ICT in Healthcare - Opportunities and Challenges

1. ICT in Healthcare
Opportunities and
Challenges
June’ 2014

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. 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. 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. 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. 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. 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. 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. 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. 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. 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

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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. 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. 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.
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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
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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.
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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. 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. 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.
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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. 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. 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. 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. 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. 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. 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. 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. 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. 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. ISRO and DIT PROJECTS PAN INDIA
Source: RNCOS
ISRO Telemedicine Projects
DIT Telemedicine Projects
ISRO and DIT Telemedicine Projects
27

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. • 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. • 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. • 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.
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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. 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.
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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
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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. 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. 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
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54. RNCOS specializes in Industry intelligence and creative solutions for contemporary business
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