ICT in Healthcare - Opportunities and Challenges

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ICT in Healthcare - Opportunities and Challenges

  1. 1. ICT in Healthcare Opportunities and Challenges June’ 2014
  2. 2. I am pleased to note that ASSOCHAM is organizing National Summit on ICT in Healthcare “Changing dimensions of Healthcare in India” on 4th June, 2014 in New Delhi. This Summit has significance and importance as there is enormous potential of ICT in the con- text of healthcare system in the country. Of the total number of doctors in India, hardly 2% practice in rural areas. So at doorstep of rural population, India does not have that kind of specialty support for treatments and diagnostics. Further, to transport every patient of rural area to the city to get specialist medical attention will be a huge task and probably impossible. Therefore Government need to formulate enabling policies regarding implementation of ICT in the healthcare industry, in order to curtail the healthcare cost burden and bring the quality at par with internationally available healthcare services. I extend my heartiest thanks to ASSOCHAM Knowledge Partner, RNCOS for bringing out this informative study. The study has put up efforts in flagging off issues related to ICT in Healthcare sector. ASSOCHAM also extends its gratitude to the Ministry of Health and Family Welfare, Depart- ment of Electronics and Information Technology (DietY) and Indian Council of Medical Research (ICMR) for their support in making this programme meaningful. This Summit would not have been a success without due support from organizations like Na- tional Accreditation Board for hospital and Healthcare Providers (NaBH), and Association of Healthcare Providers (India) (AHPI). I wish the Conference a great success. D. S. Rawat Secretary General, ASSOCHAM MESSAGE
  3. 3. TABLE OF CONTENTS Health Information Management System (HIMS) Telemedicine Mobile Health (M-Health) Challenges Solutions INDIAN HEALTHCARE PARADIGM: SNAPSHOT 1 12 15 15 30 22 35 35 36 39 41 44 34 ICT & INDIAN HEALTHCARE SYSTEM HEALTHCARE ICT COMPONENTS INDUSTRY REGULATIONS CHALLENGES & SOLUTIONS FOR THE HICT SUCCESS STORIES OPPORTUNITY AREAS CONCLUDING REMARKS
  4. 4. LIST OF FIGURES LIST OF TABLES Figure 1-1: Government Expenditure on Health as a Percentage of Total Expenditure (2012) Figure 1-2: Doctors/1000 Population Ratio (2013) Figure 1-3: Hospital Beds/1000 Population Ratio (2013) Figure 1-4: Healthcare IT Spending (Billion US$), 2013-2018 Table 1-1: Healthcare Spending Per Capita (US$), 2009-2014 Table 1-2: Number of Government Hospitals (2009-2012) Table 1-3: Number of Government Hospital Beds (2009-2012) 3 2 3 4 4 5 5
  5. 5. Indian Healthcare Paradigm: Snapshot India has taken significant leaps in terms of socio-economic development since its independ- ence, and has strengthened its position as one of the largest economies in the world. Al- though the economic prowess of India is growing consistently, still India’s ranking is among the bottom five countries, with the lowest public health spending world over, accounting for nearly 21% of the global disease burden. A World Bank report published in 2010 estimates that India is annually losing over 6% of its Gross Domestic Product (GDP) due to the prema- ture deaths and preventable illnesses. Indian healthcare sector is still suffering on account of underfunding and poor governance, which have led to substantial inequities in basic health- care provisions. While India’s expenditure on healthcare has registered marginal increase over the past few years, the government has plans to increase it to approximately 2.5% of the GDP in the 12th five year plan. India has invested less public money in health than most comparable countries. India’s overall health spending is close to 4% of the GDP, with private sector being the major contributor. In most developed nations, public money outweighs private money by the ratio of three is to one (3:1); and in middle income countries, the proportion is typically split equal- ly between public and private expenditure. As the mortality rates are declining and average life expectancy is increasing, India’s health- care indicators have improved over the last decade. However, they still lag behind the global and regional standards. 1
  6. 6. Over past 5 years, the Indian healthcare expenditure has been increasing at a CAGR of over 7 %, which is a rate higher than that of the US. In the present scenario, the healthcare spending per capita in the US is estimated to be around US$ 9950, while China stands at a level of US$ 431. On the other hand, India is lagging way behind, and is anticipated to be spending a meager sum of US$ 84. This low spending is a reflection on India neglecting its healthcare sector by not spending sufficiently in developing the infrastructure, while the focus is to transform it into an IT-enabled structure. KEY INDICATORS Table 1-1: Healthcare Spending Per Capita (US$), 2009-2014 US China India 2009 2010 2011 2012 2013 2014 CAGR (2009-14) 8265 8656 8914 9262 9559 9950 3.78% 196 227 284 330 373 431 17.07% 58.4 71.9 78.1 76.1 78.2 84.1 7.57% Source: Economist Intelligence Unit (EIU) Healthcare Spending Per Capita: 2
  7. 7. Government Expenditure on Health as a Percentage of Total Expenditure: The Indian government spends a trivial 4% of GDP on healthcare, out of which majority share is of the private sector. The govern- ment’s contribution in India stands at ap- proximately 33%, while in the US and China, the same stands at nearly 46% and 56%, respectively. For the US, the share of govern- ment has been continuously increasing, touching the aforementioned mark from 43.9% in 2002, while the China reached the current level, rising from 35.8% in 2002. Indian govern- ment held a share of 23.2% in 2002. Since government is not allocating sufficient budget for the healthcare infrastructure development, consumers have to spend a significant amount out-of-pocket. Figure 1-1: Government Expenditure on Health as a Percentage of Total Expenditure (2012) 33.1% 56.0% 46.4% US China India Source: World Health Organization (WHO) 3
  8. 8. Penetration of Physicians: The number of doctors per 1000 population stands at 3.31 in the US, and 1.53 in case of China. The ratio for India stands at nearly 0.6 doctors per 1000 population reflecting the plight of patients who have to wait in long queues for getting medical consultation and treatment. India is lagging far behind the WHO standard which states a mandate of 1 doctor per 600 people. While all the three countries are likely to register a modest increase in the penetration, the situation is likely to hover around the same dimension; no such remarkable change will be marked in the near future. Figure 1-2: Doctors/1000 Population Ratio (2013) 3.31 1.53 0.59 US China India Source: EIU 4
  9. 9. Penetration of Hospital Beds: Another drawback of the Indian healthcare sector is the shortage of beds. The level is below 1 (0.7) per 1000 population. On the other hand, the global picture is starkly ahead of India, as the number of hospital beds per 1000 people in the US and China is 2.9 and 2.6, respectively. The figures depict that not enough funds are allocated by the Indian government for the healthcare infrastructure development. India, along with the US and China is anticipated to witness this stagnancy in hospital bed penetration over the next few years as well. 0.7 2.6 2.9 US China India Source: EIU Figure 1-3: Hospital Beds/1000 Population Ratio (2013) 5
  10. 10. Hospital Network:Although the government is making endeavor to establish better healthcare fa- cilities in terms of hospitals, PHCs, CHCs, medical colleges, AYUSH, blood banks, etc. the respective infrastructure is still overburdened. As the below given table depicts, the number of hospitals in the rural areas is much more as compared to the urban hospitals, but the bed capacity per hospital is average 10 beds per hospital. On the other hand, in case of urban hospitals, the average bed capacity is 86 beds per hospital. The year 2012 marked a sudden surge in the number of rural hospitals. The National Health Profile document elicited the fact that many regions, like J&K and Uttarakhand have not reported developments in hospital infrastructure post 2008. Source: Directorate of Health Services, States/UT 2009 2010 2011 2012 CAGR(2009- 2012) Urban 3115 3748 4146 4949 16.69% Rural 6281 6975 7347 18967 44.54% Total 11613 12760 11993 23916 27.23% Table 1-2: Number of Government Hospitals (2009-2012) 6
  11. 11. Source: Directorate of Health Services, States/UT 2009 2010 2011 2012 CAGR(2009- 2012) Urban 369,351 399,195 618,664 425,721 4.85% Rural 143,069 149,690 160,862 196,907 11.23% Total 540,328 576,793 784,940 622,628 4.84% Table 1-3: Number of Government Hospital Beds (2009-2012) Healthcare Information & Communication Technology (HICT): The penetration of HICT in the Indian healthcare sector is very low as compared to developed countries like the US. Healthcare providers in India are anticipated to spend US$ 1.08 billion on Information Technology (IT) products and services in 2014, which by 2018 is likely to touch the mark of US$ 2 Billion. The major challenges hindering Information & Communication Technology (ICT) implementa- tion include underfunding of public healthcare services, restricted knowledge about applica- tions of IT, scantily trained manpower resource, huge initial investments and lack of stringent regulations. 1.92 1.65 1.43 1.27 1.08 0.88 2013e 2014e 2015f 2016f 2017f 2018f Source: Gartner, RNCOS Note: This forecast includes spending by health care providers (includes hospitals and hospital systems, as well as ambulatory service and physicians’ practices) on internal IT (including personnel), hardware, software, external IT services and telecommunications. Figure 1-4: Healthcare IT Spending (Billion US$), 2013-2018 7
