My thoughts on DISHA - The Digital Information Security in Healthcare Act, India by Mr. Inder Davalur @inderdavalur

Here's my tuppence on DISHA (Draft Digital Information Security in Health Care Act)

I have listed the areas that the CIO would do well to examine the capabilities in the HIS/EMR used at her/his hospital. The dependency for the CIO on the vendor goes up multiple fold because, the ability of the hospital to respond to the Government/Courts with reports and evidence and also provide flexibility to the patient to request and effect changes to their consent are key. I have attempted here to respond with my thoughts on some salient points in the draft legislation.
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2018 Internet Trends Rerport by Mary Meeker @KPCB



Review the Mary Meeker 2018 Internet Report to understand the most important technology statistics and trends. Legendary Venture Capitalist has released the 2018 Internet Report covering insights about mobile, commerce, competition between Tech Giants, Freelance workers, Job Trends, Healthcare spend, and many other aspects in the entire 294 page report.


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Comparison of #telemedicine with in-person care for follow-up after elective neurosurgery: results of a cost-effectiveness analysis of 1200 patients

Comparison of telemedicine with in-person care for follow-up after elective neurosurgery: results of a cost-effectiveness analysis of 1200 patients using patient-perceived utility scores


Authors

Sumit Thakar, MCh,1 Niranjana Rajagopal, DNB,1 Subramaniyan Mani, MTech,2 Maya Shyam, PGDM,3 Saritha Aryan, MS, MCh,1 Arun S. Rao, DNB,1 Rakshith Srinivasa, MCh,1 Dilip Mohan, MS, MCh, DNB,1 and Alangar S. Hegde, MCh, PhD 1Department of Neurological Sciences, 2Hospital Management Information System, and 3Finance and Accounts, Sri Sathya Sai Institute of Higher Medical Sciences, Bangalore, India

OBJECTIVES

The utility of telemedicine (TM) in neurosurgery is underexplored, with most of the studies relating to teletrauma or telestroke programs. In this study, the authors evaluate the cost-effectiveness of TM consultations for followup care of a large population of patients who underwent neurosurgical procedures.

METHODS

A decision-analytical model was used to assess the cost-effectiveness of TM for elective post–neurosurgical care patients from a predominantly nonurban cohort in West Bengal, India. The model compared TM care via a nodal center in West Bengal to routine, in-person, per-episode care at the provider site in Bangalore, India. 

Cost and effectiveness data relating to 1200 patients were collected for a 52-month period. The effectiveness of TM care was calculated using efficiency in terms of the percentage of successful TM consultations, as well as patient-perceived utility values for overall experience of the type of health care access that they received. 

Incremental cost-effectiveness ratio (ICER) analysis was done using the 4-quadrant charting of the cost-effectiveness plane. One-way sensitivity and tornado analyses were performed to identify thresholds where the care strategy would change.

RESULTS

The overall utility for the 3 TM scenarios was found to be higher (89%) than for the utility of routine care (80%). TM was found to be more cost-effective (Indian rupee [INR] 2630 per patient) compared to routine care (INR 6848 per patient). 

The TM strategy “dominates” that of routine care by being more effective and less expensive (ICER value of -39,400 INR/unit of effectiveness). Sensitivity analysis revealed that cost-effectiveness of TM was most sensitive to changes in the number of TM patients, utility and success rate of TM, and travel distance to the TM center.

CONCLUSIONS

TM care dominates the in-person care strategy by providing more effective and less expensive follow-up care for a remote post–neurosurgical care population in India. In the authors’ setting, this benefit of TM is sustainable even if half the TM consultations turn out to be unsuccessful. The viability of TM as a cost-effective care protocol is attributed to a combination of factors, like an adequate patient volume utilizing TM, patient utility, success rate of TM, and the patient travel distance.

Link to Full Article : https://thejns.org/doi/abs/10.3171/2018.2.FOCUS17543


Link to VIDEO Presentation by the Authors: https://vimeo.com/262374146


The Article has been published earlier and is re-published here with the author's permission 

AUTHORS

Sumit Thakar: Sri Sathya Sai Institute of Higher Medical Sciences, Bangalore, India | https://www.linkedin.com/in/sumit-thakar-25748b12/
Subramanyan Mani, Sri Sathya Sai Institute of Higher Medical Sciences, Bangalore, India. https://www.linkedin.com/in/subramaniyan-m-22583618/ 


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Why India needs Healthcare Information Technology (HIT) by Dr Pramod D. Jacob


