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Department of Management Sciences Mohammad Ali Jinnah University Islamabad Pakistan

Mohammad Ali Jinnah University Islamabad


Business Research Project - summer 2011Final Evaluation Form
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Introduction:
It has been observed that most families resided in Mirpur have elders living in the city even as most other family members are living abroad. There is a lack of health facilities being provided in the city while the current health centers are out dated and not up to the living standard of the people. Due to this lack of modern health facilities, people most often have to move or relocate to Rawalpindi/Islamabad. The situation calls for a solution to this problem. For this purpose, we have to start project on launching Telesehat center at Mirpur. For this research project, we have to look at Mirpur current environment regarding health facilities and issues. We also have to work to get information about the affordability of the people for modern health facilities. Our stakeholder is Telesehat which is going to launch this center.

Over view of Telesehat:


Telesehat is the Telemedicine solution provider for ever-increasing need for healthcare services throughout the world. Telesehat have worked to bridge the gap in healthcare services between rural and urban areas and brought basic healthcare to your doorstep. Telesehat is going to open their new branch in Mirpur because they found that people are from Mirpur come in rural areas for the basic health care services. Telesehat have new machinery, labs, senior doctors, mostly senior doctors dont want to go in small cities but Telesehat have senior doctors that should visit Mirpur. First Pakistani company who developed a complete Telemedicine solution integrated with hospital/clinic management system Development focus is to ensure that healthcare practitioner do not require extensive IT training Local presence allows immediate onsite and offsite support to ensure 24 hour operations

Co-branding and partnership options Team of seasoned professionals with extensive development and business knowledge Development objective is to provide globally competitive solution with most cost-effective hardware integration compatibility

How it works:
As availability of internet in rural & remote areas is still not confirmed, therefore TeleSehat ensured that Tele Diagnosis should be compatible with all the available connectivity options which are:

DSL Fiber Optic EVDO Wi-Max Satellite

CLINICAL DIAGNOSIS SUPPORT


It was embedded into the system design of the TeleDiagnosis, so that it should support maximum healthcare domains and should assist each domain specialist according to their specific domain requirement. TeleDiagnosis application has a number of modes to facilitate the remote diagnosis of the patient. Following are the peripherals which are integrated with TeleDiagnosis along with their corresponding domain: Digital Stethoscope (General Medical) Digital Dermascope (Dermatology) Digital Otoscope (ENT) Digital Iriscope (Eye) Ultrasound (Gynecology, Sonology) ECG (Cardiology) X-Ray Scanner (Radiology) Digital Notepad (Prescription Writing)

ELECTRONIC HEALTH RECORD (EHR)


TeleDiagnosis enables the healthcare facilities to capture the patients clinical data through normal workflow. TeleDiagnosis supports both paper-based records and film-based records data entry, whereas all the medical records generated while using TeleDiagnosis such as clinical prescriptions, laboratory reports, diagnostic snaps, and vital signs, are automatically stored in the system.

The EHR components are as follows:


Clinical Notes Administrative System Components Laboratory System Components Pharmacy System Components

TECHNICAL HARDWARE
In order to make Tele Diagnosis business viable, we ensure that the hardware required for this setup should be minimal. This will not only reduce the initial investment but hardware maintenance is also simple and cost effective.

The hardware includes:


General Purpose Desktop/Laptops PCs Laser Printer Web Cameras Microphones Speakers

Market Need:
Mirpur have total population 3.63 million. We found there is round about 15 hospitals. There are 3 big hospitals in Mirpur but having lots of complain about them. We found patients about OPD were satisfied about medicine but there were not satisfied about doctors. Lack of Modern health facilities Lack of efficiency Lack of advance labs Lack of advance equipments