  12. 12. PALASHHealthcareSystemsPvtLtd.(PHS)isInformaƟonTechnologysoluƟondevelopers having a niche in delivering clinical & commercial IT applicaƟon to Healthcare Provider Industry. PHS has a strong base of 200+ clients and 400+ working installaƟon across India,MiddleEast,Africa,SouthEastAsia,EuropeandUK. TM Why PALASH TM PALASH Benefits Every Healthcare OrganizaƟon Today & Tomorrow Prefers TM PALASH . OurvisionismuchbeyondHIMSsoluƟonsalone. We are a long term player with good capitalizaƟon and resourcestobepartnersofhospitalsacrossIndia&abroad. We have more than 200 installaƟons of which more than 60% areinmediumsizedhospitalsandsuperspecialtyclinics. Modernized product based on the latest Microsoft Technology. User friendly applicaƟon, Very easy to train, use and implementaswellascustomize. India'sonlyCloudbasedHIMSSoluƟons. MulƟspecialty&SuperspecialtyEMR's. We have "local engineers" for fast support services in every state. Support and upgrades provided through Internet reducing Ɵmeandcostsofsupportservices. Dedicatedremotesupportteam. 24X7supportservice. 99.95%UpƟmeguarantee.(AsperSLA's) TM PALASH helps in maintaining a totally secured database of paƟents and business informaƟon. This informaƟon can be availableatyourfingerƟps. TM PALASH helps in improving healthcare delivery by providing medical personnel with better data access, faster data retrieval, higherqualitydataandmoreversaƟlityindatadisplay. TM PALASH helps in improving efficiency, both in the cost and the clinical care perspective. This is achieved by avoiding duplications, repetitions, delays, missing records and confusions. TM PALASH helpstoenforceorderlinessandstandardizaƟonofthe paƟent records and procedures in the clinic and increasing accuracy&completenessofmedicalrecordsofpaƟent. TM PALASH acts as a good managerial tool to provide total, cost- effecƟve access to complete and more accurate paƟent care datatoofferimprovedperformanceandenhancedfuncƟons. TM PALASH helps in gathering informaƟon to meet management challenges. TM PALASH helpstoeducatepaƟentsabouttheirdiseases,oftheir surgicalproceduresthroughpicturesandanimaƟons.
  13. 13. Patient Monitoring & Tracking: It is one of the major factors burdening the Indian healthcare sector. Although in the recent past, several initiatives have been taken as pilot projects for patient tracking, there is never been an approach for overall implementation. Many patients loose time and money in case they misplace or lose their reports. Since, these reports are not stored in electronic format, their retrieval is not possible. The lack of digitization has also marred the possibility of patient monitoring and their movements across various hospitals. INDIAN HEALTHCARE SECTOR: CURRENT CHALLENGES 9
  14. 14. Government’s Healthcare Spending: The Indian government spends a frugal 2% of GDP on healthcare, and contributes a modest 33% in total healthcare expenditure. This meager funding leads to little infrastructure development, thus hindering the growth of the overall healthcare sector. Disease Burden: India currently faces the dual burden of communicable diseases and chronic Non-Communicable Diseases (NCDs) such as Cardiovascular Disease (CVD), dia- betes, cancer and Chronic Obstructive Pulmonary Disease (COPD). India has the second highest prevalence of diabetes in the world, with over 61 million diabetes patients. By 2030, the diabetes population is expected to exceed 100 million. Since there is no proper monitoring or tracking of patients, and government’s funding for healthcare infrastruc- ture development is trivial. India annually loses over 6% of its GDP due to premature deaths and preventable illnesses. HEALTHCARE SYSTEM CHALLENGES • Poor Patient Monitoring and Tracking • Low government spending on healthcare • Increasing disease burden • Low doctors and hospital beds per 1000 population ratio • Lack of awareness, accessibility and affordability in Tier 2-3 cities/rural areas • Inadequate sanitation and hygiene conditions 10
  15. 15. Doctors and Hospital Beds per 1000 Population ratio: The Indian healthcare system is underdeveloped and over pressurized. The penetration of doctors and hospital beds is 0.59 doctors/1000 population and 0.7 hospital beds/1000 population, respectively, both of which are way behind the WHO guidelines. Due to the lack of basic facilities, infra- structure, and trained paramedics, the patients undergo the agony of waiting in long queues outside the government hospitals/PHCs/dispensaries, and watching the illness reach up to the stage that is beyond any treatment. Awareness, Accessibility & Affordability in Tier 2-3 Cities/Rural Areas: Nearly 72% of the country’s population lives in rural areas, wherein a good infrastructure for healthcare delivery is certainly lacking. In a population of 1.21 billion, 26.1% is below the poverty line. Income level varies from INR 781.00 in rural areas while it is INR 965.00 in urban areas for Below Poverty Line (BPL). Moreover, the moderate literacy rate in such areas creates a bubble of unawareness, which in turn, facilitates the indifference among people for vaccination, hygiene maintenance, healthy living habits, and better treatment prospects. Such factors are overhauling the country’s healthcare infrastructure that is on the verge of collapse. Sanitation and Hygiene: In Tier 3 cities and rural areas, due to lack of basic facilities, the prevalence of communicable diseases and water/vector borne diseases have high prevalence. The improper waste management and lifestyle also creates sanitation issues, which further fuels many heath related problems. These problems are then poorly at- tended due to the inadequate healthcare facilities and monetary issues. All these factors contribute substantially in overburdening the healthcare system of the country. 11
  16. 16. The Healthcare Information Technology (HIT) epitomizes the holistic management of health in- formation across computerized systems, and its secure exchange between consumers, providers, government and quality entities, and insurers. Healthcare Information & Communication Tech- nology (HICT) is termed as the most efficient and effective tool for augmenting the quality, safety and efficiency of the health delivery system comprehensively. Despite India being an IT-enabled services’ behemoth, the use of HICT is very restricted in the country. The major users of HICT include big pharmaceutical companies, corporate hospitals and other private health sector institutions, while the public healthcare sector is lagging way behind in IT utilization. The state of Public health service run by Indian government is overburdened. Huge geographical size, high population density, lack of transportation, inaccessibility, poverty, poor nutritional conditions, petty budget for healthcare infrastructure development, lack of funds and coordination, and skewed food habits and lifestyle are various challenges that have triggered down the trend in overall healthcare sector of India. The Indian healthcare products and services system is heavily inclined towards urban population, which is nearly 28% of the to- tal Indian population. It is estimated that approximately one million Indians die every year due to inadequate healthcare facilities, and nearly 700 million people have no access to specialist care. Highly pressurized and caving-in public healthcare system of India is now zeal- ously pursuing the Information & Commu- nication technology (ICT) route in different states of the country. Bringing a paradigm shift in the healthcare dynamics of the country is the prime objective now. En- hancing the delivery and the experience of healthcare not only involves the melioration of the knowledge and skills of medical professionals, but also empowering people with the knowledge required to make informed decisions about how to lead a healthy life. Web services are now the 2. ICT & INDIAN HEALTHCARE SYSTEM • Hospital Information Management System • Telemedicine • Mobile Health HealthCare IT Segments 12
  17. 17. prerequisites for organizing, sharing and accessing medical services. ICT has laid copious alterna- tives for facilitating the communication of health messages to the public. At present, the health- care industry facades which have adopted or starting to adopt the IT include HIMS, Telemedi- cine, Mobile health (Apps, Phones, Integrated devices, etc.), and Disease Surveillance Projects. The most illustrious attribute of e-Health is its ability to revolutionize the whole health system from one that is narrowly concentrated on the cure of diseases in hospitals by medical profes- sionals, to a 3600 system, which is comprehensively inclined towards the preventive care aspect by keeping citizens healthy through the information dispersion regarding taking care of their health, whenever the need arises, and wherever they may be. Furthermore, the National Health Policy endorsed by the Parliament of India encourages the introduction of electronic communication media in health sector. The government of India also brought in the “National Rural Health Mission” for delivering the best in healthcare to the rural population. The Ministry of Health & Family Welfare and the Ministry of Communication and Information Technology (ICT) are jointly creating a national health information infrastructure, for easy capture and dissemination of health information. 13
