PHP, or hypertext preprocessor, is an open-source server-side scripting language. It’s extremely popular, too — almost 80% of all websites were using PHP as of October 2018. The major reason for its wide popularity is that it is actually an open source programming language that means it is free to use. It supports MS SQL, MySQL and Oracle databases without any sort of trouble.
A PHP framework provides a basic structure for streamlining the development of web apps. We use them because they speed up the development process. In our last year edition, we already mentioned the top PHP trends but technology always has something new or different to offer. Apart from Laravel, CodeIgniter, Yii, Zend, Cake PHP and Symfony which are as popular as anything can be in the PHP world here are a few PHP trends to look out for this coming year.
Phalcon
A full-stack PHP framework that employs the MVC web architecture design pattern, Phalcon was originally written in C and C++ and released in 2012. Since it’s delivered as a C-extension, you don’t have to worry about learning the C programming language. Phalcon is easy to install and suitable for creating highly configurable web applications that are in line with enterprise development guidelines. Key features include increased execution speed, asset management, a universal autoloader, and top security and caching. Unlike other frameworks, Phalcon optimizes performance due to its efficient memory utilization. If you’re looking to create a blazing fast website, give Phalcon a try. On the negative side, Phalcon developers are a bit slow to patch bugs, which may not jive with today’s need for high levels of security.
FuelPHP
FuelPHP is a flexible, full-stack PHP framework first released in 2011. Apart from supporting the MVC design pattern, it has its own version called the hierarchical model view controller (HMVC). With HMVC, unlike with MVC, content doesn’t need to duplicate to show on multiple pages. As a result, it consumes less time and memory. FuelPHP helps developers deliver end-to-end web solutions that are diverse in size and complexities. Key features include HMVC implementation, RESTful implementation, a URL routing system, vulnerability protection, and a caching system. It extends its security approach beyond ordinary security measures, making it a great option if security is crucial for your project. Because FuelPHP is relatively new, it offers less support and may present a steeper learning curve.
PHPixie
Introduced in 2012 and just like FuelPHP, PHPixie implements the HMVC design pattern. Its goal was to create a high-performance framework for read-only websites. It’s easy to get started with PHPixie, which is suitable for social networking websites, customized web applications, and web app development services.
Key features include HMVC architecture, standard ORM (object-relational mapping), input validation, authorization capabilities, authentication, and caching. PHPixie is built using independent components. For this reason, you can use it without the framework itself. Note that PHPixie has relatively few modules. Besides that, it lacks support for components independently made from the dependencies. Since it’s relatively new, it’s less popular and has a smaller community of users than other frameworks.
Slim
Slim is another popular PHP micro-framework that helps developers quickly create simple but powerful web applications and APIs. Just like PHPixie, Slim is easy to learn. PHP developers use Slim to develop RESTful APIs and web services. Key features include URL routing, session, and cookie encryption, client-side HTTP caching, and more. It’s the best framework for a small web application that doesn’t necessarily require a full-stack PHP framework. In addition, active maintenance and friendly documentation make Slim super user-friendly.
Fat free
Just as the name suggests, Fat free is free of fats. This is one of the most popular and trending PHP micro frameworks that comes with a number of packages. It comes with features, such as data validation, CSS compression, unit testing, image processing, Open ID and others. It supports both SQL and NoSQL databases, supporting the development of web apps with ease.
Aura
It is a set of decoupling libraries that can be used for developing basic apps. These self-contained libraries can be easily integrated with any projects and the best part of these libraries is that they have no dependencies. All the libraries are flexible, compliant and well documented.
PHP programming language helps you to develop web applications that are complex, reliable and faster. Based on your business requirements, hosting plans, experience level, app needs, and development timeframes, although there are a large variety of PHP frameworks to choose from it is important to have a clear understanding of what actually your business needs on the basis of the latest PHP trends.
The outbreak of COVID-19 has put immense pressure on the healthcare sector. The supply chain of medical supplies was hit. The sudden surge of patients made it difficult to manage the hospital operations. Since priority had to be given to COVID patients, regular consults and elective surgeries were delayed.
To go one step further and understand the disruption in healthcare amidst these adverse conditions, we interviewed Mr. Richard Roy Mendonce, Head Digital Strategy at Yashoda Hospitals to shed light on the role of technology in combating the current challenges faced by healthcare and possible mitigation strategies.
Mr. Richard Roy Mendonce has a strong domain expertise within the Healthcare Industry and has successfully infused digital transformations in various organizations like Columbia Asia Group of Hospitals, Sakra World Hospital, and Manipal Hospitals Group that ensured better customer experience and increased business.
A Digital Strategist, he currently leads the digital efforts at Yashoda Hospitals, which is among the oldest and biggest healthcare groups in the region. He has nearly a decade of experience in digital marketing, digital strategy and digital transformation, with a distinctive ability to develop highly effective and measurable strategies that drive revenue growth, new customers, brand awareness and reputation.