We have found that there is no hospital in Mirpur about Cancer and cardiology. And patients have to go out for their check up outstations. There we

found one institution regarding cardiology but there is no hospital and sufficient equipments in the Mirpur and we found old doctors have started work there but after few years they left due to less equipment. There is no facility regarding neuron surgeons. Its mean there is big gap regarding cancer hospital and neuron, radiology. We found that there is lack of modern health facility in Mirpur. Doctors are inefficient and patients have to wait for doctors. There hospitals have less advance labs. There a good/old hospital has almost 100 patients come in a day. Doctors are there inefficient so we can acquire 50 of their patients easily. Its about 3 big/old/large hospitals in Mirpur and all of them having 100 patients on daily basis and all of them are inefficient so we can acquire 50% of their customers easily. Patients regarding heart, cancer, and other diseases Hospitals in Mirpur have less modern health facility. We can acquire patients about heart or other big/fat diseases and Doctors send patients in big cities for lab tests. We can acquire market regarding lab tests. Patients want their medicines that are from some big brand. We have found their people have less affected medicines and this is the need of Mirpur peoples. There we have less old doctors. People have to come out of city for old/fat diseases. We have to give doctors advance equipments. According to our survey we asked to different doctors why OLD DOCTORS do not like to work there. In the response they said few old doctors worked here but after some time the left it because they couldnt find advance equipments. We have to give them advance labs, advance equipments, through they could work better.

Target Customers:
The key to the success of any business is to reach the right person in the right time. Hospital and Healthcare Management is there to give you the best services within the sector through its various channels.

Who are our customers?

Market size:
Mirpur have total population 3.63 million. According to our survey 600 to 650 people visit hospital in a day at Mirpur. In which 65% people visit hospital for OPD. 20% people visit for emergency and other 15% people visit for other diseases like chronic, heart patient, diabetes and other diseases. According to our survey 23% people visits out station for different diseases its mean there is a big gap in Mirpur. We can get 350000Rs per month in case we will get 10% of the unsatisfied people about OPD. We found people were not satisfied about emergency and other chronic diseases like Diabetes, heart patients, and cancer, neurology. According to our survey 35% people in OPD were not satisfied. We can get 125000Rs per month in case we will get 10% of the unsatisfied people about Medical stores. 95% people were not satisfied regarding emergency. We can get 1250000Rs per month in case we will get 10% of the unsatisfied people about chronic condition. A hospital with all the facility can earn 10 to 15 lakh per month. 90% people that came there for lab test and operations were not satisfied at all. We found there even doctors were not satisfied about advance labs, Operations. Total patients in a day 600-650

OPD 65% Satisfied with OPD 65% Unsatisfied with OPD 35% Satisfied with emergency Unsatisfied with emergency All other were unsatisfied

390 390*65%=254 390*35%= 136 120*20%=24 120*80%=96 600*15% =90

Its about 600 people in which 300 people were satisfied but others 300 were not satisfied. Its mean there is a big gap where 50% of people were not satisfied. If we talk about unsatisfied regarding OPD. We have 136 people regarding OPD are unsatisfied. Obviously 136 people want more services or something different. If we give better services and better doctors to patients so we can acquire round about 35 to 40 people. One has to spend in OPD 500-1000. 1000 include medicine and small kind of test.

In case we will get 10% unsatisfied patients about OPD


136 people were unsatisfied about OPD Total spending of people about OPD in one day 136*10%=13.6=14 14*1000=14000

Specialist fee/ Medical Officer Specialist fee/ Medical officer

14*1000=14000per day 14000*25=350000 per month

The total number of unsatisfied patients is 136.If we will get 10% of unsatisfied patient is 14. We will get revenue per month is 350000.

Expense if we get 10% unsatisfied patient


Doctor fee Nurse 20000 Rs 10000 Rs

Guard Admin/Acc Rent

8000 Rs 15000 Rs 50000 Rs

Total Expense
Profit If we get 10% unsatisfied patient Total revenue Total Expenses Profit

103000 Rs

350000 Rs per Month 103000 Rs=per Month 247000 = per month

The total expenses are 103000 Rs and the total revenue is 350000. Profit: 350000-103000=247000

In case we will get 20% of unsatisfied patients


In case we will get 20% of unsatisfied patients Total spending of 28 people about OPD in one day 136*20%=28patients 28*1000=28000

Total spending Include

Specialist fee/ Medical Officer Specialist fee/ Medical officer

28patients*1000=28000per day 28000*25days=700000 per month

If we will get 20% of the unsatisfied patients would be 28 patients. We will get revenue 700000 per month.