  18. 18. ICT: Appeasing the Overburdened Indian Healthcare System • Patient Monitoring and Tracking: By facilitating the ICT in healthcare system, the patient health records will be digitized, and will be accessible anytime anywhere. Centralization of such records will certainly expedite the patient monitoring and tracking process. This will improve the execution of health system by improving the management of information and access to that information. • Reducing the Healthcare Burden on Government: With easy patient monitoring and tracking, paperless records, and evolution of facilities, like telemedicine, will curtail the cost burden on government as this will act as a preventive care measure. This will also help improving the healthcare delivery through better diagnosis, better mapping of public health threats, and better training and sharing of knowledge among health workers. • Increased Accessibility and Affordability: Through ICT in healthcare, the reach of people liv- ing in rural areas and other Tier 3 cities could be expanded, as by deploying the channels of telecommunication, facilities like tele-consultation, tele-medicine, tele-pathology, etc. could be provided at an affordable price. Rural area people can save over 80% of their medical expenses when the need to travel to far off cities for getting medical consultation could be negated. • Managing the Scarcity of Doctors and Beds: The implementation of information and com- munication technology which negates the need of in person visits is subduing the scarcity of doctors and hospital beds. Patients can consult doctors, show reports, book prior appoint- ments, refill prescription, and send their vital signs by means of ICT without making a visit to the doctor. • Spreading Awareness: By setting up a base for telecommunication in remote locations, the knowledge about vaccination, hygiene maintenance, healthy lifestyle, preventive care, dis- ease management, etc., could be spread easily. This will facilitate the process of preventive care management, thus placating the healthcare burden to some extent. 14
  19. 19. Hospital and healthcare information system is among the vastest areas for IT applications. The field of Health Information Management Systems (HIMS) epitomizes the practice of manag- ing health records by hospitals, health departments, physician’s office/clinics, health insurance companies, and other institutions that offer healthcare services. The holistic gathering and usage of health record information is at the core of the improved patient care. With the burgeoning computerization of health records, paper records are undergoing replacement with Electronic Health Records (EHRs). Majority of the hospitals in India, specifically public hospitals and health facili- ties, use manual process for maintaining health records of patients. The storage of patient’s medical records in electronic format and their timely availability can trans- mute the quality of health delivery. Many robust and standard HIMS solutions have been developed by the major IT companies, e.g. Centre for Devel- opment of Advanced Computing (CDAC), Wipro, GE Healthcare, Tata Consultancy Services (TCS), Amrita HIS Solution, Sobha Renaissance and Siemens Information Systems Ltd (SISL). 3. HEALTHCARE ICT COMPONENTS 3.1 Health Information Management System (HIMS) • Centre for Development of Advanced Computing (CDAC) • Wipro • GE Healthcare • Tata Consultancy Services (TCS) • Siemens Information Systems Ltd (SISL) • Amrita HIS Solution • Sobha Renaissance Partial list of Major HIMS Solution Providers 15
  20. 20. HIMS: Automating the Indian Healthcare System • Automation and Data Centralization: The implementation of HIMS automates all the proce- dures ranging from patient registration, billing, financial management, laboratory and phar- macy data integration, to the archiving of radiology images in medical setting. This data is then centralized for utilization across various departments of the hospital. • EMR/EHR Maintenance: Since HIMS records all the patient related data from their first visit itself, the system helps maintaining medical records management (assignment of a medical record number, chart location and completion monitoring, laboratory and pharmacy data integration, procedure and diagnosis coding and transcription processing). • Space Saving and Information Retrieval: Since the paperless EHRs are stored on the cloud in the digitized format, a lot of space is saved in physical terms as there is no requirement to keep files/dockets/dossiers of EMRs. Moreover, the information in digital format is relatively easy to retrieve as compared to any information stored in physical format. • Better Patient Care Management: Due to the maintenance of EMRs, the patient data/test records are accessible at any point of time, anywhere. Moreover, even if the hard copies of tests are lost, the very reports could be simply traced by the Unique Identification (UID) given to the patient at the time of their first visit. All these prospects pave way for better health- care delivery to the patients. • Patient Tracking: Because of data centralization, the patient’s movements will be tracked. For instance, if a patient is visiting different hospitals, the recorded data will help in understand- ing and providing the best possible treatment to the patient on the basis of what treatment and consultation he/she has been receiving in different hospitals. • Insurance Claim Process Facilitation: HIMS enables Patient/payer accounting (patient service pricing, patient billing and insurance or other claims, electronic data interchange, payer logs) and smoothens the whole process, as the data is recorded in the electronic format. 16
  21. 21. HIMS COMPONENTS Picture Archiving and Communication Systems (PACS) • Allows digital communication, storage, processing, and viewing of pictures and images-associated information • Facilitates the EMR/EHR management Laboratory Information Systems (LIS) • Allow users to obtain, store, manage, retrieve and record laboratory data • Facilitates the EMR/EHR management Clinical Decision Support System (CDSS) • Facilitates decision-making by pro- viding referencing for medical cases • Automated alerts and reminders E-Prescription • Computer-generated prescriptions sent directly to the concerned pharmacy • Since it’s not manually written, the chances of error are subdued Pharmacy Information System (PIS) • The system detects the occurrence of drug interactions, drug allergies and other possible complications • Manages prescriptions and inventory Electronic Medical Records (EMR) • Systematically collects and manages health information in electronic format • Bring a patient’s total health information together to support better health care decisions, and more coordinated care HIMS 17
  22. 22. PENETRATION OF HIMS in INDIA In order to understand the penetration level of HIMS in India, RNCOS research team interviewed IT Head/Administrative Officers of various public and private hospitals PAN India. For the interview, a questionnaire was designed and a sample size of approximately 200 public/private hospitals was taken. For the understanding purpose, the level of penetration is defined as: • Advanced: States which have hospitals using HIMS upto e-Prescription and CDSS level; • Moderate: States which have hospitals using HIMS upto LIS and PACs level; • Basic: States which have hospitals using HIMS for general patient registration and billing process. The research outcome suggests that almost all the states of India have a basic level penetration of HIMS. Some states like Delhi, Maharashtra, and Rajasthan reported high level of penetration. PENETRATION OF HIMS in INDIA Source: RNCOS Basic Moderate Advanced 18
  23. 23. Delhi Delhi/NCR region reported higher degree automation level among private hospitals. HIMS, PACS, and LIS, were found to be integrated in several hospitals, like Max Hospital, Medanta Medcity, and Institute of Liver & Bilibary Sciences (ILBS), etc. Max Hospital also has electronic prescription and Personal Information System (PIS). Most of the hospitals are using in-house developed HIS/ HIMS. Picture Archiving and Communication System (PACS) and Laboratory Information System (LIS) .Most of the hospitals are using in-house developed HIS/HIMS. PACS and LIS system of GE, Fujifilm, Seimens, IBM, etc. are deployed. Hospitals are reported of using these systems from 2008-09. Across the public sector hospitals, a basic level automation in HIMS is there across majority of the hospitals. Some hospitals, like Ram Manohar Lohia (RML) have system for storing test reports and images from CT scan, MRI, etc. One of the hospitals reported failure in the deployment of HIMS due to some technical glitch. A couple of other hospitals, like Safdarjung hospital have laid all the plans to automate itself over a period of next 6 months. Rajasthan The ICT implementation across private sector hospitals was found to be at advance level. HIMS, and LIS are well-implemented. Some of the private hospitals, although are not using PACS, they are using in-house developed image storage system. The penetration of ICT in public sector hos- pitals was reported to be good, e.g. Sawai Man Singh Hospital. Almost all the government hos- pitals are using ICT. HIMS, LIS, and PACS are implemented in majority of the hospitals. Besides, Government of Rajasthan has taken an initiative called ‘Arogya Online’ in order to implement ICT in healthcare. MODERATE Punjab The penetration of ICT across private sector hospitals was found to be at a moderate level. For instance, in Hartej hospital, HIMS and PACS are implemented. Moreover, it was reported that ADVANCED 19
