Monday, 3 July 2017

India aims to be a Global Leader in #DigitalHealth by Rajendra Pratap Gupta @rajendragupta

The Article was first published in Mr. Rajendra Pratap Gupta's LinkedIn Pulse, the Article is republished here with the authors permission

In May this year, India had tabled a resolution at WHO for mHealth, which was supported by over 30 nations. This clearly signals India intent to be a global leader in Digital Health.

Digital Health has the potential to revolutionize how populations interact with national health services and also strengthen health systems and will play an important role in preventive , promotive and curative health. India is now embarking on a futuristic journey to bridge the healthcare divide between have’s and have-nots using digital health tools. We have a number of projects that will extensively deploy technology .

The Ministry of Health & Family Welfare has been taking several impactful initiatives in the field of Digital Health. Our Hon’ble Prime Minister has envisioned for Digital Platform & Electronic Health to be optimally leveraged, so as to meet the key challenges posed to us in health sector e.g. shortage of health human resource, accessibility of healthcare infrastructure, affordability of healthcare services etc. Electronic Health Records (EHRs) of citizens are envisaged to be created for ensuring continuity of care and other associated benefits. Delivery of services to citizens through “online mode” is at core of the overall electronic health ecosystem being talked about.

Major I.T. initiatives by Ministry include various mHealth initiatives for improving efficiency and efficacy of public healthcare across the country under the Digital  India Programme. Some of the initiatives are:


Mobile applications

Various mobile apps have been launched

Vaccine Tracker mobile application support parents in tracking immunization status of their children and helps them in ensuring complete and timely vaccination.

The India Fights Dengue mobile application provides interactive information on identification of symptoms of Dengue and links users to nearest hospitals and blood banks

The swasth Bharat ( Health India ) mobile application provides detailed information on healthy lifestyle, disease conditions and their symptoms, treatment options, first aid and public health alerts.

Ministry recently launched the Stress management app – ‘NO MORE TENSION’ on google / IOS.

Mobile Academy

Mobile Academy is a free audio training course designed to expand and refresh the knowledge base of ASHAs and improve their communication skills. Approximately 170,000 ASHAs of Jharkhand, Madhya Pradesh, Rajasthan and Uttarakhand are expected to benefit from Mobile Academy. As of 31 Aug 2016 more than 45,000 ASHAs have started the course and out of which more than 40,000 have completed it successfully.

Kilkari

Kilkari delivers free, weekly, time-appropriate 72 audio messages about pregnancy, child birth and child care delivery to families’ mobile phones. Approximately 1.9 Million pregnant women and children in Jharkhand, Odisha, Uttar Pradesh, Uttarakhand and High Priority Districts (HPDs) of Madhya Pradesh and Rajasthan have been reached by the service in Phase 1 as of 31 Aug, 2016.

Tobacco Cessation Programme

Programme launched on 15th January 2016. Ministry of Health & Family Welfare, in partnership with World Health Organisation and the International Telecommunications Union, started an initiative for utilising mobile technology for tobacco cessation. Currently, more than 1900,000 users registered for mCessation on Tobacco.

mDiabetes Program

An initiative for prevention and care of diabetes, launched on 22nd , June 2016 on ‘World Diabetes Day’. It is based on proven algorithms for diabetes prevention and care, and builds on previous international experiences in using mobile technologies to deliver these interventions. Using constant text messaging on mobile phones. Currently more than 100,000 users registered for mDiabetes

Nikshay for Tuberculosis Control Programme

To monitor and track services and status relating to screening, diagnosis, treatment and follow-up of Tuberculosis cases. NIKSHAY was launched in 2012 and has been implemented across all States, and has 6 million registered users

Online registration System (ORS)

Launched in July 2015, ORS is a system to link various hospitals across the country for online registration, appointment and for providing patient centric services like viewing Lab reports, blood availability status etc. As on date, 48 hospitals covering over around 500 departments across 18 States/UTs are offering services through ORS and over 4,00,000 appointments have been transacted online till date.