Expenses In case we will get 20% of unsatisfied patients


Doctor fee Nurse Guard Admin/Acc Rent 20000 Rs 10000 Rs 8000 Rs 15000 Rs 50000 Rs

Total Expense
Profit If we get 10% unsatisfied patient Total revenue Total Expenses Profit

103000 Rs

700000 Rs per Month 103000 Rs=per Month 597000 = per month

The total expenses are 103000 Rs and the total revenue is 700000.

Plan about pharmacy: In case we will get 10% of the unsatisfied people
136 people were unsatisfied about OPD Total spending of people about pharmacy in one day 136*10%=13.6=14 14*350=4900

Total spending on Medical stores Per month spending on medical stores

14*350=4900 per day 4900*25=122500 per month

Expenses/Operational cost In case we will get 10% of the unsatisfied people


Store keeper 10000Rs

Rent Total Expense

10000 Rs 20000 Rs

Profit If we get 10% unsatisfied patient Total revenue Total Expenses Profit 122500 Rs per Month 20000 Rs per Month 102500Rs per month

In case we will get 20% people of unsatisfied patient

136 people were unsatisfied about OPD Total spending of people about pharmacy in one day

136*20%=28 28*350=9800

Total spending on Medical stores Per month spending on medical stores

28*350=9800 per day 9800*25=245000 per month

Expenses In case we will get 10% of the unsatisfied people


Store keeper Rent 10000Rs 10000 Rs

Total Expense

20000 Rs

Profit If we get 10% unsatisfied patient Total revenue Total Expenses Profit 245000 Rs per Month 20000 Rs per Month 225000Rs per month

Chronic patient: Incase 10% of patients


600 patients in a day and 8% people belongs to chronic condition 600*8%=48 and all patients were unsatisfied about OPD 48 people were unsatisfied about Chronic condition 10% of the unsatisfied patients 48*10% 48 4.8=5

Total spending of people about pharmacy in one day: 5patients *10000 = 50000 Rs

Total spending on chronic condition day Per month spending on chronic condition month

5*10000=50000 per 50000*25=1250000 per

Expense if we get 10% unsatisfied patient


Doctor fee Nurse Guard Admin/Acc Rent Utility bills 20000 Rs 10000 Rs 8000 Rs 15000 Rs 50000 Rs 50000Rs

Total Expense
Profit If we get 10% unsatisfied patient Total revenue Total Expenses Profit

153000 Rs

1250000 Rs per Month 153000 Rs=per Month 1097000= per month

The total expenses are 153000 Rs and the total revenue is 1250000. Profit: 1250000-153000=1097000

Incase 20% patients


600 patients in a day and 8% people belongs to chronic condition 600*8%=48 and all patients were unsatisfied about OPD 48 people were unsatisfied about Chronic condition 10% of the unsatisfied patients 48*20% 48 9.6=10

Total spending of people about pharmacy in one day: 10patients *10000 = 100000 Rs

Expense if we get 20% unsatisfied patient


Doctor fee Nurse Guard Admin/Acc Rent Utility bills 20000 Rs 10000 Rs 8000 Rs 15000 Rs 50000 Rs 70000Rs

Total Expense
Profit If we get 20% unsatisfied patient Total revenue Total Expenses Profit

153000 Rs

2500000 Rs per Month 173000 Rs=per Month 2327000= per month

The total expenses are 153000 Rs and the total revenue is 2500000. Profit: 2500000-153000=2347000 Emergency:

Incase 10% of patients


600 patients in a day and 15.67%,17% people belongs to emergency condition 600*15%=90 and all patients were unsatisfied about emergency 90 people were unsatisfied about emergency condition 10% of the unsatisfied patients 90*10%: 90patients 9patients

Total spending of people about emergency in one day: 9patients *2000 = 18000 Rs

Total spending on emergency condition Per month spending on emergency condition month

9*2000=18000 per day 18000*25=450000 per

Expense if we get 10% unsatisfied patient


Doctor fee Nurse Guard Admin/Acc Rent Utility bills 20000 Rs 10000 Rs 8000 Rs 15000 Rs 50000 Rs 20000Rs

Total Expense
Profit If we get 10% unsatisfied patient Total revenue Total Expenses Profit

123000 Rs

450000 Rs per Month 123000 Rs=per Month 377000= per month

The total expenses are 123000 Rs and the total revenue is 450000. Profit: 450000-123000=377000

Emergency:

Incase 20% of patients


600 patients in a day and 15.67%,17% people belongs to emergency condition 600*15%=90 and all patients were unsatisfied about emergency 90 people were unsatisfied about emergency condition 10% of the unsatisfied patients 90*20%: 90patients 36patients

Total spending of people about emergency in one day: 18patients *2000 = 36000 Rs

Total spending on emergency condition day Per month spending on emergency condition month

18*2000=36000 per 36000*25=900000 per

Expense if we get 20% unsatisfied patient


Doctor fee Nurse Guard Admin/Acc Rent Utility bills 20000 Rs 10000 Rs 8000 Rs 15000 Rs 50000 Rs 40000Rs

Total Expense

143000 Rs

Profit If we get 10% unsatisfied patient Total revenue Total Expenses Profit 900000 Rs per Month 143000 Rs=per Month 753000= per month

The total expenses are 143000 Rs and the total revenue is 753000. Profit: 900000-123000=753000 ROI=
Gain on investment cost of investment Cost of investment

ROI=

2250, 000- 9000000 9000000

-6750000 9000000

ROI=

0.75

For this whole project we have to give facility to our customers like advance lab, Doctors efficiency, Advance equipments, Advance health facility. We have to make their advance labs where people can make it their advance test. 30% of people have been made their lab test. There were 5% people who made their lab test from Mirpur and other 25% went out for their lab test. Few of them went Lahore and other have been visited Islamabad. Few advance facilities, Major operations they have in big hospitals. In this era we have seen different changes more people are getting sick and we can say 10% people having diabetes. We found there people visit hospital even once a week.

We have divided our market into different areas. We have Purana Mirpur, chatter puriban, Bhutto Park, Allama iqbal road, Jinnah stadium, Kotli road, Mega mart. We have 3 big hospitals in Allama Iqbal road, are Riaz, Children hospital, Raiz hospital, these hospitals are having 100 patients every day. We have found their doctors arent respecting patients. Patients have to wait for doctors some time a whole day. We can acquire their 50% market because we have HMIS (hospital management information system) in which patient will take appointment and will come at time and go in time. Telesehat doctors give respect to patients. Telesehat have more effective and senior doctors Then why people will go there in different hospitals and wait for their numbers and waste their time. This is about OPD.

Competitor profile:
Telesehat will have a number of competitors in the market for privatelyprovided tertiary care. For instance, the health care division of the, Riaz hospital one of largest hospital in Mirpur, ran 1 private hospitals with more than 10 beds. City hospital managed super and multi-specialty hospital in Mirpur and planning to grow it from 13 beds in to 20 beds over the next few years. Benazir Bhutto is the largest medical store in the Mirpur. Noor memorial Hospitals Ltd., the hospitals, operated specialty hospitals in Mirpur at Kotli road. Noor memorial had formed an alliance with Benazir Bhutto Medical store to gain access to Benazir Bhutto expertise in the field of Medicines. Noor memorial planned to set up at least 1 new hospital in the next three years.i Many of Telesehat competitors including Riaz Hospital and City hospital worked on building integrated delivery networks ranging from primary to tertiary care services. Analysts expected Mirpur private tertiary care sector to grow at 15% in the next few years. The present shortage of premium medical facilities, the growing incidence of lifestyle diseases, and growing income levels, have all led to a large unfulfilled demand for high quality healthcare services, translating into a large potential opportunity. Today, healthcare is being touted as the next big boom, and the sector is expected to grow rapidly over the next decade, to reach a level of Rs. 200,000 to 300,000 crore by 2012, largely spurred by an increased corporate presence in the sector.

Competitive advantage
Telesehat Providing streamlined processes and rapid access to patient data, standardized IT infrastructures offer the key to efficient management of modern hospitals. They ensure optimized interactions between medical-technical equipment and facilities and create the conditions necessary for flexible, demandorientated assignment of doctors and nurses Telesehat has HMIS system. HMIS stand for hospital management system in which they can store information regarding employee. They can store 1. 2. 3. 4. patient registration number patient appoint management system patient history management system laboratory system

People can take appointment online most of hospital we have visited people were sitting for their number and there were inefficiency. Customers arent king regarding this industry in Mirpur. Telesehat will give facility about online registration and online appointment system and they will have history about patient. They will have advance laboratory system. Addition of new services like eDoctor at Home, eDoctor at Village etc. Patients in Mirpur will be able to get access to special healthcare facilities which are not available in their cities this whole effort is to decrease the transportation gap between the doctors and the patients It wont sound like rush in our hospital/clinic due to HMIS. We have seen rush in Mirpur hospitals. People have to wait for their number.