  24. 24. over 80% of private hospitals in Amritsar have Moderate HIMS implemented. In government sec- tor, the government medical colleges, like Christian Medical College (CMC) are reported to have moderate level of HIMS. M.P The ICT implementation across private sector hospitals was at moderate level, and the basic HIMS was well-penetrated. The penetration of ICT in public sector hospitals was found to be good. HIMS, LIS, and PACS are implemented across majority of the hospitals. For instance, Employee’s State Insurance Corporation (ESIC) hospitals have collaborated with WIPRO, for implementing HIMS, LIS, PACS and PIS at PAN India level. Some other hospitals reported to be in the process of implementing LIS and PACS. BASIC Gujarat The penetration of ICT in the public sector hospitals was not in a very good shape. Though basic level administrative automation exists, but use of PACS, and LIS was not reported. Private sector hospitals too have basic level of HIMS implementation. Kerala The penetration of basic HIMS was not reported in the public sector hospitals. Private sector hospitals are a slightly better than public hospitals as they have basic level of HIMS implementa- tion. Although, in early 2013, the state received approval from the Electronics and Information Technology Department of the Union Ministry of Communication and Information Technology, for developing an electronic demographic database and a hospital automation system. The State government is planning to invest INR 9 Crore in the project, while the Centre will share the rest of the cost burden. The project implementation will involve a central data server holding health and demographic data of the population, connected to the HIMS projects of all health institutions in the State, deep down to the level of sub-centers. 20
  25. 25. It is envisaged that the information regarding communicable and non-communicable diseases, maternal and child care and family planning will be updated persistently. The captured data will be integrated to form the State Health Information System database. The other part of the project ideates end-to-end automation of government hospitals, including all hospital processes from registration, outpatient consultation, inpatient admission and laboratory diagnosis, to the discharge of the patient. Moreover, the system will also store the electronic medical records of all citizens. Clinicians attached to any hospital in the health system will have access to the centralized database or the electronic medical records, if they have the patient’s unique id. Privacy clauses will also be incorporated so as to protect the citizen’s right to confidentiality. All healthcare institutions will be connected through the Kerala State Wide Area Network. Andhra Pradesh During our research, it was found that the penetration of HMIS is very basic across large number of hospitals. But recently some developments have taken place on the front of public hospitals. For instance, Nizam’s Institute of Medical Sciences (NIMS), Gandhi Hospital in Hyderabad, and King George Hospital in Visakhapatnam will undergo a major transformation through digitiza- tion of patient records. NIMS has signed an agreement with CDAC regarding the above stated development Every patient would be provided with a unique identification number. By entering this number in the system, doctors and officials would have access to the patient’s entire case history. The entire hospital will be networked. Officials estimate that the digital transformation would be carried out at an estimated cost of INR 10-12 Crore per hospital, depending on the size of the institution and patient load. Odisha The Health & Family Welfare Department, Government of Odisha, in 2013 had inked an MOU with National Institute of Smart Government (NISG) for implementation of Hospital Manage- ment Information System - both for the major Hospitals and District Hospitals. The key reason for deploying IT-enabled services is to fortify the monitoring and evaluation system, to bridge the gaps and prioritize the resource allocation, among others. Moreover, the All India Institute of Medical Sciences, Bhubaneswar last year declared that it is all set to introduce an ‘e-health card’, a smart card that would store patients’ ailment and treatment history. The smart card is part of uniform Hospital Information Management System which will be implemented in six AIIMS in the country. 21
  26. 26. Jammu and Kashmir The J&K government in mid-2013 introduced hi-tech computerized services at Gandhi Nagar Hospital under the first phase of centrally sponsored e-Hospital Project. The project will expe- dite the maintenance of records, creation of data base for research, quick handling of registra- tion, compilation of day-to-day data base and information regarding registration of patients. All the district hospitals will be brought under the project in order to streamline and meliorate the healthcare delivery system in the government run health institutions. At an implementation cost of INR 6.5 Crore, the e-Hospital project will undergo a two phase implementation incorporating four modules. 3.2 Telemedicine Telemedicine is the utilization of medical information exchanged from one site to another, via electronic communication tools for improving a patient’s clinical health status. A large number of people in rural India today still travel several miles by buses and trains to get diagnosed by a doctor. Telemedicine negates this requirement. Telemedicine includes a wide variety of ap- plications and services deploying two-way video, email, smart phones, wireless tools and other forms of telecommunication technology for treating patients in remote areas; also expediting the medical education and training of doctors and paramedical staff present in remote locations across the country. Courtesy: ISRO 22
  27. 27. A basic infrastructure comprising desktop com- puter with a webcam and a microphone at both the ends is sufficient for base level telemedicine services. For transmitting live data to the other end, sev- eral peripheral equipment including electronic stethoscope, microscope and Computed Tomography (CT) scan can be con- nected. For running this application, high-speed internet connectivity is indispensible. Satellite- based internet connection can be used in the places where wire connection will take long time to reach. The healthcare providers in India are getting famil- iar with the telemedicine. In fact, some states have already started adopting it, but most of the applica- tions are in project modes. It will take quite some time for the diffusion of this technology into the health delivery system in a full swing. Several hospitals, like Apollo Hospitals, AIIMS, Aravind Eye Hospitals, etc. are using this technology on a large scale, providing people access to their services at distant locations. Both government and private agencies are now venturing into Tele-healthcare by providing commu- nication link. • Indian Space Research Organisation (ISRO) • Department of Information Technology (DIT) • MoH&FW • Government of India in partnership with State Governments Infrastructure Supporting Organizations • C-DAC • The Apollo Telemedicine Network Foundation in Hyderabad • The Online Telemedicine Research Institute in Ahmedabad • Televital India in Bangalore • Vepro India in Chennai • Prognosys Medical Systems Pvt. Ltd. in Bangalore • Medisoft Telemedicine Pvt. Ltd in Ahmedabad • Idiagnosis Technologies in Ahmedabad • Karishma Software Ltd. in New Delhi Partial List of Hardware and Software Support Organizations 23
  28. 28. Majority of the telemedicine platforms, both in public and private health sector in India are being launched as start up projects supported by the Indian Space Research Organization (ISRO), Department of Information Technology (DIT), Ministry of Communication and IT and the Government of India in partnership with state governments. All the nodes/platforms are linked to multi-specialty hospitals. Many institutions, like Amrita Institute of Medical Sciences, AIIMS (All India Institute of Medical Sciences) (Delhi, Patna), SGPGIMS (Sanjay Gandhi Post Graduate Institute of Medical Sciences), etc. are offering facilities, like tele-education as well. Public Awareness Disaster Management Remote Consultation and Critical Care Monitoring Second Opinion and Complex Interpretations Disease Survelliance and Program Tracking Home Care and Ambula- tory Monitoring Continuing Medical Education Tele-mentor Procedures/ Surgey-Robotics Telemedicine 24
  29. 29. Telemedicine: Extending Healthcare • Facilitating Healthcare Accessibility and Affordability: With the implementation of telemedi- cine, the healthcare prospects in remote locations are meliorated. For instance, several multispecialty hospitals located in the heart of a metropolitan city provide telemedicine, tele-consultaton, tele-opthalmology, tele-pathology, etc. to rural areas/villages where necessary healthcare facilities are lacking. Moreover, these services save time and cost on travelling as remote consultation is provided. • Negating the Need To Travel To Far Off Cities for Treatment: Since telemedicine in itself delivering the healthcare in rural areas, the patients don’t need to travel to far off cities to get better treatment. Patients hence, are able to save upon the travelling cost. • Treatment at Par with What Is Offered in Metropolitans: Telemedicine is usually provided in collaboration with multispecialty hospitals/medical colleges which already excel in offering the best treatment and boast of hiring best medical professionals. So, when the paramedics of such medical institutions provide tele-medicine, it is certainly at par with metropolitan standards. • Overcoming the Scarcity of Paramedics and Hospital Beds: As it is known, in India the pen- etration of doctors and hospital beds is very low; telemedicine is subduing its impact. “No in person visits” to a hospital is required. Moreover, a specialist sitting in a multi-specialty hospital in a metro can expedite the healthcare delivery process by guiding the nurses and general physicians sitting in a rural setting. 25
