Case study– Obstetrics

& Pediatrics

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consent of Asclepius Consulting.
 Anita Roy

anita@gmail.com 9899720801

Irregular menses Gynaecology

Dr. D. Prasad

20 OCT 2007

21 OCT 2007

Patient logs into the

website or makes a
phone call for an
appointment
 SMS- 15 min delay
SMS- 30 min delay
SMS- 1 hr delay
SMS- 2 hr delay
SMS- 4 hr delay
SMS- 1 day delay

Patient is given
reminder about the
appointment and
current status of the
queue on her mobile
 RBN20071021012 ROY O +VE

MRS HOUSEWI FE 17 NOV 1969

ANI TA
MARRI ED

C-56, FI RST FLOOR

2210221
ARDEE CI TY
997202225
NEW DELHI
ANI TA@GM
DELHI

110016

Patient gets a DI LEEP HUSBAND

unique registration
ROY 9972022251
number for all
subsequent visits
 Charges calculated based on
Doctor’s Specialty
Doctor’s Seniority
Patient meets the Visiting doctor’s own OP rates
Date of last visit
relevant doctor, fee is Cross-referral charges
Patient category discounts
collected based on Corporate/ Insurance rate lists
Patient’s income category
relevant price list
 Anita 31 yrs 11 mon 8 d Female OPD
Roy 1 - -

Duration of present
complaint
Obstetrical and
menstrual History
Suspected pregnancy
3w
Past cycle 10-12 / 24-25 days Para 1 + 0. Last child age 3 yrs. 2 month amm

Mother with asthm a

Family History

Past Medical & Surgical NA

History

Doctor takes the 80 98

relevant history, Per abdmonial examination shows a lump arising from the pelvis 8-10 week size. Per vaginal examination
shows uterus 14-16 week size mobile
conducts systemic I rregular menses with bulky uterus suggestive pregnancy

examination and
records provisional
diagnosis
 My Templates

History & Physical Anita 31 yrs 11 mon 8 d Female OPD

Obs & Menses Roy 1 - -

Infertility

Irreg ular menses

Suspected pregnancy
Hysterectom y
Duration of present 3w
Ovarian cancer
complaint
Preg nancy
Obstetrical and Past cycle 10-12 / 24-25 days Para 1 + 0. Last child age 3 yrs. 2 month amm
Rup ture uterus menstrual History
Vag inal d ischarg e
Mother with asthm a
Family Family History
Ellip sis

Card iac
Past Medical & Surgical NA
Diab etes History
Asthma

Infertility

Jaund ice

Prov. Diagnosis
Fallop ian Tub e

Vesicular stone

Doctor takes the Uterine fib roid

Preg nancy
80 98

relevant history, Per abdmonial examination shows a lump arising from the pelvis 8-10 week size. Per vaginal examination
shows uterus 14-16 week size mobile
Orders
conducts systemic Systemic Exam I rregular menses with bulky uterus suggestive pregnancy

examination and Follow up

records provisional
diagnosis
Based on the provisional
diagnosis, additional
investigations and
medications are ordered
using templates
 Images

Anita 31 yrs 11 mon 8 d Female Room #6 Bed #3

Roy Full term pregnancy
1

GENERAL EVALUATION:

I rregular menses with pain in lower abdomen since 21/04/2007 Fetal Cardiac Activity: Normal at
Excessive menstrual bleeding since 18/10/2007 141 BPM.
Fetal Lie: Longitudinal
Bulky uterus since 21/04/2007 Fetal Presentation: Cephalic
Placenta: Anterior, Grade II.
Uterus: Normal
Cervix: Closed
Adnexa: Not seen.
Amniotic Fluid: Normal
BIOMETRY:
BPD: 6.4cm consistent with 38
weeks, 2 days
Chest X Ray received at 22/10/2007 10:05 AM
HC: 33.1cm consistent with 37
weeks, 5 days
AC: 37.0cm consistent with 40

