Novel Strategies to Bring Private Hospital Industry in Sri Lanka to the Next Level

Introduction

In the modern world, healthcare has become an indispensable aspect of economic and social existence. Decision-making management practices, such as Information Systems, are widely employed in healthcare systems to enhance their efficiency and improve patient satisfaction, service quality, and the overall quality of care.

The health system in Sri Lanka is divided into two main sectors namely, the state sector and the private sector. The private health sector comprises more than 141 hospitals that provide in-patient services, catering to over 135,000 admissions annually. However, this only represents about 2% of the annual admissions to government hospitals. This therefore indicates significant potential for growth in the private health sector within the Sri Lankan healthcare system.

In this context, the purpose of this article is to identify Strategic Information Systems (SISs) opportunities for the private hospital sector in Sri Lanka and assess their potential impact on the strategic position of the hospitals in terms of competitive advantage, cost feasibility, and the risks associated with implementing the SIS opportunity.

All about SIS and the theories used to identify SIS opportunities

SISs are information systems that support or modify an organization’s strategy, and in doing so, provide strategic advantages to an organization by capturing opportunities that arise. SIS also plays an pivotal role in healthcare organizations as it can provide them with a competitive advantage.

Besides, various models exist for identifying SIS opportunities within an organization or industry. One framework commonly used to identify and analyze such opportunities is the Rackoff, Wiseman, and Ullrich (1985) “strategic thrusts model.” This framework analyzes five strategic thrusts (differentiation, cost, innovation, growth, and alliances) of the opportunity over suppliers, customers, and competitors as strategic targets.

Identifying potential SIS opportunities in Sri Lanka’s private hospital industry

 The Sri Lankan hospital system is characterized by several steps of documentation, including OPD visits, admissions, daily bed ticket updates, lab results, discharge documents, and disease notifications. Most of these steps involve paper-based processes, resulting in a large workload for staff when entering, filing, retrieving, and transmitting information between departments or institutions. This also necessitates the handling of significant amounts of data. Therefore, there is a great opportunity to implement a fully-electronic health record (EHR) system within leading private hospitals in the country. According to the International Organization for Standardization (ISO), an EHR system is defined as the digital collection of patient data, which is stored, exchanged securely, and can be accessed by multiple, authorized users (ISO, 2004).

How can we utilize EHR systems in hospitals to gain sustainable competitive advantage?

This is where we can use the above-mentioned model (Rackoff, Wiseman, and Ullrich (1985) “strategic thrusts model”), where we can see how this EHR system can utilize under different strategic thrusts to identify their final impact on our main strategic targets where to decide whether it will provide our expected sustainable competitive advantage.

a. Innovation

The hospitals can incorporate this EHR system with the bed head tickets (BHT) of the inward patients by introducing E- BHT system replacing handwritten BHTs. Further, the relevant imaging details and laboratory test results can also directly update into this system by linking those departments with the system. So, the relevant consultant/physician can get the details and decide on the management plan of the patient without doing physical ward rounds which reduce the patient waiting time and delay in treatments.

Then the hospital can introduce E- referral system where the physicians/ general practitioners who are the main suppliers of the organization can directly enter the details of the patient in to this EHR system and refer to the hospital. As such, the hospital can be ready to take over the patient by preparing equipment, wards, theater facilities which prevent unnecessary delays.

b. Alliances

Given the payment methods in Sri Lankan private hospitals, 86% comes directly from the patients out of pocket, 6% from the private health insurances and 3% from the private companies via employer paid insurances. This EHR system can alliance with those financial authorities (Insurance companies, banks, and private companies) where the system can send E bill directly to the relevant authority at the time of patient discharge.

Then this EHR system can make alliances and link with the organizations such as care givers, ambulance services, geriatric support centers, elderly homes etc. which can offer further services to the patient after discharging.

c. Growth

As the 80% of leading private hospitals in Sri Lanka have their own laboratories with wide range of sample collecting centers, mobile labs, and intermediate labs throughout the country, linking those laboratories with the EHR system can provide electronic lab reports. This can further be developed by establishing a remainder system (Eg: SMS alert, voice record) of monthly clinic visits, blood investigations, checkups depending on the EHR of the patients which helps widen the services provided by the hospital.

d. Cost

Implementation of integrated EHR system can speed up the processing time, eliminating the certain steps of the routine procedures and the paper works which ultimately leads to the reduction of the operational cost, storage cost and logistics cost. This also helps gain competitive advantage over the other competitors which will be further explained in the next section.

How does this EHR system provide sustainable competitive advantage to hospitals?

EHR system provides accessibility of health information to patients which improves their disease awareness, new treatments and investigations, next clinic visits/appointments which ultimately boost the relationship and trust of the patients towards the hospital. It also provides patients with direct access to information preventing the handwritten prescription misinterpretation, improper drug dosage, repetitive testing which are the main causes of medical errors. In addition, the integration of different departments and making alliances with insurance and banks provides easy patient registration, insurance verifications and payment information. Thus, it can be said that EHR system increases the competitiveness of the hospitals in their competitive environment among other key players in the market.

What are the associated risks and pitfalls in EHR system?

 The identified risks and mitigations are as follows,

a. Security, privacy, and confidentiality of data

This EHR system contains highly confidential and sensitive data of the patients. As such, any security breach or hacking leads to leaking of the data into third parties creating ethical and legal issues. In order to avert these hiccups, the system can be protected via anti-virus software, fire walls and data encryption methods, which control the system access through password protection

b. Inaccuracy of data

Inaccuracy of data can be prevented incorporating unique patient identity and data entry process with data validation, data verification and algorithms.

c. System failures

System failures can lead to shutdown of the entire system and to prevent that, it should have a backup system and disaster recovery system.

d. Legal issues

When handling and transferring the patient data, breach of confidentiality create legal issues such as compensations, legal actions, lawsuits. To avert these issues, the system should have mechanism to obtain the consent of patients for the disclosure, storage and sharing of their information.

e. Financial risk

Since implementation of this system requires huge amount of capital, hospitals need to control the other risk factors in a more systematic and effective manner.

Conclusion

According to the above analysis, an integrated EHR system is identified as a possible SIS opportunity for private hospital industry in Sri Lanka. By implementing this system, it brings the hospital towards a cost leadership strategy from its current hybrid strategy which improves the competitiveness. The main barrier of establishing this type of SIS in Sri Lanka is its high implementing cost which is more than its annual revenue. Among the number of risks associated with implementing this SIS system are data protection/ privacy, accuracy of data and the system failure.

Dr. Asiri B. Dissanayake

(Dr. Asiri B. Dissanayaka is a medical doctor and researcher with a diverse educational background, holding an MBBS degree from Sri Lanka and an MBA degree from the United Kingdom. Currently serving as a Medical Officer at the District General Hospital Avissawella, he is dedicated to providing high-quality healthcare services to the local community. Dr. Dissanayaka’s research focuses on recent advancement in hospital management aspects in view of improving patient outcomes, and quality of the health services. As an author, he shares his expertise through publications, contributing to the medical field and improving healthcare practices. With his combined medical and managerial skills, Dr. Dissanayaka strives to enhance patient care and promote advancements in healthcare management aspects.)

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