treatment for them in our clinic. Since the treatment takes only about 20 days, many of them find this to be the easiest ( and least expensive ) option.

However, some cannot take leave for more than 10 days. This is why they'd rather start their superovulation locally, and then come to Bombay on Day 10. This way they need to spend only about 10 days in Bombay, saving themselves a lot of precious time.

While many local doctors are happy to help them out by prescribing their medications and doing their Day 3 check scan, some doctors refuse to cooperate. This often makes if very difficult for patients, and adds to their frustration.

The good news is that we have now worked out a protocol which allows us to manage the patient's superovulation by remote control, so that they do not need any assistance from their local doctor at all !

How can we manage this ?

1. Firstly, we have a very clear treatment protocol, which is available online at This allows patients to plan their treatment and book their tickets

2. Using our Second Opinion Form, I customise their protocol for them, based on their age, FSH levels and antral follicle counts. They can check their blood levels of FSH,LH,PRL , TSH and AMH from , which is much easier and cheaper than going to their doctor ! They can also check their antral follicle count and confirm their pelvic anatomy is normal by doing an ultrasound scan using the medical imaging services provided by RemakeHealth.

3. I prescribe their meds for them, so that they can buy them online from This is much cheaper than buying them from a US pharmacy ! All they need to buy is Lupron for downregulation; and Menogon ( Repronex/ generic HMG) for superovulation.

4. On Day 3, they do an ultrasound scan to confirm they are downregulated and to check their antral follicle count. They can do this anywhere in the US, using the medical imaging services provided by RemakeHealth. They can also do a blood test for checking their estradiol ( E2) level at , to ensure they are downregulated.

5. They email me the scan results, and based on this I individualise the Menogon dose they need for their superovulation, which starts on Day 4. They then fly down to the clinic on Day 10; and need to spend only about 10 days in Bombay for their egg collection and embryo transfer !

Using this protocol, patients now need to spend only 10 days in India !

Testing the Infertile man

Wednesday, January 06, 2010

Increasing ROI through an EMR - a guide for Indian doctors

Doctors love buzz words and acronyms and money – and this article by Aditya Patkar of Plus91 has lots of them !

ROI or Return on Investment is a very popular term these days , with everyone investing in the share market. Doctors too , need to maximize their ROI – and they have done this traditionally by investing in their clinic and practice.

As a doctor , you invest in the real estate, the interiors, furniture and fittings, medical equipment, and your staff. Your clinic is now doing well. So what more can you do to increase your return on the investment you have made? One option is to improve your productivity by using technology effectively. Of course this requires an additional investment , but this is miniscule compared to your sunk costs – the money you have already invested in your clinic
How does investing in technology help you improve your ROI ? Both by increasing your patient base by improving patient satisfaction ; and by improving the efficiency and productivity of your clinic , leading to savings in time and money.

The plus points of an EMR are:

a. Better Management of Time – All medical reports are safely and securely stored in one location for easy search and recall, allowing quick patient registration process, easy look up ; efficient retrieval of older records; and easy creation of bills and receipts.
b. Better Management of Space because of less Paper . You now have more space, because you don’t need to store old paper records which eat up valuable real estate. Also, because it’s easier to manage your appointment schedule, patient flow is improved, so that there are fewer patients waiting impatiently in your waiting room .
c. Better Management of Money – The EMR allows you to track your most profitable streams of income; and also allows you to keep an eye on your expenses. It allows you to analyse ledger reports across income and expenses; and keep track of who refers your patients to you .
d. Better Management of Patients – Integrated SMS and Email features allow you to communicate efficiently with your patients. Not only does this add to patient satisfaction, it allows you to manage your workday more efficiently by reducing no-shows . Studies have shown that if patients are reminded about their appointments in advance, they are much more likely to turn up on time, thus improving your efficiency !

Let’s look at some more examples of how technology can improve your life.

1. You have recently invested in a new smart phone. A good EMR system will help you make your smart phone clinic smart ! You can get SMS alerts about your appointments; and emails of your patients’ reports or images. You can also use the camera on the smartphone to take images of a medical report or your patient; and store it with the EMR instantly !
b. You have invested in an Internet connection, and you can now use the power of the Internet to maximize your efficiency. Your EMR system allows your patients to access their records remotely, so that they don’t need to waste their time and yours by crowding in your clinic.
c. You take pride in your clinical acumen and have finally developed the perfect medical form to help you collect your patient’s clinical details , so you can improve your medical decision making. With the help of an EMR, you can use this form as a “smart template” ! The EMR allows you to capture medical data and display it in graphs and tables, so you can analyse the medical data you spend so many hours to collect more intelligently.
d. The EMR is intelligent, and makes it much easier for your staff to enter patient data, so that you can look it up easily later on. How many of your patients have diabetes ? How many stay in Colaba ? How many were referred by Dr Shah ? How many had their annual check up done over 1 year ago and need to be sent a reminder that they need to come back for their next annual checkup , thus helping you to keep them in better health and also improving your profitablility ?

Let’s look at a real-life success story of how a radiology clinic improved their efficiency by investing in an EMR.

1. Many imaging clinics lose patients , especially if they are small because of over crowding. Patients get fed up waiting for their scan ; and for their reports. Using a good EMR system like Ultrasite from Plus91 allows the clinic to create a streamlined flow of patients. Faster and quicker report generation using the EMR system means less waiting time for patients.
2. A good machine generates images, but the reporting using these images is what creates productivity. You can now directly import or attach digital images into the EMR, hence minimizing the time required to separately print them from the machine.
3. Government rules require each and every sonography machine to be registered and the clinic to generate Forms and Reports for all sonographies done for pregnant women, as per the PNDT Act. This can be long and tedious with doctors investing manpower, time and stationery in creating this. The Ultrasite EMR system allows you to automatically generate the PNDT Form F and the final report as part of the normal ultrasound reporting process. This saves time and resources , increasing ROI. Since the formats are strictly followed as per the Act , the EMR ensures you are always in compliance with the Act.
4. All radiology clinics today have a PC , which is used primarily just to print images or make reports using MS Word. Not using an EMR means you are under utilizing a vital resource that you already have!

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