Pregnancy is confirmed weeks, 6 days

FL: 7.7cm consistent with 39
weeks, 3 days
after the USG – Pharma Order: Autrin at 21/10/2007 6:10 PM CI (BPD/OFD): (70-86) 83
FL/BPD: (71-87) 82
radiology reports and Radiology order: ECG order at 21/10/2007 6:10 PM Appears at emergency with full term on 22/10/2007 11:30 PM
FL/HC: (20.6-23.4) 23.3
FL/AC (20-24) 21
images are available to HC/AC: (0.87-1.06) 0.89

doctor at her computer

 Anita 41 yrs 11 mon 8 d Female Room #6 Bed #3
Roy I rregular menses with pain in lower ...
1
Pregnancy 1st trimester. Routine investigations

Routine investigations
are ordered using
templates and results
are compiled centrally
 Patient Education
The hospital reminds the
patient of the next
appointments – and gives
education material for
each trimester- using pre-
defined templates
Anita 31 yrs 11 mon 8 d Female Room #6 Bed #3
Roy Full term pregnancy
1
I Asthma
rregular menses with pain in lower abdomen since 21/04/2007
Asthma during pregnancy
Excessive Since asthma
menstrual bleeding is a very common disease affecting millions of people, it is not strange that lots of
since 18/10/2007
Medicine
mothers-to-be would be suffering from asthma as well.
Bulky uterus since 21/04/ 2007
Allergy Asthma often worsen during pregnancy, especially in conditions that are already severe. There are
others who improve during pregnancy, especially if their disease was mild before they became
Dietary
pregnant. Another third experience no change. Cases where asthma or asthma attacks become
Exercise worse, they mostly occur during 24 to 36 weeks of pregnancy. Only about 1 in 10 women with
asthma have symptoms during delivery.
Medication - to take or not to take
Continuing to take asthma medications during pregnancy is a must. One can do worse damage by
not taking them.
Chest X Ray received Today there are
at 22/ 10/2007 many
10:05 AM excellent medications for treating asthma and allergies. Although no
medication can be proven entirely safe for use during pregnancy, the patient and the doctor can
work together to develop a treatment plan that carefully balances medication use and symptom
control, and assures that the potential benefits of the medication outweigh the potential risks of the
medication and of uncontrolled asthma.
Can one take allergy shots during pregnancy?
Allergy shots do not have an adverse effect on pregnancy, so they can be continued. As
Pharma Order: Autrin at 21/10/2007 6:10 PM
always, your allergist will monitor your dose to lessen the risk of an allergic reaction to the shots.
Radiology order: ECGThese
order atreactions are
21/ 10/ 2007 rare;
6:10 PM however, such a reaction
Appears atcould be harmful
emergency with fullto the
term onfetus. Allergy
22/10/2007 shot
11:30 PM
treatments should not be started for the first time during pregnancy
 31 yrs 11 m on 8 d Fem ale Em ergency
Anita Roy
4 - Full term pregnancy

Severe pain

60 99.1 125

40 80 100

Full term pregnancy Under hospital

Patient appears at supervision

emergency without
any records – triage
conducted at the ER
Attending doctor views
patient history
allergies, radiology
reports, medications,
past lab results and
other specific
instructions
The admitting doctor
consults with the
attending
gynecologist on
phone
 Doctor advises
admission, patient
appears for estimation
and finds out the
deposit amount
 The provisional
diagnosis and the
estimate are sent to
the cashless insurance
company with the
Patient is allocated a
room based on the MRN2345566
Asha Goyal , F/21

patient choice and Uterine Fibroid

Dr. B.Prasad

availability
 Anita 41 yrs 11 mon 8 d Female Room #6 Bed #3
Roy I rregular menses with pain in lower ...
1

OT is scheduled for
the patient based on
the availability of
the visiting surgeons
Nurses place the ward
charges directly to the
patient account at the
point of care – rather
than making paper
charges
 All orders for the
patient are
consolidated for quick
review – thus
minimizing follow up
needs
 Order Flag

The relevant lab results

are consolidated in
clinically useful forms
for the doctor
 Anita 41 yrs 11 mon 8 d Female Room #6 Bed #3
Roy I rregular menses with pain in lower ...
1

Primary surgeon : Dr. D. Sinha

Proc surgeon : Dr. R. Gupta
Monitoring staff : Shyamala 120
Monitoring start :10/11/2007 11:00 am

