[Kurukshetra December Summary] e-Governance in Healthcare Services Delivery – Explained, pointwise

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Introduction

According to the Ministry of Electronics and Information Technology, Government of India, e-Governance is the application of e Information and Communication Technology to promote ‘Simple, Moral, Accountable, Responsive and Transparent’ (SMART) governance. The Government has launched various initiatives for e-Governance in healthcare sector. For instance, the National Health Portal serves as a single point of access to health-related information for citizens and e-Hospital Management System tracks the delivery of patient care and diagnostic services. Mobile-based Applications have also been launched like TB Missed Call initiative and Kilkari App. Healthcare sector faces several challenges in India. Technology can be a game-changer in delivery of healthcare services. Government must scale-up the use of technology to make healthcare affordable and inclusive.

Policy Measures for e-Governance in Healthcare

Over the last few years, the Government has announced several policy measures to usher in a new era of technology-enabled healthcare delivery.

National Health Policy, 2017 envisions a digital health ecosystem and recognises the integral role of technologies such as eHealth, mHealth, Internet of Things (loT), wearables and cloud, among others, in the delivery of health services.

In 2018, NITI Aayog released a proposal on National Health Stack with the objective of providing a framework for the country‘s futuristic digital health system.

National Digital Health Mission (NDHM) aims to create a management mechanism to: (a) Process digital health data and facilitate its seamless exchange; (b) Develop registries of public and private facilities, health service providers, laboratories and pharmacies; (c) Support clinical decision-making as well as offer services like telemedicine.

The NDHM has the potential to make the health system more evidence based, transparent and efficient. Operationalising a single health ID and profile for every citizen, as envisaged under the NDHM, is an important reform for optimising health information systems.

Challenges to e-Governance in Healthcare in India

Fragmented Sector: It is estimated that nearly 98% of the country’s health facilities employ 10 people or less. The fragmentation of the sector creates hurdles for digitisation.

Isolated Systems: A lot of information including patient records are scattered across disparate manual or IT systems with limited or no possibility of interoperability. In addition there are issues related to lack of shared standards for health records as well as the absence of a common and consistent healthcare design

Importance of eGovernance in Healthcare: Health Information Systems

Informed Decision-making: Operationalising a single health ID and profile for every citizen can minimize the need for repeat investigations and facilitate more informed decision- making by doctors.

Enable Data Analytics: Digital health records can also enable data analytics at the population level to identify treatments which are likely to evoke a better response from patients.

Monitoring: A system-wide electronic health profile can enable monitoring of diseases and efficient analysis of patient data. It can facilitate geographical, demographical and risk-factor based monitoring of health, followed by the design of targeted interventions. e.g., in context of COVID-19 pandemic, an analysis of comprehensive digital health profiles of a substantial part of the population, can give a head start in identifying people with comorbidities and implementing preventive health interventions expeditiously.

Avoid Duplicity: An effective IT infrastructure linking public and private healthcare establishments, through information exchanges, will ensure data consistency across systems, eliminate duplication and minimize the reporting burden.

Accurate Information: Digitization will enable access to accurate information about the credentials and pricing of services offered by various health facilities, providers and diagnostic laboratories.

Eliminate Geographical Barriers: The concept of connected care where eICUs, neonatal ICUs and remote operating centres can be monitored by experts who are not present in same geographical location can eliminate geographical barriers and enhance access.

Research and Development: For researchers, access to this healthcare data can facilitate the evaluation of programme and policy effectiveness as well as accelerate innovation. Analytics of disease load and patient response can help in drug/vaccine development. The use of technologies like Artificial Intelligence (Al) for anonymised, aggregated health data can pave the way for predicting the likelihood of a patient falling sick.

Operational Efficiencies: Technology can improve operational efficiencies in the healthcare sector, strengthening supply chain performance and enabling skilling of health professionals at large scale. For skilling and up-skilling health professionals as well as delivering continuing medical education, digital education platforms can enable dissemination of information pertaining to the latest advancements in the field along with training modules for specific diseases.

