#DigitalHealth as a tool to Protect the National Health Protection Scheme by Dr. Oommen John @oommen_john

Author: Dr. Oommen John, Date: 12/02/2018

Digital Health would have a pivotal role towards efficient implementation of the National Health Protection Scheme announced in the #budget2018.

Healthcare related costs is one of the leading cause of impoverishment in India. In recent times, there has been a growing "trust deficit" between the consumers of healthcare services and the care providers.

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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 .

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5 Steps towards an Integrated Digital Health Experience in Indian Healthcare in 2016

In 2016, we expect Interoperability, Move to the Cloud, Connectivity Data and Analytics Trifecta, Personalised Digital Health Services will dominate the Digital Health Landscape in India


Fard Johnmar, describes 2016, as the “Age of Implementation”. Bringing the inflection point of providing services to customers of healthcare; by moving from treating the ‘patient’, to providing  services to the ‘customer’ across the continuum of care. In my opinion the Indian Healthcare Providers should be focussing on these areas in 2016

Efficiency in Workflow, Speed in Communication will be the key implementation factor


Indian healthcare providers have implemented solutions that have the ability to capture the patient demographic, test results, clinical summaries and financial data. This data resides in the Hospital Information systems as silos and there is a need to implement interoperability solutions that allow for the exchange of the patient data between the healthcare information systems and Digital Health solutions like a patient CRM, mHealth solutions, medication reminders apps, appointment scheduling solutions, telehealth etc.

Absence of interoperability between existing solutions in the hospital and other connected solutions required to enable an Integrated Digital Health experience for the patient, causes duplication of work, information silos and data information errors. Interoperability should become a de-facto feature provided by the vendors with APIs and interface capabilities using Standardised formats, i.e., HL7, CDA.

Since the billing and insurance information is being captured by most of the providers, we believe there can be paperless electronic claims processing capabilities that can really drive the adoption for interoperability in Healthcare in India.

Move to the Cloud

More enterprises and specialty clinics will put into place strategic partnerships towards enabling a cloud infrastructure. The needs of each of the Healthcare providers is different and varies from specialty to specialty.

With the need to orchestrate between multiple systems the Healthcare Providers will have to work on putting in place long term strategic partnerships with Solution Developers and system integrators.

Such partnerships will allow for a continuous evolution of their Digital Health solutions that will enable the Healthcare Providers to Innovate in the "Agile" way, while delivering a personalised experience and always operating in the real time for service delivery requirements

Connectivity, Data and Analytics Trifecta

Digital Health solutions will be implemented providing connectivity to the customers with the range of services offered by the Healthcare Providers.

With the availability of the Data, the Healthcare Providers will be able to personalise the offerings for each customer, since the requirements for a customer in need of a Health checkup is completely different from a patient in need of chemotherapy.

With the availability of the data, the Healthcare Providers will be able to continuously improve the offerings to each segment of the customer by utilising actionable intelligence.

Personalised Digital Health Services

The patient of today wants faster access to services, personalised experiences, 24/7 access and connectivity and access to these services from a host of devices. To meet these expectations Hospital providers in India will start to engage the patient via multiple channels by implementing  Patient Engagement Services with a focus on a Multi-channel approach required to deliver alerts, messages, video visits, email.

More and more hospitals have started having their presence on the Internet and Social Media. In 2016, the hospitals will leverage this presence and offer a real Integrated & personalised Digital Health experience to their customers.

Integrated Digital Health platforms can provide specialised, focussed and personalised solutions for curative care and preventive care.

Healthcare Apps

Indian Healthcare providers will offer their services via Healthcare Apps to provide an integrated Digital Health experience to their customers. These apps will be used to provide medication reminders, personalised healthcare advice, appointment scheduling for doctors and services, telehealth for followup care. The Healthcare Providers will work towards implementing mHealth 3.0 services, the next level of mHealth capabilities.

From Indian Experts

Some of the experts too chimed in on their strategic opinions for Digital Health in 2016:

Dr. Ruchi Dass @drruchibhatt, MD Healthcursor Consulting Group, stated her priority areas as, “Get "Healthcare delivery" - a fundamental reset. Brings a dash of frugality to medical innovations.”