  30. 30. ISRO & DIT Towards societal benefit of indigenously developed space technology, Indian Satellite System (INSAT), ISRO has implemented telemedicine pilot projects around the country under GRAMSAT (rural satellite) program. In collaboration with state governments ISRO has established a Telemedicine Network consisting of 382 Hospitals-306 Remote/Rural Dis- trict Hospitals/Health Centers connected to 51 super specialty hospitals located in major states. Sixteen mobile Telemedicine units are part of this network. • In collaboration with state government ISRO has sup- ported establishment of Karnataka state telemedicine network where all the district hospitals in the state are connected with five specialty hospitals in Bangalore and Mysore. • In the state of Rajasthan all the 32 district hospitals are connected with six medical college hospitals and S.M.S. hospital in Jaipur. • ISRO also assisted Maharashtra, Madhya Pradesh and Odisha states in establishing satellite communication based telemedicine pilot projects. Partial List of ISRO Projects Telemedicine Initiatives On the other hand, the Department of IT has taken a critical role in designing and determining the future of telemedicine applications in India. The DIT has been involved at multiple levels – from insti- gation of pilot schemes to the standardization of tel- emedicine in the country. DIT has established more than 100 nodes all over India in collaboration with the state governments. The below given map depicts the telemedicine initiatives taken by ISRO and DIT. • DIT sponsored the telemedicine project connecting three premier medical institutions - viz. SGPGIMS-Lucknow, AIIMS- New Delhi and PGIMER (Post Graduate Institute of Medical Education and Research)-Chandigarh. • Telemedicine network in West Bengal for diagnosis and monitoring of tropical diseases. • Kerala and Tamil Nadu Oncology Network for facilitating cancer care. Partial List of Hardware and Software Support Organizations 26
  31. 31. ISRO and DIT PROJECTS PAN INDIA Source: RNCOS ISRO Telemedicine Projects DIT Telemedicine Projects ISRO and DIT Telemedicine Projects 27
  32. 32. Central Government Most telemedicine activities are in the project mode, supported by the Indian Space Research Organization, Department of Information Technology, Ministry of External Affairs, Ministry of Health and Family Welfare and few others are being implemented by the support of state gov- ernment. A few corporate hospitals have developed their own telemedicine networks. Below- mentioned are some of the government projects: • Pan-African e-network project The Ministry of External Affairs, Government of India will implement this project with the as- sistance of Telecommunications Consultants India Ltd. (TCIL). The project will involve establish- ment of a VSAT based Tele-Medicine and Tele-Education Infrastructure for African Countries (53 nations of the African Union). Through the satellite and fiber optic network effective Tele-Educa- tion, Tele-Medicine, Internet, Videoconferencing and VoIP services will be provided and also the e-Governance, e-Commerce, infotainment, resource mapping and meteorological services will be supported. Ten super specialty hospitals in India have already been identified for this project. • SAARC Telemedicine Network Project The South Asian Association of Regional Cooperation, (SAARC), created as an expression of the region’s collective decision to evolve a regional cooperative framework, incorporated the initial preparatory work for a pilot project connecting one/two hospitals in each of the SAARC coun- tries with 3-4 Super Specialty hospitals in India. The Super Specialty hospitals in India include the AIIMS, New Delhi; SGPGIMS, Lucknow; Post Graduate Institute of Medical Education and Re- search (PGIMER), Chandigarh and the CARE Hospital, Hyderabad. • Tele-ophthalmology Project Ministry of Health and Family Welfare (MoH&FW) has approved tele-ophthalmology project to provide eye care specialty services to the patients of rural and remote areas of Punjab, Uttar Pradesh and West Bengal states of India through tele-ophthalmology mobile vans. 28
  33. 33. • National Medical College Network The National Task Force on Telemedicine, set up by the Union Ministry of Health and Family Wel- fare, plans to establish a national grid on telemedicine for networking of medical colleges. Few tertiary care academic medical institutes from different regions of the country will be identified as Medical Knowledge Resource Centres (Regional Hub), each of which will be connected to medi- cal colleges (nodes) in that region. One of these regional hubs will be identified as the Central Hub which will be responsible for coordinating with the National Network apart from providing the infrastructure for Central Content Development Centre. • National Rural Telemedicine Network (NRTN) National Rural Telemedicine Network (NRTN) Project under National Rural Health Mission (NRHM) is under planning phase. Four Regional Workshops for NRTN are planned in four different regions of the country to educate the state functionaries and finalize the state project proposals. • National OncoNET Project Under National Cancer Control Program, 27 Regional Cancer Centers will be linked with 100 peripheral centers for primary prevention, early detection, treatment and rehabilitation of cancer patients. 29
  34. 34. M-Health basically is the delivery of healthcare services/ information via mobile phones. The availability of the services across India varies substantially depending on the level of advancement in the state. For instance, some services provide only static information about a disease/ illness, while other services, holding higher slots in the value chain, offer holistic healthcare management beyond what could only be delivered by a face-to-face interaction with a healthcare provider. M-Health services at different levels of the value chain are as follows: Information Services This is the lowest tier of M-Health MVAS. Herein a one- way communication exists. Vodafone’s Ask a Doctor – Health@5 mobile app: This service enables reading basic information about disease management, common health- care myths and wellness. Users can also forward queries to a panel of medical experts that are answered within 24 hours. All of these services are offered at a cost of Rs. 5 per day. Enabling Services These services provide a basic platform for a two way information flow between patients and healthcare providers. Such services tend to function as substitutes for traditional care. Today, there are numerous partnerships between healthcare and telecom providers including: : Aircel and Apollo, Airtel and Fortis Hospitals (enabled by Health force), and Idea with Apollo Hospitals. These partnerships provide services, such as teleconsultation, video consultation over 3G, ap- pointment scheduling, triaging and SMS prescription services. 3.3 Mobile Health (M-Health) 30
  35. 35. Transformative Services The transcendency from enabling services to transformative services occurs when the crucial healthcare data can be collected. At present, such MVAS are largely limited to the health monitor- ing services for treating chronic conditions including diabetes and Cardiovascular Disease (CVD). In India, partnerships between BlackBerry, technology enablement organizations and Vodafone provide vital sign monitoring during healthcare transport, as well as monitoring high-risk patients for early warning signs of heart failure. World over, India has the second highest prevalence of diabetes after China with over 61 million diabetes patients. By 2030, the diabetic population is expected to surpass the mark of 100 mil- lion. M-Health services can portray a major role in tending to the India’s chronic disease predica- ment. In other global markets services such as blood glucose and pacemaker monitoring via M-Health have also been implemented. Other Mobile Apps • Maestros Mediline Systems have an appli- cation for BlackBerry phones which allows physicians remote access to patients’ ECG and heart performance reports on their BlackBerry smart phones. • TeleDoc provided handheld mobile phone devices to village health workers in India, permitting them to communicate with doctors. • Narayana Hrudalaya and SANA use mobile technology to enable early disease detection 31
  36. 36. thus creating a win-win situation for patients, hospitals and even insurance and wireless companies. • My Medisupport Powered by mCura, lets health users pinpoint physicians and healthcare ser- vice providers by location, view Physician profile, qualifications and consultation timing. The user can then request appointment by a simple touchscreen button, and the doctor gets an automated request for appointment via email. • Ucheck, a smartphone app for analyzing the urine for the presence of up to 10 markers cov- ering 25 different medical conditions. The app clicks the chemical strips dipped in a sample of urine and then compares them to a color-coded map and within a few seconds reports the results, showing levels of glucose, bilirubin, proteins, ketones, leukocytes, and up to 5 other parameters in a chart. The app is currently undergoing testing in a Mumbai hospital. The major barriers identified across the M-Health adoption are not unique, but they’re rather more complex as compared to other MVAS when deployed in a healthcare context. For instance, unsound network coverage concern is major; patient under mobile monitoring for a heart attack cannot be left at the mercy of poorly developed mobile network. Other major hindrances include security and privacy of healthcare information; and the complex nature of mobile apps. With over 120 widely-spoken languages, these concerns prove to be a bottleneck in the M-Health adop- tion. On the other hand, the key drivers for M-Health were found to be savings in terms of time and money and fewer in-person visits. 32