Constantly inspired & fascinated by the dynamics of the digital landscape, he has developed a skill set built on the art of leveraging digital technologies focused to deliver positive user experiences and achieve business objectives. In 2019, he was awarded as one of the 50 Most Influential Strategy Leaders by COM Global at World Marketing Congress.
Many hospitals are reassessing their digital marketing strategy and budgets in light of the uncertain economic situation. Most healthcare organizations can benefit from taking this time to strategize and plan for the future, rather than putting the brakes on. Please share some key insights into the changing patient behavior and the steps you are taking to reach them? Also, How will the healthcare marketing landscape change Beyond COVID-19?
Mr. Richard: In terms of healthcare, especially telemedicine, COVID-19 has completely cut down the channel of visiting doctors in-person for a consult. Lack of options has increased more acceptance towards Telemedicine. A couple of months back, we compared the benefits and comfort of direct consultation to an online one. We were reluctant to have those experiences but now acceptance has increased.
Another thing I feel is — we do not need high-end technology or equipment. When we hear of telemedicine, what comes first to our mind is jazzy computers, high-tech connections, software, etc.; but that is not the case. Even a simple SMS/call/WhatsApp call is enough to connect with a doctor. We don’t really need any high-end equipment to start a telemedicine service.
Today, most of the spending is being diverted to digital channels rather than traditional offline ones and it will continue to happen. Digital channels are more trackable, more efficient, and more controllable. Even digital connect to engage with offline channels is gaining momentum. Healthcare set-ups will have offline referral networks, business partners. Traditionally, there would be a sales team who go meet and connect with them. Now with the social distancing and lockdowns, even that connection is replaced with digital connections such as webinars, video calls, etc.
Communication in marketing has also changed. Before COVID-19, the communication was “Don’t ignore your health, come to us”. During the COVID-19 situation, the communication was “Come to us only if it is an emergency, it’s better to stay at home”. Post COVID-19, the communication might be- “Wherever you are, we are accessible, come to us or use our online services.”
Telemedicine in a Post-Pandemic India
In the short time since the Pandemic began, the impact of social distancing norms has changed our daily lives & routines. Due to which, services like live remote consultations and telemedicine are getting more attention. Telemedicine is likely a permanent beneficiary of the pandemic. Do you think it will remain a key mode of healthcare delivery even after restrictions are lifted? Are there other digitally-enabled services that can potentially find greater adoption in a Post-Pandemic India?
Mr. Richard: Telemedicine will continue to be one of the modes of care delivery but that will not replace the existing care delivery system. Rather, it will be a mix of both. People will opt for telemedicine for the initial consultation (a non-serious one) and post-treatment follow-ups or review visits or to update on reports. People might get accustomed to telemedicine services but I think that will never replace serious conditions or surgical specialty where doctors need to examine personally to deliver proper care.
In terms of acceptance level of technology, there has been wider acceptance for non-clinical support systems. For example, chatbots in place to address customer service and AI-driven platforms to check symptoms and guide the patient to respective specialists. This is not for prescriptions, but to enable patients to help themselves in availing services.
Medical supplies: Another area where digital platforms should have a wider scale of adoption is traveling for non-essential medical supplies. Pharma delivery is one sector that can go entirely digital. We can also have a format where physical stores are eliminated. Delivery can be from warehouse to customer.
Diagnostics: Apart from radiology, diagnostics can go completely digital. Home care such as remote ICUs, remote monitoring could have potentially greater adoption in the current scenario.
Disruption in healthcare will also include technologies to strengthen medical education and training.
Operational Challenges in Healthcare
From the operations point of view, digital transformation alone cannot help in preparing for an outbreak of this scale. The reality is we also have to be prepared for the possibility of a next Pandemic wave. The pandemic itself is testing the digital readiness and operational resilience of hospitals, in digitizing services and bringing innovation into healthcare.What are the operational challenges, as far as digital capabilities go, that hospitals are facing currently? And, what steps must they take to bridge these gaps?
Mr. Richard: We all know that the entire system was not geared up for a pandemic of this scale. Hospitals are facing both operational and clinical challenges. However, I’ll address this one particular issue from a digital angle.
The biggest challenge for any hospital is the lack of a digital care platform and is still heavily dependent on paper-based systems. Now we know that anything can be sanitized but how do we sanitize paper documents. Patients have to carry these documents, touch them, and exchange multiple hands which can be potential carriers of the virus. Now it is more important to keep all the medical records digitized.
Another aspect is the nature of this virus which is highly communicable and is leading to the community spread of this disease. Therefore, hospitals have a responsibility to maintain data at a patient-level so that contact tracing becomes much more easier and automated. So, maybe a symptom can be added as a trigger in the system and automatically do a contact tracing and give a list of people they can reach out to.