Value proposition
Patients in Mirpur will be able to get medical advice from specialist doctors using telecom infrastructure. Patients in Mirpur will be able to get access to special healthcare facilities which are not available in their city. Patients will be provided a service in which they will be able to choose between different physicians and appointment times according to their need and convenience. The patients will also get an electronic health record facility, where all their medical record/history will be maintained and can be accessed from anywhere around the world. This record system will include their previous medical test reports, their drug history as well as their visit records at designated hospitals/clinics Tele Diagnosis enables the healthcare facilities to capture the patients clinical data through normal workflow. Tele Diagnosis supports both paperbased records and film-based records data entry, whereas all the medical records generated while using Tele Diagnosis such as clinical prescriptions,

laboratory reports, diagnostic snaps, and vital signs, are automatically stored in the system.

The EHR components are as follows:


Clinical Notes Administrative System Components Laboratory System Components Pharmacy System Components Establishment of specialist doctors pool in large cities Establishment of medical centers in semi-urban areas, towns, and rural areas Establishment of doctors telemedicine cabin at large hospitals Connecting the hospitals and pool of doctors in large cities with patient centers in rural areas Telemedicine outlets of existing hospitals in urban areas Doctor at home Doctor at Village

Financial Statement:
This is a brief description of the project cost of the Telesehat Hospital, Golden Temple to provide the basic healthcare facility of the local population. The hospital basically needs the minimum infrastructure which can be categorized in departments as follows: Casualty/Emergency Clinical laboratory Radiography Dialysis Operation Theatre (for minor procedures only)

The costing of each department based on the equipments needed is summarized and the total cost for this project is quoted at the end. 1. EMERGENCY DEPARTMENT The equipments needed for the emergency department as well as in-patient wards are: Pulse Oximeter Syringe Pump Infusion Pump ECG Cautry Multiparameter Monitor Defibrillator

The total costs of these equipments is summed up to 24, 51,060 Rs


2. CLINICAL LABORATORY The equipments needed for basic investigations and also life-saving investigations are: Auto analyzer (Analysiss serum, plasma, urine, CSF, Hemolysate) ABG Machine or Analyzer (Arterial blood gas analyzer) The total cost of these equipments is summed up to 22, 00,000Rs 3. RADIOGRAPHY An X-ray machine (HF Advantage 32KW with FTT) needs to be purchased to replace the present old X-ray which is damaged. The total cost of this is 10, 07,500Rs 4. DIALYSIS The hospital needs four dialysis machines of which two are needed in first stage and the cost of the dialysis machine is 8,50,000 Rs (Eight lac fifty thousand Rupees) for each machine. Total cost will be summed up to 17, 00,000

5. OPERATION THEATRE To conduct minor procedures which can be operated without risk, an operation theatre with the following equipments should be furnished. OT Table OT light Suction Machine Anesthesia Machine Autoclave Fumigator Instruments for minor procedures

Objectives:
Our research is applied research because we are working on establishment of health center through this research which will be able to estimate the earning potential of health center at Mirpur. Understanding size of people being affected by poor health facilities which would in turn be our potential patients (customers). The costs involved in operating and maintaining Telesehat facility and services. Analysis on how cost can be reduced and facility or services can be extended to facilitate increasing number of patients. Using IT infrastructure and virtual interactivity of doctors with patients to provide quick health services and reduce distances in travelling. The basic objective is to provide health facility to Mirpur people who come in rural areas.