India with its vast population of over 1.3 billion firstly has a challenge in keeping a track of this vast population's health, much less keep them healthy.  One of the major reasons for this is lack of timely, accurate and reliable healthcare information in today's paper world



State of Health in India


In healthcare India ranks very poorly, even compared to our neighbouring countries. For example in the following health indicators: -

Maternal Mortality Rate (year 2015): defined as number of women who die during pregnancy and childbirth, per 100,000 live births. India has a rate of 174 maternal deaths per 100,000 live births, which is worse than Bhutan (148 /  100,000) or Sri Lanka (30 / 100,000 ). China which also has a large population is much better (27 / 100,000) 

Infant Mortality Rate (year 2017): defined as number of children who die less than one year of age per 1000 live births. In India the figure is 39 per 1000 live births, behind Bangladesh ( 32 / 1000 ) and Nepal ( 28 / 1000 ). China is 12 / 1000.


State of healthcare information collection for events like epidemics in India

Before 2010, it would take about six months for the health information to be collected, collated and analysed to prove that a given region in India had an epidemic as the entire process was paper based. By that time the disease (with most being self-limiting) would have struck, had its toll of morbidity and mortality and run its course. With most data collection being paper based this delay costs India loss of lives and productivity with high morbidity, especially in rural areas ( in urban areas- private hospitals and clinics have a process of notifying the public health authorities for notifiable diseases, hence epidemics are identified earlier in urban areas) .

To top it all there is general disbelief in the official published health statistics in India. For example, official data claimed that Malarial deaths in India was only 1,023 in 2010, however a Lancet published study showed the figure to be actually 46,800. Following the Lancet article, the official data agreed that they had their figures off by twenty to thirty times.  Even for a common disease like Cholera, which strikes every monsoon in endemic areas along the Ganges and Brahmaputra, the official estimate for India is 3,631 cases per year, while research has shown this to be about 22,200 per year.   

While the immediate reaction is to blame the public health authorities and Government in India, one must understand the limitations in a paper world to collect health information of 1.3 billion people across 3,200,000 square kilometres. Compare that to collection of information electronically - an electron can travel around the world in about 19 seconds. 

The solution - Healthcare Information Technology (HIT)

The solution is to produce healthcare information in a timely manner with accuracy and reliability. To achieve speed, it is best to do so with Information Technology - hence HIT. To achieve accuracy and reliability, it is best if the patient's data is put into the HIT system by the providers of healthcare such as doctors, nurses, pharmacist etc at the point of care. This patient level data can then be collated and processed to get timely, accurate and reliable population-based healthcare information.

 In addition, HIT systems provides the power of IT to healthcare such as giving alerts for drug-drug interactions, duplication in lab tests and bringing about efficiency in processes and workflows in a healthcare setting, producing reports quickly which will help in planning and deployment of healthcare. It is estimated that healthcare doubles in knowledge every few months and it is difficult for doctors to keep up. With HIT it will be possible to keep up with the latest and deploy best practice evidence-based medicine applicable for India.

The proof of HIT bringing exponential improvement in speed and access to important healthcare information like epidemics even in Indian public health, is best exemplified by the IDSP program. The IDSP program has gone digital from district level upwards to state and then to the National Centre for Disease Control (NCDC), Delhi. As a result, the NCDC now publishes data on epidemics and events on a month to month basis and will soon be publishing it on a weekly basis. Will cover the details of this program in a future write up. 

This article has been republished here with the author's permission. The article was first published here.

Author
Dr Pramod D. Jacob (MBBS, MS- Medical Informatics)

After completing his medical degree from CMC Vellore and doing his Master of Science in Medical Informatics from Oregon Health Sciences University (OHSU) in the US, Dr Pramod worked in the EMR division of Epic Systems, USA and was the Clinical Systems Project Manager in Multnomah County, Portland, Oregon. He has been a Healthcare Information Technology consultant to Benton County, Oregon and Santa Cruz County, California. In 2007 he relocated to India and did consultancy work for the state governments of Tamil Nadu and Himachal Pradesh. He was a member of the HIMSS Global EHR Task Force and the lead for India in the task force.