Dr. Supten Sarbadhikari,  ‏@supten  Project Director at the Center for Health Informatics of the National Health Portal, stated his priority areas as, ‘National eHealth Strategy / Policy for India; Health Informatics as a formal discipline; Capacity building’

Dr. Vikram Venkateswaran ‏@drvikram   Healthcare Influencer & Marketing Leader, stated his priority areas as, ‘reduce #infantmortality introduce  #universalcare increase #preventivecare.’

Dr. Sunita Maheswari, Chief Dreamer, RxDx and Teleradiology Solutions, in a recent article in Deccan Herald, opined the growth of the Home Health Services such as medicines, pathology, nurse & physiotherapy visits. She also has indicated the need for more funding in other aspects of Digital Health services.

Dr. Pankaj Gupta, @pankajguptadr, Founder Taurus Glocal Consulting, stated his top three areas to focus in 2016 as SMAC, IoT and CRM

Dr. Aniruddha Malpani, MD Malpani Infertility Clinic , stated his top three priorities as, prescribing information therapy for patients, productivity solutions for doctors and Indian Language content

Srikrishna Seshadri, Healthcare IT Consultant, stated his top three areas to focus as telemedicine, IoT and Digital Health Platforms

Dr. Suresh Munuswamy, Assistant Professor, Program Coordinator, Indian Institute of Public Health- Hyderabad is an academic arm of Public Health Foundation of India
  1. Standards and Structure- For digital health care to even start, India needs standardized treatment schedules, standardized documentation (as EHR), standardized job roles, standardized continuous education and standardized social networking procedures for health care. Lack of standards and structure will lead to poorly inter operable and overlapping systems and procedures.
  2. Digital Health needs reliable supporting infrastructure ecosystem.
  3. Digital Health should focus on developing innovative, smarter, smaller and usable devices that can deliver quality health care...with lesser emphasis on (big or small) data analytics.

I would like to thank all the experts for sharing their opinions.

To provide an Integrated Digital Health experience the Hospital Providers need to enable agility in innovation, create the infrastructure to ease the interoperability of patient information, establish connectivity with the patient and continuously engage with the customer in the care continuum.

Please share your views with me on LinkedIn or Twitter @msharmas or via email: [email protected]

The article was also featured on the February 2016 issue (pg.40-41) of Healthcare Radius
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Manish Sharma
Founder HCITExpert.com, Digital Health Entrepreneur

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Dhanvantri Aarogya Saanchara Sevaa (DASS) : A framework for a low cost and far reaching solution towards the #DigitalIndia initiative

DASS: Dhanvantri Aarogya Saanchara Sevaa

Dhanvantri Aarogya Saanchara Sevaa: A Mother and Child care Management System developed as a mHealth (mobile app) platform to enable the FLWs and subscription members to be updated and informed via Alerts, Reminders, Data Capture and Analytics. 

The DASS system will enable the smooth interlay of the existing governmental machinery with the m-Health capability to deliver focused result oriented outcome based solutions in the rural parts of India. 

DASS has all the potential to demonstrate the capability of m-Health solutions around low cost phones in aiding the fulfilment of Millennium Development Goals (MDG) and the #DigitalIndia initiative.

The DASS system proposes to be used to create an Alerts, Data Collection & Registry, Location and Data Analytics platform for the subscribers of the DASS system. The framework proposes to build the DASS system to incorporate services as a mHealth app. These services are proposed to be covering various aspects of the public health programs.

As a first step we propose to use the DASS system to create a Mother and Child welfare framework that will allow the “connect” to be established between the Frontline Healthcare Workers, Healthcare Services and the Women patients who have subscribed to the program. 