Pre-op checklists given 100

to nurse using 80

templates – patient is ITEMS

Systolic BP
60

monitored through Diastolic BP 40

flowsheet and charts

OT notes during the
surgery prepared
using templates
 Anita 41 yrs 11 mon 8 d Female Room #6 Bed #3
Roy I rregular menses with pain in lower ...
1

After the surgery,

the patient is
monitored and
medication record
prepared
 The patient account
balance is periodically
reviewed and
additional deposits are
requested, if needed
 Direct material are
tracked to the patient
consumption
Consumption is tracked
to the departments,
based on budgetary
guidelines; while the
inventory is tracked at
the stores and sub-
 ANITA ROY

17 NOV 1979 FEMALE HOUSEWIFE

Em ergency arrival with labor pain

Routine investigations to establish surgical fitness – USG, CBC, routine urine, blood sugar, serum , SGPT

Full term pregnancy requiring Cesarean section

Discharge summary
is automatically Cesarean section was conducted. Infant and m other recuperated sufficiently. The postoperative period was uneventful.
Som e bleeding seen, m ostly in the anterior uterine wall.
prepared and
specific follow up
instructions are
given using
 Discharge bill is
immediately
consolidated based on
all the charges made
through the patient
stay
 Baby is
automatically
registered in the
hospital for
subsequent visits
 0 yr 0 mon 2 d -
1 Nil Nil

Nil

-
Born of LSCS. Uneventful birth.

Maternal grandmother with a history of asthma

Pediatrician 18
6.2

assigned, history Nil

and vitals Nil

maintained as
medical record
 Patient Education

Baby Nutrition Tip

Learn what healthy nutritional needs your
new baby or infant has. The below tips will
help you decide what feeding schedules and
baby food is age appropriate for you child.
When Can Baby Drink Water?
Nighttime Feeding Weaning
How Often Should You Breast Feed Baby?
What Mom Should Eat While Breast Feeding
Storing Homemade Baby Food
Baby Clothing Tip
These baby clothing and apparel tips will
help you pick the right clothing styles that are
safe, comfortable, and seasonally appropriate
for your baby. Read how you can make the
most of your baby clothing budget and not
over buy certain items.

Education material Baby Behavior Tip

Learn all about your babies cries? Is she
hungry, sick, or just need attention? Find
on baby care given more information and tips about why your
baby fusses, smiles and acts the way she.
using templates
 I mmunization due RBN071020013

Reminders for
immunization and
birthday wishes given
for entire 5 years
 Welcome Ms. Anita Roy

The patient logs in the

hospital website to
download discharge
summary, lab reports,
bills and seek
appointments
 The documentation
generated –for clinical as well
administrative workflow –
closely meets the HL7 and
NABH guidelines
Extensive graphical
reports and excel–
like queries are
generated based on
the billing data
The reporting tool is
leveraged to carry
out patient research
based on clinical
conditions
 • Effective Surgical Revenue (ESR)
• Effective Bed Revenue (EBR)
• Effective Diagnostic Revenue (EDR)
• Operating
Operating costs
costs
• No. of case sheets Operating costs
generated • Consumablecosts
Consumable costs
• No. of research published Operations • Average revenue/ patient • Salary
Salary costs
costs
• No. of technology • Market share •Rental
Rental costs
costs
initiatives underway • % of repeat patient • Pharmacy
Customers Pharmacy costs
costs
Innovation • Patient satisfaction index • Marketing
Marketing costs
costs
• General
General Admin
Admin costs
costs
DASHBOARD
METRICS

Employees Investors
• Attrition rate
• No. of training days • ROCE
• Partners • Operating Margin
No. of full time doctors
• Employee satisfaction • PAT growth
index1 • Cost of Capital Consumable costs
• No. of partner patients • Direct material
• No. of referrals from partners • Overhead material
Asclepius Consulting • Operating margin at partner sites • A- Category material purchase
collaborates with the No.
sitesof technology transfer
• initiatives
No. of technology
underwaytransfer
• Avg. direct consm per patient

hospital to generate initiatives underway

specific dashboards
to Report-by-
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