At present he is the Chief Medical Officer of dWise Healthcare IT solutions, involved in the designing and implementation of Clinical Information Systems and the EHR for the company. He is also a consultant for WHO India in the IDSP project and for PHFI for a Non Communicable Diseases Decision Support Application.
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How can Digital Health be Implemented as envisaged in the National Health Policy 2017? by Prof. Supten Sarbadhikari @supten



The National Health Policy 2017 (NHP-2017) of India correctly identified the need for creating many new institutions like the National Digital Health Authority (NDHA).  However, the ground realities don’t appear to have been considered well enough. Early setting up of a functional NDHA is essential for India to avoid a digital health mess in future. The first job for the proposed NDHA will be to formulate a robust National Digital Health Strategy / Policy, in consultation with all the stakeholders. Caution needs to be exercised before cross referrals and sharing disparate information among different systems of medicine. Health informatics education must be embedded as an integral part for health and hospital management. It may be prudent to include Health in the Concurrent list of the Constitution of India. That will ensure a smooth adoption of digital health in India. Seeking comments on the Draft Bill DISHA (Digital Information Security in Healthcare Act) is a good start.

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Clinical Decision Support Systems: Resolving the “Build or Buy” Dilemma - Part 2 by Dr. Ujjwal Rao, @drujjwalrao


The 2 part paper (review part 1 here): Discusses the key role of evidence-adaptive clinical decision support systems (CDSS) in the healthcare system of the future. Weighs the pros and cons that hospitals should consider when deciding to buy or build such decision support tools


Healthcare providers today face the challenge of delivering up-to-date, evidence-based care given the ever burgeoning pool of medical evidence, which is not only prone to inconsistencies but also take an average of 17 years to make their way into routine clinical practice. 

Coupled with the hassle of meeting advance electronic health record (EHR) platform integration requirements, Dr. Rao proposes that buying knowledge-based CDSS is increasingly more favorable and the way forward. 

A number of major initial and ongoing hurdles with home-grown solutions – including the significant time and effort needed to constantly update evidence – could overwhelm and overburden healthcare organizations, taking time away from delivering standardized and evidence-based care. 

Dr. Rao offers five ways on how these challenges can be avoided with the purchase of third-party CDSS platforms.


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Clinical Decision Support Systems: Resolving the “Build or Buy” Dilemma - Part 1 by Dr. Ujjwal Rao, @drujjwalrao

The 2 part paper: Discusses the key role of evidence-adaptive clinical decision support systems (CDSS) in the healthcare system of the future. Weighs the pros and cons that hospitals should considered when deciding to buy or build such decision support tools


Healthcare providers today face the challenge of delivering up-to-date, evidence-based care given the ever burgeoning pool of medical evidence, which is not only prone to inconsistencies but also take an average of 17 years to make their way into routine clinical practice. 

Coupled with the hassle of meeting advance electronic health record (EHR) platform integration requirements, Dr. Rao proposes that buying knowledge-based CDSS is increasingly more favorable and the way forward. 

A number of major initial and ongoing hurdles with home-grown solutions – including the significant time and effort needed to constantly update evidence – could overwhelm and overburden healthcare organizations, taking time away from delivering standardized and evidence-based care. 

Dr. Rao offers five ways on how these challenges can be avoided with the purchase of third-party CDSS platforms.


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How do we value your #startup?  Part 2 by Arpit Agarwal, @arpiit



How do we value your startup? — Part 2

In the previous post we talked about how VCs perceive valuation and how to broadly deal with it. It was aimed to dispel some misconceptions most first-time entrepreneurs may have about this very important aspect of our business. This posts builds on that and another and gives you actual numbers to play with. Before you go on, it maybe a good idea to take a look at the way I define stages of a startup.

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How do we value your #startup?  Part 1 by Arpit Agarwal, @arpiit



This is the favorite topic of every single startup entrepreneur in early stages of their evolution. It also incites an academic curiosity in a large number of people who, like the 3 adorable dads in this video, have a highly misplaced notion about it. A big reason why this happens is because we don’t write about it so often in India and, perhaps, everyone understands this quite well in US or China.
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5 product management hacks to build great products by Subhadeep Mondal, @smondal1008

In the past 5 years, I had the opportunity to build and ship great consumer products which touches the lives of millions of people around the world. Recently, Branchmetrics invited me to share some of my learnings at Innov8 CoWorking Space along with speakers from UrbanLadder, HeadSpin, Branch.io and Glispa Global.
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Vision 2025: What Health Care Could Look Like a Decade from Now by Dr. Vicky Parikh, @ParikhVicky

Value-based care, coordinated care, information technology integration . . . healthcare is undergoing transformation.

Sweeping changes are putting pressure on the entire system, particularly from an administrative standpoint. With all the paperwork and logistics to worry about, it's easy to grow frustrated and lose sight of what we are working to achieve: economically viable solutions for providing the highest level of care to all our patients.