Yet another aspect in healthcare which is prone to change is remote working. Most of the industries such as IT have already geared up for remote working but healthcare has not. Many of the processes still need people coming to the office and working on a computer that is in the network. So, the disruption in healthcare relies on digital platforms to ensure that staff is efficiently deployed.
Changes in the Patient Experience
Both outpatient and in-patient treatment for all major non-communicable diseases including emergencies have declined. Going forward, as the country tries to resume life in the New Normal, industries like retail are experimenting with touchless interfaces to boost the customer’s confidence in shopping in-store. What changes, if any, do you foresee to the physical patient experience?
Mr. Richard: Wherever possible, currently hospitals are trying to minimize contact. Like airports, one can print their boarding pass, even hospitals can ask the patients not to wait in a line at the reception but rather book an appointment and make payments online. Once the appointment is booked, patients can just come and wait for the doctor’s call. We have seen multiple robotic-assisted surgeries where contact with the patient is avoided. Similarly, some technologies may come up taking vitals from the patient in a no-contact manner. There are hospitals in the country that have introduced innovative robots who screen patients coming to the hospitals. There are lots of innovations possible in this area.
Role of AR, VR and AI in Digital Healthcare
Huge volumes of data are flowing into the cloud, not just from doctors’ offices and imaging centers, but also from remote devices and sensors worn or operated by patients. By harnessing the vast amounts of data and putting it to work in applications, it helps care providers to improve effectiveness and efficiencies. Do you see technologies like AR/VR/AI playing a role in the future of digital healthcare in India? Can you share some examples of areas that Yashoda Hospitals has begun experimentation or implementation with these technologies?
Mr. Richard: Artificial intelligence, Machine Learning, Augmented Reality, Virtual Reality, Cloud systems, etc. are the buzzwords these days. I do believe that these technologies will pick pace in the healthcare industry as well. But I see a challenge there. Though all the data is on the cloud, the data is held by individual stakeholders and corporations. And standardization of data is the biggest challenge right now.
So, any company which is working towards utilizing these technologies should first look at technologies that can bring data on one platform which is usable, accessible, and standardized without compromising confidential information of the patient. In terms of innovation at Yashoda hospitals, we are working on a couple of them such as AI-based radiology systems, optimizing customer journeys in hospitals, manpower planning, etc.
Let’s take the patient discharge process for instance. Transitioning a customer from ‘in-patient’ to ‘out-patient’ is a significant challenge for any hospital, since it involves multiple departments. You’ve even stated before that it takes the integrated view of HIS (hospital information systems), EMR (electronic medical records), inventory, billing, and real-time updates of treatment progress to facilitate discharge at the click of a button. What is your experience in the transformation process and the ground realities of addressing this critical pain point?
Mr. Richard: Theoretically speaking, the discharge process takes a lot of time but the reason it takes so much time is because it involves multiple stakeholders at a time- internal as well as external. It further gets complicated when the insurance is involved. I think all healthcare providers are looking to simplify the discharge process. The only way it is possible is having technology cut across stakeholders and in real-time. So wherever possible, we can avoid these internal communication delays.
Return to Normal: The way forward
As hospitals plan for the complicated return stage (once restrictions are lifted), the volume of footfalls, testing, etc. will gradually increase. What advice can you share with other healthcare leaders to prepare their organization on the frontline to manage specific risks regarding employee safety, patient outcomes, etc? What investments (in remote patient monitoring, medical equipment, CRM systems, etc.) should healthcare organizations be making to respond to ‘the return to normal’?
Mr. Richard: I think that the precautionary steps taken by most of the healthcare providers are commendable. It is much better than in other countries across the world. We are in touch with a few of the major chains and the precautions that are being taken are phenomenal. Starting from thermal screens and fever clinics at the entrance, social distancing blogs; we have implemented Cluster Systems within our hospitals. It is a system where the employees are clustered in certain areas to minimize cross-contamination between employees.
In terms of investment in technology, clinical data can be good to start working on. A good EMR system that seamlessly integrates and exchanges data between all relevant information systems is the need of the time. This investment will not just be in terms of technology but also behavioral change.
So the system has to be friendly to seamlessly capture the data and make it available across systems. Using data efficiently is important to guide clinical decision support, developing user experience protocols and creating empowerment for the patient.
Summing up
COVID-19 has changed a lot in us. The lockdown has unlocked a lot of things. It is a good time to innovate. Essential services would be a keyword used for a very long time now in every aspect. Be it shopping, be it food, be it health. And social distancing will be a new lifestyle.
In this session, Mr. Richard shared insights on the disruption in healthcare and the importance of technological innovations in the new normal for hospitals.
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