The DASS program will cover the Ante Natal, Peri Natal and Post Natal aspects of a Woman’s pregnancy (18 months – 9 months + 9 months). The DASS program proposes to allow the users to choose the list of services that she wants to subscribe to. Once the user has registered and subscribes to the specific services, the DASS program will enable the delivery of the information to the relevant subscribers, thus giving a double impetus to the name of our project:
  • Dhanvantri – The God of Medicine
  • Aarogya – Health in Sanskrit
  • Saanchara – Mobility, works for both the Mobile platform using the mHealth platform and the Mobile Medical Units (MMUs)
  • Seva – Service


While creating the system we envisage the creation of a location based information delivery mechanism that will allow the users to be delivered with location specific services. For instance, we propose to create a location based hierarchy that is specific to the country where the system is proposed to be deployed. If the DASS program is rolled out in the State of Karnataka, the location based hierarchy that we propose for the categorisation of the data, services, alerts based on the following classification shown below:

 Zones -> State or UTs -> District -> Taluk -> City, Town or Village

We propose to capture the location for all the services to enable the data aggregation and collection to contain the location specific information. We propose to use this information to deliver location specific services.


We have envisaged the Dhanvantri Aarogya Sanchar Seva’s Mother and Child services to be categorised under the Ante-Natal Services, Peri-Natal Services and Post Natal Baby and Mother Health services.

C.1 ANTE NATAL – Mother and Child Care SERVICES

Under the proposed system we envisage a list of services to be built for the 9 month period of the pregnancy. The list of services we propose to cover under the DASS - ANTE NATAL Mother and Child Services are elaborated below.

C.1.1 Pregnancy Checklist
The Pregnancy Checklist service provided by the DASS system proposes to allow the health worker to create templates comprising of various tests, pregnant mother care, schedule of visits to the doctor/ healthcare worker, the patient information alerts that are generated on a daily basis and based on the current stage of the mother’s pregnancy. Once the template has been created by the healthcare workers, the same will be released for the location based services to be delivered for the patients subscribing for the services.

C.1.2 Mother Gestational Diabetes Tracking and Alerts System (MGDTAS)
For the pregnant mothers who are identified with having gestational diabetes, the DASS system will allow the patients to subscribe to the service. Once the patient has subscribed to this service, the system will start sending alerts regarding the specific condition of the patient. Also the system will allow the patient to record specific parameters as defined by the checklist created for mother’s with Gestational Diabetes.

The MGDTAS service will consist of the following aspects: 
  • Capture of mother’s EDD (expected date of delivery)
  • Recording of blood sugar of mother based on the alert. Once the patient enters blood sugar information, the MGDTAS service will advice the patient on the amount of insulin to be taken (or be administered by the family member)
  • Adherence to the schedule
  • Blood parameter trends (last 5 results)

We propose to expand the DASS system’s “specialised” services by incorporating other services as required.

C.1.3 Antenatal Health Checkup Alerts
The DASS system’s Antenatal Health Checkup Alerts system allows the delivery of reminders to the patient about the dates (based on the patient’s pregnancy stage and the EDD captured at the time of registration to the DASS system) when the patient needs to go to for the health checkup.

C.1.4 Complicated Case Referral System
In case of a complication being identified in a patient’s pregnancy, the FLW will raise a request for additional care and refer the patient to a more specialised care at a well-equipped healthcare facility that can handle the case of the patient. The details of complications and the referral locations will be identified and uploaded in the system allowing the FLW to capture this information and generate the referral request.

C.1.5 Pregnant Women MMU Appointments
The DASS system is proposed to be location aware and hence will utilise this functionality in the system to do the following:
  • once the mother has registered with the DASS system, the system will keep track of the location of the patient.
  • Whenever a MMU (Mobile Medical Unit) is available in the vicinity of the location of the patient, the system will aggregate the list of patients within an 'X' mile radius of the location.
  • Once the list of patient’s have been identified by the system, the DASS system will send alerts to these patients, informing them about the availability of a MMU in their specific location by providing the patients with the date and time when the MMU available.

C.1.6 MMU (Mobile Medical Unit) Location Alerts
The purpose of the MMU location alerts is alert the patient population in a particular location about availability of the MMU in the patient location. This will allow the patient’s with specific needs to approach for specialised care for any complications etc.

Additionally the MMU location alerts are going to be used for providing the FLW with the visibility on the current location of a MMU at any given point in time, by typing a simple coded message.  Once the FLW receives the message regarding the location of the MMU, the FLW could “forward” the same message to patient’s registered for the service in the location.