  37. 37. M-Health Benefits • Bridging the Gap: M-Health closes the gap between the existing and required healthcare services. Facilities such as remote monitoring of patients, online appointment scheduling, online prescription renewal, consultation, etc. are bridging the gap between the consumer expectations and the services available. • Time Saving: Visiting the doctor’s clinic and waiting in queue is always exasperating for any patient. M-Health services such as telephone-based appointment scheduling and, prescrip- tion refill save plenty of time. • Basic Tests at Home: There are several apps and devices compatible with a smartphone which are available and can help performing basic tests, like glucose monitoring, BP/heart beat monitoring, urine analysis, and so on at home itself. The test readings could be for- warded to the physician online. • Online Consultation: The availability of consultations via telephone or 3G video provides quality care just a button away. All such apps and facilities offer medical care on the go. • Better Facilities in Rural Areas: Since there is a lack of basic healthcare facilities in rural areas and the people travel miles just for medical consultation, video calling and online consultations comes into play, herein. Thus, M-Health is improving the healthcare access for the vast underserved rural market and enhances patient care for urban consumers. 33
  38. 38. Although there are no such regulations or policy mandates existing, by which the healthcare pro- viders have to abide, there do exist certain guidelines floated by the government. For instance, in March 2014, the Government declared that it will introduce a uniform system for maintenance of Electronic Health Records (EHR) by hospitals and healthcare providers. The government has taken initiatives to implement standard protocols, standard codes for treatments, diagnosis, dis- eases, and to maintain health records through various methods including electronic models. On the other hand, to standardize the services of different Telemedicine centers, DIT drafted a document, “Recommended Guidelines & Standards for Practice of Telemedicine in India”, which is aimed at enhancing interoperability among the various Telemedicine systems being set-up in the country. These standards will assist the DIT and state governments and healthcare providers in planning and implementation of operational telemedicine networks. DIT also took initiative, in a project mode, for defining “The framework for Information Technology Infrastructure for Health (ITIH)” to efficiently address the information needs of different stakeholders in the health- care sector. Furthermore, MoHandFW also established National Task Force on Telemedicine in 2005 to work on: • Inter-operability, standards for data transmission, software, hardware, training, etc; • Defining standards and structures of electronic medical records and patient data base which could be accessed on a national telemedicine grid; and • Drafting a national policy on “telemedicine and tele-medical education”. The government needs to decree some stringent policies and mandates regarding the implemen- tation of ICT in the healthcare industry, in order to curtail the healthcare cost burden and bring the quality at par with internationally available healthcare services. 4. INDUSTRY REGULATIONS 34
  39. 39. Government Regulations: Till date, there are no regulations for the adoption of ICT in the Indian healthcare sector. Although there are several guidelines in flotation, none of them im- poses mandatory adoption over a period of time. Several guidelines and recommendations are mentioned in the Planning Commission’s 12th 5 year Plan, but no strict regimen is there in place imposing the adoption of ICT by the medical institutions. Interoperability: There are various hospitals in India who have imple- mented HIMS for the management of EHR/EMR. The patient records are maintained at the department and hospital level, but these records are not centralized at the state/national level. The movement of patients cannot be tracked if he/she is visiting different hospitals for getting treatment as there is a lack of interoperability. Scalability: Most of the government initiatives for the establishment of telemedicine platform, Common Service Centers (CSCs), Vil- lage Resource Centres (VRCs) etc. are in the pilot mode. There are three to four mission mode projects running under healthcare and time has come now to integrate all of them. Due to lack of resources, scalability of the already existing pilot projects is a huge challenge. 5. CHALLENGES AND SOLUTIONS FOR THE HICT 5.1 Challenges • Lack of Government Regulations • Constrained Interoperability • Scalability issues due to Scarcity of Resources • Numerous Regional Languages • Reluctance of Medical Professionals towards Technology Adoption HICT: DETERRING FACTORS 35
  40. 40. Regional Languages: India is a country of multiple languages. Every region has its own vivid language. Moreover, in some of the regions, people cannot even understand Hindi and English, while former being the national language of the country. Spreading awareness about the ben- efits and utilization of ICT in healthcare, and teaching the people around the same periphery is significantly hindered due the language barriers. Technology Adoption: It’s a commonplace witnessing employees reluctant to adopt any new information technology tool deployed across the workplace. The implementation of ICT in the healthcare sector is facing the same predicament with paramedics loathing the IT tools as they need to undergo training in order to learn the usage. Imposing Stringent Government Regulations: In order to facilitate the implementation of ICT in the healthcare sector in India, the government must float laws and bylaws mandating the adoption of ICT over a period of time. After imposing the law, government should also initiate a route of offering an incentive to the paramedics/medical institutions if they are encouraging the use of ICT in hospital administration, or penalize them strictly if they are hindering the ICT adoption by any means. Link EMRs with PAN or UID: Another route of paving smooth way of incorporating ICT in the healthcare sector is by linking the patients’ records with PAN or UID (Adhaar Card No.). This link- age will negate the hassle of providing a unique ID to every patient. Creation of Data Repositories: The government should establish more and more databases/ data repositories for better utilization of ICT in healthcare. 5.2 Solutions 36
  41. 41. National Health Portal: Endorsed by the National Knowledge Commission, a working group committee suggested setting and developing a national health portal for India in August 2010. The government in December 2013 launched the national health portal in Delhi. The portal aims to serve as a repository of medical history of over one billion Indians. The portal is funded by the union ministry of health and family welfare, and is being developed by the centre of health informatics, national institute of health and fam- ily welfare. The portal is a single point of access to public health informatics. Cloud computing services from BSNL IDC together with Dimension Data, have been chosen to host India’s national health portal using public compute-as-a-service (CaaS). The government has not yet taken the effort to set up a recommended set of data standards which can be followed by all hospitals and institutes while storing data. Un- less data standards to be followed are finalized soon, linking/ merging of diverse sets of healthcare data will be close to impossible in the future. The project objective is also to improve health literacy of the masses in India. Capacity Building: Government in partnership with the private firms should focus more on capacity building in or to deal with the challenge of scalability. There are several initiatives that government has taken under the NeGP, some of which are mentioned below: Village Resource Center (VRC): The VRC concept was devised by ISRO to provide a vari- ety of services such as tele-education, telemedicine, online-decision support, interactive farmers’ advisory services, tele-fishery, e-governance services, weather services and water management. By providing tele-education services, the VRCs act as learning centers focused on the virtual community. At the same time, VRCs will provide connectivity to specialty hospitals, thus bringing the services of expert doctors closer to villages. Nearly 500 such VRCs have been established in the country. 37
  42. 42. Common Service Centers, DIT Project: DIT proposed the establishment of 100,000 com- mon service centers (CSCs) in rural areas, which will serve as a means to connect the citizens of rural India to the web. The CSCs were to provide high quality and cost-effec- tive video, voice and data content and services, in the areas of e-governance, education, health services (telemedicine, health check-ups, medicines), rural banking and insurance services (micro-credit, loans, insurance), entertainment services (movies, television), utility services (bill payments, online bookings) and commercial services (DTP, printing, Internet browsing, village level BPO). By August 2013, 82% of the 153,098 CSCs had already been rolled out. • Imposing Stringent Government Regula- tions Link EMRs with PAN or UID • Provide quality training and knowledge sessions for the end users • Incentive/Penalty Route for Medical Professionals • Creation of Data Repositories • Capacity Building - National Health Portal: - Village Resource Center (VRC) - Common Service Center, DIT Project - E-Panchayat HICT: IMPLEMENTATION FACILITATION SOLUTIONS E-Panchayat: The government, at present, is implementing an aspira- tional broadband infrastructure plan through an optical fiber network con- necting gram panchayats. Gram Pan- chayats to be reached were allocated to BSNL, POWERGRID and RAILTEL in the ratio of 70%, 15% and 15%, re- spectively and this deployment was to be completed in 24 months. The first 100000 Gram Panchayats were to be covered in the first phase up to March 31, 2014, and an additional 100000 Gram Panchayats were to be reached by March 31, 2015. The rest were to be covered by September 30, 2015. Priority was accorded to villages in the north-east region of the country and 88 districts in the heart of the coun- try affected by Left Wing Extremism (LWE). 38