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#HIMSS18: Where the brightest mind in healthcare meet !! by @ tejasvdeshmukh



It’s been over 3 weeks post HIMSS18 in Las Vegas; I am almost done with all my follow-ups and before getting caught up with ATA18 preparation, allow me to share my experience!
Known as the Mecca of Healthcare, HIMSS is a platform to explore innovation, meet thought leaders, network and partner. That said it is easy to get lost, loose orientation and miss out on meetings, when you are dealing with 40k+ attendees and 1000+ exhibitors. It is overwhelming the moment you enter Sand Expo and see HIMSS banners all over the place.
The Pinksocks meet-up that took place on the March 5th at Money Play Restro was filled with the most exuberant people. Nick Adkins has taken an initiative to consolidate all Healthcare professionals, who are determined to disrupt the industry with innovation. The HIMSS Social Media Ambassadors are part of this group and real meaningful exchange of information happened at the meet-up.

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How to Bridge the Healthcare Digital Divide by @Ishaq_Quadri



With the proliferation of smart phones, usage of internet coupled with the challenges of a busy modern day lifestyle, the way we transact has completely changed to an extent that availing services online is becoming first choice for a growing number of consumers. But still, adoption of IT in Hospitals is lagging by about 15 years when compared to its counterparts in Retail and BFSI.

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Regulatory Essentials for e-Health in India by Dr. Milind Antani @milindantani




A doctor should not give any advice over electronic media that would ordinarily require the physical examination of the patient.
» The Supreme Court has noted that prescriptions should generally not be given out without actual examination.
» It has also stated that prescriptions should not be given over the telephone, except in case of emergency.

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Artificial Intelligence #AI – the new hope for Pharma R&D - By Manishree Bhattacharya @ManishreeBhatt1


Pretty much every article starts with the challenges that pharmaceutical industry across the globe is facing. It is a difficult industry and everybody acknowledges that, considering the time to develop an original drug (10-15 years), the costs involved (last time I checked it was USD 2-3 billion), the high attrition rates of drug candidates (1 out of 5,000 or 10,000 leads make way for FDA approval), the tough regulatory environment which is varied across countries and geographies, and the rising pressures on pricing (pricing advantage for truly outcome-driven therapeutics). All of these, with the looming patent expiry, the imminent entry of generics, and the tantalizing RoIs, make it even more difficult.


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KPIs on fingertips - Healthcare by Jyoti Sahai @JyotiSahai



During a recent conversation with the CEO-Doctor of a multi-specialty hospital our discussion veered towards how data-driven decision-making using analytic insights could benefit the hospital. His response, typical of most of the CEOs (for that matter from any industry) was - Oh! I really don't need any analytics! All the facts I need to run my organization are on my finger-tips!


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#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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Consent Fatigue by Karunakar Rayker @krayker



Recently, the Justice SriKrishna Committee came out with its draft White Paper on Data Protection framework for India. One of the key issues mentioned in the report was regarding Consent Fatigue. While the Whitepaper delves into the Consent issue at a policy level, we can see it at a micro level & around us in our everyday lives. Let us explore the issue through the eyes of an ordinary user, Ramesh.


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Train your Mind to be an Entrepreneur By Priyanka Singh @1_priyankasingh


I have often read these powerful words, Entrepreneurship is for those who can think big. It was almost in contrast to my personality of being someone ambitious yet complacent with the success I would find with my sincere work. To think big, probably you have to be the person who constantly strives for success & works towards climbing the upper most pedestal even before you have climbed the nearest next. 

The Article was first published by Ms. Priyanka Singh on her linkedin pulse blog, the article is republished here with the authors' permission


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Health Information Technology: A Longer ROI for Higher ROI? by Dr.Ujjwal Rao @DrUjjwalRao



Recently I gave a talk at the Revolutionizing Healthcare with IT Conference in Mumbai around ROI of Health IT. Here's the gist!

Before I delve any deeper, let’s understand what ROI is.

ROI can mean different things to different people. To nurses and infection control teams, ROI means ‘Risk of Infection’. To most of us burdened by home loans, car loans and education loans, ROI means 'Rate of Interest’. To the CEO who makes gut-wrenching investments and wants to make money back, ROI means ‘Return on Investment’. As for me, the emergency physician in me wants to take ROI at its face value, but the clinical informaticist in me thinks of ROI as the ‘Radius of Information’.

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