From Papyrus to Paperless

Created on Monday, 05 July 2010 Published Date

By Ayushman Baruah, InformationWeek, June 28, 2010

Rajiv Gandhi Cancer Institute and Research Center (RGCI), which treats about 30,000 patients every year, is undergoing a major transformation. Its shelves will now be empty and the office boy will have the leisure of sipping an extra cup of coffee.

 RGCI is heading towards a paperless office with its new IT project entitled TRANSCEND (Transformation of Service Effectiveness and Delivery). TRANSCEND is an integrated programme for patient care and service delivery effectiveness across the hospital. While all clinical functions are already automated, other functions such as OPD and IPD activities, billing etc are set to become paperless in the next few months.

The problem that was

Delivering care for cancer patients involves several interventions such as regular consultations in the OPD, Diagnostics and Radiation therapy. “Patient care records are currently maintained in a single physical file containing notes, prescriptions, test results etc. Multiple care providers are involved over a period of time, and structured data from files is not readily available,” says Sundareshan, CFO, RGCI.

As with most super-specialty hospitals, the data available is in paper form. Since no standard is followed, the data captured is inconsistent across multiple departments. This makes the data unsuitable for research or analysis.

“TRANSCEND addresses the business problem of making information readily available to the care provider so that there is effective patient care.


Second, the software provides an evolving framework for incorporating, disseminating and sharing best practices across clinicians and paramedical staff.


This IT project ensures that hospital management activities are automated towards being less paper-intensive and more efficient. This will bring down the overall cost of patient care,” says Sharath Hangal, Principal Consultant of eGestalt and RGCI Programme Manager. Technology services provider eGestalt Technologies has helped RGCI in rolling out this initiative.

Implementation Challenges

Given the fact that this was the first hospital to have complete integrated clinical and business functions, there were several items that needed to be re-engineered to fit the paperless model. “Technical integration and seamless working of different software across multiple business processes and clinical protocols was a major challenge,” informs Hangal.

Since clinical teams across the country—doctors, nurses, and OT wards—were not familiar with IT, the team embarked on a major training exercise. This involved providing the staff with basic training and even creating customized user interfaces to encourage adoption among users.


    • Discharge time for in-patients is expected to come down by half a day


    • Minimum chances of prescription errors as medication and prescriptions have validation alerts


    • HR processes, payroll and doctors accounting will now take less time and will be accurately linked to finance and banking functions


Paperless cure

Automating the hospital functions and going paperless have brought about massive transformation in terms of time consumed, access to information and accuracy in deliverables at RGCI.

“Transforming the data into electronic form across multiple disciplines has helped us obtain a 360 degree view of patient care, which in turn will provide valuable insights for patient care,” says Sundareshan.

With the automated process in place, patients no longer need to carry papers such as reports, prescriptions or X-rays as information is stored in the form of electronic records which can be instantaneously retrieved whenever required.

Rajiv Gandhi cancer institute

Patients who earlier had to wait in long queues to get a consultation appointment with the doctor, can now get an appointment at short notice. The discharge time for patients is expected to come down by half a day.

Similarly, doctors who earlier had to sift through innumerable files to locate a particular record no longer need to do so. Access to files is now instantaneous as information is classified systematically according to its relevance.

It is expected that there will be fewer prescription errors since medication and prescriptions have validation alerts and are also checked for allergies or interactions. Pathologists at the lab can also view the patient EMR for a comprehensive view of the case.

Before the paperless initiative, ‘Shift handover’ was a critical area where there was a huge gap in terms of handing over patient information from a nurse in the first shift to a nurse in the next shift. The new process ensures all patient information is handed over immediately.

Software that powers ‘TRANSCEND’

    • At RGCI, VistA, an open source software, has been used extensively for OPD. This has also been used to note down the case history of patients, for pharmacy prescriptions and recording allergies


    • PARAS, a Hospital Management Software includes features such as Registration, Appointments, Billing, Finance, Human Resources, Materials and Purchase. This software is completely integrated with clinical activities. Once all information related to the patient has been entered into the system, PARAS allows immediate access to data retrieval through a unique patient care ID.


    • SYNAPSE, a Picture Archival and Communication System (PACS), is used for all radiology and diagnostic imaging activities. Through Synapse, the image link of a patient’s X-ray or MRI can be directly sent to VistA along with the radiologist’s report, thereby saving a lot of time.


Information is classified according to patients, so that there are no errors in nursing duties and procedures. During the next phase, bar coded medical administration will be introduced, which will further improve efficiencies.

HR processes, payroll and doctors accounting now take less time and are accurately linked to finance and the bank.

Earlier, interaction with the institutions and their response to queries took several hours to a few days. With clinical and non-clinical data now available at the click of a mouse, the time to respond to queries will be drastically reduced.

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