  43. 43. In the recent past, the government of India has taken several initiatives to monitor and track the prevalence of certain disease and health conditions and provide the patients with best possible and affordable healthcare solutions. Below-mentioned are some of the examples of such govern- ment initiatives: MOTHER AND CHILD TRACKING SYSTEM (MCTS) Launch Year: 2009 Objective: To collate the information of all pregnant women and infants Working: The MCTS software sends reminders to the Auxiliary Nursing Midwives (ANMs) or ASHAs on the various treatments to be availed by the expecting mothers having mobile phones. Once a mother receives her immunization, ANMs have to send the details to the MCTS service through an SMS. After the enrolment, every expectant mother receives SMS regarding their next immunization and check up dates. Benefit: Ensures timely delivery of maternal and child health services from conception till 40 days after delivery in the case of pregnant women and up to five years for children. Over 10.5 Crore pregnant women and children have been registered in MCTS by the January 2014. 6. SUCCESS STORIES 39
  44. 44. INTEGRATED DISEASE SURVEILLANCE PROGRAM (IDSP) Launch Year: 2004 Objective: To detect and respond to disease outbreaks Working: Weekly disease surveillance data on epidemic prone disease is collected from report- ing units, such as sub-centres, primary health centres, community health centres, hospitals, and medical colleges. At present, over 90% districts report such weekly data through e-mail/portal. The weekly data are analyzed by State Surveillance Unit/District Surveillance Unit (SSU/DSU for disease trends. Benefit: Whenever there is rising trend of illnesses, it is timely investigated for diagnosing and controlling the outbreak. On an average, 30-40 outbreaks are reported every week by the States. 1584 outbreaks in 2012, 1964 outbreaks in 2013, and in 2014, 67 outbreaks have been report- ed till 26th January. NIKSHAY FOR TB: Launch Year: 2012 Objective: To keep a track of the TB patients across the country Working: Whenever a new patient is registered on NIKSHAY, an SMS is sent to the patient with registration ID and details of Directly Observed Treatment, Short Course (DOTS) Operator along with advisory note to take the regular medicine. Daily SMS is sent to all monitoring authorities. Benefit: Proper monitoring and tracking of the TB patients and ensuring timely delivery of the medication. More than 3.5 lakh TB patients have been registered since its launch in June 2012. 40
  45. 45. Apart from the general applications around the health record management, process automation, telemedicine and mobile health, there exist some other potential areas where the ICT could be applied in the healthcare domain. For instance, nanotechnology and 3D printing can revolution- ize the healthcare sector with their vast applications in the diagnostics and medicines. Below- mentioned are some of the opportunity applications of the nanotechnology and 3D printing: a) NANOTECHNOLOGY Nanotechnology incorporates the manipulation of matter at the atomic and molecular level in order to create materials with remarkably varied and novel properties. Today, the immense knowledge pool on how the body functions at the cellular level is paving way for several new and better medical techniques. • Quantum Dots based Diagnosis: A potential application of nanotechnology is at the level of DNA analysis/diagnostics. For example, it is known that earlier a disease can be detected, more easier it is to treat. To attain this, several countries are conducting the research focus- ing on the introduction of specially designed nanoparticles in the body. These nanoparticles comprise tiny fluorescent ‘quantum dots’ that are ‘bound’ to targeting antibodies. In turn, these antibodies bind to diseased cells. When this phenomena occurs, the quantum dots fluoresce brightly. This fluorescence can be identified by new, specially developed, advanced imaging systems, enabling the accurate analysis of a disease even at a very nascent stage. • Swift Diagnosis: Diagnosis can be a lengthy and vexing process, for many-a-times, a test sample needs to be sent away for analysis. The results can take several days or even weeks to arrive. Now, Nanotechnology is facilitating way faster and more precise diagnosis, as many tests can be built in a single, palm-sized device requiring trivial sample quantity. Such devices are even termed as a ‘lab-on-a-chip’. The samples can be processed and analyzed so quickly that the results can be read out almost instantaneously. 7. OPPORTUNITY AREAS 41
  46. 46. • Targeted Drug Delivery: For treating a disease, multiple drugs are prescribed at a time, in order to target the disease site and many patients complain about the moderate to severe side effects of those drugs. By deploying specially-designed drug-carrying nanoparticles, accurate targeting of the drug can now be achieved. This elicits the fact that much smaller quantities of a drug will be required for treating a disease, thus reducing toxicity to the body. The progress of the cure can also be monitored using advanced imaging techniques. Nanotechnology can be embedded within the mobile devices for faster and at-home diagnosis which in turn will sweep the healthcare world with an unprecedented revolution. b) 3D PRINTING 3-D printing revolves around the use of digital 3-D design data utilized for building up a com- ponent layer by layer. Recently, only 3-D printing has travelled beyond the prototyping, making a foray in the production applications. 3-D printing can save time and reduces the cost, as the technology consumes lesser quantities of raw material as compared to the conventional manu- facturing, and eliminates the need for tooling since the process stretches directly from design to production. More importantly, 3-D printing has unleashed the novel possibilities because it allows for designing and producing some components that can’t be designed using traditional production processes. There are three categories of healthcare where 3-D printing could be applied, or is already used: Body Parts or Prosthetics (scaffolding); Medical Devices; and Human Tissues. • Scaffolding: Prosthetics printing technology has already revolutionized joint replacements. For instance, knee replacement is a very common procedure, and there are nearly six differ- ent types of knees that surgeons use. With each one the bone needs to be cut differently. But with 3-D printing, surgeons aren’t limited to those six knees. They can design knees specific to each patient. Patients with custom knees don’t have to lose extra inches of bone, instead the surgeon can cut at the optimal point, which could lead to faster recovery times and better functionality. 42
  47. 47. • Medical Devices: Most of the hearing aids are already 3-D printed, since these have always been customized to the user. The scanning, modeling and printing saves time over casting a handmade mould of the inner ear. A process which used to take a week, now takes less than a day, thanks to the 3D printing technology. Similarly, making crowns and dental implants used to take two weeks, but now the same can be done within few hours. • Human Tissues: Scientists have been able to print the artificial meat tissue suitable for eat- ing, but devising life supporting tissues and organs l has been much harder. Printing function- al human tissues will be a revolution, but it’s far out. Additionally, the sequencing of the human genome has made personalized medicine a virtual re- ality. It’s repeatedly overlooked that, like genetic sequencing, 3-D printing can also be a technol- ogy that could be used in personalized medicine. This is because 3-D printing allows for products to be custom made to fit individuals Scientists, at least in theory, have also worked out, how blood vessels, skin, even embryonic stem cells could be printed. 43
  48. 48. As discussed in the previous chapters, it is for the Indian healthcare system to adopt information and communication technology, and make it an integral part of the hospital and patient man- agement. Initiatives are being taken by the government and private sector, although there does not exist any law or government mandate which is imposing the mandatory adoption of the ICT by such institutions. So, in order to establish a healthcare system which is fully ICT enabled, the government must take over the reins and decree some stringent policies which will specify the norms and the time frame for adoption of ICT. Incentives and penalties must be there for over- hauling the ICT incorporation process. Cooperation amongst government/infrastructure provid- ers/healthcare providers is very much necessary for the successful implementation and reaping of benefits of their synergies. 8. CONCLUDING REMARKS 44
  49. 49. Moreover, the technology to be developed or adopted should not be complex that it becomes really exasperating for the user. Simple, existing and affordable technology, such as SMS needs to be used in innovative ways to facilitate access and spread awareness. A provision for dispend- ing high quality, locally relevant information from a reliable source should be there in order to ensure the success of ICT components, such as M-Health. This can be achieved through effective partnerships between private parties, such as telecom operators, local NGOs, and healthcare providers, and the government using a strong and well-branched out data collection network and a team of doctors. Additionally, the government must increase its spending on the health- care for promoting the infrastructure development. Like National Health Portal, more health in- formation repositories/databases should be created for better dissemination of healthcare infor- mation. Campaigns, trainings, workshops, knowledge sharing sessions, etc. should be organized in order to facilitate the implementation of ICT in the Indian healthcare sector. All these factors will pave way for fluidic adoption of ICT in the healthcare, thereby improving the flow of health- care information and delivering enriched healthcare services to the patients across the country. 45