These initiatives are ensuing remarkable improvement in healthcare delivery and management.

MyGov

A discussion group viz. ‘Healthy India’ has been created by MoHFW under the “MyGov” portal and seven discussion areas covering various issues have already been hosted so far. https://www.mygov.in/

National Health Portal (NHP)

Launched on 14.11.2014, serves as a single point access for authenticated health information for citizens. (http://www.nhp.gov.in).

NHP Voice Portal

Toll free national number 1800-180-1104 for providing information related to health, diseases, lifestyle, first aid, directory services, health programs etc.

National Healthcare Innovations Portal

(www.nhinp.org)- An online portal for documenting innovations taken up by states, NGOs and other private sector organizations.

National Identification Number (NIN) Portal

put in place for allocation of NIN to all health Facilities in India. As of 10th October 2016, 2,14,340 facilities were allocated NIN. Out of these 1,88,841 public health facilities (88%) facilities were verified by the states.

HMIS-MCTS Facility master mapping has been completed for all states and states are currently verifying the mapping to match health facilities in both systems. Incorporation of other hospitals of MoHFW and other ministries in NIN Portal is in progress

National Health Resource Repository (NHRR)

NHRR envisages creating a single gateway of authentic, standardized, updated public and private healthcare resource intelligence and develop user friendly system with utility to serve as a decision making tool for varied categories of health system stakeholders. The pilot of the survey was completed and the soon the pan-India survey will be initiated to collect health resources data. This data will be placed online for easy access to all stakeholders.

eHospital@NIC

6 modules available on eHospital Cloud version; other modules to be made available by Dec’16 by NIC. Over 30 large hospitals are using eHospital and 7 hospitals are using cloud version of eHospital

EHR Standards

were first notified in 2013. The EHR standards are meant to facilitate semantic interoperability between different EMR /EHR systems. EHR Standards include SNOMED CT standards for providing consistent terminology across all health care domains. India became member of International Health Terminology Standards Development Organization (IHTSDO), effective from 1st April, 2014.

Notification of revised EHR Standards (2016) is under process and will be released shortly. CDAC, Pune has been nominated as interim National Release Center (NRC) for SNOMED CT. As of now 140 SNOMED CT affiliate licenses are issued by iNRC.

Mother and Child Tracking System/ RCH System

Implemented across all the States & UTs, approximately 3.00 crore pregnant women and 2.72 crore children are expected to be covered annually under MCTS and RCH application combined. 1,16 million pregnant women and 994,000 children were registered in MCTS and RCH portal combined as on 20th September, 2016.

Missed Call Centre for reaching unreached TB patients

A dedicated toll free number with a call centre that is currently available in the States of Punjab, Haryana, Chandigarh and Delhi. Around 30,899 calls have been made till date.

National AIDS Control Organization (NACO)- Strategic Information Management Information System (SIMS)

has over 20,000 reporting units across the country. Centralized Project Financial Management System (CPFMS)- details of allocation, expenditure of budget disbursed at Central and state level are monitored.

Inventory Management System (IMS)

for tracking inventory at every point of supply chain to establish a robust supply chain Management,

India HIV/AIDS Resource Centre (IHRC)

A Digital Resource Centre (www.indiahivinfo.naco.gov.in ) which is one stop shop for resources available on HIV and related issues, and get an average of 2000 calls per month and covers 60 districts in 10 States (Bihar, Haryana, Punjab, Rajasthan, Karnataka, Maharashtra, Uttarakhand, Uttar Pradesh, Chhattisgarh, Jharkhand)

Rashtriya Swasthya Bima Yojana

RSBY uses IT platform for enrolment of beneficiaries, smart card for beneficiary authentication, cashless transactions, grievance management, has over 41 million (41,331,073 ) smart Cards : and has handled over 11 million (11,841,283 ) hospitalisation Cases : as on date: 31/03/16 .This scheme is likely to be the template for the National Health Protection Scheme

‘Mera Aspataal’ (Patient Feedback System)