Methodology:
We got data through survey of Mirpur and we analyzed the market yesterday and we found market have potential regarding Telesehat. We made Questionnaire for survey we are going to use non probability sampling. We used in further types of non-probability sampling. For survey about doctors we used snowball sampling, and about patients we used convanience sampling. We have been visited Mirpur fill the questionnaire from patients. We have been asked question to doctors regarding their job satisfaction and their salary. Performa for the Survey
Date Time Male / Female Age

Filled By
Hospital Name

Reason for Hospital Visit Spent in this visit Spent for lab tests Spent on medicine / pharmacy How frequent do you visit doctors How many persons in your family visit doctors Go out of Mirpur / to Islamabad Annual spending on health for all the family Any Complaint

OPD Rs. 100-500 Rs. 100-500 Rs. 100-500

Emergency Rs. 600-1000 Rs. 600-1000 Rs. 600-1000

Chronic Ra 1100 1500 Ra 1100 1500 Ra 1100 1500

Others Rs 2000 or above Rs 2000 or above Rs 2000 or above

Once a month 1

Once a week 3

Once in 3 months 5

When there is a need More than 5

YES/No 1000

Shifa / Private Hospital 5000

Rew/ISB Gove Hospitals 10000

More than 10000

Any other question you asked and response?

Results:
We have taken 185 sample sizes in which 14% are females and 86% are male. We have been asked different question to them. We found more than 15 hospitals in Mirpur and our main market was on Allama Iqbal road and Kotli road where we have found 12 hospitals and 3 big hospitals. The total population of Mirpur is 3.63 million. We found that in big hospitals there are more than 65% patients fall in OPD And 20% fall in emergency other 15% fall in other Categories. We found there more or less 100 patients visit in 3 big hospitals so there are total numbers of patients is 300 in big hospitals and in other hospitals patients are different in number in some hospitals there were 30 patients so roundabout we can say 600 patients visit hospitals in a day at Mirpur. In 600 patients there are total number of patients in OPD are 65% so there are 390 people visit OPD in a day. 20% people visit emergency its mean there are 120 people visit emergency and other 15% are people regarding cardiology, advance test, radiology. We found there 45/185 people have visited outstation for different diseases. Few people told us they went outstation in Fuji foundation, PIMS and SHIFA and the reason we found for their outstation visit is Diabetes, heart patient, neurology and cancer patients and people we found that came outstation with their elders so there is big gap about these diseases. People from Mirpur fall in 3 classes and 30% people are have high class living standard and other 50% have fall in middle class and 20% people fall in lower class. 40% people spend more than 10000 annually on health its mean people have high purchasing power there.

GENDER

MALE/FEMALE

MALE FEMALE

Interpretation:

Where we have more hospitals in which area we have more hospitals

HOSPITALS

ALLAMA IQBAL ROAD KOTLI ROAD HALL ROAD SECTOR F2/ C1

Interpretation:
In this question where we have more hospitals in which area we have more hospitals and we found there in Allama Iqbal road and Kotli road.

How many people for what reason they visit hospital?


And we found 65% people visit hospital for OPD and 20% visit for emergency others 15% include chronic and other diseases.

REASON FOR HOSPITAL VISIT


SPEND IN THIS VISIT OPD 150 123 100 50 OTHERS 19 0 15 29 EMERGENCY

CHRONIC

Interpretation:

How many people & how much they have to spend on visit?

100-500 600-1000 1100-1500 2000 ABOVE

Interpretation:

How much they spent on the lab test?


100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 100-500 600-1000 1100-1500 2000 ABOVE SPENT IN LAB TEST

NO LAB TEST

Interpretation:

How much they spent in pharmacy?

100-500 600-1000 1100-1500 2000 ABOVE

Interpretation:

How frequent they visit doctors?


80 70 60 50 40 30 20 10 0 Once a month Once a week Once in three Where there is months need How frequent do you visit doctors?

Interpretation:

How many people in your family visit doctors?

90 80 70 60 50 40 30 20 10 0 1 3 5 More than 5 How many person in your family visit doctors

Interpretation:

Go out of Mirpur:

YES/NO SHIFA/PRIVATE RPW/ISB GROVE Fouji foundation

Interpretation:

How much they annually spent in the hospitals/health?


90 80 70 60 50 40 30 20 10 0 1000 5000 10000 MORE THAN 10000 ANNUAL SPENDING

Interpretation:

Time line:
Current Week Weeks objective Analysis of Market build questionnaire

Survey analysis Conduct survey Built Strategy Implementation Post Survey

Conclusion: Reference:

P.T. Jyothi Datta, Wockhardt plans 225-bed hospital in Delhi, Financial Daily, April 3, 2004.