Initiatives for e-Governance in Healthcare Services Delivery

e-Sanjeevani: It is a tele-consultation services initiative that employes Information Communication Technologies (ICT) to enable diagnosis, treatment and management of diseases.

Swasth: It is a coalition of over 100 healthcare specialists in the private sector to launch a telemedicine application which aims to deliver equitable and affordable healthcare to all Indians, by cutting across geographical and income barriers. It is an open-source platform built with inter-operability principles that comply with the Government’s National Digital Health Mission. The application facilitates seamless, remote interaction between registered medical practitioners and patients through multiple modes of video and telephony. It also deploys Artificial Intelligence based triaging to determine the care required, culminating in a digitally signed prescription and treatment advice. It also provides services like home quarantine assistance, access to diagnostic laboratories and pharmacies as well as hospital bed discovery and booking assistance at a subsidised cost.

e-Hospital Management System tracks the delivery of patient care and diagnostic services.

The Mera Aspataal initiative captures patient feedback for the services received by them in hospital.

The TB Missed Call initiative is mobile service for providing treatment and counselling to TB patients.

Through the Kilkari application, the Government delivers free messages every week pertaining to pregnancy and child care between the second trimester of pregnancy until the child is one year old.

The M-Cessation application encourages people to quit tobacco use.

Numerous platforms have also been launched by the Government for tracking service delivery. These include the Nikshay platform for tracking TB patients, the Mother and Child Tracking System for monitoring pregnant women and children under five years of age and the Ayushman Bharat – Health and Wellness Centre portal for overseeing the delivery of comprehensive primary healthcare services through Health and Wellness centres across the country.

Inclusion of telemedicine in the NDHM’s digital suite will help connect patients with doctors and specialists. It can help address lack of access to doctors and healthcare professionals in rural areas. A timely 5-minute consultation enabled by telemedicine can save lives and avoid huge downstream costs.

Aarogya Setu: It was launched during COVID-19 pandemic to facilitate effective contact tracing. It allows people to assess their risk of contracting the infection based on their location and interactions with others.

The CoWIN Application is a repository of COVID vaccination data. It is a platform to register for COVID-19 vaccine. It helped in tracking the pace of vaccination during the pandemic.

Electronic-Urban Primary Healthcare Centres (e-UPHCs): With a footfall of 12,000 on a daily basis, the program has touched 5.2 million lives over two years and has brought quality healthcare within the reach of all citizens, by significantly leveraging technology. This model can be replicated in other rural areas with private players. E-ICUs can also be set up in semi- urban and rural areas and connected to a central monitoring hub.

Changing Trends in Healthcare Services Post COVID-19 Pandemic

Earlier patients from Tier-2 and Tier-3 cities travelled to Tier-1 city for accessing healthcare services. Now they can access Tier-1 city services through digital platforms.

Online training and education of medical learning and the use of simulators is far more prevalent and acceptable nowadays.

New technologies in simulation like haptic feedback are enabling realistic online training. With haptic feedback, trainees can get an experience of touch to realistically simulate the jerks and vibrations which would otherwise be experienced by a surgeon during surgery.

Conclusion

The market size for  telemedicine in India was around US$ 830 million in 2019. It is projected to increase to US$ 5.5 billion by 2025 growing at a CAGR of 31%. What is clear from these trends is that the healthcare sector is moving towards the digital transformation. In future, connected care may become a norm and patients may no longer be constrained by geography in accessing healthcare services. The Government should scale-up its efforts regarding e-governance in healthcare sector to equip doctors and hospitals to deliver accurate diagnosis and treatment to patients using the latest technologies.

Syllabus: GS II, Issues relating to development and management of Social Sector/Services relating to Health; e-Governance: applications, models, successes, limitations, and potential

Source: Kurukshetra December 2022

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