To empower the patient to give his / her views on quality of services rendered by a healthcare facility, MoHFW has designed an ICT-based Patient Satisfaction System (PSS) for implementation in public and empanelled private hospitals. During the pilot phase 117 State / Central government hospitals are being considered where feedback will be collected from more than 1,00,000 patients per day. 37 hospitals were sharing data with My Hospital as on 19th September, 2016.

eRakt Kosh

Launched on 7th April 2016, eRakt Kosh application is a centralized blood bank management system. eRakt Kosh is being rolled out for all the licensed blood banks in public and private health facilities in States / UTs. Presently eRakt Kosh is running in 4 blood banks of Madhya Pradesh, 5 blood banks of West Bengal and blood bank of national HQ of Indian Red Cross Society in Delhi. The application is going to be initiated in some blood banks of Gujarat, Jharkhand, Telangana and Uttar Pradesh shortly.

National Organ & Tissue Transplant Orgnaization (NOTTO)

(http://notto.nic.in)- (Launched in 2015). There are two registries in place under this program-

1. Online Registration for Organ/Tissue Transplantation or Retrieval- Total registration- 1721

2. Online pledge registry by citizen for organ donation: Total registration-23695

National Cancer Registry Program

(http://www.ncrpindia.org/)- National Cancer Registry Program being run by ICMR collects data on cancer patients across country. The registry data is used to compile cancer atlas which provide details about cancer incidences, types underlying causative agents and risk factor details

Central Drugs Standard Control Organization (CDSCO)

“SUGAM” for processing of applications for import and registration of drugs and permits for import of small quantities of drugs for personal use. System Launched in November 2015.  Total Firms registered for import of drug (2089), medical devices (1076) and cosmetics (116). 

FSSAI

The system facilitates online License to the Food Business Operators falling under central license-; online clearance mechanism for imported food items; online system for product approval of food items which are not standardised under the Food Safety and Standards Act & Regulations made there under.

Total Bill Of Entries filed: 26997 for 34235 food items.

32597 food Items granted No Objection (NOC) whereas 292 items were rejected

NOC generation for 1346 items is under process

Food Licensing and Registration system:

Total application received online till date for central license : 28461

License issued till date : 28027

Total renewal application received : 13705

Total renewal done : 13649

ERMED (Electronic Resource in Medicine) Consortium

National Medical Library’s ERMED Consortium is an initiative taken by the MOHFW to develop nationwide electronic information resources in the field of medicine . The consortium is coordinated through its headquarter set up at the NML since 2008.

At present, 70 state and centrally funded Government Institutions (including all AIIMS) from 24 states are selected as its members

One of the advantages of ERMED consortium is that it not only provides current issue of Journals from leading publishers , but also facilitates its users with the archival issues (print as well as electronic) for example, British Medical Journal, an International peer reviewed Medical journal is fully searchable, with an archival backup since 1840. National Medical Library have a distinction of having BMJ since 1840 in print format. Print archive available since Oct 1840 to Dec 1993, and online archive available Jan 1994 to till date, and The BJU International is available since 1929 with full-text archive. One of the biggest strength of NML is its vast collection of 7.5 lakh volumes of books, reports, bound volume of journals and other literature, and adds latest books and journals every year. It also subscribes to 1500 current periodicals. The library has good collection of 19th century medical literature.

National Medical College network

Under National Medical College Network (NMCN), scheme , 50 Govt. Medical Colleges  are being inter-linked with the purpose of Tele-education, e-Learning and Online Medical Consultation by utilising the connectivity provided by National Knowledge Network (NKN). Under this imitative, a virtual layer of Specialty/ Super Specialty doctors from these Medical colleges would also be created  for providing “Online Medical Consultation” facility to citizens which will be similar to OPD facility but in a virtual way through a web-portal. This will help patients from rural, remote and urban areas to access doctors and specialists easily even from their home location through their Smart Phones, through Government healthcare institutions (PHC/CHC) and through Common Service Centers (CSCs). 