  50. 50. GDP ................................................................................................................................................Gross Domestic Product EIU...............................................................................................................................................Economist Intelligence Unit WHO............................................................................................................................................World Health Organization BPL ..........................................................................................................................................................Below Poverty Line HICT....................................................................................................Healthcare Information & Communication Technology IT.......................................................................................................................................................Information Technology ICT........................................................................................................................Information & Communication Technology HIMS.......................................................................................................................Health Information Management System EHR.................................................................................................................................................Electronic Health Records UID........................................................................................................................................................Unique Identification PACS................................................................................................................Picture Archiving and Communication System LIS..........................................................................................................................................Laboratory Information System ESIC..........................................................................................................................Employee’s State Insurance Corporation PIS.............................................................................................................................................Personal Information System PAN...........................................................................................................................................Permanent Account Number CDAC.........................................................................................................Centre for Development of Advanced Computing Abbreviations 46
  51. 51. ISRO .................................................................................................................................Indian Space Research Organisation DIT ..............................................................................................................................Department of Information Technology SAARC ..........................................................................................................South Asian Association of Regional Cooperation MoH&FW .......................................................................................................................Ministry of Health and Family Welfare NRTN .............................................................................................................................National Rural Telemedicine Network NRHM ........................................................................................................................................National Rural Health Mission ITIH ...............................................................................................................Information Technology Infrastructure for Health EMR .................................................................................................................................................Electronic Medical Record VRCs ..................................................................................................................................................Village Resource Centres CaaS .......................................................................................................................................................Compute-as-a-Service CSCs ..................................................................................................................................................Common Service Centers MCTS ..................................................................................................................................Mother and Child Tracking System ANMs .............................................................................................................................................Auxiliary Nursing Midwives IDSP ...........................................................................................................................Integrated Disease Surveillance Program SSU .......................................................................................................................................................State Surveillance Unit DSU ....................................................................................................................................................District Surveillance Unit DOTS ......................................................................................................................Directly Observed Treatment, Short Course 47
  52. 52. Evolution of Value Creator ASSOCHAM initiated its endeavor of value creation for Indian industry in 1920. It has witnessed upswings as well as upheaval of Indian Economy and contributed significantly by playing a catalytic role in shaping up the Trade, Commerce and Industrial environment of the coun- try. The Chamber has 300 Chambers as members and represent over 4, 00,000 large, medium and small scale industrial units. ASSOCHAM derives its strength from the following Promoter Chambers: Bombay Chamber of Com- merce and Industry, Mumbai; Cochin Chamber of Commerce and Industry, Cochin; Indian Merchant’s Chamber, Mumbai; The Madras Chamber of Commerce and Industry, Chennai; PHD Chamber of Com- merce and Industry, New Delhi. VISION Empower Indian enterprise by inculcating knowledge that will be the catalyst of growth in the barrier less technology driven global market and help them upscale, align and emerge as formidable player in respective business segment MISSION As representative organ of Corporate India, ASSOCHAM articulates the genuine, legitimate needs and interests of its members. Its mission is to impact the policy and legislative environment so as to foster balanced economic industrial and social development. We believe education, health, agriculture and environment to be the critical success factors. GOALS To ensure that the voice and concerns of ASSOCHAM are taken note of by policy makers and legisla- tors. To be proactive on policy initiatives those are in consonance with our mission. To strengthen the network of relationships of national and international levels/forums. To develop learning organization, sensitive to the development needs and concerns of its members. To broad-base membership. Knowl- edge sets the pace for growth by exceeding the expectation, and blends the wisdom of the old with the needs of the present. THE KNOWLEDGE CHAMBER 48
  53. 53. ASSOCHAM REGIONAL OFFICES ASSOCHAM Southern Regional Office No. 3524, First Floor, 17th Main Service Road, HAL 2nd Stage Indiranagar, Bangalore - 560 008 Mobile: +91-90352 63457 Landline: +91-80-4094 3251-53, Fax: +91-80-4125 6629 E-mail: events.south@assocham.com, events@assocham.com director.south@assocham.com ASSOCHAM Western Regional Office 4th Floor, Heritage Tower, B/h, Visnagar Bank, Ashram Road Usmanpura, Ahmedabad - 380 014 Tel: +91-79-2754 1728/ 29, 2754 1867 • Fax: +91-79-3000 6352 Email: assocham.ahd1@assocham.com, assocham.ahd2@assocham.com ASSOCHAM Eastern Regional Office 88A, 3rd Floor, Sarat Bose Road, Kolkata - 700026 Tel: +91-33-6614 1600/1601 • Fax: +91-33-6614 1601 E-mail: kolkata@assocham.com The Associated Chambers of Commerce and Industry of India 5, Sardar Patel Marg, Chanakyapuri, New Delhi - 110 021 Tel: 011-4655 0555 (Hunting Line) | Fax: 011-23017020 Email: assocham@nic.in | Website: www.assocham.org 49
  54. 54. RNCOS specializes in Industry intelligence and creative solutions for contemporary business segments. Our professionals study and analyze the industry and its various components, with comprehensive study of the changing market behavior. We provide corporations with an insight of the ‘industry and market’ necessary to compete in today’s business environment. Additionally, our team focuses on the cause and effect relationship between federal and state regulations and the industries affected by regulation. The company also works closely with small and medium sized consultancy firms, in various industry sectors. We assist in back-end research and data gathering processes. Our accuracy and data precision proves beneficial in terms of pricing and time management that assist the consultants in meeting their objectives in a cost-effective and timely manner. About RNCOS 50

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