The document describes several healthcare IT systems implemented in Tamil Nadu, India: 1. A disease surveillance system for HIV/AIDS that automates data gathering, reporting, and provides mapping and analytics at the village level. 2. An electronic medical record system for ART patients with biometric identification and access to records across centers. 3. A patient management system using digital pen technology for physicians to record exam notes and prescriptions. 4. Remote patient monitoring services for ICU, radiology and cardiology using devices like ECG monitors and mobile transmission of data. 5. An ambulatory patient monitoring system called SmartChair that measures vital signs and transmits data via SMS or to a central

1. Healthcare Portal & Innovation Solutions www.webhealthcenter.com www.webhealthcentre.com Part - II

2. DISEASE SURVEILLANCE SYSTEM Has been Implemented for HIV / AIDS for the Government of Tamil Nadu, India – Tamil Nadu AIDS Control Society The entire Data Gathering, Collation and Reporting for all aspects of HIV Surveillance in the State of Tamil Nadu are completely automated Resource consumption in terms of manpower, time, cost and maintenance are remarkably brought down. A full fledged GIS System provides information down to the Village Level and a concentration map gives an immediate idea on where the fresh cases are occurring from. The Dynamic Reporting Engine permits instant decision making and facilitates data analysis and mining to an extent not generally possible with simple MIS systems. Over 1100 Centers across the State of Tamil Nadu have been brought on to a unified platform at minimal cost and the results are an example of what is possible in E-Governance. Full Fledged Work flow based Electronic Medical Record Management for ART Patients – web based. Biometrics based Patient Identification mechanism has been implemented in the web based ART System to facilitate the unique identification of the patient thereby enabling the easy and instantaneous retrieval of the patient records. Visit based Patient clinical data has been maintained in an organized and systematic manner Access to the patient data (demographic and clinical) across the ART Centers by authorized users Facility to transfer the patients from one ART center to another without any massive transmission of data (in the form of reports etc)

3. Comprehensive Patient Management system targeted at the General Physicians and clinicians with the special feature of data entry through their own handwriting The Handwriting capture is powered through the Digital pen and pad equipment With the usage of this equipment, the doctors can directly register the details like Patient’s Appointment, Complaints and History, Clinical Examination, Investigation and test results, Treatment procedures etc. Digital Pen and Pad Technology Key Features Patient Registration Visits Encountering Patient’s clinical details Management (Complaints and History, Clinical Examination, Investigation and test results, Treatment procedures) – Hand writing enabled Appointments (Patient as well as other visitors) – Hand writing enabled Automatic as well as User Initiated Data Backup facilities Automatic Data polling to the central server Remote Patient Care services (like remote ECG viewing, Tele-radiology consultation etc) Scribble pad– Hand writing enabled Search tool Package creation for Investigation (Tests) and treatment– Hand writing enabled HEALTHNET FOR DOCTORS (MEDPAD)

4. Anoto technology enables digital capture, transfer and processing of handwritten text and drawings—all with pen and paper. This eliminates the need of a PC terminal at the user end as the data captured by the Anoto pen could be transmitted to the central servers using Bluetooth /GPRS Technology. Some of the key areas of the application of this Data entry model are Selective portions of Electronic Medical Record System which requires Doctors interpretation Health Screening systems (Health related Data collection from large population) Anoto Technology HEALTHNET FOR DOCTORS (MEDPAD)

5. The Remote Patient care services have been offered for the following units Intensive Care Unit (ICU) – To remotely monitor the Vital signs like Blood pressure, heart rate, ECG etc pertaining to the patient admitted to the ICU , by the doctor at the remote end. Radiology Centers - The patient diagnosis's images can be viewed by the physician, anywhere instantaneously & can be reported without loss of time. Cardiac Centers – To remotely monitor the ECG and the heart rate of the patient. REMOTE PATIENT CARE SERVICES

6. Ambulatory ECG Device and Solution that provides real-time monitoring of heart condition via ECG Is a miniature monitoring system providing real-time heart monitoring and telemetry of data Can perform classification of heart beats and determine severity of the cardiac condition Can warn the user of the onset of a serious heart condition - so that the individual can slow down Can contact the monitoring center when a cardiac disorder is detected (Could also be a PDA in the near vicinity) Can also perform respiration rate monitoring Facilitates 12 Lead ECG Data capturing Can act as a Bedside monitor, Holter monitor and a Portable ECG Device Facilitates the transmission of ECG Data through GPRS to the following destinations: Doctor’s Mobile as an MMS so that the doctor can directly view the ECG SMS with a link to view the ECG available in the Central server) Central Web server through internet , Doctor can view the transmitted ECG data (either as a running wave or as an static image Silicon Locket AMBULATORY PATIENT CARE SERVICES

7. SmartChair Multi parameter monitoring equipment that keeps track of the crucial health parameters like Blood Pressure, Heart rate , ECG etc in a real time basis Can be setup in the Health Kiosks / Hospitals / Patient’s home to monitor the health parameters, based on the duration set by the Patient’s Attendant The Key parameters that could be monitored by the SmartChair includes Blood Pressure Systolic Diastolic Pulse Rate %Sp02 Weight (in Kgs) Height (in cms) Calories Body Surface Area (BSA) Body Mass Index (BMI) ECG (3 Lead ) Pleth wave Bar Graph Reporting of results SMS to the patients Printout of the report handed over to the patient @ kiosk AMBULATORY PATIENT CARE SERVICES

8. CLINICAL DECISION SUPPORT SYSTEM RULE ENGINE based Application Guides users in making Informed decisions in the process of Diagnosis, Investigation and treatment of Patients Can be used as a Screening tool, Diagnostic Support Application and as a Treatment Guidance solution.  Challenges No Universally accepted CDSS System in the Market Most Systems stop at Diagnosis stage Most systems do not allow the users to build rules Many are not self learning Not linked to Alert Engines  Implementation Models Standalone Screening tool Integrated with Electronic Medical Record Call centre Model – Treatment Guidance Mobile based Implementation – for health workers Trend Analyzer Tool Enabling Doctors, Para Medics and the community make the right Decisions. Providing Doctors, Para Medics and the community the right options for Informed Decisions.

9. CLINICAL DECISION SUPPORT SYSTEM – FOCUS AREAS HEALTHCARE PROVIDERS / PHARMA Cos. Tool for reference to the doctors Stand alone Application or Integrated with the Electronic Medical Records Second opinion service for the doctors – to check and validate their decisions pertaining to Diagnosis & Treatment Facilitate Quality Healthcare to the rural/poor at remote place where there is scarce in the availability of doctors /specialists DOCTORS / GEN.PHYSICIANS MEDICAL CALL CENTRES System shall act as a guide to the doctors Enable the doctors to check whether they are on the right track w.r.t Diagnosis and treatment procedures Doctors shall build their own rules and tune the system such that the decisions can be arrived based on the rules defined by them Field Workers /Counselors /Mobile Health workers deployed at remote locations to collect patient data and post the same to call centers Call centre comprising Doctors / paramedics feed the data collected in to CDSS CDSS to provide Diagnostic / treatment inferences Call centre staff to convey the inferences to the field workers after validation by the specialist Validation tool to validate the medical claims made by the customers/ claimants. Validate the Investigation and treatment procedures (with the cost involved) against the Disease(s) for which the customer(claimant) had taken investigation / Treatment . HEALTHCARE PAYERS

10. CLINICAL DECISION SUPPORT SYSTEM

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