National Telemedicine Network (NTN)

In the first phase of National Telemedicine Network project, it is proposed to connect 500 PHC/CHC/SDH at remote/rural locations with 50 District Hospitals. These District hospitals will be networked with 50 Medical Colleges.

Telemedicine by using Space Technology

Establishment of SATCOM based telemedicine centres at Chardhams and other important places of pilgrimage in collaboration with DoS (ISRO).

Integrated Health Information Platform (IHIP)

In order to augment the overall Electronic Health ecosystem further, the Ministry has envisaged setting up IHIP. This is a major step in the direction of addressing the existing situation of ‘electronic silos’ in health system. Interoperability and data exchange amongst Health IT Systems is almost lacking.

IHIP is expected to address various key issues and challenges such as fragmented information systems, accessibility & quality of data, duplicate information systems and most important lack of common EHR System. Today, most of the patient records get trapped in multiple silos. IHIP would work in the direction to enable the EHRs of citizens to be made available nationwide with the help of Health Information Exchange.

IHIP would in due course facilitate better health services to citizens and improve efficiency of healthcare services and programmes through optimal utilization of resources, availability of information for better decision and reduction in medical errors etc. With help of EHRs, cost reduction in medical cost is expected as requirement of redundant medical tests would be checked.

Citizens would be empowered through online access to IHIP to view their health records and also to upload other medical records in order to create and maintain personal health record.

In line with Startup India initiative, IHIP would also provide an opportunity to Health IT start-ups to host their innovative solutions for use by different stakeholders. 

States and Union Territories (UTs) are being supported for implementation of hospital information system at hospitals and health centres for facilitating creation of EHRs.

Ministry has already started the process for setting up IHIP and it is expected to be ready for pilot in select States/UTs early next financial year. The platform will by then be ready for progressive roll-out all over the country. 

National Digital Health Authority

Setting up of the National Digital Health Authority (NDHA) is another milestone for Indian Healthcare IT. The various regulatory aspects of digital health deployent like privacy, security, access, disclosure, exchange. would be taken care of by National Digital Health Authority (NDHA) proposed to be set up by MoHFW. The work on the same is already on , and this will institutionalize the support for digital health.

National Health Helpline

The Ministry is working on setting up of the health helplines . We want to ensure that people have the information they need, and on time 24 x7 in the remotest and inaccessible areas . This project should roll out by early next year . National Health Helpline  is envisioned to be offering its services in 16 regional language including reliable medical information with a doctor/an expert by harnessing the high number of mobile connections in India (in almost every household). This health helpline facility will help rural population save money and time on visits to doctor in a large number of cases

India Health Information Network (IHIN)

The Ministry of Health & Family Welfare , Government of India has initiated IHIN – A think tank of private and public sector to advice the Government on Digital Health.

Ministry is committed to financially support all the digital initiatives, and looks forward to multi-stakeholder engagement, and private public partnerships to scale up these initiatives

Update: 
CHANGING THE PARADIGM OF #DIGITALHEALTH IN INDIA REPORT 5TH GOVERNMENT INDUSTRY DIALOGUE by @rajendragupta 
http://governmentindustrydialogue.org/documents/pdf/5th-gid-report.pdf 






Rajendra Pratap Gupta is the Advisor to the Union Minister of Health & Family Welfare , Government of India . Views are personal. 


Author
Rajendra Pratap Gupta
Rajendra Pratap Gupta (Rajendra) is an original thinker and an innovator and one of the most influential and sought after public policy expert in the country. He has worked with some of the largest organizations across the world and was nominated to the Global Agenda Council of the World Economic Forum for 2012-2014 in recognition of his work.

He was conferred; 'Global Healthcare Leader of the Year' award in 2012 by the sheriff of Los Angeles; named the 'Thought Leader of the Year' three years in a row by ICT Post; Featured amongst the ’25 living Legends of Healthcare in India’ and is listed amongst the “100 Most Impactful Healthcare Leaders”.

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