C.1.7 Location Based MMU Alerts
The DASS system proposes to alert patients about the availability of the MMU in a specific location to the registered FLWs in the location. This information will be used by the FLW to inform patients.

Additionally, the system will also allow for the delivery of these alerts to patients registered in the DASS system as unsolicited information informing them about the MMU in their area.

C.2 PERI NATAL – Mother and Child Care SERVICES

C.2.1 Medical Health Worker Referral System
The DASS system will allow the FLW to generate and alert specific healthcare facilities to take referrals made by the FLW for patient’s in critical and urgent need of specialised care because of any complications during birth.

C.3 POST NATAL – Mother and Child Care SERVICES

C.3.1 Child Immunisation Alerts
Once the Child has been born, the information will be updated in the system regarding the date of birth of the baby. Once the date of birth has been registered in the system, the DASS system will generate alerts based on the age of the baby about the vaccination schedule.

The FLWs, MMU and the parents of the child will have the ability to update the administration of the vaccination to the child. This information will also be used to update the Data Analytics aspect of the DASS system.

C.3.2 Child Care Alert Info
The DASS system will be used to send information regarding the various aspects of the child care to the mother. These alerts will be used as primary child care options by the FLWs to inform and educate the patient’s in their specific locations. The DASS system will allow the users to create these alerts specific to their respective locations.

C.3.3 Health Worker Information Alerts
The DASS system will also be used to send important alert information to the FLWs regarding various aspects of the DASS services, new options in the system, new protocols of care for the mother and child, alert messages to the FLWs regarding their village, district, state level meetings, availability of the MMU in their locations, etc.

C.3.4 NRHM Data Collector System
While creating and using the DASS system, we propose to align the platform to have the ability to generate analytical reports that can be used by the NRHM personnel for their monthly reporting of data collected during specific time frames. 

With this ability the DASS system will allow the users of the system to have a real-time and up-to-date information database for relevant reporting.

C.3.4.1 Infant Birth/ Death Child Registry
This service in the DASS system will allow the users to record the birth or death of an infant. This information will be logged into the system to enable or disable the alerts for a particular mother, to ensure relevance of the messages and alerts sent to the mother/ FLWs, etc.

C.3.4.2 Mother Mortality Registry
In the unfortunate event of a complication at birth, the DASS system will allow the users to update any mother related unfortunate outcome.

C.3.4.3 Child Immunisations Registry
Each time a vaccination has been given to an infant, the system will update this information in the database. The information captured in this registry will allow the users to report the child immunisations performed based on the location (district/ village/ state etc).

C.3.4.4 Communicable/ Infectious Diseases Registry (CIDR) 
The DASS system will have the CIDR service which will allow the FLW to identify an outbreak of any disease in a specific location. Based on this information, relevant alert messages can be sent to the FLWs to organise correct responses from the local government agencies to this outbreak. The DASS system will allow the users to define the trigger criteria for generating the alerts from the system.
  • The DASS system is proposed to be a modular system, thus allowing relevant services to be enabled to various FHWs based on their expertise and area of work, based on an authentication and authorisation functionality within the system. For instance, the Gestational Diabetes (MGDTAS) module can be used as a standalone app to capture the occurrences of gestational diabetes in a particular location.
  • We also propose to link the Patient Registration modules within our proposed system with the Aadhar system to identify beneficiaries and patients being registered within our system. This will allow integration with existing systems thereby reducing the data duplication across multiple systems.

Manish Sharma

Founder HCITExpert.com, Digital Health Entrepreneur.

Additional Articles by the Author
  1. Health ID as Patient IDs unifier in India  by Manish Sharma  
  2. 5 Steps towards an Integrated Digital Health Experience in Indian Healthcare in 2016 
  3. Top Healthcare & Digital Health Predictions for 2016
  4. Zen Clinicals: An Activity & Workflow based solution (1 of 3)
  5. RFID in Healthcare: Usecases from Hospitals
  6. 10 Solutions for the Healthcare IT Fringes
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